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East African Community Digital Health and Interoperability Assessments: The United Republic of Tanzania
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MEASURE Evaluation |
2020 |
English |
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Tanzania, EHealth, Zanzibar, HIS, Digital Health, Health Information Systems, Interoperability, Assessment |
This report is a summary of the East African Community (EAC) Digital Health and Interoperability Assessment that was conducted in The United Republic of Tanzania. The assessment was implemented separately in the Mainland of Tanzania and the semi-autonomous state of Zanzibar. After a background section about the EAC and the Digital Regional East African Community Health (Digital REACH) Initiative, the report is divided into two chapters that further describe the background, methods, results, and recommendations for Tanzania and Zanzibar. |
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East African Community Digital Health and Interoperability Assessments Results at a Glance: Zanzibar
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MEASURE Evaluation |
2020 |
English |
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Health Information Systems, EHealth, HIS, Digital Health, Assessment, Intervention, Zanzibar |
The East African Community (EAC), a regional intergovernmental organization of six partner states, has worked for the past decade to improve the efficacy and efficiency of health services in member countries, with a focus on strengthening digital health (also known as eHealth). The EAC has committed
to supporting regional actions to strengthen the enabling environment for effective digital health information systems (HIS).
In 2018, the EAC commissioned an assessment of the status of eHealth and the interoperability of its components across member states under the oversight of the EAC’s East African Science and Technology Commission. In 2019, the Ministry of Health, Community Development, Gender, Elderly, and Children (MOHCDGEC) of Tanzania, the President’s Office of Regional Administration and Local Government (PORALG), and the Ministry of Health of Zanzibar partnered with MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID)—to assess the interoperability and readiness of the United Republic of Tanzania’s HIS as part of this regional assessment. This brief highlights the results of this assessment for the semi-autonomous state of Zanzibar. |
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East African Community Digital Health and Interoperability Assessments Results at a Glance: Tanzania
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MEASURE Evaluation |
2020 |
English |
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Digital Health, EHealth, Health Information Systems, HIS, Tanzania, Interoperability, Assessment |
The East African Community (EAC), a regional intergovernmental organization of six partner states, has worked for the past decade to improve the efficacy and efficiency of health services in member countries, with a focus on strengthening digital health (also known as eHealth). The EAC has committed to supporting regional actions to strengthen the enabling environment for effective digital health information systems (HIS).
In 2018, the EAC commissioned an assessment of the status of eHealth and the interoperability of its components across member states under the oversight of the EAC’s East African Science and Technology Commission. In 2019, the Ministry of Health, Community Development, Gender, Elderly, and Children (MOHCDGEC) of Tanzania, the President’s Office of Regional Administration and Local Government (PORALG), and the Ministry of Health of Zanzibar partnered with MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID)—to assess the interoperability and readiness of the United Republic of Tanzania’s HIS as part of this regional assessment. This brief highlights the results of this assessment for Mainland Tanzania. |
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Linking Data from Demographic and Agricultural Surveys to Examine the Drivers of Stunting and Wasting in Nigeria: Lessons Learned
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Emily H. Weaver, Siân Curtis, John Spencer, Gustavo Angeles |
2020 |
English |
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Nigeria, Data Science, Children, Child health, Population, Data, LMICs, Nutrition |
Stunting and wasting are still global issues, with an estimated 149 million children under five with stunted growth and 49 million children under five suffering from wasting worldwide. Wasting and stunting can have severe health effects on children and are therefore a major health concern for most low-middle income countries where stunting and wasting rates are highest (UNICEF/WHO/World Bank Group, 2019). Both stunting and wasting share underlying risk factors that derive from several different levels of influence. Existing studies focus on demographic and health indicators, such as those that are available in the Demographic and Health Surveys (DHS). However, additional influences on these outcomes are also agricultural and community-level indicators that are not included in conventional demographic and health surveys. Studies are needed to trial the linking of these data and to provide lessons learned for others seeking to do the same.
The increased availability of data from multiple sources in low- and middle-income countries in recent years, combined with advances in data science, have stimulated an increased interest in using existing data in innovative ways to bring new insights to population, health, and nutrition problems. MEASURE Evaluation was contracted to do just that—to conduct an analysis of publicly available secondary data using innovative linking methods to better understand a broader range of drivers of wasting and stunting, particularly in contexts with stagnant or increasing wasting levels and decreasing stunting trends. The study links data from the Nigeria DHS (NDHS) with a Living Standards Measurement Survey Integrated Survey on Agriculture (LSMS-ISA) that contains agricultural and community information. This study also sought to use machine learning to identify additional or unique patterns of indicators that influence stunting and wasting. Neither of these two methods are prevalent in current research; therefore, these analyses also serve as proof of concept for these two approaches and provide lessons learned for future research. |
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Cross-Border Health Integrated Partnership Project Performance and Costing Evaluation
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Markiewicz, M., Weaver, E., Morris, L., & Xiong, K. |
2020 |
English |
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HIV, Scale-up, HIV prevention, Evaluation, Costing, AIDS |
East Africa and Southern Africa are the two regions most affected by the HIV/AIDS epidemic worldwide. East Africa alone is home to more than six million people living with HIV/AIDS. People whose occupations require travel, such as truckers and fisherfolk, are a priority population with heightened risk for HIV. Many of the people who inhabit areas regularly visited by mobile populations are also part of this priority population.
The Cross-Border Health Integrated Partnership Project (CB-HIPP) worked from 2014–2019 to extend high-quality integrated health services to cross-border and mobile populations in strategic border areas and waterways in East Africa. As stakeholders consider a transition plan for CB-HIPP project activities, the United States Agency for International Development (USAID) East Africa Mission contracted with MEASURE Evaluation, which is funded by USAID and the United States President’s Emergency Plan for AIDS Relief, to conduct a performance evaluation of CB-HIPP and to assess the cost of CB-HIPP programmatic scale-up. The performance evaluation gathered information about each component of the program’s Standard Package of activities, and the cost assessment developed a model to project the price of various scale-up scenarios.
Results indicate that the CB-HIPP model worked well to extend services to cross-border and mobile populations. Stakeholders were satisfied with the program and expressed interest in extending the reach and scope of the activity. The estimated cost of scaling up the program to six to ten additional sites ranges from $1.3–2.6 million per year. Costs vary based on the number of sites and type of implementing partner selected. At a dissemination meeting in February 2020, stakeholders discussed recommendations regarding the following topics: several operational modifications to the program, programmatic expansion, support for the continued development of the interoperable digital HMIS and portable insurance scheme, and work with stakeholders to build consensus on who will lead policy advocacy moving forward. |
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East African Community Digital Health and Interoperability Assessments: Rwanda
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MEASURE Evaluation |
2020 |
English |
RWANDA |
Interoperability, eHealth, EAC, HIS, Health Information Systems, Rwanda |
The regional health program of USAID/Kenya and the USAID East Africa Mission, in coordination with the USAID Global Health Bureau, United States Global Development Lab, and USAID Bureau for Africa, engaged MEASURE Evaluation to provide technical support to EASTECO to conduct an EAC regional digital health readiness assessment, incorporating aspects of systems interoperability and the cost of investing in eHealth in the EAC region. The assessment will be conducted in four EAC Member States (Kenya, Rwanda, the United Republic of Tanzania, and Uganda). This report presents the results of the Rwanda assessment, which had two objectives:
· Review the status of digital health and HIS interoperability in Rwanda by assessing the processes, structures, and capacities needed to support the enabling environment for digital health and interoperability in the country.
· Using the Rwandan assessment results, contribute to the assessment of the regional landscape for digital health and interoperability in the EAC to inform a regional analysis of and recommendations for moving digital health forward in the EAC. Access the related Health Information Systems Interoperability Toolkit. |
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East African Community Digital Health and Interoperability Assessments Results at a Glance: Rwanda
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MEASURE Evaluation |
2020 |
English |
RWANDA |
EAC, Interoperability, Rwanda, Health information systems, eHealth, HIS |
Over the past decade, the East African Community (EAC) has prioritized digital health by committing to regional actions to strengthen the enabling environment for health services. In 2019, the Ministry of Health (MOH) of Rwanda partnered with MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID)—to conduct an interoperability readiness assessment of the Rwandan health information system (HIS). This was part of a broader EAC-commissioned regional assessment carried out with oversight by the EAC’s East African Science and Technology Commission to understand the status of eHealth and interoperability in each of its member states. This brief provides an overview of the results. |
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How to Include Laboratories in a Master Facility List: Preliminary Guidance
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MEASURE Evaluation |
2020 |
English |
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Health data, Health Facilities, Master facility list, MFL |
A Master Facility List (MFL) is an authoritative, up-to-date list of all health facilities in a country. The original version of the MFL Resource Package was published by the World Health Organization (WHO) in January 2018 to guide country governments and other stakeholders through the key decisions in planning, establishing, maintaining, and sharing an MFL. This document is intended to be a supplement to the MFL Resource Package to provide additional guidance on incorporating laboratories into an MFL. |
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East African Community Digital Health and Interoperability Assessments Results at a Glance: Kenya
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MEASURE Evaluation |
2020 |
English |
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Over the past decade, the East African Community (EAC) has prioritized digital health by committing to regional actions to strengthen the enabling environment for health services. In 2019, the Ministry of Health (MOH) of Kenya partnered with MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID)—to conduct an interoperability readiness assessment of the Kenyan health information system (HIS). This was part of a broader EAC-commissioned regional assessment carried out with oversight by the EAC’s East African Science and Technology Commission to understand the status of eHealth and interoperability in each of its member states. This brief provides an overview of the results. |
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Report on the Review of Sierra Leone’s National Malaria Monitoring and Evaluation Plan 2016–2020: Addendum to the Malaria Programme Review
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MEASURE Evaluation |
2020 |
English |
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Malaria Control, Monitoring, Sierra Leone, Malaria, Evaluation |
The Sierra Leone Ministry of Health and Sanitation’s National Malaria Control Programme (NMCP) developed and launched the Sierra Leone Malaria Strategic Plan (SLMSP) 2016–2020, which was based on recommendations from the malaria program review (MPR) 2013, the recognition of the impact of malaria interventions, and the Sierra Leone Health Sector Recovery Plan 2015–2020. The SLMSP has guided the implementation of key malaria interventions as Sierra Leone continues to strengthen the country’s effort in the fight against malaria.The SLMSP follows the guiding principles of the broader National Health Sector Strategic Plan 2010–2015, the Sierra Leone Health Recovery Plan 2015–2020, the National Ebola Strategy for Sierra Leone 2015–2017, and the Basic Package of Essential Health Services 2010 (revised 2015). Among these principles are universal coverage with proven malaria interventions; equity, equality, and nondiscrimination; participation and accountability; and the right to the health elements of availability, accessibility, acceptability, adequacy, quality, and contiguous expansion of interventions.The national malaria monitoring and evaluation (M&E) plan 2016–2020 was developed alongside the SLMSP. The malaria M&E plan 2016–2020 is aligned to the SLMSP 2016–2020 and contains priority indicators that the NMCP uses to monitor and evaluate the implementation of the intervention strategies and track the performance of the malaria program.The objectives of the M&E plan review were as follows:
To review the existing malaria M&E plan 2016–2020
To provide recommendations for developing a well-aligned comprehensive national M&E plan in preparation for the national malaria strategy 2021–2025
To build consensus on the understanding of a specific, measurable, relevant, attainable, and time-based (“SMART”) and actionable malaria M&E plan
To contribute to the MPR
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Cadre d’évaluation des programmes nationaux de lutte contre le paludisme dans les zones de transmission modérée et faible
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Groupe de travail sur l’évaluation du Groupe de référence pour le suivi et l’évaluation de Roll Back Malaria |
2020 |
French |
Global |
Malaria control, Evaluation, Malaria |
Le cadre d'évaluation présenté dans ce document a l'intention de s'appuyer sur les travaux existants du Groupe de référence pour le suivi et l'évaluation de la gestion axée sur les résultats, en l'étendant pour aborder les paramètres le long du continuum de la transmission du paludisme, en mettant l'accent sur les paramètres de transmission modérée et faible. Ce cadre souligne également l'importance de l'évaluation des processus pour l'évaluation de l'impact, en reliant les processus de mise en œuvre à la force de la mise en œuvre pour ensuite démontrer l'impact du programme sur la transmission, la morbidité ou la mortalité du paludisme.
Accédez au Framework for Evaluating National Malaria Programs in Moderate and Low Transmission Settings: Aide Memoire. |
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Assessment Tool for Electronic Health Record Security: Guidance for Low-Resource Settings
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MEASURE Evaluation |
2020 |
English |
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EHR, Health data, Electronic Health Records, Information System |
The Assessment Tool for Electronic Health Record Security: Guidance for Low-Resource Settings was developed to help ministries of health, implementing partners, software developers, donors, and other stakeholders examine the security of electronic health record (EHR) systems. Designed using internationally accepted best practices, the assessment approach is tailored to the needs of low-resource settings. The guidance takes into consideration typical EHR implementation scenarios, such as a single instance of an EHR being used for retrospective data entry, while also allowing users to continue to assess security as their EHR systems mature to interconnected point-of-care systems. This document provides instructions on the use of several tools to assess EHR system privacy and security and for instituting continuous monitoring of EHR privacy and security. |
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Standard Operating Procedures for a Secure Electronic Health Record in Low-Resource Settings
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MEASURE Evaluation |
2020 |
English |
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Electronic Health Records, EHR, Information system |
These standard operating procedures have the following objectives:
Provide guidance for implementing security safeguards for an electronic health record (EHR) in a low-resource country using current best practices tailored for low-resource settings.
Incorporate best practices based on National Institute of Standards and Technology Special Publication 800, International Organization for Standardization 27001, the Office of the National Coordinator Security Risk Assessment Tool, and other international privacy and security standards.
Understand common threats to security that must be regularly assessed.
Safeguarding an EHR to maximize privacy, confidentiality, and security while ensuring that the system data are accessible to users is critical to EHR adoption and acceptance as well as respecting the rights of patients to private and confidential treatment. EHR implementers should take advantage of safeguards built into software and operating systems that enhance privacy and security. In addition, policies and procedures should be in place that promote a culture of information and system security awareness and respect for privacy.
Best practices around privacy and security for information systems are widely available, but often they do not account for the availability of resources, such as human resource capacity and Internet connectivity. This job aid has been curated to highlight critical privacy and security safeguards based on international best practices while taking into account EHR implementation scenarios commonly practiced in low-resource settings. |
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Evaluation de la performance du système d’information sanitaire de routine du Burkina Faso
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Kebe, M.R., Ouangaré, A., Tohouri, R.R., Kouassi, C., Barry, M.A., Chauffour, J., Sawadogo, I., & Ilboudo, F. |
2020 |
French |
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Health Information Systems, Routine Health Information Systems, Burkina Faso, Performance of Routine Information System Management, PRISM, Information systems |
Au Burkina Faso, de nombreux efforts de modernisation du système national d’information sanitaire ont été mis en œuvre pour répondre à la nécessité de disposer d’une information sanitaire de qualité. Ces initiatives font du Burkina Faso l’un des premiers pays d'Afrique de l'Ouest à disposer à l’échelle nationale depuis 2013, d’un système de gestion électronique des données sanitaires de routine basé sur le logiciel DHIS2 intégrant la plupart des programmes de santé. Des documents d’orientation sur des normes et procédures de gestion de l’information sanitaire ont également été élaborés et vulgarisés permettant ainsi de répondre aux exigences de qualité requises en vue de rendre plus performant le système de santé. Malgré ces efforts, le manque de données de base pour surveiller les performances du système d’information sanitaire de routine (SISR) reste encore non résolu. En outre, de nombreux programmes et projets de santé verticaux existent avec leurs propres systèmes d’information, au détriment d’un système de gestion intégré national.
Dans le cadre de l'initiative mondiale de la santé unique, le Ministère de la Santé à travers la Direction des Statistiques Sectorielles avec le soutien technique et financier de l’USAID à travers le projet MEASURE Evaluation, a conduit une évaluation du SISR en utilisant la méthode et les outils PRISM (Performance of Routine Information System Management) développés par MEASURE Evaluation, afin d'évaluer les progrès et l'efficacité des interventions de renforcement du SISR. Cette évaluation contribuera à établir une base de référence permettant de mesurer dans le futur l’évolution de la performance du SISR.
Un poster résumant cette évaluation est disponible au lien suivant : https://www.measureevaluation.org/resources/publications/gr-19-101-fr/
Les outils PRISM développés par MEASURE Evaluation sont disponibles au lien suivant : https://www.measureevaluation.org/prism
English
Many efforts aimed at modernizing Burkina Faso’s national health information system have been implemented to respond to the need for high-quality health data. These initiatives have made Burkina Faso one of the first West African countries to have an electronic health management information system (HMIS) set-up nationwide since 2013. This DHIS2-based system integrates most of the health programs’ data. National guidelines, norms, and procedures to manage health data have been developed and disseminated to respond to data quality improvement needs in hopes of strengthening the overall health system. Despite these efforts, the lack of baseline data to monitor routine health information system (RHIS) data remains unsolved. Furthermore, many vertical health programs and projects operate their own health information system, to the detriment of an integrated national HMIS.
In the context of the Global Health Security Agenda, the Ministry of Health and its Directorate for Sectoral Statistics, with financial and technical support from USAID through the MEASURE Evaluation project, conducted a Performance of Routine Information System Management (PRISM) assessment using the PRISM Tools developed by MEASURE Evaluation. This assessment aimed to evaluate the progress and the effectiveness of RHIS-strengthening interventions, and will contribute to establishing a baseline reference allowing future evaluations to measure the progress of the RHIS’ performance.
An English-language poster summarizing this assessment is available at https://www.measureevaluation.org/resources/publications/gr-19-101
The PRISM tools developed by MEASURE Evaluation are available at https://www.measureevaluation.org/prism |
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Evaluation de la performance de la gestion du système d’information sanitaire de routine (PRISM) au Burkina Faso (2018)
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Mohamed Rahim Kebe, MD, MPH, MBA; Cyrille Kouassi; Issaka Sawadogo; Romain-Rolland Tohouri, MD, MSc; Jeanne Chauffour, MSc |
2020 |
French |
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Performance of Routine Information System Management, Information System, Evaluation, Burkina Faso, PRISM |
Une évaluation de la performance de la gestion du système d'information sanitaire de routine (SISR) a été menée en 2018 avec les outils PRISM récemment révisés par le projet MEASURE Evaluation, financé par l'Agence des Etats-Unis pour le développement international (USAID). L'évaluation a inclus 64 formations sanitaire, cinq hôpitaux, quatre districts, une direction régionale de la santé et le niveau central représenté par la Direction des Statistiques Sectorielles (DSS).
Le Burkina Faso a un SISR qui porte le nom d’ENDOS basé sur le District Health Information Software, version 2 (DHIS2). Il intègre les données provenant de tous les niveaux de la pyramide sanitaire et appuie la saisie, l'analyse et l'interprétation des données. ENDOS intègre aussi des indicateurs de qualité des données.
D'après les résultats du PRISM de 2018, les efforts de renforcement du SISR devraient se focaliser sur les visites de supervision à la fois régulières et systématiques à tous les niveaux du système sanitaire, accompagné d'un développement consensuel de rapports et de plans pour le suivi et la mise en œuvre des recommandations. Mettre en place une culture de l'utilisation des données est d'une importance primordiale. Chaque niveau du système sanitaire devrait être encouragé de produire des rapports périodiques ou des bulletins de rétro-informations, et les procédures opérationnelles standards et les tâches de saisie des données devraient être étendues aux points de prestation de services.
Le rapport complet de l'évaluation PRISM menée au Burkina Faso est disponible au lien suivant: https://www.measureevaluation.org/resources/publications/tr-20-420-fr
La version anglaise de ce poster est diponible au lien suivant: https://www.measureevaluation.org/resources/publications/gr-19-101 |
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La plateforme électronique « One Health » du Burkina Faso
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Mohamed Rahim Kebe, MD, MPH, MBA; Cyrille Kouassi; Issaka Sawadogo; Romain-Rolland Tohouri, MD, MSc; Jeanne Chauffour, MSc |
2020 |
French |
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Information System, One Health, Global health security, DHIS 2, Burkina Faso, Zoonotic |
MEASURE Evaluation—financé par l’Agence des Etats-Unis pour le développement international (USAID)—a débuté sous le Global Health Security Agenda au Burkina Faso en mars 2018. La priorité de l’USAID étant le renforcement de l'approche “une seule santé”, le projet a entrepris de renforcer les systèmes de surveillance épidémiologique du Ministère de la Santé (MS) pour la santé humaine, du Ministère des Ressources Animales et Halieutiques (MRAH) pour les animaux d'élevage et du Ministère de l'Environnement (MEEVCC) pour la vie sauvage à travers le développement et la mise en œuvre de plateformes de surveillance électroniques des maladies zoonotiques basées sur le logiciel DHIS2 (District Health Information Software, version 2). Il en a découlé une coalition multisectorielle et la plateforme électronique One Health, qui fournit des données en temps réel sur les évènements inhabituels et cas suspects aux directions centrales, aux laboratoires et au Centre des Opérations de Réponses aux Urgences Sanitaires (CORUS). Le comité national One Health assure le pilotage de la plateforme électronique. De plus, le système électronique de gestion de l'information sanitaire au Burkina Faso—ENDOS— est intégré avec la plateforme One Health. Les zones d'intervention du projet MEASURE Evaluation sont les régions du Centre-Sud et du Plateau Central, où les agents des trois ministères ont été formés sur l'utilisation de la plateforme électronique One Health et sont capables d'effectuer la remontée des information en temps réel. Depuis mars 2020, cette plateforme joue un rôle essentiel dans la lutte contre et la réponse à l'épidémie de COVID-19.
Le rapport sur l'architecture d'entreprise "une seule santé" du Burkina Faso est accessible au lien suivant: https://www.measureevaluation.org/resources/publications/tr-20-406-fr/
Le manuel des procédures de gestion de l'information sanitaire "One Health" au Burkina Faso est accessible au lien suivant: https://www.measureevaluation.org/resources/publications/tr-20-416-fr
La version anglaise de ce poster est diponible au lien suivant: https://www.measureevaluation.org/resources/publications/gr-19-100 |
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Standard Operating Procedures for the Health Management Information System: Data Management Procedures Manual I
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MEASURE Evaluation |
2020 |
English |
Africa, SIERRA LEONE |
Information System, Data, Health data, Sierra Leone, HMIS |
A health management information system (HMIS) is a routine, integrated system for the collection, collation, analysis, presentation, dissemination, and use of relevant health‐related information. It covers other health information system (HIS) sub‐systems, such as the human resources information system, administrative records, integrated disease surveillance and response, the logistics management information system, registration of births and deaths, population‐based information systems, and research‑generated health information. It is designed for use at the community and health facility levels, and by district health management teams, local councils, civil society organizations, partners, and the Ministry of Health and Sanitation (MOHS) for planning, allocating resources, and managing and evaluating the healthcare delivery system.
The Data Management Procedures Manual, within the context of the HIS, is a written description of the management practices required for effective coordination, monitoring, and supervision of the HIS, as well as the procedures required to address issues relating to data collection, quality, and accessibility. The Data Management Procedures Manual should therefore accurately reflect good information management practices, be sufficiently practical, and be usable in the HIS sub‐system. Good HIS management practices relate to general aspects of HIS management functions, including the following: data collection, compilation, analysis, storage, and processing; records storage; handling of urgent data requests and needs; and management of the devices, tools, and appliances used to manage the data.
The goal of the Standard Operating Procedures for HMIS: Data Management Procedures Manual is to provide a standardized system of data management practices for the MOHS and its partners, with the view of reaching maximum data accuracy, correctness, completeness, integrity, and reproducibility in the HMIS in Sierra Leone. The application of the Data Management Procedures Manual requires effective coordination and oversight at all levels.
Access the related Standard Operating Procedures for the Health Facility Registers and Summary Forms: Data Management Procedures Manual II. |
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Standard Operating Procedures for the Health Facility Registers and Summary Forms: Data Management Procedures Manual II
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MEASURE Evaluation |
2020 |
English |
Africa, SIERRA LEONE |
Information System, Data, Health data, Sierra Leone, HMIS |
The purpose of these standard operating procedures (SOPs) is to provide guidance in filling health facility registers and summary forms at the health facility level. These SOPs are an additional document to the Standard Operating Procedures for the Health Management Information System: Data Management Procedures Manual I. |
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A Compendium of the Kenya Malaria Programme Review 2018
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Kenya Ministry of Health |
2020 |
English |
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Kenya, Malaria |
Kenya conducted a malaria programme review (MPR) at the end of the Kenya Malaria Strategy (KMS) 2009–2018 (revised 2014). The MPR was conducted to assess the progress made during the implementation of the KMS 2009–2018. Recommendations and findings of the MPR informed the development of the KMS 2019–2023. The MPR consisted of nine thematic area reviews formed along the key strategic and intervention areas of the KMS 2009–2018. The thematic area reviews were evidence-based assessments of progress made against the KMS objectives and strategies.
This compendium contains 10 separate reports developed as part of the MPR. Chapter 1 contains the report detailing the process for conducting the MPR and the nine thematic reviews. Chapters 2–10 provide the nine thematic reports, covering these areas: programme management; finance; procurement and supply management (PSM); vector control; malaria in pregnancy; case management; advocacy, communication, and social mobilisation (ACMS); epidemic preparedness and response (EPR); and surveillance, monitoring, evaluation, and operational research (SMEOR). These thematic reviews provided the information used to develop the main findings and recommendations of the MPR. |
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Open Client Registry: Final Deliverables
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MEASURE Evaluation |
2020 |
English |
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Electronic Health Records, Data, Information System, Client Registry, Digital Health |
With support from the United States Agency for International Development (USAID), through MEASURE Evaluation, IntraHealth International developed a prototypical client registry (CR) informed by stakeholders in Uganda, including the Ministry of Health (MOH) and the Central Public Health Laboratory (CPHL), as well as technical teams at the United States Centers for Disease Control and Prevention (CDC) and USAID. OpenCR is an open source and standards-based client registry. A client registry facilitates the exchange of patient information between disparate systems and holds patient identifiers and a subset of patient demographic information. It is a necessary tool for public health to help manage patients, monitor outcomes, and conduct case-based surveillance. This document provides an overview of the project and the deliverables. |
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Quality of Tuberculosis Services Assessment: Global Tools
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MEASURE Evaluation |
2020 |
English |
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TB, Tuberculosis, QTSA, Tools |
The Quality of Tuberculosis Services Assessment (QTSA) is conducted with the support of four tools: the Facility Audit, the Provider Interview, the Patient Interview, and the Register Review. MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID)—developed these four tools with the assistance of colleagues at USAID. These tools exist in a generic format that demonstrates the content and topics covered in the QTSA. They are not meant to be used without proper adaptation by a country. For instance, some countries may have different names for their health administrative units (e.g., district, province, ward, or woreda) or the name of their tuberculosis (TB) registers (e.g., TB patient logbook, TB confirmed cases register). The tools must be customized to fit the country priorities and context in which they will be used. Note that these tools were designed to be administered electronically and may need to be restructured if used in hard copy format. This document presents detailed information about the structure and content of the tools. It also includes a generic version of all the associated consent and assent forms needed. More information on the QTSA purpose, methods, and steps for implementation can be found in the QTSA Global Implementation Guide: https://www.measureevaluation.org/resources/publications/ms-19-170/ MEASURE Evaluation also adapted the QTSA tools for use in several country assessments. These examples are available here: https://www.measureevaluation.org/our-work/tuberculosis/quality-of-tb-services-assessments |
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Manuel des procédures de gestion de l’information sanitaire « One-Health » au Burkina Faso
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MEASURE Evaluation |
2020 |
French |
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HIS, Burkina Faso, Health Information Systems, One Health, Health data |
Ce manuel de procédures représente le document de référence principal pour le système d'information sanitaire One-Health (SIS-OH) et formalise les principales procédures de gestion des données. Ce manuel est destiné aux directions centrales des trois Ministères du Burkina Faso impliqués dans l’approche One-Health (« une seule santé »), aux coordinateurs des programmes de surveillance des maladies humaines et zoonotiques et aux partenaires. Ce manuel décrit le SIS-OH, indique l'objectif de la collecte de données, la structure du SIS-OH, le circuit de l'information et également le concept de cycle de données et aussi explique la fréquence à laquelle les rapports doivent être établis, pour chaque niveau de la pyramide. Pour chaque niveau de la pyramide sanitaire, du niveau central au niveau communautaire, le manuel identifie les ressources nécessaires à la collecte des données, désigne les personnes responsables de ces données et fournit des consignes permettant de savoir quelles données de santé doivent être recueillies et faire l'objet de rapports, quand et comment.
Ce manuel de procédures est accompagné d'un rapport sur l'architecture d'entreprise "une seule santé" du Burkina Faso, accessible au lien suivant: https://www.measureevaluation.org/resources/publications/tr-20-406-fr/
English Abstract:
This French-language standard operating procedures (SOP) manual is the main reference document for the One-Health health information system (OH-HIS) of Burkina Faso. It formalizes the main procedures for managing One-Health data. This SOP is aimed at central directorates within the three Burkina Faso ministries involved in the One-Health work (namely the Ministry of Health, the Ministry of Livestock and Fisheries, and the Ministry of the Environment), at coordinators of human and zoonotic diseases surveillance programs, as well as to implementing partners. This manual describes the OH-SIS, its data collection purpose, its structure, its information flow, and its data cycle. It also provides information on the frequency at which reports should be developed at each level of the health system. For each of these levels, from the central to the community level, this manual also identifies the resources necessary to collect data and designate staff as responsible for these data, and provides instructions so as to recognize which health data need to be collected and reported, when, and how. A companion to this SOP is a French-language report on the enterprise architecture for the One-Health system in Burkina Faso, available at the following link: https://www.measureevaluation.org/resources/publications/tr-20-406-fr/ |
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L’architecture d'entreprise « une seule santé » du Burkina Faso
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Tohouri, R.R., Kebe, M.R., Kouassi, C., & Chauffour, J. |
2020 |
French |
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Global health security, One Health, Burkina Faso, Infectious disease, Zoonotic |
Suite à l'avènement de menaces sanitaires graves impliquant des maladies transmises des animaux aux hommes, le gouvernement burkinabè a décidé de prendre au sérieux la menace que représente les maladies zoonotiques, en adoptant l’approche « One-Health » encore appelée « une seule santé » en français. Cette approche promeut une gestion unique et intégrée de la santé animale et humaine afin de fournir une réponse adéquate et compréhensible aux menaces d'épidémies en général et de maladies zoonotiques en particulier. Cependant, pour devenir une réalité, une telle approche nécessite la mise en place d'une plateforme électronique capable de remonter les informations en temps réel et de notifier les acteurs clés de potentielles menaces sanitaires dans le pays, d'où la nécessité d'une infrastructure informatique en adéquation avec les objectifs poursuivis. Le présent document est une tentative de décrire les actions requises pour un alignement parfait entre les objectifs et l'infrastructure technique pour atteindre les résultats escomptés, à travers la mise en lumière des prérequis organisationnels, politiques, informationnels, techniques et infrastructurels nécessaires au succès d'une telle entreprise.
L'objectif principal de ce document est de fournir un outil de politique et de planification aux différents ministères participant à l’approche « une seule santé » au Burkina Faso, leur permettant d'établir et de mettre en œuvre un système d'information commun de surveillance en temps réel des maladies zoonotiques, interopérable entre ministères afin d'offrir au pays une vue globale sur les données collectées afin d'optimiser la riposte. Plus particulièrement, ce document établit une analyse comparée des architectures d'entreprise des systèmes d'information sanitaire des Ministères de la Santé, de l'Environnement et des Ressources Animales et Halieutiques du Burkina Faso, afin de leur garantir un alignement parfait entre la vision de l'approche « une seule santé », leur politique de gouvernance, leur flux d'information, les applications informatiques mises en place et l'infrastructure informatique qui les supporte.
Ce rapport est accompagné d'une manuel des procédures de gestion de l'information sanitaire "One Health" au Burkina Faso, accessible au lien suivant: https://www.measureevaluation.org/resources/publications/tr-20-416-fr/
English Abstract:
Following recent severe health threats and epidemics involving diseases transmitted from animals to humans, the Burkina Faso government has decided to take action against the threat posed by zoonotic diseases, by adopting the One-Health approach. This approach promotes a unique and integrated management of animal and human health so as to provide an adequate and comprehensive response to epidemic threats and zoonoses specifically. However, to become reality, such an approach necessitates the set-up of an electronic platform capable of transmitting data to higher-levels in real time and to notify key actors of potential health threats in the country, further stressing the need for a robust IT infrastructure able to meet these demands. This report describes the actions required for a perfect alignment between these objectives and the technical infrastructure in order to reach the wished-for results, and highlights the organizational, political, informational, technical, and infrastructural prerequisites necessary to the success of such an enterprise.
The main objective of this document is to provide a political and planning tool to the different ministries participating in the One-Health work in Burkina Faso. This, in the hope of allowing them to establish and implement a common real-time zoonotic diseases surveillance information system, interoperable across ministries in order to provide the country with a global perspective on data collected so as to optimize responses. Specifically, this document establishes a comparative analysis of the enterprise architectures of the health information systems of the Ministries of Health, of the Environment, and of Livestock and Fisheries of Burkina Faso, in order to guarantee a perfect alignment between the One-Health vision, these ministries' governance politics, the information flow within their system, the IT software in place, and the IT infrastructure that support them. A companion to this French-language report is a French-language standard operating procedures manual (SOP) on managing the One-Health information in Burkina Faso, available at the following link: https://www.measureevaluation.org/resources/publications/tr-20-416-fr/
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Mobility and Treatment Outcomes among People Living with HIV and/or Tuberculosis in East African Cross-Border Regions
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Edwards, Jessie K.; Mulholland, Grace E.; Markiewicz, Milissa; Bahemuka, Ubaldo; Seeley, Janet; Kidega, William; De Bont, Jan; Kwena, Zachary; Oketch, Bertha; Okech, Brenda; Nanyonjo, Gertrude; Kidola, Jeremiah; Okello, Elialilia |
2020 |
English |
UGANDA, Africa, East Africa |
HIV, HIV care, TB, Global health, Tuberculosis, HIV/AIDS |
Regional economic integration and trade are high on the political and development agendas of East African leaders. Greater regional integration and increased trade are expected to enhance opportunities for income generation and employment, resulting in increased movement of people as they look for new and expanded opportunities in the region. However, the increased movement of humans, animals, and goods across nations leads to intensified transmission of infectious diseases, including HIV/AIDS and tuberculosis (TB), which do not respect political boundaries. Health affects peoples’ ability to work, the type of work they can perform, and how long they can work. Unless specifically addressed in health programming, infectious diseases have the potential to dampen trade and even reverse economic growth.
This report presents the results of a study—funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief—to understand mobility patterns, treatment outcomes, and the feasibility of regional tracing strategies among patients in care for HIV and/or TB in the Lake Victoria region. This study was undertaken by MEASURE Evaluation and local partners from the Lake Victoria Consortium for Health Research: Uganda Virus Research Institute and the International AIDS Vaccine Initiative; Kenya Medical Research Institute; Medical Research Council/Uganda Virus Research Institute and the London School of Hygiene and Tropical Medicine; and the Mwanza Intervention Trials Unit. Results of this study will improve treatment strategies for mobile populations, identify facilities serving mobile populations, and inform planning for cross-border coordination of health services, including medical record linkages, patient referrals, and defaulter tracing. |
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Quality of Tuberculosis Services Assessment in Uganda: Report
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Kola Oyediran, Bruce Kirenga, Stavia Turyahabwe, Nikki Davis, Jeanne Chauffour, Winters Muttamba, Abel Muzoora, Herbert Muyinda |
2020 |
English |
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Tuberculosis, Uganda, TB, QTSA |
According to the 2018 Global Tuberculosis Report released by the World Health Organization (WHO), tuberculosis (TB) is the tenth leading cause of death and is the leading cause of death from a single infectious agent. Heads of state committed to ambitious targets aimed at eliminating TB during the first-ever United Nations High-Level Meeting on Tuberculosis conducted in September 2018 at the United Nations General Assembly.
Uganda is one of the 30 countries with the highest burden of TB/HIV, with an estimated TB incidence of 200 cases per 100,000. The proportion of multidrug-resistant tuberculosis and rifampin-resistant TB among new and previously treated TB cases was estimated at 1 percent and 12 percent, respectively, in 2018. For the estimated 86,000 people who fell ill with TB in 2019, TB treatment coverage was 65 percent, and the treatment success rate was 72 percent—both far below the 85 percent national target for 2019. In response, the Government of Uganda gave the Ministry of Health, through the National Tuberculosis and Leprosy Programme (NTLP), a mandate to bring the disease under control by means of providing high-quality prevention, diagnosis, and treatment services to affected Ugandans. Specifically, TB incidence is to be reduced by 5 percent by 2019/2020, and the treatment success rate among notified incident cases is targeted to increase from 75 percent in 2015/16 to 85 percent by 2019/20.
Studies show that good quality of care in TB services helps patients and their families address their health needs safely and effectively. Therefore, to enhance TB service use, there is a need to assess and improve the quality of TB services. A Quality of TB Services Assessment (QTSA) was conducted by MEASURE Evaluation in Uganda to assess the quality of TB services in randomly selected health facilities. Its purpose was to identify where services were of high quality and where there were gaps and to ensure that TB patients were receiving the care that they deserve. The QTSA assessed three domains of quality of care: the structure of the health facility, the service delivery process, and the outcomes of service delivery. The results were used to develop programs or interventions to improve TB service delivery.
The qualitative findings from the QTSA in Uganda are described in a separate report, available here: https://www.measureevaluation.org/resources/publications/tr-20-417/
The QTSA tools adapted for use in Uganda are available here: https://www.measureevaluation.org/resources/publications/tl-20-79/
QTSA documents for other countries are available here: https://www.measureevaluation.org/our-work/tuberculosis/quality-of-tb-services-assessments |
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Quality of Tuberculosis Services Assessment in Uganda: Report on Qualitative Findings
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Herbert Muyinda, Stavia Turyahabwe, Kola Oyediran, Bruce Kirenga, Nikki Davis, Jeanne Chauffour, Esther Buregyeya, Winters Muttamba, Linda Ruvwa |
2020 |
English |
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Tuberculosis, TB, Uganda, QTSA |
This report describes findings of a qualitative study on tuberculosis (TB)-related stigma among community members from two regions in Uganda. This research is part of a broader Quality of Tuberculosis Services Assessment (QTSA) conducted in Uganda in 2019 by MEASURE Evaluation, which is funded by the United States Agency for International Development (USAID), in collaboration with the Uganda National TB and Leprosy Programme (NTLP), and implemented by Makerere Lung Institute—a local research organization at Makerere University’s College of Health Sciences that was contracted by MEASURE Evaluation.
Stigma is a recognized challenge affecting prevention, diagnosis, treatment, and care of infectious diseases, including TB. Stigma is a complex social construct shaped by inadequate knowledge and information about modes of transmission, care, and prevention and is exacerbated by the inadequate availability of TB services and low-quality services, especially in rural areas.
This qualitative study explored community-level knowledge, attitudes, and perceptions of TB-related stigma to inform the NTLP to design interventions to improve TB prevention, diagnosis, and treatment in Uganda. The study had the following objectives: (1) assess the causes of TB-related stigma; (2) document the manifestations of stigma; (3) determine the perceived effects of stigma on treatment-seeking behavior; and (4) provide evidence-based recommendations to address stigma and discrimination toward people with TB at the community level.
The quantitative findings from the QTSA in Uganda are described in a separate report, available here: https://www.measureevaluation.org/resources/publications/tr-20-398
The QTSA tools adapted for use in Uganda are available here: https://www.measureevaluation.org/resources/publications/tl-20-79/
QTSA documents for other countries are available here: https://www.measureevaluation.org/our-work/tuberculosis/quality-of-tb-services-assessments |
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Quality of Tuberculosis Services Assessment in Ethiopia: Report
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Upama Khatri, Nikki Davis |
2020 |
English |
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Tuberculosis, QTSA, TB, Ethiopia, Service delivery |
According to the 2018 Global Tuberculosis Report released by the World Health Organization (WHO), tuberculosis (TB) is the tenth leading cause of death and is the leading cause of death from a single infectious agent. Heads of state committed to ambitious targets aimed at eliminating TB during the first-ever United Nations High-Level Meeting on Tuberculosis conducted in September 2018 at the United Nations General Assembly. WHO has identified 30 countries where the TB burden is high, including Ethiopia. The incidence of TB in Ethiopia was estimated to be 151 per 100,000 population, and the mortality was 22 per 100,000 population in 2018. TB treatment coverage was 69 percent in 2018, indicating that 31 percent of TB cases were missed. In response, the Government of Ethiopia has committed to accelerating the fight to end the TB epidemic by 2035 by endorsing the post-2015 Global End TB Strategy and the targets set by the United Nations High-Level Meeting. The Federal Ministry of Health’s National Tuberculosis and Leprosy Program strategy aims to end the TB epidemic by reducing TB-related deaths by 95 percent and cutting incident TB cases by 90 percent between 2015 and 2035.
Studies show that good quality of care in TB services helps patients and their families address their health needs safely and effectively. Therefore, to enhance TB service use, there is a need to assess and improve the quality of TB services. A Quality of TB Services Assessment (QTSA) was conducted by MEASURE Evaluation in Ethiopia to assess the quality of TB services in randomly selected health facilities. Its purpose was to identify where services were of high quality and where there were gaps and to ensure that TB patients were receiving the care that they deserve. The QTSA assessed three domains of quality of care: the structure of the health facility, the service delivery process, and the outcomes of service delivery. The results were used to develop programs or interventions to improve TB service delivery.
The QTSA tools adapted for use in Ethiopia are available here: https://www.measureevaluation.org/resources/publications/tl-20-87/
QTSA documents for other countries are available here: https://www.measureevaluation.org/our-work/tuberculosis/quality-of-tb-services-assessments |
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Quality of Tuberculosis Services Assessment in Uganda: Tools
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MEASURE Evaluation |
2020 |
English |
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Uganda, QTSA, Tuberculosis, Tools, TB |
The Quality of Tuberculosis Services Assessment (QTSA) in Uganda was conducted with the support of five tools: the Facility Audit, the Provider Interview, the Patient Interview, the Register Review, and the Focus Group Discussion Guide. MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID)—developed these five tools with the assistance of colleagues at USAID.
The tools exist in a generic format that is adaptable to any country wishing to conduct a QTSA. For instance, some countries may have different names for their health administrative units (e.g., district, province, ward, or woreda) or the name of their TB registers (e.g., TB patient logbook or TB confirmed cases register). They are customized to fit the country priorities and context in which they will be used.
The generic QTSA tools are available at the following link: https://www.measureevaluation.org/resources/publications/tl-19-41/
This document presents only the QTSA tools adapted for use in Uganda. It provides detailed information about the structure and content of the tools. More information on the QTSA purpose, methods, or results can be found in the individual QTSA reports. Uganda’s QTSA report is available here: https://www.measureevaluation.org/resources/publications/tr-20-398
The report on qualitative findings is available at the following link: https://www.measureevaluation.org/resources/publications/tr-20-417/
QTSA documents for other countries are available here: https://www.measureevaluation.org/our-work/tuberculosis/quality-of-tb-services-assessments |
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Quality of Tuberculosis Services Assessment in Ethiopia: Tools
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MEASURE Evaluation |
2020 |
English |
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Tuberculosis, QTSA, Tools, TB, Ethiopia |
The Quality of Tuberculosis Services Assessment (QTSA) is conducted with the support of four tools: the Facility Audit, the Provider Interview, the Patient Interview, and the Register Review. MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID)—developed these four tools with the assistance of colleagues at USAID.
The tools exist in a generic format that is adaptable to any country wishing to conduct a QTSA. For instance, some countries may have different names for their health administrative units (e.g., district, province, ward, or woreda) or the name of their TB registers (e.g., TB patient logbook or TB confirmed cases register). They are customized to fit the country priorities and context in which they will be used.
The generic QTSA tools are available at the following link: https://www.measureevaluation.org/resources/publications/tl-19-41/
This document presents only the QTSA tools adapted for use in Ethiopia. It provides detailed information about the structure and content of the tools. More information on the QTSA purpose, methods, or results can be found in the individual QTSA reports.
Ethiopia’s QTSA report is available here: https://www.measureevaluation.org/resources/publications/tr-20-415/ QTSA documents for other countries are available here: https://www.measureevaluation.org/our-work/tuberculosis/quality-of-tb-services-assessments |
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Malaria Routine Data Quality Assessment Tool: A Checklist to Assess the Quality of Malaria Program Data
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MEASURE Evaluation |
2020 |
English |
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Routine data, Malaria, Data Quality, Data quality assessment, Tool |
A comprehensive approach to data quality assurance should include three complementary approaches using standardized methods and tools. These approaches are as follows:
Routine and regular (i.e., monthly) reviews of data quality built into a system of checks of the malaria or other program reporting systems as part of a feedback cycle that identifies errors in near real-time so that they can be corrected as they occur.
An annual independent assessment of a core set of tracer indicators to identify gaps and errors in reporting and the plausibility of trends in health facility data reported during the previous year.
Periodic in-depth program-specific reviews of data quality that focus on a single disease or program area and are timed to meet the planning needs of the specific programs (e.g., before program reviews).
This tool aims to standardize and facilitate the routine review of malaria data quality at health facilities, by the district monitoring and evaluation teams that support them via routine supervision to health facilities. While the Malaria Routine Data Quality Assessment (MRDQA) tool provides some details on use of the tool, a User Manual expanded details exists and is meant to accompany this tool. Access the manual at https://www.measureevaluation.org/resources/publications/ms-20-190/ |
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Malaria Routine Data Quality Assessment Tool: User Manual
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MEASURE Evaluation |
2020 |
English |
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Routine data, Malaria, Tool, Data Quality, Data quality assessment |
In 2020, the United States Agency for International Development- and U.S. President’s Malaria Initiative-funded MEASURE Evaluation project developed the Malaria Routine Data Quality Assessment (MRDQA) Tool: A Checklist to Assess the Quality of Malaria Program Data, for use by malaria programs (MEASURE Evaluation, 2020; https://www.measureevaluation.org/resources/publications/tl-20-85/).
The MRDQA tool is a checklist that supports a targeted, rapid data-quality assessment focused on malaria data for use in routine data quality monitoring as part of regular supervision efforts. The tool aims to standardize and facilitate the routine assessment of malaria data quality by a district team during supportive supervision visits at health facilities. The tool can also be used by central and regional staff jointly with district teams to assist in data quality efforts.
This manual describes the purpose and structure of the MRDQA tool and offers considerations for personnel and logistics, sampling considerations, details on preparing for fieldwork, and step-by-step instructions for using the tool. The MRDQA tool provides even more detail on use of the tool in the Instructions tab. |
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Creating a New Digital Health System in Bangladesh by Building Interoperability between the Country’s Family Planning Service Statistics System and the DHIS2
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Mohammad Golam Kibria, Nibras- Ar-Rakib, Md. Humayun Kabir, Gabriela Escudero |
2020 |
English |
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The government of Bangladesh is prioritizing the management of comprehensive digital health information and is increasingly generating high-quality data for planning and decision-making purposes, which ultimately leads to better health outcomes. The Directorate General of Family Planning (DGFP), under the Ministry of Health and Family Welfare, has collected subdistrict-level family planning (FP) service statistics (SS) in electronic form for more than 10 years. However, this SS system lacked an interactive visual interface, which hindered data analysis and the use of data for decision making. To resolve this issue and maximize the effective use of the copious data collected through the SS system, with technical assistance from implementing partners (IPs), the DGFP created an innovative interoperability mechanism between the SS and the country’s District Health Information Software, version 2 (DHIS2) platform. This brief shares more. |
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MEASURE Evaluation Phase IV Project Les réussites du projet Mali 2016–2019
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MEASURE Evaluation |
2020 |
French |
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Mali, Health, Monitoring, Evaluation, Health Information Systems |
MEASURE Evaluation a travaillé au Mali afin d’apporter une assistance technique dans le suivi-évaluation (S&E) des programmes sanitaires depuis 2014. Le projet a fourni des outils, de la recherche, des formations, de l’encadrement et des stratégies pour aider à améliorer les systèmes d’information sanitaire du Mali.
Le projet a procuré un appui important dans le renforcement des systèmes d’information sanitaire de routine, des systèmes de surveillance épidémiologique et du système national d’information sanitaire (SNIS) en intégrant ces systèmes dans la plateforme du District Health Information Software, version 2 (DHIS2) aux niveaux districts, régions et central.
Le portfolio des activités a inclus:
Le renforcement du S&E du paludisme
Le renforcement du SNIS malien
Les évaluations des campagnes nationales de promotion de la planification familiale de 2016 et 2017 au Mali
L’appui au plan de S&E de l’USAID/Mali en s’adressant à des besoins en information spécifiques liés à la prévention de la mortalité maternelle et infantile
Le développement et le déploiement d’un système de surveillance de la maladie à virus Ebola et l’amélioration des indicateurs, des outils de collecte des données et de la qualité des données du système de surveillance
Ce livret décrit, de manière plus détaillée, certains aspects du travail impressionnant que le gouvernement et le Ministère de la Santé du Mali ont réalisé ces dernières années. |
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Counseling on injectable contraception and HIV risk: Evaluation of a pilot intervention in Tanzania
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Janine Barden-O’Fallon, Jennifer Mason, Emmanuel Tluway, Gideon Kwesigabo, Egidius Kamanyi |
2020 |
English |
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Contraception, Tanzania, Evaluation, Family Planning, HIV |
In a context of high rates of HIV prevalence, concerns over hormonal contraceptive use and the potential for increased risk of HIV acquisition have led to increased attention to counseling messages, particularly for users of the injectable. However, the consequence of adding additional HIV risk messages to family planning counseling sessions was not well understood. This evaluation assessed the effect of providing revised injectable and HIV risk counseling messages on contraceptive knowledge and behavior during a three month pilot intervention. The pilot intervention was conducted September-November 2018 with all eligible family planning clients in ten healthcare facilities located in the Iringa and Njombe regions of Tanzania. Data collection for the evaluation occurred November-December 2018 and included 471 client exit interviews, 26 healthcare provider interviews, and the extraction of service statistics for 12 months prior to the intervention and three months of the intervention. Univariate and bivariate analyses were used to assess quantitative interview data. Thematic qualitative assessment was used to assess qualitative interview data from healthcare providers. Interrupted time series analysis was used to assess changes in the trend of contraceptive uptake. Results indicate that the counseling messages did not cause a decrease in the uptake of injectables (Depo-Provera): 97 percent of interviewed clients received Depo-Provera at their visit; sixty percent reported an intention to use condoms for dual protection. The analysis of service statistics showed no statistical difference in the trend of Depo-Provera uptake between the pre-intervention and intervention periods (p = 0.116). Overall knowledge of counseling messages by clients was good; however only 64.8% of women correctly responded that women at risk of getting HIV can use any method of family planning. Providers’ knowledge of the messages was high, though it appears that not all messages were consistently provided during the counseling sessions. The findings from this evaluation provide evidence that complex HIV counseling messages can be implemented in family planning programs in Tanzania, and potentially in other countries that are considering how to better integrate HIV risk messages into family planning counseling. |
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Comparison of Cause-of-Death Classification Methods for Verbal Autopsies in Mozambique: 2017 Inquérito Sobre Causas de Mortalidade (INCAM)-2 Pilot
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MEASURE Evaluation |
2020 |
English |
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Mortality, Verbal Autopsy, Mozambique |
In advance of the August 2017 Population and Housing Census, the Mozambique National Institute of Statistics (INE) and Ministry of Health (MISAU) began discussing the implementation of a post-census mortality survey. This would be the country’s second such survey. Following the 2007 Population and Housing Census, INE and MISAU conducted a post-census mortality survey (Inquérito Sobre Causas de Mortalidade [INCAM]) in 2007/2008 using verbal autopsies (Mozambique National Institute of Statistics, et al., 2012). Like the first INCAM, the 2017 Population and Housing Census included questions on household deaths in the previous 12 months, collecting the name, sex, age, and date of death for the deceased. A sample of census enumeration areas representative of the national and provincial levels would then be selected, and all deaths reported in the census in those areas would be visited to administer a verbal autopsy (VA) for each death.
In 2008, INCAM used physician-based certification of cause of death based on the VAs. Given the cost of using physicians to determine the cause of death from verbal autopsies and the development in the past 10 years of alternative methods for interpreting VAs, it was decided that the pilot for INCAM-2 would focus on a comparison of multiple methods for determining the cause of death. The goal of the comparison is to help the government select the most appropriate interpretation method for full implementation of INCAM-2. Based on other studies, it was determined that a minimum of 300 completed VAs with at least 30 neonatal deaths would be needed (King, Lu, & Sibuya, 2010). |
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Tool to Assess the Quality of Data on the Number of People on Antiretroviral Therapy: User Guide
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MEASURE Evaluation |
2020 |
English |
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Data Quality, Data quality assessment, ART, DQA, Toolkit |
Data from health facilities must be of high quality for U.S. government funders and for the country’s policymakers to make sound decisions on health policy, health programs, and the allocation of scarce resources.
At the request of the United States Agency for International Development (USAID)/Zambia and with the benefit of expert guidance from the mission, the USAID- and United States President’s Emergency Plan for AIDS Relief (PEPFAR)-funded MEASURE Evaluation project and USAID/Zambia developed and implemented an intervention-based, expedited data quality assessment (EDQA) that was intensive and used a rapid set of activities and assessments focused on data quality. This tool (which is available here: https://www.measureevaluation.org/resources/publications/tl-20-84/) is based on Zambian experience where a novel method for classifying cases by treatment status was used that included organization of client records and cleaning of data. An assessment team can use the tool to clean up client files; it helps to clarify, identify, and follow up with clients classified as lost to follow-up (LTFU). Stakeholders needing to clean up files and improve the quality of data for the HIV clients currently on treatment are encouraged to use this tool.
The tool focuses exclusively on the TX_CURR indicator (number of individuals currently on antiretroviral therapy [ART]) because the assessment of this indicator, in particular, requires effort and procedures well beyond what is needed for most HIV indicators. Verification of this indicator requires a thorough review of the individual (paper-based) client file folders. In many health facilities, these will number in the hundreds, and in the larger hospitals, there can be thousands of files to review. Sorting, organizing, reviewing, and documenting these files for an accurate indicator recount is an especially complicated and time-consuming process.
The materials presented here incorporate experience gained from a collaborative effort between the MEASURE Evaluation project and USAID/Zambia. The manual and Excel-based tool are designed to facilitate efforts by USAID missions and their implementing partners in PEPFAR priority countries to undertake expedited data quality assessments for the TX_CURR indicator, during regularly scheduled site visits. Although the tool was built from instruments developed and used for a particular assessment in Zambia, it can be readily adapted to a specific country context. The tool is intended for use by health program staff, including project directors and program and monitoring and evaluation officers who work in HIV-sector initiatives, such as PEPFAR. These concepts and procedures can be adapted to fit an indicator quality assessment for any type of program providing ART in any country. The EDQA can be used as an intervention when source documents are found to be incomplete or inconsistent after assessment with the lotq uality assurance sampling triage system or following a more comprehensive data quality assessment. |
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Performance of Routine Information System Management (PRISM): Analysis Tool for Data from a PRISM Assessment
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MEASURE Evaluation |
2020 |
English |
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Data analysis, PRISM, Performance of Routine Information System Management, Tool |
The United States Agency for International Development-funded MEASURE Evaluation project developed this Excel-based Performance of Routine Information System Management (PRISM) Analysis Tool (PAT) to support the analysis of PRISM survey data. Users must configure the tool’s key elements (periods, indicators, and tolerance range), as appropriate. The tool also provides basic instructions on using its modules, guiding the user through the steps of PRISM data importation from the SurveyCTO (https://www.measureevaluation.org/resources/publications/ms-18-143/) and Open Data Kit servers into the PAT, in order to conduct the basic analysis as outlined in the PRISM Analysis Guide (https://www.measureevaluation.org/resources/publications/ms-18-141). |
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Data Quality Assessment for Number Currently on Antiretroviral Therapy: Toolkit
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MEASURE Evaluation |
2020 |
English |
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Data quality assessment, Toolkit, Data Quality, ART, DQA |
This is a semiautomated data quality assessment tool to determine a health facility's accuracy in reporting the number currently on antiretroviral therapy (ART) (TX_CURR) indicator to the country ministry of health and the United States President's Emergency Plan for AIDS Relief (PEPFAR). This toolkit is divided into four sections separated by coloured tabs: Introductions (blue), Data Capture (red), Data Outputs (green), and Dashboard (yellow). Access the user guide. |
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e-Learning Curriculum on Routine Health Information Systems: Guide for Facilitators
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Dufour, W., Kunaka, D., & Frankel, N. |
2020 |
English |
Global |
Curriculum, Routine Health Information Systems, RHIS |
This guide was developed to help facilitators navigate the online routine health information systems (RHIS) course, select classes that meet learners’ capacity-building needs, support learning using adult learning principles, and provide updates and modifications to class content, as needed.
This document provides an outline of the content of the online modules including learning objectives, quiz questions and answers, sample discussion questions that facilitators can use with learners, and definitions of key terms/concepts covered in the course, as well as an index of where those terms/concepts are covered in the modules.
Also included in the document are tips on facilitation to improve adult learner engagement and the transfer of learning to the workplace. The online curriculum may also be used for teaching university students. This guide does not cover the specifics of using online materials with traditional students. |
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Implementation of the UgandaEMR: Results of a Security Assessment
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MEASURE Evaluation |
2020 |
English |
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EHR, Health data, Health information, Uganda |
The United States Agency for International Development (USAID), the United States President’s Emergency Plan for AIDS Relief (PEPFAR), and the United States Centers for Disease Control and Prevention (CDC) have all contributed significant funding to the development and implementation of electronic medical records (EMRs) to support the capture of patient medical data. Using USAID’s Software Global Goods Valuation Framework, it has been estimated that the total development cost for development of OpenMRS—a widely used open-source EMR system—is roughly $8 million (Center for Innovation and Impact, 2019). The increased demand for patient-level data needed to achieve epidemic control of HIV and for other health monitoring has caused a shift from using EMR software for retrospective data entry to real-time point-of-care systems.
As these systems move from a single computer to interconnected computers at multiple sites, the need for improved security has become more critical. Security guidelines, such as International Standards Organization (ISO) 2700 and National Institute of Standards and Technology (NIST) 800, are burdensome to use as assessment tools in these settings. Instead, implementing partners (IPs) in low-resource settings require tools that can be tailored to their circumstances so they can continuously assess the privacy and security of the health information systems they manage.
PEPFAR asked the USAID- and PEPFAR-funded MEASURE Evaluation project to develop an assessment tool to address this issue. We took high- and moderate-impact priority controls from NIST 800, ISO 2700, and the Health Insurance Portability and Accountability Act and adjusted them to be practical in a low-resource setting. We then used the tool to conduct a security assessment. This was a step-by-step process involving questionnaires, in-person assessment and verification, and automated security testing tools.
USAID chose the UgandaEMR system for us to assess because it uses the most recent reference implementation of OpenMRS—version 2.9—and because it is being widely used at more than 1,000 facilities in Uganda. The Monitoring and Evaluation Technical Support (METS) Program, at the Makerere University School of Public Health, acts as the above-site mechanism to support the development and implementation of UgandaEMR, and numerous IPs; their subgrantees oversee the day-to-day use and maintenance. The assessment team visited six sites representing a range of IPs and donors as part of this assessment.
UgandaEMR was determined to be a moderate-impact system based on three criteria: confidentiality, integrity, and availability. The assessment found gaps in all the control areas, although there was some variation between facilities. The recommendations to address and mitigate the gaps were identified though prioritization, and their implementation will vary by IP based on available resources and relevant risk. |
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Child Protection Case Management Information Systems: Promoting Appropriate Care for Children: A Framework for Engagement
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Molly Cannon, Stuardo Herrera, Patricia Mechael |
2020 |
English |
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Child Health, Children, CMIS, Care for children, Information systems |
In March 2017 USAID, through its Displaced Children and Orphans Fund (DCOF), engaged the USAID-funded MEASURE Evaluation (MEval) project to reinforce and build on U.S. government programming on childcare and protection in Armenia, Ghana, Moldova, and Uganda. MEval works globally to strengthen country capacity to gather, analyze, and use data for decision making to improve sector outcomes. Successful implementation of child protection and social welfare services depends on the availability and effective use of relevant child protection and social welfare data. With countries’ and programs’ increased interest in advancing digital solutions for case management of children at risk, USAID DCOF asked MEval to convene experts from December 4–6, 2019, at Palladium’s office in Washington, D.C. to inform the development of a framework for case management information systems (CMIS) centered on child protection and care.
The main purpose of the Information Systems Framework for the Case Management of Child Protection and Care (hereafter, the framework) is to consolidate lessons learned from those who have developed, implemented, and used such systems and agree upon best practices when approaching the design and strengthening of such systems. This document is written from the perspective of supporting government-led and owned systems, but it recognizes that nongovernmental organizations (NGOs) may have other systems that feed into those government systems or operate independently for their programming purposes. S recommendations so ply to
The framework is a product of a participatory design workshop involving 25 women and 17 men from USAID DCOF and the Office of HIV/AIDS, UNICEF headquarters and field offices, case management experts, monitoring and evaluation (M&E) experts, and digital solution experts. Armenia, Cambodia, Ghana, Guatemala, Kenya, Moldova, Romania, Uganda, and the United States were represented (https://www.measureevaluation.org/resources/publications/ws-20-57). |
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Health Information System Stages of Continuous Improvement Toolkit: Digital Assessment Tool Add-On Module
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2020 |
English |
Global |
Data, Tool, SOCI, Toolkit, Health Information Systems, HIS, Stages of Continuous Improvement |
This add-on module is designed to accompany the full User Guide for the Health Information System (HIS) Stages of Continuous Improvement (SOCI) Toolkit, available at https://www.measureevaluation.org/resources/publications/ms-19-158. The guide was developed by the United States Agency for International Development-funded MEASURE Evaluation project, the United States Centers for Disease Control and Prevention, and members of the Health Data Collaborative’s Digital Health and Interoperability Working Group. Users of the digital assessment should review the full User Guide before using the digital version of the assessment. A description of the toolkit and its background and the assessment timeline and process can be found there. This document provides only technical guidance to use the digital version of the SOCI assessment.
The HIS SOCI app can be downloaded from GitHub through this link: https://github.com/talexie/his_soci/blob/master/ dist/his_soci.zip/. Detailed instructions can be found in the Digital Assessment Tool Add-On Module. |
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Reproductive Health Cost Reporting System: Results of a Pilot Test in Nigeria
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Scott Moreland and Obialunamma Onoh |
2020 |
English |
NIGERIA |
Reporting, Cost management, Reproductive Health, Pilot, Cost analysis |
MEASURE Evaluation, which is funded by the United States Agency for International Development, developed the Reproductive Health Cost Reporting System (RHCRS). The RHCRS is a management tool that can help health service delivery organizations capture and analyze financial and other data on a regular basis. It is designed to treat financial, commodity, labor, and other cost data as inputs to a system that allows service delivery organizations to estimate what it costs to deliver specific health services, what the cost drivers are, and how these costs may differ across service delivery points, across regions, and over time.
This report summarizes MEASURE Evaluation's experience, and lessons learned, from conducting two pilot tests in Nigeria in the process of developing the RHCRS. |
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Discontinuation of Contraceptive Intrauterine Devices and Implants in Bangladesh
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MEASURE Evaluation, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) |
2020 |
English |
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Bangladesh, Contraception, Family Planning |
Intrauterine devices (IUDs) provide effective contraception for 10 years and implants for three. These two family planning (FP) methods are known as long-acting reversible contraceptives (LARCs), and both are highly effective. Unfortunately, low rates of use and high rates of discontinuation of these methods have negative implications for programs seeking to achieve effective contraception in Bangladesh. The Bangladesh FP program has long sought to increase the rates of acceptance and continuation of LARCs. Bangladesh’s Directorate General of Family Planning (DGFP) is responsible for mobilizing the resources necessary to promote the use of IUDs and implants, including procurement and supply of devices, training of service providers, and provision of insertion fees and client compensation. These investments are most costeffective when method acceptors continue to use LARCs throughout the effective life of the method.
This brief presents an analysis of longitudinal data n IUD and implant discontinuation conducted by Research for Decision Makers—an activity under the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)—and MEASURE Evaluation. Both are funded by the United States Agency for International Development (USAID). We obtained longitudinal data from the Matlab Health and Demographic Surveillance System (HDSS)1 and compared the results of our analysis with those from the Bangladesh Demographic and Health Surveys (BDHS). The method discontinuation data collected by the BDHS (1994–2017) are nationally representative but suffer from small sample sizes. Exploring other reliable data sources, such as Matlab HDSS, can help generate evidence that will improve the rates of IUD and implant use. |
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Gaps in Global Monitoring and Evaluation of Adolescent and Youth Reproductive Health: Research Brief
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MEASURE Evaluation |
2020 |
English |
Global |
Monitoring, Evaluation, Indicators, Adolescent health, Adolescents, Reproductive Health, M&E |
Adolescents and youth are a key population for reproductive health (RH) interventions, because young people suffer disproportionately from negative RH outcomes, including acquisition of HIV and other sexually transmitted infections; unintended, unwanted, or mistimed pregnancy; unsafe abortion; and gender-based violence. Effective monitoring and evaluation (M&E) of RH interventions designed for adolescents and youth is essential to determine their success and impact and show where improvement is needed.
MEASURE Evaluation, which is funded by the United States Agency for International Development, conducted the research presented in this brief to identify gaps in the M&E of adolescent and youth reproductive health (AYRH) programs. This process consisted of reviewing the landscape of M&E of AYRH interventions, outcomes, and impacts; identifying measurement gaps; and making recommendations to improve the M&E of AYRH activities and programs across a spectrum of RH categories. |
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The Sustainability of the Electronic Management Information System of Bangladesh’s Directorate General of Family Planning
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Kabir, M.H. |
2020 |
English |
|
Information System, Sustainability, EMIS, Family Planning, Bangladesh |
This report addresses the sustainability issues of the electronic management information system (eMIS) that has been implemented in the Directorate General of Family Planning (DGFP) under the Ministry of Health and Family Welfare (MOHFW) of Bangladesh. The pilot implementation of the eMIS began in January 2015 in two districts (Tangail and Habiganj), with support from the United States Agency for International Development (USAID)-funded MEASURE Evaluation project, in partnership with icddr,b and the Mamoni Maternal and Newborn Care Strengthening (MNCSP) project. The eMIS was scaled up in 2018 and reached 32 districts, either partially or in full, by December 2019. At the field level, the tools are being used by more than 10,000 users.
The eMIS aimed to automate the business processes of community health and family planning workers, their supervisors, and providers working in first-line facilities (called Union Health and Family Welfare Center), based on mobile technologies. Web-based tools were also developed for managers at the subdistrict and district levels and for decision makers at the central level. The eMIS tools help users and managers of the DGFP gain the benefits of digitization, as well as enable the DGFP to become a data-driven organization. The eMIS reached a milestone with the declaration of a paperless Tangail on March 1, 2020 by the minister for health and family welfare.
The implementation of the eMIS was supported within a project framework, and carrying it forward requires internalizing it within the DGFP and making it sustainable. Key issues related to sustainability, such as the acquisition of hardware, software maintenance and development, capacity building (human resource development, skills, training), implementation mechanisms, and the use of data for decision making are discussed in this report, and relevant recommendations are provided, along with an action plan. |
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Surveillance, Suivi, et Evaluation des Programmes de Lutte contre le Paludisme : Cours en Ligne
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MEASURE Evaluation |
2020 |
French |
|
Monitoring, Malaria, Surveillance, Training, Evaluation |
La surveillance, suivi et'évaluation (SSE) jouent un rôle vital dans tous les programmes de contrôle et de prévention du paludisme. Ce cours en ligne, offert par MEASURE Evaluation, fournit une introduction complète aux SSE des programmes de lutte contre le paludisme.
Téléchargez un PDF du cours complet ou téléchargez les modules individuels ci-dessous. Pour accéder au cours en ligne de certification, rendez-vous sur ce site: www.memalaria.org.
Module 1: Présentation du Paludisme
Module 2: Utilisation des Données pour la Prise de Décisions dans les Programmes de Lutte contre le Paludisme
Module 3: Introduction à la Surveillance, Suivi et Évaluation des Programmes de Lutte contre le Paludisme
Module 4: Comment Développer un Plan de Surveillance, Suivi et Évaluation pour les Programmes de Lutte contre le Paludisme
Module 5: Les Cadres de Surveillance, Suivi et d’Évaluation pour les Programmes de Lutte contre le Paludisme
Module 6: Les Indicateurs pour la Surveillance, le Suivi et l’Évaluation des Programmes de Lutte contre le Paludisme
Module 7: Les Sources des Données pour la Surveillance, le Suivi et l’Évaluation des Programmes sur le Paludisme
Module 8: Analyse, Interprétation et Présentation des Données sur le Paludisme
Module 9: Les Éthiques dans la Surveillance, Suivi et Évaluation des Programmes de Paludisme
Module 10: Le Leadership dans la Surveillance, Suivi, et Évaluation des Programmes de Paludisme
Module 11 : La Surveillance des Programmes de Paludisme
Module 12: Le Genre dans la Surveillance, Suivi et Évaluation des Programmes de Paludisme
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Étude prospective sur le renforcement des systèmes d’information sanitaire (SIS) à Madagascar: Intégration des systèmes d’information sanitaire de routine et de surveillance épidémiologique axés sur la lutte contre le paludisme
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MEASURE Evaluation |
2020 |
French |
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HIS strengthening, Madagascar, Health Information Systems, HIS, Malaria, Routine Health Information Systems |
Le Ministère de la Santé Publique de Madagascar (MSANP), avec l’appui de l’Agence des États-Unis pour le développement international (USAID) et les autres bailleurs de fonds internationaux, oeuvre à l’amélioration le système d’information sanitaire (SIS) du pays. Le MSANP et plusieurs partenaires ont mis en place un système de gestion électronique des données sanitaires à travers une base de données Access appelé Gestion du système d’information sanitaire (GESIS), pour consolider et faciliter la transmission de l’information sanitaire au niveau national et à l’échelle des districts. Le Système de la surveillance intégrée de la maladie et la riposte (SIMR) et le Système de surveillance de la fièvre de l’Institut Pasteur sont les deux systèmes de surveillance de maladie existants. D’autres programmes verticaux ont développé des systèmes d’information parallèlles pour répondre à leurs besoins spécifiques. Le Plan national stratégique de renforcement du SIS de Madagascar (2013–2017) avait pour but de réduire la redondance des rapports au niveau des districts et à l’échelle régionale et nationale, en éliminant les systèmes de notification verticaux et en les intégrant au système d’information sanitaire national.
L’USAID/Madagascar a financé le projet MEASURE Evaluation pour appuyer le processus de renforcement des systèmes d’information sanitaire de routine (SISR) et de la surveillance intégrée. En novembre 2016, le projet a commencé à fournir une assistance technique au MSANP visant à renforcer les SISR et les systèmes de surveillance du paludisme à Madagascar sur la base de résultats d’évaluation et à renforcer la capacitor du MSANP pour mieux gérer les SIS à travers l’installation de deux Conseillers Résidents au MSANP.Les principales activités du projet consistaient à mettre en place un système d’assurance qualité des données, le renforcement des SISR à travers la mise à jour du Plan Strategique de Renforcement du SIS, elaboration de document de normes et procedure du SIS, un meilleur accès en temps réel aux données sanitaires et une amélioration des compétences, et l’apport d’un soutien dans le cadre du suivi- évaluation et de la surveillance du paludisme.
Peu de temps après avoir enclenché ce processus le MSANP, en collaboration avec le projet MEASURE Evaluation, a organisé un atelier en février 2017 à Antsirabe dans le but de rassembler les diverses parties prenantes et de rédiger la version préliminaire d’un plan de mise en oeuvre des activites de renforcement du SIS comprenant neuf stratégies et désigné comme la Feuille de route de renforcement du système d’information sanitaire. L’équipe d’étude de MEASURE Evaluation a utilisé la Feuille de route comme document clé pour les aider à comprendre les activités qui étaient planifiées afin de réaliser le but qui est de disposer d’un : « système d’information sanitaire performant, unique et intégré. »
Outre les activités financées par l’USAID décrites ci- dessus et dans le cadre du Programme d’apprentissage de MEASURE Evaluation [une approche collaborative et adaptative pour répertorier et appliquer les résultats au renforcement du système d’information sanitaire (SIS)], nous avons réalisé une étude à Madagascar sur les effets de la performance du SIS de tous les efforts récemment entrepris par MEASURE Evaluation et d’autres parties prenantes pour renforcer le système d’information sanitaire. Cette étude avait pour but de fournir des données probantes au Ministère de la Santé Publique de Madagascar , à l’USAID et à la communauté élargie oeuvrant dans le SIS quant à la manière d’intégrer efficacement des éléments clés du système. Ce résumé rapporte les observations relevées dans le cadre de l’étude. |
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Prospective Study of Health Information Systems (HIS) Strengthening in Madagascar: Integration of Routine Health Information Systems and Epidemiologic Surveillance with a Focus on Malaria
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MEASURE Evaluation |
2020 |
English |
|
Madagascar, Malaria, Health Information Systems, HIS strengthening, HIS, Routine Health Information Systems |
Madagascar’s Ministry of Public Health (MPH), supported by the United States Agency for International Development (USAID) and other international donors, is working to improve the country’s health information systems (HIS). The MPH and partners have developed an electronic health management information system—a Microsoft Access database called Gestion du Système d’Information Sanitaire (GESIS)—to strengthen and facilitate reporting of health information at national and district levels. Existing disease surveillance systems are the integrated disease surveillance and response (IDSR) system (Surveillance Intégrée de la Maladie et la Riposte [SIMR]) and the Pasteur Institute’s fever surveillance system. Other vertical programs have developed parallel information systems to meet their specific information needs. The Madagascar National HIS Strengthening Strategic Plan (2013—2017) aimed to reduce reporting redundancies at district, regional, and national levels by eliminating vertical reporting systems and integrating them in health management information systems (HMIS).
USAID/Madagascar supported the USAID-funded MEASURE Evaluation project to strengthen the country’s routine health information systems (RHIS) and integrated surveillance. In November 2016, we began technical assistance to strengthen Madagascar’s RHIS and malaria surveillance systems based on assessment results and to build capacity in the MPH to manage HIS through the placement of resident advisors. These activities included establishing a data quality assurance system; strengthening the RHIS through updated policies, improved real-time access to health data, and improved capacity; and providing support to strengthen malaria monitoring and evaluation and surveillance.
Soon after we began, the MPH, in collaboration with MEASURE Evaluation, convened a workshop in February 2017 in Antsirabe, bringing together stakeholders and drafting a nine-strategy implementation plan called the Road Map for the Sub-Committee on Health Information Systems. The MEASURE Evaluation study team used the Road Map as a key document to help us understand the activities that were planned to achieve the Road Map’s stated goal: “an efficient, unique and integrated health information system.”In addition to the USAID-funded activities described above and as part of MEASURE Evaluation’s Learning Agenda (a collaborative and adaptive approach to documenting and applying results for health information system [HIS] strengthening), we conducted a study in Madagascar of the effects on HIS performance of all recent efforts by MEASURE Evaluation and also other stakeholders to strengthen the HIS. This study aimed to provide evidence to the MPH, USAID, and the broader community working on HIS on how to integrate key elements of the HIS effectively. This brief reports our study’s findings. |
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Assessment of the MaMoni Health Systems Strengthening Project, in Bangladesh
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Barkataki, S., Billah, M., Chakraborty, N., Haider, M. M., Imam, M. A., Khan, S., Priyanka, S. S., Rahman, M, Rahman, M, & Al-Sabir, A. |
2020 |
English |
Asia, BANGLADESH |
Child survival, Family Planning, Maternal and child health, Antenatal Care, Bangladesh, Maternal health, Maternal Health, Child health, Antenatal care |
The United States Agency for International Development (USAID)-supported MaMoni Health Systems Strengthening (MaMoni HSS) project sought to improve the use of integrated family planning (FP), maternal, newborn, and child health (MNCH), and nutrition services in six low-performing districts of Bangladesh from September 2013 to September 2017. Save the Children in Bangladesh implemented the project.
The MaMoni HSS project pursued a multipronged strategy to ensure service delivery at the different types of health facilities in the six districts. At the union-level facilities, it focused on ensuring primary-level outpatient care and increasing skilled birth attendance and round-the-clock delivery care. At the district and upazila levels, MaMoni HSS focused on referrals for maternal and newborn care, including caesarean section services, management of preeclampsia/eclampsia, care for newborns at specialized units, and management of severe acute malnutrition. Although the MaMoni HSS project followed this multipronged strategy, its primary purpose was to strengthen the delivery of services at the union-level facilities. Moreover, although the project worked with community clinics (CCs) for growth monitoring and promotion, counseling, and antenatal care (ANC), the CCs were not a focus area of the intervention. |
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An Assessment of the Advancing Adolescent Health Program in Bangladesh
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Quamrun Nahar, Anadil Alam, Sadia Afrin, Sharad Barkataki, Shusmita Khan, Ali Ahmed, Iffat Sharmin, Musarrat Rubina Mannan, and Mizanur Rahman |
2020 |
English |
BANGLADESH |
Adolescents, Reproductive Health, family planning, Adolescent health, Reproductive Empowerment |
The Advancing Adolescent Health (A2H) program was funded by the United States Agency for International Development (USAID) and implemented by Plan International in Rangpur District, Bangladesh, from January 2016 to January 2019. Plan International collaborated with two local nongovernmental organizations to implement A2H: The Eco-Social Development Organization and World Mission Prayer League’s LAMB Hospital—popularly known as LAMB Hospital.
The goal of A2H was to improve adolescent sexual and reproductive health and family planning knowledge and access and use of related services for married and unmarried adolescents.
To assess the program, the USAID-funded projects Research for Decision Makers, based at the International Centre for Diarrhoeal Diseases Research, Bangladesh, and MEASURE Evaluation, based at the University of North Carolina at Chapel Hill (USA), conducted a household survey from July–September 2018 among 8,501 girls ages 15–19 years from the two selected program areas and 3,005 similar girls from a comparison area. This report presents findings from an analysis of this survey. |
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The PEPFAR Local Capacity Initiative Strengthens Organizational Capacity in Uganda
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Mary Freyder, Eve Namisango, Tory M. Taylor, Annie Glover, and Katherine Andrinopoulos |
2020 |
English |
UGANDA |
Sex Workers, Capacity Assessment, People Living with HIV, Key Populations, Capacity Building, HIV, M&E |
The Local Capacity Initiative (LCI) strengthened the capacity of civil society organizations (CSOs) to support policy advocacy, with the ultimate goal of improving health services for key populations affected by the HIV epidemic. The United States President’s Emergency Plan for AIDS Relief (PEPFAR) funded the initiative from 2013–2018 to help local CSOs create an enabling environment for PEPFAR’s objectives.
Under the LCI, the United States Centers for Disease Control and Prevention worked in Uganda between 2015 and 2018 to strengthen the policy advocacy capacity of CSOs that worked with men who have sex with men, transgender women, and sex workers and develop the capacity of public health officials to consider gender and sexual diversity issues. MEASURE Evaluation, which is funded by the United States Agency for International Development and PEPFAR, conducted an evaluation of LCI Uganda between 2017 and 2018.
This brief presents the results of LCI's efforts to build capacity through training and structural interventions. Additional briefs summarize the main interventions that LCI employed to create an enabling environment for policy advocacy, the community scorecard strategy to improve HIV clinical services in Uganda, efforts to support KPs in coalition building, the methods used by the evaluation team to study the efficacy of LCI’s work and measure change resulting from it, and the process used to measure changes in organizational capacity. |
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The PEPFAR Local Capacity Initiative Evaluation Measures Organizational Capacity in Uganda
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Tory M. Taylor, Annie Glover, Katherine Andrinopoulos, and Mary Freyder |
2020 |
English |
UGANDA |
Key Populations, Capacity Assessment, M&E, HIV, Sex Workers, Capacity Building, PLHIV, Assessment |
The Local Capacity Initiative (LCI) strengthened the capacity of civil society organizations (CSOs) to support policy advocacy, with the ultimate goal of improving health services for key populations affected by the HIV epidemic. The United States President’s Emergency Plan for AIDS Relief (PEPFAR) funded the initiative from 2013–2018 to help local CSOs create an enabling environment for PEPFAR’s objectives.
Under the LCI, the United States Centers for Disease Control and Prevention worked in Uganda between 2015 and 2018 to strengthen the policy advocacy capacity of CSOs that worked with men who have sex with men, transgender women, and sex workers and develop the capacity of public health officials to consider gender and sexual diversity issues. MEASURE Evaluation, which is funded by the United States Agency for International Development and PEPFAR, conducted an evaluation of LCI Uganda between 2017 and 2018.
This brief provides an overview of efforts to measure changes in organizational capacity. Additional briefs summarize the main interventions that LCI employed to create an enabling environment for policy advocacy, the community scorecard strategy to improve HIV clinical services in Uganda, efforts to support KPs in coalition building, the methods used by the evaluation team to study the efficacy of LCI’s work and measure change resulting from it, and the results of organizational capacity building. |
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Cadre d'évaluation des programmes nationaux de lutte contre le paludisme dans les zones de transmission modérée et faible: Aide-Mémoire
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MEASURE Evaluation |
2020 |
French |
Global |
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L’épidémiologie du paludisme est devenue de plus en plus hétérogène dans de nombreux pays. Ces pays ont besoin de données détaillées sur le risque et l’incidence de la transmission pour orienter la mise en œuvre efficace de leurs interventions et suivre les progrès réalisés. Pour répondre à ces besoins de renforcement des programmes nationaux de lutte contre le paludisme (PNLP), un groupe de travail sur l’évaluation composé d’un sous-groupe du Groupe de référence sur le suivi et l’évaluation de Roll Back Malaria - « Faire reculer le paludisme » a élaboré le Cadre d’évaluation des programmes nationaux de lutte contre le paludisme dans les zones de transmission modérée et faible. Ce document fournit un cadre général d’évaluation des PNLP tout au long du continuum de transmission du paludisme. Chaque zone de transmission est définie par les classifications de l'Organisation Mondiale de la Santé [1]. L’examen et la synthèse des documents d’orientation et des outils existants pour la surveillance, le suivi et l’évaluation du paludisme ont permis de définir la portée et les objectifs de ce document. Cet aide-mémoire est un résumé du document complet sur le cadre.
Les principaux objectifs du cadre d'évaluation sont les suivants :
Fournir un cadre général d’évaluation des PNLP tout au long du continuum de transmission du paludisme
Fournir une description des liens entre l’évaluation d’impact et l’évaluation de processus
Donner des recommandations et orientations spécifiques pour la mise en œuvre des évaluations d’impact dans les pays où la transmission est modérée, faible ou hétérogène.
Donner des conseils pratiques sur la manière d’analyser les résultats d'évaluation au niveau sous-national pour avoir une vue d’ensemble au niveau national dans des contextes de transmission hétérogène
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Enquadramento para Avaliação de NMPs em Cenários de Transmissão Moderada e Baixa: Aide Memoire
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MEASURE Evaluation |
2020 |
Portuguese |
Global |
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A epidemiologia da malária tornou-se cada vez mais heterogénea em muitos países. Estes países requerem dados granulares sobre o risco e incidência para informar efectivamente e direccionar as suas intervenções e acompanhar o seu progresso. Para responder a estas necessidades de fortalecimento dos programas nacionais para controlo da malária (NMPs) um grupo de trabalho compreendendo um subgrupo do Grupo de Referência para Monitoria e avaliação do Programa Roll Back Malaria desenvolveu o Quadro para Avaliação dos Programas Nacionais Contra a Malária em Cenários de Transmissão Moderada e Baixa. Este documento oferece um quadro abrangente para avaliação dos NMPs ao longo do contínuo da transmissão da malária. Cada cenário de transmissão é definido pelas classificações da Organização Mundial da Saúde [1]. O âmbito e objectivos foram informados através de uma revisão e síntese dos documentos de guia e ferramentas existentes para vigilância, monitoria e avaliação da malária. Este aide memoire resume o documento do quadro completo.
Os objectivos chave do quadro de avaliação são fornecer o seguinte:
Um quadro abrangente para avaliação dos NMPs ao longo do contínuo da transmissão da malária
Descrição de ligações entre o impacto e processo de avaliação
Recomendações específicas e orientação para conduzir avaliações do impacto em países com cenários de transmissão moderada, baixa e heterogénea.
Orientação sobre como juntar os resultados da avaliação a nível sub-nacional para contar uma narrativa nacional em cenários de transmissão heterogénea |
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The PEPFAR Local Capacity Initiative Evaluation Methods in Ghana
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Mary Freyder, Samuel Essah |
2020 |
English |
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The Local Capacity Initiative (LCI) strengthened the capacity of civil society organizations (CSOs) to support policy advocacy, with the ultimate goal of improving health services for key populations (KPs) affected by the HIV epidemic. The United States President’s Emergency Plan for AIDS Relief (PEPFAR) funded the initiative from 2013–2018 to help local CSOs create an enabling environment for PEPFAR’s objectives.
The United States Agency for International Development (USAID) funded a local partner to implement the People for Health project in Ghana between 2015 and 2020. People for Health implemented interventions that strengthened CSO capacity and mobilized citizen groups to advocate better health services. LCI funding supported the integration of KP-specific interventions in the general health policy advocacy strategy of People for Health. Key population citizen groups included men who have sex with men (MSM), sex workers, and people living with HIV (PLHIV). MEASURE Evaluation, which is funded by USAID and PEPFAR, conducted an evaluation of People for Health in Ghana in 2019.
This brief provides an overview of the most significant change (MSC) methods used to evaluate the People for Health project in the Greater Accra and Eastern Regions. Access additional resources on the LCI evaluation in Ghana and Uganda. |
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The PEPFAR Local Capacity Initiative Evaluation Findings in Ghana
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Mary Freyder, Samuel Essah |
2020 |
English |
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Key Populations, PEPFAR, Ghana, Evaluation, HIV prevention, HIV |
The Local Capacity Initiative (LCI) strengthened the capacity of civil society organizations (CSOs) to support policy advocacy, with the ultimate goal of improving health services for key populations (KPs) affected by the HIV epidemic. The United States President’s Emergency Plan for AIDS Relief (PEPFAR) funded the initiative from 2013–2018 to help local CSOs create an enabling environment for PEPFAR’s objectives.
The United States Agency for International Development (USAID) funded a local partner to implement the People for Health project in Ghana between 2015 and 2020. People for Health implemented interventions that strengthened CSO capacity and mobilized citizen groups to advocate better health services. LCI funding supported the integration of KP-specific interventions in the general health policy advocacy strategy of People for Health. Key population citizen groups included men who have sex with men (MSM), sex workers, and people living with HIV (PLHIV). MEASURE Evaluation, which is funded by USAID and PEPFAR, conducted an evaluation of People for Health in Ghana in 2019.
This issue brief provides an overview of the most significant change findings from the evaluation of the People for Health project in The Greater Accra and Eastern Regions. Access additional resources on the LCI evaluation in Ghana and Uganda. |
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Considerations for the Use of Routine Data for Evaluation of Public Health Programs
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MEASURE Evaluation |
2020 |
English |
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Data quality, Evaluation, RHIS, Routine Health Information Systems, Data use |
A routine health information system (RHIS) collects and provides data about standard health and vital events at regular intervals to support the decision-making process at each level of the health system. Use of data from RHIS for evaluation has grown as more resources are dedicated to improving these systems. Secondary data, including routine data, are not collected by the data user but have appealing advantages over primary data collected for specific research. They are typically collected more frequently or over a longer period; boast greater cost efficiency, in some cases; and may be available more quickly. However, routine data are not appropriate for all evaluation questions or all contexts. Evaluators must carefully consider aspects such as data quality, usability, and accessibility before deciding to use these data.
MEASURE Evaluation, which is funded by the United States Agency for International Development (USAID), has used RHIS data in numerous evaluations over the past 20 years. This brief shares field experiences from this work and key considerations for the use of RHIS data in evaluation. |
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An Assessment of the Prerequisites for a Social Welfare Information Management System in Ghana
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Otieno, P., Mutwiri, J., & Antwi-Boasiako, E. W. |
2020 |
English |
GHANA, Africa |
Ghana, Social services, Information System, Alternative Care, Children, Child Health, Care for children |
Since 2017, through financial support from the USAID Displaced Children and Orphans Fund, the MEASURE Evaluation project has collaborated with the Republic of Ghana’s Department of Social Welfare (DSW), USAID/Ghana, and UNICEF to assess, address, and monitor alternative care of children in Ghana in line with the United Nations Guidelines for the Alternative Care of Children, which serves to enhance the implementation of the United Nations Convention on the Rights of the Child.
In 2018, Ghana’s MOGCSP, with support from UNICEF, developed a concept note for an information system that would capture data for child protection and social welfare services. This system aims to strengthen the coordinated delivery of social services across the areas of social protection, community development, gender-based violence, justice for children, child protection, education, and health. Alternative care will be included in the system, with the plan to eventually provide access to RHCs.
The SWIMS will adopt an open-source case management software, developed by UNICEF headquarters, called Protection Related Information Management System, or “Primero.” This online platform is designed to be adapted to the country-specific context and can be configured to the specific system of child welfare services in Ghana.
To support preparations for the SWIMS deployment, MEASURE Evaluation gathered information for some of the requirements for the rollout of a national Ghana SWIMS. This report presents our findings. |
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Learner’s Guide to Monitoring and Evaluation of Care Reform in Armenia
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Charyeva, Z., Ghukasyan, H., & Gheorghe, C. |
2020 |
English |
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Monitoring, Evaluation, Alternative Care, Child health, Armenia, Children, Care for children |
The United States Agency for International Development (USAID) Displaced Children and Orphans Fund (DCOF) works in countries around the world to improve the safety, well-being, and development of vulnerable children, with particular attention to preserving and facilitating their access to appropriate, protective, and permanent family care. The overall goal of the USAID/DCOF-funded activity in Armenia is to strengthen the country’s leadership to advance the reform of national policies and systems for the care of children who lack adequate family care. Enhanced government capacity to assess, address, and monitor care reform is the long-term vision of USAID/DCOF, the USAID-funded MEASURE Evaluation project, and government partners in the country. To support this agenda, MEASURE Evaluation conducted a series of training sessions in monitoring and evaluation (M&E) during 2018 to 2019 for stakeholders in Armenia. The training included basic training in M&E, training on data use and demand, data quality, and data analysis.
This guide serves as a reference document for participants who attended the MEASURE Evaluation training sessions. It also serves as a self-learning guide for people who do M&E work but who were unable to attend the training. It is expected that the guide’s users will apply key M&E concepts in their daily work. Because this is a self-learning material, there is no opportunity to discuss new concepts in a group setting or to ask questions. It is therefore suggested that users visit the MEASURE Evaluation website (https://www.measureevaluation.org/resources) for additional M&E materials. |
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Evaluation of mainstreaming youth-friendly health in private clinics in Malawi
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Janine Barden-O’Fallon, Shara Evans, Chrissie Thakwalakwa, Witness Alfonso, Ashley Jackson |
2020 |
English |
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Youth, Adolescents, Evaluation, Family Planning, Malawi |
BackgroundHigh fertility rates and low modern contraceptive use put African youth and adolescents at high risk for health complications, including maternal mortality. Mainstreaming youth-friendly health services (YFHS) into existing services is one approach to improve access to reproductive health services for youth and adolescents. The objective of the evaluation was to assess the effects of a Population Services International (PSI)-sponsored YFHS training package on voluntary uptake of family planning among youth and perceptions of service quality by youth and trained healthcare providers in Malawi.
MethodsIn 2018, a mixed-methods convergent parallel design was used to assess relevant monitoring and evaluation documents and service statistics from PSI Malawi and qualitative data on perceptions of service quality from Malawian youth and healthcare providers. The data were assessed through separate descriptive and thematic analysis and integrated to generate conclusions.
ResultsResults show that the number of family planning clients ages 15–24 increased from 72 to 2278 per quarter during the implementation of the YFHS training packages, however, positive trends in client numbers were not sustained after youth outreach activities ended. Focus group discussions with 70 youth and adolescents indicated that clinics were perceived as providing high-quality services to youth. The main barriers to accessing the services were cost and embarrassment. Interviews with ten healthcare providers indicated that many made efforts to improve clinic accessibility and understood the barrier of cost and importance of outreach to youth and the broader community.
ConclusionsThe findings support research showing positive effects of mainstreaming YFHS when training for healthcare staff is combined with additional YFHS programming components. Furthermore, the findings provide evidence that provider training alone, though beneficial to perceived service quality, is not sufficient to sustain increases in the number of adolescent and youth family planning clients. |
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Reproductive Empowerment Scale
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MEASURE Evaluation |
2020 |
English |
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Reproductive Health, Reproductive Empowerment, Fertility, Women |
To strengthen and standardize a measurement of reproductive empowerment among women in sub-Saharan Africa, MEASURE Evaluation—a project funded by the United States Agency for International Development—recently developed and validated a multidimensional scale that can be incorporated in survey instruments. The Reproductive Empowerment Scale consists of five short subscales that measure women’s communication with healthcare providers; communication with partners; decision-making; social support; and social norms on issues related to women’s reproductive health and fertility.
Access related reports from work done in Nigeria, Kenya, and Zambia. |
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Evaluating malaria programmes in moderate- and low-transmission settings: practical ways to generate robust evidence
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Ruth A. Ashton, Debra Prosnitz, Andrew Andrada, Samantha Herrera & Yazoumé Yé |
2020 |
English |
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Evaluation, Malaria, Transmission |
BackgroundMany countries have made substantial progress in scaling-up and sustaining malaria intervention coverage, leading to more focalized and heterogeneous transmission in many settings. Evaluation provides valuable information for programmes to understand if interventions have been implemented as planned and with quality, if the programme had the intended impact on malaria burden, and to guide programmatic decision-making. Low-, moderate-, and heterogeneous-transmission settings present unique evaluation challenges because of dynamic and targeted intervention strategies. This paper provides illustration of evaluation approaches and methodologies for these transmission settings, and suggests how to answer evaluation questions specific to the local context.
MethodsThe Roll Back Malaria Monitoring and Evaluation Reference Group formed a task force in October 2017 to lead development of this framework. The task force includes representatives from National Malaria Programmes, funding agencies, and malaria research and implementing partners. The framework builds on existing guidance for process and outcome evaluations and impact evaluations specifically in high transmission settings.
ResultsThe theory of change describes how evaluation questions asked by national malaria programmes in different contexts influence evaluation design. The transmission setting, existing stratification, and data quality and availability are also key considerations. The framework is intended for adaption by countries to their local context, and use for evaluation at sub-national level. Confirmed malaria incidence is recommended as the primary impact indicator due to its sensitivity to detect changes in low-transmission settings. It is expected that process evaluations provide sufficient evidence for programme monitoring and improvement, while impact evaluations are needed following adoption of new mixes of interventions, operational strategies, tools or policies, particularly in contexts of changing malaria epidemiology. Impact evaluations in low-, moderate-, or heterogeneous-transmission settings will likely use plausibility designs, and methods highlighted by the framework include interrupted time series, district-level dose–response analyses, and constructed control methods. Triangulating multiple data sources and analyses is important to strengthen the plausibility argument.
ConclusionsThis framework provides a structure to assist national malaria programmes and partners to design evaluations in low-, moderate- or heterogeneous-transmission settings. Emphasizing a continuous cycle along the causal pathway linking process evaluation to impact evaluation and then programmatic decision-making, the framework provides practical guidance in evaluation design, analysis, and interpretation to ensure that the evaluation meets national malaria programme priority questions and guides decision-making at national and sub-national levels. |
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Experiences and Lessons Learned: Implementing the Ripple Effects Mapping Method
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MEASURE Evaluation |
2020 |
English |
Africa, BOTSWANA, TANZANIA, Global |
REM, ripple effects mapping, Qualitative Evaluation, Monitoring, Evaluation, Mapping |
Ripple effects mapping (REM) is a qualitative, participatory group method for evaluating complex programs. MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID)—adapted and used REM to supplement traditional evaluation methods and increase stakeholder participation. This brief shares how the application of REM was carried out in two studies in sub-Saharan Africa and lessons learned from the experience. |
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A Practical Way to Prevent Mother-to-Child Transmission of HIV: Learning from the Partnership for HIV-Free Survival
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Hales, D. K., Bobrow, E. A., Davis, H. B., & Munson, A. J. |
2020 |
English |
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HIV prevention, PEPFAR, PHFS, Transmission, HIV, PMTCT |
The Partnership for HIV-Free Survival (PHFS) was an innovative project designed to prevent mother-to-child transmission of HIV. PHFS brought together proven practices from prevention of mother-to-child transmission (PMTCT), quality improvement (QI), nutrition, and community outreach initiatives to improve the health outcomes for mothers living with HIV and their HIV-exposed infants. Supported by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR), PHFS was active from 2012 to 2016 in six sub-Saharan African countries: Kenya, Lesotho, Mozambique, South Africa, Tanzania, and Uganda.
A team from the USAID- and PEPFAR-funded MEASURE Evaluation project conducted a legacy evaluation of the PHFS in 2018. We identified several compelling lessons for successful PMTCT programs from the ways the project was implemented in the participating countries. These lessons are broadly applicable to countries and facilities that are working to reduce mother-to-child transmission of HIV, increase retention in antiretroviral therapy (ART), support better nutrition practices, and improve clients’ health-seeking behaviors.
Although many of the lessons are cited in the PHFS legacy evaluation report (Hales, Davis, Munson, & Bobrow, 2019; https://www.measureevaluation.org/resources/publications/tr-18-314), this document was prepared to provide practical guidance for identifying and implementing appropriate activities in the local context. It includes descriptions of the key lessons, tips, and an extensive checklist to help decision makers and implementers understand how and why to launch, implement, and sustain the critical activities in the PHFS approach.
Access a separate, editable Word file of the checklists at https://www.measureevaluation.org/resources/publications/tl-20-80/ |
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A Practical Way to Prevent Mother-to-Child Transmission of HIV: Learning from the Partnership for HIV-Free Survival—Checklists
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Hales, D. K., Bobrow, E. A., Davis, H. B., & Munson, A. J. |
2020 |
English |
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PHFS, PMTCT, HIV prevention, PEPFAR, HIV, Transmission |
The Partnership for HIV-Free Survival (PHFS) was an innovative project designed to prevent mother-to-child transmission of HIV. PHFS brought together proven practices from prevention of mother-to-child transmission (PMTCT), quality improvement (QI), nutrition, and community outreach initiatives to improve the health outcomes for mothers living with HIV and their HIV-exposed infants. Supported by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR), PHFS was active from 2012 to 2016 in six sub-Saharan African countries: Kenya, Lesotho, Mozambique, South Africa, Tanzania, and Uganda.
A team from the USAID- and PEPFAR-funded MEASURE Evaluation project conducted a legacy evaluation of the PHFS in 2018. We identified several compelling lessons for successful PMTCT programs from the ways the project was implemented in the participating countries. These lessons are broadly applicable to countries and facilities that are working to reduce mother-to-child transmission of HIV, increase retention in antiretroviral therapy (ART), support better nutrition practices, and improve clients’ health-seeking behaviors.
We used what we learned from the legacy evaluation to develop a manual offering guidance for identifying and implementing appropriate activities in the local context. A Practical Way to Prevent Mother-to-Child Transmission of HIV: Learning from the Partnership for HIV-Free Survival (available here: https://www.measureevaluation.org/resources/publications/ms-19-182/) includes descriptions of the key lessons, tips, and an extensive checklist to help decision makers and implementers understand how and why to launch, implement, and sustain the critical activities in the PHFS approach.
We offer this separate Microsoft Word version of the checklists to make it easy for users to adapt them to their context and needs. |
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Using a quality improvement approach in the prevention of mother-to-child HIV transmission program in Uganda improves key outcomes and is sustainable in demonstration facilities: Partnership for HIV-Free Survival
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Flax VL, Kasasa S, Ssendagire S, Lane C, Atuyambe L, Lance PM, Ssengooba F, Draru J, Bobrow EA |
2020 |
English |
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Uganda, HIV prevention, AIDS, HIV, PMTCT |
Background: The Partnership for HIV-Free Survival (PHFS) in Uganda used a quality improvement (QI) approach to integrate the prevention of mother-to-child transmission (MTCT) of HIV, maternal and child health, and nutrition services, with the goal of increasing the retention of mother-baby pairs in care and decreasing vertical transmission of HIV.
Methods: This evaluation of PHFS used a retrospective longitudinal design to assess the program’s association with four outcomes. Data were extracted from patient records from 2011 (before the program) to 2018 (after the program) at 18 demonstration, 18 scale-up, and 24 comparison facilities. Difference-in-differences analyses were conducted with significance set at p<0.15 during and p>0.15 or a continued improvement after PHFS.
Results: PHFS was associated with an increase in exclusive breastfeeding (EBF) (p=0.08), 12- month retention in care (p<0.001), and completeness of child 18-month HIV test results (p=0.13) at demonstration facilities during program implementation. MTCT at 18 months decreased but did not differ between groups. Increases in EBF (p=0.67) and retention in care (p=0.16) were sustained, and data completeness (p=0.10) continued to increase at demonstration facilities after the program. PHFS was associated with an increase in EBF (p<0.001) at scale-up facilities, but there was no difference between groups for retention in care, MTCT, or data completeness. Gains in EBF were lost (p=0.08) and retention in care declined (p<0.001) at scale-up facilities after the program.
Conclusion: PHFS′ quality improvement approach increased EBF, retention in care, and data completeness in demonstration facilities during the program and these benefits were sustained. |
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Identifying the Right Gender M&E Resource for Your Needs
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MEASURE Evaluation |
2020 |
English |
Global |
Monitoring, Evaluation, Gender, M&E |
This resource can help users identify the best gender monitoring and evaluation (M&E) resource for their needs. A version for printing is available here. |
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Surveillance, Monitoring, and Evaluation of Malaria Programs: Online Course
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MEASURE Evaluation |
2020 |
English |
|
Malaria, Training, SME, Malaria Surveillance |
Surveillance, monitoring, and evaluation (SME) plays a vital role in all malaria control and prevention programs. This course provides a comprehensive introduction to SME of malaria programs.
Download a PDF of the full course or download the individual modules below. The course is also available in French.
To access the online course for certification, go to www.memalaria.org.
Module 1: Overview of Malaria
Module 2: Using Data for Decision Making
Module 3: Introduction to SME for Malaria Programs Course
Module 4: Designing and Implementing a SME Plan
Module 5: Frameworks
Module 6: Indicators for Malaria Programs
Module 7: Data Sources for Malaria SME
Module 8: Analysis, Interpretation, and Presentation of Malaria Data
Module 9: Ethics of Malaria SME
Module 10: Leadership for Malaria SME
Module 11: Malaria Surveillance
Module 12: Gender in Malaria SME
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Promoting Appropriate Care for Children: Report on a Workshop on Case Management Information Systems
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MEASURE Evaluation |
2020 |
English |
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Child health, Children, Case management, Information System, Worskhop, CMIS, Care for children |
The United States Agency for International Development (USAID) works in countries around the world to improve the lives of the world’s most vulnerable children in keeping with the three objectives established in the U.S. government strategy for Advancing Protection and Care for Children in Adversity (APCCA). Those objectives are to build strong beginnings, put family first, and protect children from violence (https://www.childreninadversity.gov). In support of key country priorities and in line with APCCA objectives, USAID/DCOF-funded activities focus on assisting families to better care for their children, reforming national systems for children’s care, strengthening child welfare and protection policies, and developing and operationalizing the local systems needed to sustain program efforts. In March 2017, USAID/DCOF engaged the USAID-funded MEASURE Evaluation (MEval) project to build on and reinforce current USG programming on child care and protection in four focus countries: Armenia, Ghana, Moldova, and Uganda. MEval works globally to strengthen country capacity to gather, analyze, and use data for decision making to improve sector outcomes. The overall goal of this USAID/DCOF-funded activity is to intensify country leadership in advancing national efforts on behalf of children who lack adequate family care, that is, national care reform. MEval is working to strengthen the capacity of government partners to accomplish the following:
Provide leadership in implementing a structured assessment of national care reform systems and strategies using a standardized framework/tool.
Identify gaps and continuing needs in care reform.
Develop plans to address priority needs.
Establish indicators and systems for the regular assessment of progress and monitoring of results against country plans for care reform.
Efforts to build digital information systems have been made in the four focus countries, with lessons learned about what is working well and what can be strengthened. In light of the increased interest in advancing digital solutions for the case management1 of children in various settings, USAID/DCOF asked MEval to convene a group of experts from December 4–6, 2019, at Palladium’s office in Washington, DC, on case management information systems (CMIS). This report outlines the workshop sessions and provides highlights, key discussion points, and action items.
Access Ignite presentations from the workshop. |
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Gaps in Global Monitoring and Evaluation of Adolescent and Youth Reproductive Health
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Bridgit Adamou |
2020 |
English |
Global |
Indicators, Youth, Reproductive Health, Monitoring, M&E, adolescent, Monitoring, Evaluation |
Adolescents and youth are a key population for reproductive health (RH) interventions, because young people suffer disproportionately from negative RH outcomes, including acquisition of HIV and other sexually transmitted infections; unintended, unwanted, or mistimed pregnancy; unsafe abortion; and gender-based violence. Effective monitoring and evaluation (M&E) of RH interventions designed for adolescents and youth is essential to determine their success and impact and show where improvement is needed.
MEASURE Evaluation, which is funded by the United States Agency for International Development, conducted the research presented in this report to identify gaps in the M&E of adolescent and youth reproductive health (AYRH) programs. This process consisted of reviewing the landscape of M&E of AYRH interventions, outcomes, and impacts; identifying measurement gaps; and making recommendations to improve the M&E of AYRH activities and programs across a spectrum of RH categories. |
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The Story of DHIS2 in Mali: Toward a Fully Integrated Health Information System
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MEASURE Evaluation |
2020 |
English |
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HIS, Mali, Health Services, Health Information Systems, Data Quality, DHIS 2, HIS strengthening, Health outcomes, Data |
A strong health information system provides high-quality data to measure health outcomes, track disease outbreaks, measure service coverage, and guide strategy. Mali transformed its health information and can track disease trends and health services, manage resources, and plan strategically for the future. Thousands of users and multiple stakeholders work in concert. |
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Building a Cadre of Experts in Routine Health Information
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MEASURE Evaluation |
2020 |
English |
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Routine Health Information Systems, Data, Data Demand and Use, Data use, RHIS, Mali, Training |
Good data management provides Mali evidence for meeting health needs. Read about work in Mali to improve data quality and use for sound decision making by implementing routine health information systems (RHIS) training. |
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Mali takes deliberate steps to improve health information
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MEASURE Evaluation |
2020 |
English |
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Health Information Systems, HIS strengthening, RHIS, Routine Health Information Systems, HIS, Mali |
Assessing and improving health data systems enables better outcomes. In 2013, MEASURE Evaluation supported Mali to conduct a study to develop evidence of gaps and challenges in its HIS and recommendations for improvement. The findings guided Mali’s steps to strengthen its HIS. In 2018, a second assessment showed major accomplishments in data accuracy at the service level, data completeness and timeliness in reporting, a functioning system integrated from the local to the national level, and suggestions for improvements. |
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Global Health Security: Surveillance that keeps abreast of potential outbreaks
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MEASURE Evaluation |
2020 |
English |
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Digital Health, Global health security, Data, Surveillance, GHSA, Mali, Data use |
This poster reviews Mali's path to stronger disease surveillance. Digital data systems—when well-maintained—yield real-time disease surveillance for quick response. Strengthening digital systems requires skilled people and continuous monitoring for data quality and facilitated data use. |
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A Successful Trial of Digitized Health Records in Mali
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MEASURE Evaluation |
2020 |
English |
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Mali, Pregnancy, Digital Health, Child Health, Health outcomes, EHealth, Health, Antenatal Care |
eRegisters in Mali improved monitoring of pregnant women and children and reduced the health provider workload. |
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Statistical Yearbooks--Current data helps Mali track health services and performance
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MEASURE Evaluation |
2020 |
English |
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Health data, Health Information Systems, Data, DDU, Mali |
Mali produced draft yearbooks with compiled data from local and national disease surveillance and other health data—plus indicator analysis of performance. These population health statistics constitute a reliable basis for Mali’s health planning. |
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Mali's Mighty Malaria Bulletins
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MEASURE Evaluation |
2020 |
English |
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HIS, Mali, Health Information Systems, Malaria, DHIS 2, Malaria Surveillance |
Malaria bulletins in Mali provide consistent and high-quality malaria data to guide program implementation and measure achievements. |
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The PEPFAR Local Capacity Initiative Supports the Community Scorecard to Improve HIV Services for Key Populations in Uganda
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Mary Freyder, Eve Namisango, Tory M. Taylor, Annie Glover, and Katherine Andrinopoulos |
2020 |
English |
UGANDA |
Health care, Health Services, Key Populations, Capacity Building, KP, policy |
The Local Capacity Initiative (LCI) strengthened the capacity of civil society organizations (CSOs) to support policy advocacy, with the ultimate goal of improving health services for key populations affected by the HIV epidemic. The United States President’s Emergency Plan for AIDS Relief (PEPFAR) funded the initiative from 2013–2018 to help local CSOs create an enabling environment for PEPFAR’s objectives.
Under the LCI, the United States Centers for Disease Control and Prevention worked in Uganda between 2015 and 2018 to strengthen the policy advocacy capacity of CSOs that worked with men who have sex with men, transgender women, and sex workers and develop the capacity of public health officials to consider gender and sexual diversity issues. MEASURE Evaluation, which is funded by the United States Agency for International Development and PEPFAR, conducted an evaluation of LCI Uganda between 2017 and 2018.
This brief provides an overview of the community scorecard strategy to improve HIV clinical services in Uganda. Additional briefs summarize the main interventions that LCI employed to create an enabling environment for policy advocacy, efforts to support KPs in coalition building, and the methods used by the evaluation team to study the efficacy of LCI’s work and measure change resulting from it. |
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The PEPFAR Local Capacity Initiative Supports a Coalition of Civil Society Organizations Serving Key Populations in Uganda
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Katherine Andrinopoulos, Eve Namisango, Tory M. Taylor, Annie Glover, and Mary Freyder |
2020 |
English |
UGANDA |
Health Services, Key Populations, Health care, policy, KP, Capacity Building |
The Local Capacity Initiative (LCI) strengthened the capacity of civil society organizations (CSOs) to support policy advocacy, with the ultimate goal of improving health services for key populations affected by the HIV epidemic. The United States President’s Emergency Plan for AIDS Relief (PEPFAR) funded the initiative from 2013–2018 to help local CSOs create an enabling environment for PEPFAR’s objectives.
Under the LCI, the United States Centers for Disease Control and Prevention worked in Uganda between 2015 and 2018 to strengthen the policy advocacy capacity of CSOs that worked with men who have sex with men, transgender women, and sex workers and develop the capacity of public health officials to consider gender and sexual diversity issues. MEASURE Evaluation, which is funded by the United States Agency for International Development and PEPFAR, conducted an evaluation of LCI Uganda between 2017 and 2018.
This brief summarizes LCI’s efforts to develop organizational capacity through coalition building in Uganda. Additional briefs summarize the main interventions that LCI employed to create an enabling environment for HIV policy advocacy, implement the community scorecard strategy to improve HIV clinical services, and the methods that the evaluation team used to study the efficacy of LCI’s work and measure change resulting from it. |
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The PEPFAR Local Capacity Initiative Evaluation Methods in Uganda
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Mary Freyder, Eve Namisango, Tory M. Taylor, Annie Glover, and Katherine Andrinopoulos |
2020 |
English |
UGANDA |
Health care, Health Services, Key Populations, Capacity Building, KP, policy |
The Local Capacity Initiative (LCI) strengthened the capacity of civil society organizations (CSOs) to support policy advocacy, with the ultimate goal of improving health services for key populations affected by the HIV epidemic. The United States President’s Emergency Plan for AIDS Relief (PEPFAR) funded the initiative from 2013–2018 to help local CSOs create an enabling environment for PEPFAR’s objectives.
Under the LCI, the United States Centers for Disease Control and Prevention worked in Uganda between 2015 and 2018 to strengthen the policy advocacy capacity of CSOs that worked with men who have sex with men, transgender women, and sex workers and develop the capacity of public health officials to consider gender and sexual diversity issues. MEASURE Evaluation, which is funded by the United States Agency for International Development and PEPFAR, conducted an evaluation of LCI Uganda between 2017 and 2018.
This brief provides an overview of the methods that the evaluation team used to measure change resulting from LCI’s work in Uganda. Additional briefs summarize the main interventions that LCI employed to create an enabling environment for HIV policy, provide overviews of work to develop organizational capacity through coalition building, and an overview of the community scorecard strategy to improve HIV clinical services. |
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Évaluation de la qualité des données sur le paludisme à l'aide de l'outil d'examen systématique de la qualité des données de l’OMS au Mali
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Diadier Diallo, Ignace Traoré, Seydou Fomba, Assitan Dembélé, Madina Konaté, Issiaka Dembélé, Adama Ouattara, Madina Kouyaté, Aminata Traoré, Ramine Bahrambegi, Jules Mihigo, Erin Eckert, Alimou Barry, et Yazoume Yé |
2020 |
French |
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Data Quality, Health Information Systems, HISS, DHIS 2, RDQA, Malaria, Mali, HIS, Information System |
Le Mali s'appuie sur les données des formations sanitaires (FS) pour la planification et le suivi des progrès et des performances des programmes de santé. Cependant, le manque de données de qualité pour une prise de décision saine reste un défi majeur dans les pays à ressources limitées. Depuis 2010, le projet MEASURE Evaluation travaille avec le Ministère de la Santé (MS) et d'autres partenaires locaux pour améliorer la disponibilité de données de qualité pour la prise de décision. En 2016, le logiciel DHIS2 a été introduit et déployé au niveau des FS en tant que plateforme nationale pour la collecte et la gestion des données de routine avec le soutien de MEASURE Evaluation. En 2018, MEASURE Evaluation a appuyé le MS dans l’intégration de l’application DQR (Data Quality Review) de l'Organisation mondiale de la santé dans DHIS2 afin de continuer à améliorer la qualité des données. |
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Intégration des données de routine et de surveillance du paludisme dans le système national d’information sanitaire du Mali: Acquis et meilleures pratiques
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Diadier Diallo, Edem Kossi, Ignace Traoré, Issiaka Dembélé, Madina Konaté, Diakalia Koné, Jules Mihigo, Aminata Traoré, Ramine Bahrambegi, Jean-Marie N’Gbichi, Erin Eckert, Alimou Barry, and Yazoume Yé |
2020 |
French |
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HIS, Routine Health Information Systems, HMIS, Information System, DHIS 2, Mali, Malaria, Data Quality, Routine Data, RHIS, HISS, Health Information Systems |
Jusqu’en 2010, le logiciel de la plateforme du système national d’information sanitaire (SNIS) du Mali était sous Microsoft Access. Cette plateforme avait été conçue pour le rapportage trimestriel des données sanitaires de routine et incluait seulement quatre indicateurs clés du paludisme. A cause des limitations présentées par cette plateforme, MEASURE Evaluation a appuyé le Programme National de Lutte contre le Paludisme (PNLP) en 2011 à développer et mettre en oeuvre une application pour le rapportage des données paludiques de routine en utilisant des téléphones portables dans certaines régions. A la fin de 2015, 465 centres de santé communautaire (CSCom) utilisaient cette application pour la collecte et la transmission des données de routine du paludisme. En 2013, cette application a été adaptée pour la surveillance hebdomadaire du paludisme afin de détecter des flambées et prévenir des épidémies dans plusieurs CSCom. Ceci dit, l’intérêt qu’a eut le Mali dans un SNIS intégré capable de collecter et d’analyser toutes les données sanitaires pour une planification d’actions stratégiques et le développement de politiques a mené à l’évaluation du système d’information sanitaire de routine (SISR) en 2013. Les recommandations qui en sont sorties a conduit à l’introduction du District Health Information Software (DHIS2), développé afin d’appuyer la gestion des données sanitaires des districts. |
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Évaluation de la performance du système d'information hospitalier au Mali (2018)
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Aminata Traoré, Madina Ba Kouyaté, Abdoulaye Maiga, Adama Ouatara, Issaka Dembélé, Alamako Doumbia, Ismael Dembélé, Ouassa Berthe, Mamoutou Diabaté, Mamadou Alimou Barry, Jeanne Chauffour |
2020 |
French |
|
HMIS, Data Quality, Health Information Systems, RHIS, HISS, Routine Health Information Systems, PRISM, Performance of Routine Information System Management, Information System, Mali |
L'évaluation 2018 de la performance de la gestion du système d'information hospitalier (SIH) est la première évaluation de ce système. Elle a permis d’établir une base de référence àpartir de laquelle des interventions plus pertinentes seront conduites pour suivre et renforcer le SIH.
Si des progrès importants ont été notés dans le domaine de la collecte et de l’automatisation des procédures de contrôle et d’analyse des données, il est important de relever le besoin de renforcer le système à la base. En d’autres termes, sur l’ensemble des domaines explorés, il a été observé des faiblesses non seulement au niveau des hôpitaux mais également au niveau de la Cellule de Planification et de Statistique (CPS) ---en dehors de l’analyse---qui méritent d’être revues et renforcées. Fait notable, nous n’avons pas été enmesure de confirmer l’utilisation des données au niveau de la CPS. Bien qu'un rapport analytique soit produit à ce niveau, le plan annuel ne couvre pas la gestion des ressources humaines et les disparités liées au genre. Ceci représente une grosse inquiétude quand on sait que la ressource la plus importante est celle des ressources humaines qui mérite une attention particulière de manière à déployer le personnel là où se situent les besoins.
Les résultats ont également montré que la seule promotion de la culture de l’information ne suffit pas pour changerles habitudes et qu’un suivi plus rapproché est nécessaire pour une pratique régulière des capacités du personnel en s’appuyant sur les outils rendus disponibles à cet effet. Les résultats ont également montré que les fonctions critiques de gestion et de support bien qu’existantes restent hautement vulnérables et méritent d’être renforcées pour mieux soutenir le SIH, et cela à tous les niveaux (hôpitaux et CPS). Il a aussi été observé un besoin important de développement d’outils normatifs pour le soutien du SIH (manuel de procédures de gestion des données, procédures de validation des données, outils de supervision adaptés aux hôpitaux, etc.). |
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Évaluation de la performance du système local d'information sanitaire au Mali (2018)
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Aminata Traoré, Madina Ba Kouyaté, Abdoulaye Maiga, Adama Ouatara, Issaka Dembélé , Alamako Doumbia, Ismael Dembélé, Ouassa Berthe, Mamoutou Diabaté, Mamadou Alimou Barry, Jeanne Chauffour |
2020 |
French |
|
HMIS, Data Quality, Health Information Systems, RHIS, HISS, Routine Health Information Systems, PRISM, Performance of Routine Information System Management, Information System, Mali |
L'évaluation 2018 de la performance de la gestion du système local d'information sanitaire (SLIS) du Mali, à l’aide des outils PRISM, a mesuré les changements de l'état du système d'information sanitaire de routine (SISR) depuis la dernière évaluation datant de 2013.
L'évaluation de 2018 a révélé des progrès significatifs dans l'utilisation des données, l'assurance de la qualité des données et les preuves de l'analyse des données aux niveaux district, régional et central du SISR. Cependant, l'évaluation a également révélé des faiblesses au niveau des formation sanitaires (FS). Surtout, l'exactitude des données était une préoccupation à (et seulement à) ce niveau car c'est là que l’entrée de toutes les données se fait à présent.
Les autres faiblesses qui se sont dégagées de l'évaluation de 2018 sont liées aux difficultés d'archivage des outils et des rapports du SISR, au mauvais partage des documents de gestion normatifs du SISR, à l'instabilité et au renouvellement fréquent du personnel de santé et aux problèmes de sécurité dans le nord et le centre du pays. Ces problèmes ont sérieusement affecté la performance des sites enquêtés, en particulier au niveau le plus périphérique (c'est-à-dire les centres de santé communautaire, ou CSCom), non seulement en terme de qualité des données mais aussi en terme d'utilisation des données.
Les résultats de l’évaluation ont montré que la promotion de la culture de l’information ne suffit pas à elle seule à changer les habitudes. Un suivi plus étroit est nécessaire pour renforcer la capacité du personnel à travailler avec les outils à leur disposition et leur volonté de les utiliser régulièrement.
Les résultats ont montré que des fonctions de gestion essentielles existent mais doivent être renforcées, afin qu'elles soutiennent mieux le SISR à tous les niveaux de la pyramide sanitaire: FS, district, région et central. L'évaluation de 2018 a également souligné la nécessité de maintenir les progrès accomplis par le SISR du Mali. |
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Registre électronique dans les centres de santé communautaire au Mali
|
Ouassa Berthé, Mamoutou Diabaté, Madina Kouyaté, Issiaka Dembélé, Adama Ouattara, Edem Kossi, Aminata Traoré, Alimou Barry, Souleymane Ya Samaké |
2020 |
French |
|
HIS, HISS, Immunization, Health Information Systems, Information System, Antenatal Care, Mali |
Face à la multiplicité et à la complexité des supports dans les structures de santé, en 2017, la Direction Nationale de la Santé avec l’appui technique et financier de MEASURE Evaluation a mis en place une expérience pilote sur l’utilisation du registre électronique à travers DHIS2. Compte tenu du volume des activités et de l’aspect longitudinal des services de consultations prénatales (CPN) et de la vaccination dans le paquet minimum d’activités, le choix des registres de CPN et de vaccination a été fait pour expérimenter l’approche. En effet, dans le DHIS2, un modèle standard a été développé par l’Université d’Oslo et chaque pays l’adapte à sa situation. C’est dans ce contexte que le Mali a commencé en 2017 l’expérimentation des registres électroniques pour la CPN et la vaccination dans le centre de santé communautaire (CSCom) de Sanancoroba. |
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Collaboration des parties prenantes dans le développement d’un logiciel d’information sanitaire intégré avec une couverture nationale: l’historique de la mise en oeuvre du DHIS2 au Mali
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Aminata Traoré, Alimou Barry, Edem Kossi, Karim Traoré, Mamoutou Diabaté, Moussa Samaké,, Ouassa Berthe, Madina Kouyaté, Issiaka Dembélé, Adama Ouattara, Alamako Doumbia, Ismael Dembélé, Abdoulaye Maiga, Jessica Posner |
2020 |
French |
|
Health Information Systems, Mali, DHIS 2, Stakeholder engagement, HIS, HISS, HMIS, Information System |
Le système d’information sanitaire (SIS) du Mali était jusqu’à présent géré par différentes entités qui ne communiquaient pas assez entre elles. Le système local d’information sanitaire était géré par la Direction Nationale de la Santé (DNS), le système d’information sanitaire des hôpitaux par la Cellule de Planification et de Statistique, le système d’alerte épidémiologique par la DNS. En plus, chaque programme de santé gérait son propre système d’information avec une multitude de logiciels différents. L’intégration des données sanitaires se faisait seulement lors de l’élaboration de l’annuaire statistique. Développer et mettre en oeuvre un système d’information intégré et le soutenir est une tâche difficile dans tout contexte. Ces défis sont encore plus importants quand les ressources (financières, infrastructurelles et humaines) sont limitées. Cette pénurie de ressources rend le financement du SIS malien très dépendant des bailleurs. Malheureusement, dû à la complexité du SIS et des coûts élevés de mise en oeuvre, un seul partenaire ne peut le soutenir. Par conséquent, multiples partenaires doivent être invités à travailler avec le Ministère de la Santé (MS) pour l’appuyer dans la mise en oeuvre du système national d’information sanitaire (SNIS). |
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A Guide for Conducting Malaria Data Review Meetings
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Hai, T., Andrada, A., & Yé, Y. |
2020 |
English |
|
RHIS, Data, Health Information Systems, Malaria control, Malaria, Routine Health Information Systems, Surveillance, Data Quality |
Routine health information systems, including surveillance systems, have become critical tools to streamline malaria control efforts in endemic countries. Governments and health programs rely on health information systems to allocate resources to subpopulations to optimize interventions (Ashton, Bennett, Yukich, Bhattarai, Keating, & Eisele, 2017; World Health Organization, 2017). These systems often face data quality issues that limit their use by service providers and decision makers to better inform health services (Chilundo, Sundby, & Aanestad, 2004). To improve the quality of the data generated from these systems, national malaria control programs (NMCPs) from several malaria-endemic countries began to conduct regular data review meetings at the subnational levels (e.g., counties; health facilities) to review and address data quality issues.
These periodic data review meetings provide feedback on the quality of routine malaria data and the use of data to improve service delivery. The need for good-quality data at subnational levels, particularly at service delivery points (health facilities), increases as transmission reduces and the risk of epidemics increases; health facilities need to be analyzed more frequently to ensure early detection of a potential outbreak or abnormal increases in cases (World Health Organization, 2018). Data review meetings bring together national and subnational stakeholders to identify data quality issues more immediately and provide an opportunity to use the data to identify gaps in the performance of health services compared to national policy. The results should be converted into informational presentations to allow participants to assess trends and define action plans quickly to address data quality and performance disparities.
MEASURE Evaluation conducted a review in five malaria-endemic countries (the Democratic Republic of the Congo, Kenya, Liberia, Madagascar, and Mali) to understand how NMCPs conduct data review meetings. The review found that countries have different processes for conducting these meetings. Some countries have better structures in place to improve data quality and use data for service delivery compared to other countries. Although NMCPs conduct data review meetings periodically, we did not come across consolidated standard guidelines or protocols for conducting these meetings. In addition, few documents exist on the follow-up action plan recommended from these meetings. In light of these findings, MEASURE Evaluation proposes a brief standard protocol for these periodic data review meetings. The protocol aims to highlight the best practices for conducting data review meetings and is derived from the findings of the review (see MEASURE Evaluation, 2019). Having a standard protocol that countries can use and adapt to their specific context can streamline the validation process, optimize data use, and improve the documentation of follow-up actions to improve data quality and service delivery.
Access a related report on data review meetings in five countries. |
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Assessing Efforts to Mainstream Youth-Friendly Health Services in Madagascar, Malawi, and Mali
|
Janine Barden-O'Fallon and Shara Evans |
2020 |
English |
MADAGASCAR, MALAWI, MALI |
Reproductive Health, Youth, adolescent, Evaluation |
High fertility rates and low modern contraceptive use put African youth and adolescents at high risk for health complications, including maternal mortality. Mainstreaming youth-friendly health services (YFHS) into existing services is one approach to improve access to reproductive health services for youth and adolescents. This report details an evaluation MEASURE Evaluation conducted to assess the effects of three YFHS training packages sponsored by Population Services International (PSI) on voluntary uptake of family planning (FP) among youth and perceptions of service quality by youth and trained healthcare providers.
In 2018, a retrospective review and analysis of relevant monitoring and evaluation documents and service statistics from PSI Madagascar, PSI Malawi, and PSI Mali was conducted. Qualitative data on perceptions of service quality from Malawian youth and healthcare providers were also collected and assessed through thematic analysis.
Results show that the number of FP clients ages 15–24 increased after implementation of the YFHS training packages. Data from PSI Madagascar and PSI Malawi show that positive trends were not sustained after other YFHS components ended. Focus group discussions with youth in Malawi indicated that clinics were perceived as providing high-quality services to youth. The main barriers to accessing the services were cost and embarrassment. Malawi’s healthcare providers made many efforts to improve clinic accessibility and understood the barrier of cost and importance of outreach to youth and the broader community. The results provide evidence that provider training alone will not sustain initial increases in youth FP clients. Across the three countries, the greatest benefits of the YFHS training packages were seen when combined with demand-generation activities and increased access to peer education. |
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L’effet boule de neige de la compétition sur la qualité des données sanitaires au Mali
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MEASURE Evaluation |
2020 |
French |
|
Health Information Systems, DHIS 2, HIS, Data, Mali |
En 2018, le Mali a organisé une compétition amicale entre les structures sanitaires afin de motiver tous les niveaux du système sanitaire à améliorer la qualité des données sanitaires et d’utiliser ces données stratégiquement. La première compétition a eu lieu une fois que le Mali eut adopté et déployé le District Health Information Software, version 2 (DHIS2) avec succès comme plateforme nationale de gestion des données sanitaires.
Ce qui commença en 2018 comme une incitation à la bonne qualité des données conçue par le Ministère de la Santé et des Affaires Sociales (MS) a depuis été accueillie avec enthousiasme par les prestataires de soin à travers tout le système sanitaire. Non seulement a-t-elle attiré plus de participants en 2019 (comparé à 2018), elle a aussi manifestement amélioré la qualité des données sanitaires. Le MS compte institutionnaliser cette compétition, et l’a incluse parmi ses activités prioritaires pour le système national d’information sanitaire (SNIS) et organisera une troisième édition de cette compétition pour 2020.
En 2018, la compétition a récompensé huit structures sanitaires (cinq centres de santé communautaire [CSCom], deux centres de santé de référence [CSRef] et un hôpital) pour l’amélioration de la qualité de leurs données de 2017 à 2018. En 2019, le MS a récompensé 16 structures sanitaires (10 CSCom, quatre CSRef et deux hôpitaux). L’atteinte, par les structures sanitaires, des critères pour juger la qualité des données (100% de complétude et 80% de promptitude des données) a considérablement augmenté entre la compétition de 2018 et celle de 2019 et le nombre de structures participant à la compétition a également augmenté de 65 structures en 2018 à 308 en 2019 (un chiffre cinq fois supérieur à celui de l’année précédente). |
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Le bulletin mensuel du paludisme contribue à l’amélioration de l’utilisation des données pour le contrôle du paludisme au Mali
|
MEASURE Evaluation |
2020 |
French |
|
Malaria, Mali |
En tant que partenaire proche du Programme National de Lutte contre le Paludisme (PNLP) au Mali depuis 10 ans, MEASURE Evaluation a appuyé des activités de contrôle et de prévention du paludisme qui ont eu un impact dans la lutte collaborative contre cette maladie. Ensemble, MEASURE Evaluation et le PNLP ont amélioré la qualité des données paludisme disponibles, en partie à travers des efforts de renforcement des capacités du personnel du PNLP en suivi-évaluation. |
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Une approche durable et abordable du renforcement des capacités du personnel du système d’information sanitaire de routine au Mali
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MEASURE Evaluation |
2020 |
French |
|
Health Information Systems, RHIS, Routine Health Information Systems, HIS strengthening, HIS, Mali |
Jusqu’à récemment, le Ministère de la Santé et des Affaires Sociales (MS) du Mali n’avait aucun programme de formation spécifique pour fournir à son personnel un renforcement des capacités abordable afin de gérer et renforcer le système d’information sanitaire de routine (SISR) du pays. Aucun mécanisme formel n’existait pour reconnaitre et engager le personnel du SISR ou pour lui fournir la formation nécessaire à son parcours professionnel. De plus, la plupart des formations sur le SISR étaient organisées au niveau régional dans des institutions de pays voisins et y participer était souvent coûteux par rapport aux ressources du gouvernement malien.
Le manque de personnel qualifié dans le maintien et la gestion du SISR pose un important défi à la performance de l’ensemble du système d’information sanitaire. Le SISR comprend des ressources et outils pour appuyer la collecte, la revue, l’analyse et l’interprétation des données—toutes essentielles pour la production de données de qualité pour la prise de décisions basée sur les évidences.
En connaissance de cause, MEASURE Evaluation a approché l’Ecole de Santé Publique de la Faculté de Médecine de l’Université de Bamako pour discuter des options possibles pour fournir une telle formation au Mali. Ces conversations ont commencé en début 2017 et ont conduit à la création d’un diplôme universitaire sur le SISR au sein du Département d’Enseignement et de Recherche en Santé Publique (DERSP), utilisant le curriculum du SISR développé conjointement par MEASURE Evaluation et des partenaires mondiaux — tels que l’Organisation mondiale de la santé— et plusieurs universités. |
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Surveillance épidémiologique en temps réel au Mali: L’importance de la qualité des données pour une bonne prise de décisions afin de prévenir et riposter aux épidémies
|
MEASURE Evaluation |
2020 |
French |
|
DHIS 2, Infectious disease, Surveillance, HIS, Health Information Systems, HIS strengthening, Mali, Information systems |
Depuis le tout début de la riposte à l’épidémie de la maladie à virus Ebola au Mali en 2014, le Ministère de la Santé (MS) a rendu prioritaire le renforcement du système de rapportage des maladies à potentiel épidémique.
En 2016, MEASURE Evaluation, projet financé par l’Agence des Etats-Unis pour le développement international (USAID), en collaboration avec la Direction Nationale de la Santé (DNS) et la Division de Prévention et Lutte contre la Maladie du MS, a mis en place une surveillance et un rapportage épidémiologique en temps réel dans le DHIS2 pour améliorer la prise de décision fondée sur des preuves.
MEASURE Evaluation a fourni son assistance dans l’adaptation de DHIS2 à couvrir les maladies principales et les maladies prioritaires identifiées par le pays: la fièvre hémorragique, la rougeole, la méningite, la fièvre jaune, le choléra et l’anthrax, parmi d’autres. Le Mali utilise le DHIS2 à tous les niveaux du système sanitaire (central, intermédiaire et opérationnel), avec l’exception des structures sanitaires situées en zone de conflit (qui représentent environ quatre pourcent de toutes les formations sanitaires). Les données de surveillance épidémiologique basées sur DHIS2 sont maintenant disponibles à tous les utilisateurs quel que soit leur niveau de prise de décision (communautaire, district, régional et central). MEASURE Evaluation et la DNS ont développé un plan de suivi des utilisateurs, mis en oeuvre une année après le déploiement du DHIS2, qui inclut des visites de supervision post-formation.
Deux ans après la mise en oeuvre de DHIS2, cependant, des difficultés de qualité des données sont devenues un défi majeur pour la DNS. Une pauvre qualité des données a limité la capacité du Mali à utiliser les données pour la prise de décision car les données ne répondaient pas aux standards de qualité—tels que la complétude, promptitude, exactitude et fiabilité. |
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L’amélioration de la qualité des données du paludisme au Mali permet une meilleure prise de décisions dans le secteur santé
|
MEASURE Evaluation |
2020 |
French |
|
Mali, DHIS 2, Malaria, Data Quality, HIS strengthening, HIS, Health Information Systems |
Depuis l’introduction du système d’information de routine du paludisme (SIRP) en 2011, le Programme National de Lutte contre le Paludisme (PNLP) du Mali n’a pas été capable de soutenir adéquatement la plateforme. Un nombre de facteurs qui incluent le financement limité—ainsi qu’une insuffisance dans les formations du personnel, l’équipement et les connexions Internet—ont abouti à un manque de données promptes dans plusieurs régions, limitant ainsi la capacité du PNLP de cibler les services de manière plus efficace.
Pourquoi les données fiables sont-elles si importantes?
Les gouvernements dépendent d’informations promptes sur les besoins en services sanitaires et sociaux de leur population afin de permettre des politiques publiques et des allocations de ressources efficaces. Les systèmes d’information sanitaire permettent le suivi d’indicateurs sanitaires critiques, et dans plusieurs pays ces données sont capturées dans le DHIS2.
Au Mali, la Cellule de Planification et de Statistique du Ministère de la Santé a dirigé le déploiement national du DHIS2. Cet effort ambitieux, mené avec l’appui de MEASURE Evaluation, inclut la personnalisation des indicateurs du paludisme et l’intégration de la base de données SIRP dans la plateforme du DHIS2. |
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Développement participatif pour une gestion pérenne du système d’information sanitaire
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MEASURE Evaluation |
2020 |
French |
|
Health Information Systems, HIS strengthening, HIS, DHIS 2, Mali |
Durant la dernière décennie, le Mali a utilisé un logiciel personnalisé pour gérer son système d’information sanitaire (SIS). Malgré son utilité des années durant, le système, qui n’était pas adaptable aux technologies modernes et électroniques, dépendait d’un groupe de développeurs tiers pour sa gestion et restait limité dans son utilité pour gérer et analyser une grande quantité de données.
Récemment, le Mali a pris la décision—dans le cadre de son processus de renforcement du SIS de manière générale—de passer de son système de l’époque (DESAM) au DHIS2, qui est perçu comme étant le système le plus prometteur pour l’intégration, la gestion, l’analyse et la présentation des données sanitaires pour la prise de décision au sein du secteur santé. MEASURE Evaluation a apporté une assistance technique au Ministère de la Santé (MS) du Mali au cours de cette transition. |
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L’alignement de parties prenantes pour renforcer le système d’information sanitaire: Une démarche en plusieurs étapes
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MEASURE Evaluation |
2020 |
French |
|
Health Information Systems, HIS, Mali, HIS strengthening |
Mettre en oeuvre des systèmes d’information sanitaire (SIS), qu’ils soient privés ou publics, est un défi de taille en raison de nombreux facteurs, dont la pénurie de ressources humaines et financières et d’un leadership nécessaire à la durabilité d’un SIS fonctionnel. Ces défis sont particulièrement préoccupants dans les pays en développement où les SIS et les technologies de l’information qui les accompagnent peuvent avoir un impact important sur les services sanitaires disponibles. Des SIS forts sont l’épine dorsale de systèmes de santé robustes. Un SIS qui fonctionne correctement envoie les données pertinentes aux bons acteurs au bon moment, permettant aux décideurs, politiques, gestionnaires et prestataires de soin de prendre des décisions fondées sur des preuves pour des sujets importants allant des soins du patient aux budgets nationaux. Des SIS robustes soutiennent davantage la transparence et la reddition de comptes en augmentant l’accès à l’information.
Deux principaux défis de la mise en oeuvre complète du SIS au Mali sont la difficulté de passer d’un projet pilote à une mise à l’échelle, et une focalisation singulière sur les technologies de l’information ou les solutions techniques au détriment d’une approche plus large pour améliorer la performance technique, comportementale et organisationnelle du SIS. Par exemple au Mali, comme dans de nombreux autres pays, la gouvernance et la gestion du SIS, qui inclut les ressources financières et humaines et les rôles et responsabilités des contributeurs clés à chaque niveau du système sanitaire, sont de la même importance –si pas plus importantes– que les facteurs techniques.
En réponse à ces défis, le projet MEASURE Evaluation au Mali, financé par l’Agence des Etats-Unis pour le développement international (USAID), a proposé une approche en étapes pour aligner les parties prenantes qui mettent en oeuvre des initiatives disparates sur le SIS dans un « réseau » en appui au SIS national du Mali. |
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Les données actuelles permettent au Mali de suivre les services sanitaires et la performance
|
MEASURE Evaluation |
2020 |
French |
|
HIS, Mali, Health Information Systems, HIS strengthening, Population |
Les statistiques de la santé de la population sont une référence fiable pour la planification sanitaire du Mali. |
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La réussite du pilotage de registres sanitaires électroniques au Mali
|
MEASURE Evaluation |
2020 |
French |
|
Health Information Systems, HIS strengthening, Digital Health, EHealth, HIS, Mali |
Les registres électroniques ont amélioré le suivi des femmes enceintes et des enfants et ont réduit la charge de travail des prestataires de soins.
L’essai au Mali fut un succès et démontre que la couverture sanitaire peut bénéficier de l’utilisation de registres électroniques pour améliorer le suivi et réduire la charge de travail. |
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Les puissants bulletins du paludisme
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MEASURE Evaluation |
2020 |
French |
|
Health Information Systems, Malaria, Mali |
Les bulletins fournissent des données du paludisme cohérentes et de bonne qualité afin de guider la mise en oeuvre de programmes et de mesurer les réalisations. Les décideurs à tous les niveaux peuvent maintenant prendre de bonnes décisions fondées sur des données fiables au bénéfice de toute la population malienne. |
|
Sécurité sanitaire mondiale
|
MEASURE Evaluation |
2020 |
French |
|
Health Information Systems, HIS strengthening, Global health security, HIS, Mali, Surveillance |
Les systèmes de données électroniques bien entretenus génèrent des données de surveillance en temps réel afin d’assurer une riposte rapide. |
|
Des institutions fortes et des experts pour l’information sanitaire
|
MEASURE Evaluation |
2020 |
French |
|
HIS, Mali, Health Information Systems, HIS strengthening, Capacity Building |
Une bonne gestion des données fournit au Mali des évidences pour répondre aux besoins sanitaires. |
|
L’histoire du DHIS2 au Mali
|
MEASURE Evaluation |
2020 |
French |
|
Mali, DHIS 2, HIS strengthening, HIS, Health Information Systems |
Un système d’information sanitaire robuste fournit des données de bonne qualité pour évaluer les résultats de santé, détecter les flambées épidémiques, mesurer la couverture des services et guider la stratégie. Le Mali a transformé son système d’information sanitaire. |
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Le Mali prend des démarches délibérées pour améliorer les données sanitaires
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MEASURE Evaluation |
2020 |
French |
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HIS strengthening, Health Information Systems, HIS, Mali |
Evaluer et améliorer les systèmes de données sanitaires mène à de meilleurs résultats. Comment une évaluation de la performance de la gestion du système d’information sanitaire a guidé la stratégie du Mali. |
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Plan d’analyse des données de planification familiale Une évaluation des tendances de la PF pour le Mali
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Moussa Konaré, MD, MPH; Janine Barden-O’Fallon, PhD |
2020 |
French |
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Data, Family Planning, Mali, Data analysis, Evaluation |
Dans le cadre du repositionnement de la PF, le Mali participe de manière active, à l’instar des pays francophones de l’Afrique de l’Ouest à l’initiative mondiale Family Planning 2020 (FP2020) et le Partenariat de Ouagadougou afin de contribuer à la réduction des taux élevés de mortalité maternelle (325 pour 100 000 naissances vivantes), et de mortalité néonatale (33 pour 1000 naissances vivantes), selon l’EDSM-VI 2018. Ainsi, pour accompagner les différentes stratégies et initiatives des acteurs nationaux et internationaux les données sont essentielles pour prendre des décisions sur l’évolution du programme PF dont l’objectif du TPCm est de 30% dans le PANB-PF 2019–2023.
Le gouvernement du Mali, à l’aide du financement et du soutien technique de donneurs et partenaires de mise en oeuvre, s’est engagé à renforcer et à améliorer la collecte d’informations sanitaires de routine. En 2017, la plateforme du système d’information de santé DHIS2 a été lancée pour obtenir des informations sur les indicateurs clés concernant la santé à des fins de surveillance et d’évaluation. Le DHIS2 comporte un certain nombre d’indicateurs concernant la planification familiale (PF), qui sont utilisés pour évaluer les activités du programme, notamment la campagne annuelle de PF au niveau national. Ce plan d’analyse des données présente les étapes nécessaires pour utiliser les données DHIS2 concernant la PF, afin d’évaluer l’efficacité des activités de PF.
Le plan d’analyse des données ci-dessous présente des instructions étape par étape, à titre d’exemple, de l’utilisation des données DHIS2 de routine dans l’analyse des performances du programme de PF. Ces instructions sont fondées sur les données recueillies dans le DHIS2 au cours des années 2017, 2018 et 2019. En 2019, le système a été mis à niveau, et certains indicateurs de routine ont été modifiés ou ajoutés. La section portant sur les recommandations propose des analyses ultérieures pour les données provenant du système mis à niveau. Les étapes fondamentales d’analyse et les conseils d’interprétation des données présentés dans ce document peuvent être suivis pour les analyses ultérieures, y compris celles concernant les nouveaux indicateurs.
Ce plan d’analyse des données met l’accent sur l’analyse des tendances, qui permet d’examiner l’évolution des indicateurs clés de PF au cours du temps, notamment le nombre de nouveaux utilisateurs de PF, le nombre d’anciens utilisateurs qui continuent d’utiliser la PF et le nombre d’utilisateurs de PF âgés de moins de 25 ans. L’analyse de tendance proposée inclut les données recueillies en dehors des mois de la campagne nationale de PF, afin d’obtenir des informations concernant l’impact de la campagne sur les résultats de PF au Mali avec le temps. |
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Reproductive Empowerment Scale: Psychometric Validation in Nigeria
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Mandal, M., & Albert, L. M. |
2020 |
English |
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Reproductive Empowerment, Reproductive Health, What's New, Empowerment, Family Planning |
MEASURE Evaluation, a project funded by the United States Agency for International Development (USAID), validated a previously developed measure of reproductive empowerment (RE) that can be used in evaluations or other types of surveys in sub-Saharan African countries, with the goal of providing family planning (FP) and reproductive health (RH) programs and national or regional governments with a tool to measure the status of and changes in RE in their populations. We examined the validity of the RE scale by embedding the scale items in a baseline survey, implemented from May to June 2019, for the evaluation of the John Templeton Foundation-funded Masculinities Faith, and Peace (MFP) intervention in Plateau State, Nigeria. First, we examined the psychometric properties of the scale by using confirmatory factor analysis (CFA). We assessed the construct validity of the scale by using logistic regression to test the association between RE and FP outcomes. The results from this study suggest that the final RE scale has considerable potential to be a valid and predictive measure of RE. When used in future studies, the scale should be psychometrically tested with various samples to provide additional data on its validity. The new 20-item RE scale presented in this report can be used to evaluate programs or interventions designed to improve women’s RE and to assess the state of RE in populations of sub-Saharan Africa.
Access the reproductive empowerment scale and related reports sharing findings from a study in Zambia and findings from a study in Kenya. |
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Validating Measures of Reproductive Empowerment in Kenya
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Mandal, M., Treves-Kagan, S., & Mejia, C. |
2020 |
English |
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Empowerment, What's New, Kenya, Reproductive Health, Reproductive Empowerment, Family Planning |
Although a substantial body of research has examined the role of empowerment in influencing reproductive outcomes, the reproductive sphere has only recently emerged as a distinct dimension of empowerment. Inconsistency in the conceptualization and measurement of reproductive empowerment (RE) has led to the use of a wide range of research measures on the determinants of reproductive behavior in relation to empowerment. We adopted the following definition of RE from a recently developed framework: “Both a transformative process and an outcome, whereby individuals expand their capacity to make informed decisions about their reproductive lives, amplify their ability to participate meaningfully in public and private discussions related to sexuality, reproductive health and fertility, and act on their preferences to achieve desired reproductive outcomes, free from violence, retribution or fear” (Edmeades, Hinson, Sebany, & Murithi, 2018).
MEASURE Evaluation—a project funded by the United States Agency for International Development—developed a draft RE scale using three steps. First, we conducted a systematic literature review to identify existing domains, subdomains, scales, and indexes related to RE. Second, through a consultative meeting, we shared our findings from the systematic review with experts in reproductive health (RH) and empowerment research and measurement, and sought their feedback on gaps and limitations in the field. Third, we conducted focus group discussions with men and women in Zambia to explore in depth the meaning of the identified domains and subdomains of RE, and to surface new domains and subdomains. At the end of this process, we prepared a draft RE scale with 44 items across five subscales. The next step in the development of the RE scale was to establish its face validity, the subject of this study. The objectives of this study were to (1) pretest the draft scale items using cognitive interviews (CIs) with women and men in Kenya to examine the items’ face validity; and (2) revise the draft RE scale based on the results of the CIs. This report shares more on the work in Kenya.
Access the reproductive empowerment scale and related resources on work done in Nigeria and Zambia. |
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Midline Evaluation of the Tanzania Public Sector System Strengthening Program – Final Report
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Gustavo Angeles, Jessica A. Fehringer, Lisa Calhoun, Brittany Iskarpatyoti, Willis Odek, Gideon Kwesigabo, Joe L.P. Lugalla, Aimee M. Benson, Hannah Silverstein, Courtney McGuire |
2020 |
English |
Africa, TANZANIA |
Health Systems Strengthening, Health Services, Health System, Monitoring, Evaluation, Evaluation, M&E, Tanzania, Public Health, Africa |
The Public Sector System Strengthening (PS3) project, funded by the United States Agency for International Development (USAID), supports the Government of Tanzania (GOT) in strengthening the public-sector system to promote the delivery, quality and use of public services. This report presents the findings of a midline performance evaluation of PS3 conducted by MEASURE Evaluation which examined time trends and pre- and post-program inception changes in the uptake of health services as well as in financial and human resources indicators in PS3 regions and in other regions of the country. The evaluation also used qualitative methods to examine the perceptions from program implementers, community members, and other stakeholders about the adoption and performance of the PS3 intervention, its strengths and remaining challenges, and the stakeholders’ recommendations on ways to address those challenges.
PS3 works across national, regional, and local government levels. The implementation strategy seeks to strengthen each of the five component areas, while working across all sectors and levels of public governance. The expectation is that strengthening systems at all levels will result in improved service delivery at the lowest level—the service provider—which will lead to higher public service utilization by the population and better health outcomes. At the national level, emphasis is placed on providing support for key policies and strategies as well as strengthening the national system to foster improvements in service delivery at lower government levels. At the regional and LGA levels, the PS3 program facilitates the understanding and implementation of national policies and guidelines as well as providing targeted assistance to improve the management and strengthening of systems and resources.
This midline evaluation undertook an outcome evaluation to understand how system-level indicators related to human resources, financial resources, and health service utilization changed over time in PS3 and in other (non-PS3) regions of the country. Data from national routine information systems formed the basis for quantitative measurements. Adapted difference-in-differences models were used to examine time trends before PS3 and during the time PS3 has been active, changes in those trends, and to examine differences between PS3 regions and other regions of the country. Potential differences between Phase 1 and Phase 2 PS3 LGAs were also examined. In addition, qualitative methods provided a more in-depth understanding of the performance of the PS3 intervention in human resources, finance, and system strengthening, captured unintended, indirect effects of the intervention, illuminated the process of change, and examined the quality and character of the intervention implementation. The qualitative component also captured the stakeholders’ perceptions of pending challenges in system functioning and community engagement and their recommendations on how to address them.
The findings of this evaluation will contribute to USAID’s portfolio of projects focused on public-sector strengthening while informing PS3’s continued program implementation. This evaluation was performed at about the mid-point of PS3, three years after the project’s inception. |
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The PEPFAR Local Capacity Initiative Interventions in Uganda
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Mary Freyder, Eve Namisango, Tory M. Taylor, Annie Glover, and Katherine Andrinopoulos |
2020 |
English |
UGANDA |
policy, Health Services, Key Populations, Health care, Capacity Building, KP |
The Local Capacity Initiative (LCI) strengthened the capacity of civil society organizations (CSOs) to support policy advocacy, with the ultimate goal of improving health services for key populations affected by the HIV epidemic. The United States President’s Emergency Plan for AIDS Relief (PEPFAR) funded the initiative from 2013–2018 to help local CSOs create an enabling environment for PEPFAR’s objectives.
Under the LCI, the United States Centers for Disease Control and Prevention worked in Uganda between 2015 and 2018 to strengthen the policy advocacy capacity of CSOs that worked with men who have sex with men, transgender women, and sex workers and develop the capacity of public health officials to consider gender and sexual diversity issues. MEASURE Evaluation, which is funded by the United States Agency for International Development and PEPFAR, conducted an evaluation of LCI Uganda between 2017 and 2018.
This brief summarizes LCI’s effort to create an enabling environment for policy advocacy in Uganda by identifying key interventions. Additional briefs provide overviews of work to develop organizational capacity through coalition building, the community scorecard strategy to improve HIV clinical services, and methods that the evaluation team used to study the efficacy of LCI’s work and measure resulting change. |
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Quality of Tuberculosis Services Assessment: Global Implementation Guide
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MEASURE Evaluation |
2020 |
English |
Global |
Tuberculosis, Quality of care, TB, Assessment, Toolkit |
The guide is coming soon. |
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Framework for Evaluating National Malaria Programs in Moderate- and Low-Transmission Settings: Aide Memoire
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Evaluation Task Force of Roll Back Malaria’s Monitoring and Evaluation Reference Group |
2020 |
English |
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Transmission, Monitoring, Evaluation, Malaria, Evaluation |
The epidemiology of malaria has become increasingly heterogeneous in many countries. These countries require granular data on transmission risk and incidence to effectively inform and target their interventions and track their progress. To meet these needs for strengthening national malaria programs (NMPs), an evaluation task force comprising a subgroup of the Roll Back Malaria Monitoring and Evaluation Reference Group developed the Framework for Evaluating National Malaria Programs in Moderate- and Low-Transmission Settings. This document provides an overarching framework for evaluating NMPs along the continuum of malaria transmission. Each transmission setting is defined by the World Health Organization classifications. The scope and objectives were informed through a review and synthesis of existing guidance documents and tools for malaria surveillance, monitoring, and evaluation. This aide memoire summarizes the larger framework document. |
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Framework for Evaluating National Malaria Programs in Moderate- and Low- Transmission Settings
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Evaluation Task Force of the RBM Monitoring and Evaluation Reference Group |
2020 |
English |
Global |
Malaria, Evaluation, Monitoring, Evaluation, Transmission |
The evaluation framework presented in this document intends to build on existing work by the RBM Monitoring and Evaluation Reference Group, expanding it to address settings along the continuum of malaria transmission, with a specific focus on moderate- and low-transmission settings. This framework also emphasizes the importance of process evaluation to impact evaluation, linking implementation processes to implementation strength to then demonstrate program impact on malaria transmission, morbidity, or mortality.
Access the related Framework for Evaluating National Malaria Programs in Moderate and Low Transmission Settings: Aide Memoire. |
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L’expérience du Mali dans le déploiement du DHIS2
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MEASURE Evaluation |
2019 |
French |
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DHIS 2, HIS, Health Information Systems, Mali |
Dans le but de renforcer le système d’information sanitaire, le Ministère de la Santé et des Affaires Sociales avec l’appui des partenaires techniques et financiers, dont l’Agence des Etats-Unis pour le développement international (USAID) à travers MEASURE Evaluation, s’est engagé en août 2015 dans un processus d’adaptation du Logiciel de Gestion de l’Information Sanitaire de District version deux : District Health Information Software (DHIS2).
La présente documentation, donne les principaux résultats du déploiement de DHIS2 au Mali après quatre (4) années de mise en œuvre des activités. |
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Postpartum Family Planning in Bangladesh: A Situation Analysis and Way Forward
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Barkataki, S., Huda, F., Nahar, Q., Rahman, M. |
2019 |
English |
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Contraception, Postpartum care, Pregnancy, Family Planning, Bangladesh |
Postpartum family planning (PPFP) focuses on providing family planning (FP) counseling and services to women and couples in the first 12 months after birth. This publication reviews the policies, programs, and status of PPFP in Bangladesh and seeks to identify the need, gaps, and future focus areas for PPFP in the country. |
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East African Community Regional Digital Health and Interoperability Assessments: Kenya
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MEASURE Evaluation |
2019 |
English |
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Interoperability, Digital Health, Health Information Systems, Assessment, HIS, Kenya |
The regional health program of the United States Agency for International Development (USAID)/Kenya and East Africa Mission, in coordination with the USAID Global Health Bureau, U.S. Global Development Lab, and USAID Bureau for Africa, engaged MEASURE Evaluation to provide technical assistance support to EASTECO in conducting an East African Community (EAC) regional digital health readiness assessment incorporating aspects of systems interoperability and the cost of investing in digital health in the EAC region. When completed, the assessment will have covered four of the six EAC partner states. This report details the results of the Kenya assessment, which had two objectives:
Assess the status of digital health and HIS interoperability in Kenya by assessing the processes, structures, and capacities needed to support the enabling environment for digital health and interoperability. This objective included beginning to develop a registry of digital health solutions being implemented in Kenya.
Using the Kenyan assessment results, contribute to the regional landscape assessment of digital health and interoperability in the EAC to inform regional analysis and recommendations for moving them forward.
Access the related Health Information Systems Interoperability Toolkit. |
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Effective Access to Long-Acting Reversible Contraceptives and Permanent Methods in Bangladesh
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M. Moinuddin Haider, Sharad Barkataki, Ali Ahmed, Quamrun Nahar, Mizanur Rahman |
2019 |
English |
BANGLADESH |
Health Facilities, Service delivery, Assessment, Contraception, Service access and availability |
This report presents the results of an analysis to determine the effective accessibility of health facilities designated to provide long-acting reversible contraceptives (LARCs) and permanent methods (PMs) of contraception to Bangladeshi couples.
We define LARC and PM services as effectively accessible to consumers if facilities that are designated to offer LARCs and PMs do indeed offer these types of contraception and if those facilities are ready to provide an appropriate quality of services.
Bangladesh has an extensive health infrastructure that delivers preventive and curative services, including family planning. However, compared to global rates, Bangladesh has a relatively low prevalence of LARCs and PMs.
This analysis is based on data collected from 963 facilities during the Bangladesh Health Facility Survey 2014 (National Institute of Population Research and Training, Associates for Community and Population Research, and ICF International, 2016). |
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Bangladesh District Level Socio-demographic and Health Care Utilization Indicators
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2019 |
English |
Asia, BANGLADESH |
Maternal and child health, Bangladesh Demographic and Health Survey, Bangladesh Maternal Mortality and Health Care Survey, Antenatal care, Maternal Health, Maternal health, Health care, Family Planning, Bangladesh, Antenatal Care, Maternal Mortality |
The purpose of this report is to present health care utilization and socio-demographic indicators at the district level. The data from this report comes from the 2016 Bangladesh Maternal Mortality and Health Care Survey (BMMS). The objectives of the 2016 BMMS were to a) estimate the national level Maternal Mortality Ratio (MMR); b) identify the specific causes of maternal and nonmaternal deaths among adult women; c) assess the pattern of antenatal, delivery, and postnatal care practices; d) assess maternal complications experience and careseeking; e) estimate childhood mortality rates; f) measure the level of selected maternal morbidities (obstetric fistula and pelvic organ prolapse); and g) provide district-level socioeconomic, demographic, family planning, and health care utilization indicators. |
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La Surveillance à base communautaire des maladies et zoonoses prioritaires au Sénégal
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MEASURE Evaluation |
2019 |
French |
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Global health security, Zoonotic, One Health, Senegal, GHSA, Global Health Security Agenda, Surveillance, Infectious disease |
Le Sénégal est membre du Programme de Sécurité Sanitaire mondiale (PSSM), financé par l’USAID et visant à renforcer la capacité des pays à mieux prévenir, détecter et riposter aux menaces des maladies infectieuses, et à élever la sécurité sanitaire mondiale au rang de priorité nationale et mondiale. Dans le cadre de ce PSSM, MEASURE Evaluation, a apporté un appui technique pour la mise en oeuvre de la surveillance à base communautaire (SBC) des zoonoses prioritaires dans une approche « Une Seule Santé » dans six districts sanitaires dans les régions de Saint Louis et Tambacounda. Cette initiative met l’accent sur la collaboration multisectorielle et le partage de l’information à temps réel pour une réponse rapide. Elle est la continuité du projet de SBC des huit maladies prioritaires appuyé par MEASURE Evaluation entre Avril 2016 et Mars 2018.
Les contributions phares de cette activité comprennent tout d’abord l’élaboration des définitions de cas communautaires pour chacune des maladies prioritaires pour la SBC, en concertation avec les experts techniques des Ministères de la Santé, de l'Environnement, de l'Elevage et des partenaires techniques intervenants dans la surveillance.
MEASURE Evaluation a soutenu le développement de la plateforme électronique dénommée mInfoSanté, accessible via internet et permettant aux agents communautaires de la santé d’envoyer par SMS des signaux de maladies prioritaires sous surveillance et recevoir des instructions et retro informations des infirmiers et agents de l’élevage.
Un curriculum, des guides et outils de formation ont été développés dans un processus participatif en collaboration avec le Haut Conseil de la Sécurité Sanitaire Mondiale (HCNSSM) et les secteurs parties prenantes.
Des formations en cascade des professionnels des secteurs de la santé humaine, animale et environnementale et des comités de veille et d’alerte communautaire (CVAC) ont eu lieu dans les six district pilotes. En outre, MEASURE Evaluation a réalisé en collaboration avec le Ministère de l’éducation, l’orientation de 391 lycéens sur l’approche « Une Seule Santé » et les maladies prioritaires sous surveillance, dans un lycée de chacun des districts pilotes.
Enfin, le guide technique national pour l’opérationnalisation de la SBC dans une approche « Une Seule Santé » a été élaboré dans une approche participative.
Dans cette phase pilote, un total de 1650 signaux a été reçus à la date du 31 mai 2019, soit 135 par les infirmiers chefs de poste (ICP) et chefs de poste vétérinaire (CPV) pour les zoonoses et 1515 par les ICP pour les autres maladies prioritaires. Parmi les signaux, 999 ont été vérifiés, dont 744 dans les 48 heures, pour 617 cas suspects. La proportion de signaux vérifiés est de 60%, celle des cas suspects parmi les signaux vérifiés est de 62%. La diarrhée sanglante est la maladie la plus signalée avec 976 signaux, soit 59% de l’ensemble des signaux. Vient ensuite la rougeole avec 322 signaux, soit 20%. Parmi les zoonoses, la tuberculose bovine reste la maladie la plus fréquemment signalée avec 58 signaux, soit 37% de tous les signaux de maladies zoonotiques y compris la maladie à virus Ebola, qui est sous surveillance depuis le début de la phase pilote en 2017. Elle est suivie de la rage avec 38 signaux, soit 24%. |
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MEASURE Evaluation–Tanzania Final Project Report (2014–2019)
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MEASURE Evaluation–Tanzania |
2019 |
English |
|
Tanzania, MEASURE Evaluation Tanzania |
The five-year MEASURE Evaluation–Tanzania (MEval-TZ) Associate Award (AA) began on February 28, 2014 and ends on September 30, 2019. The project was funded by the United States Agency for International Development (USAID), the United States President’s Emergency Plan for AIDS Relief (PEPFAR), and the President’s Malaria Initiative (PMI). The aim was to strengthen monitoring and evaluation (M&E) and research capacity of community health and social service programmes in the United Republic of Tanzania for malaria and HIV control programmes in Mainland Tanzania and Zanzibar.MEval-TZ addressed three intermediate results (IRs):
IR 1: Policy makers use quality data to develop policies and guidelines, and advocate for community health and social service programs (activities to strengthen national-level M&E systems, data quality, and data use)
IR 2: Quality data routinely used by local governments, community providers, and facilities to improve program planning, budgeting, and program implementation (subnational strengthening of M&E, data quality, and data use with health management teams, local government, and implementing partners)
IR 3: Increased evidence base for community health and social service programs (crosscutting activities to strengthen the evidence base and enhance capacity for M&E and research)
The project’s technical approach assumed that health and social service programmes are more successful when supported by relevant, robust, and timely information to guide resource allocations and programming. Two complementary pillars were described to achieve this: (1) the foundation of an enhanced evidence base derived from evaluation, monitoring, and focused research; and (2) widespread use of this evidence to develop policies and guidelines; advocacy for community health and social service programmes; and the details of programme planning, budgeting, and implementation. The project worked at the national and subnational levels.
Underpinning the project’s work were the principles of collaboration, gender integration, and sustainability. Working in a collaborative and participatory manner while fostering relationships with government and non-governmental partners, the project sought to establish and strengthen systems that would be sustained through enhanced local capacity. By focusing on gender as a crosscutting issue, the project sought to highlight gender disparities in health access, programming, and health outcomes, and to promote investigation and action to address those issues to ensure the best services for all Tanzanians. Gender integration encompassed three strategies: (1) gender-focused M&E training with M&E staff at selected ministries; (2) increased availability of sex-disaggregated and gender-specific data; and (3) support for special studies related to gender. |
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Decreased consumption of common weaning foods is associated with poor linear growth among HIV-exposed infants participating in the Kigali antiretroviral and breastfeeding assessment for the elimination of HIV (Kabeho) study
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Charlotte Lane, Emily A Bobrow, Dieudonne Ndatimana, Gilles F Ndayisaba, Linda S Adair |
2019 |
English |
|
Children, HIV prevention, Child health, HIV, Nutrition |
ObjectiveThe World Health Organization recommends that complementary foods that are adequate, safe, and appropriate be introduced to infants at age 6 months. Using an innovative modeling technique, we examine patterns of nutrient intake in HIV‐exposed and uninfected (HEU) infants and establish their relationship with growth.
MethodsSingle‐day dietary recalls and anthropometrics were collected every two to 3 months from 543 infants living in Kigali, Rwanda, and attending clinics for the prevention of mother‐to‐child HIV transmission. A common weaning food index (CWFI) was calculated in grams and nutrient density for infants to reflect the extent to which the infants consumed the weaning foods typical of this population at ages 6 to 10, 11 to 15, and 16 to 20 months. Regressions among the CWFI, length‐for‐age z‐scores (LAZ), and weight‐for‐length z‐scores (WLZ) were conducted to estimate the relationship between the dietary patterns and growth.
ResultsMean absolute intake of zinc and calcium from complementary foods was insufficient. Increasing CWFI was related to increasing cow milk consumption. The density CWFI showed a decrease in the density of iron and folate as infants consume more of the weaning foods typical of this population. Density CWFI, breastfeeding, and caloric intake act on early LAZ and WLZ and interact with one another. Among breastfed infants, those who consume little of the common weaning foods and have a high caloric intake develop deficits in LAZ and have an elevated WLZ.
ConclusionsA diet that is more dominated by the typical weaning foods of this population may support a healthy growth pattern.
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Caregiver exposure to malaria social and behaviour change messages can improve bed net use among children in an endemic country: secondary analysis of the 2015 Nigeria Malaria Indicator Survey
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Kirsten Zalisk, Samantha Herrera, Uwem Inyang, Audu Bala Mohammed, Perpetua Uhomoibhi, & Yazoumé Yé |
2019 |
English |
|
Bed nets, Malaria, Malaria control, Nigeria, ITN |
Background: To reduce the malaria burden in Nigeria, the National Malaria Strategic Plan (NMSP) 2014‒2020 calls for the scale-up of prevention and treatment interventions, including social and behaviour change (SBC). SBC interventions can increase awareness and improve the demand for and uptake of malaria interventions. However, there is limited evidence supporting the implementation of SBC interventions to improve key malaria behaviours, such as insecticide-treated bed net (ITN) use, among children in Nigeria.
Methods: Using data from 2015 Nigeria Malaria Indicator Survey, this study used multiple logistic regression to assess the relationship between caregiver exposure to malaria messages and ITN use among children under fve.
Results: Caregiver exposure to ITN-related messages was signifcantly associated with ITN use among children under fve (odds ratio [OR]=1.63, p<0.001).
Conclusions: The results suggest that caregiver exposure to topic-specifc SBC messages improves the use of ITNs among children. Given these results, Nigeria should strive to scale up SBC interventions to help increase ITN use among children in line with the objectives of the NMSP. Further evidence is needed to determine which SBC interventions are the most efective and scalable in Nigeria. |
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A subnational profling analysis reveals regional diferences as the main predictor of ITN ownership and use in Nigeria
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Andrew Andrada, Samantha Herrera, Uwem Inyang, Audu Bala Mohammed, Perpetua Uhomoibhi, & Yazoumé Yé |
2019 |
English |
|
Nigeria, Malaria control, Malaria, ITN |
BackgroundTo reduce the malaria burden in Nigeria, the country is scaling up prevention and treatment interventions, especially household ownership and use of insecticide-treated nets (ITNs). Nevertheless, large gaps remain to achieve the goals of the National Malaria Strategic Plan 2014–2020 of universal access to ITNs and their increased use. To inform the targeting of intervention strategies and to maximize impact, the authors conducted a sub-national profiling of household ITN ownership and use in the general population to identify key predictors of ITN ownership and use, and the sub-groups that are at higher risk of low ITN coverage and use.
MethodsThe authors conducted a secondary analysis of data from the 2015 Nigeria Malaria Indicator Survey. Using the Chi square automatic interaction detector (CHAID) and multiple logistic regression analysis, the authors examined the key predictors of ITN ownership and use in the general population throughout Nigeria.
ResultsThe CHAID models identified region of the country as the best predictor of household ownership of at least one ITN and its use in the general population, with higher ownership and use observed in the northern regions. The odds of a household owning an ITN were five times greater in the North West region compared with the North Central region (odds ratio [OR] = 5.47, 95% confidence interval [CI] 4.46–6.72, p < 0.001). The odds of ITN use were two times greater for those living in the North West region compared with the North Central region (OR = 2.04, 95% CI 1.73–2.41, p < 0.001). Other significant predictors were household size, head of household education level, household wealth quintile, and place of residence. The CHAID gain index results identified households in the South West, North Central and South Central regions with low ITN ownership, and the general population in the South South, South East and North Central regions with low ITN use.
ConclusionsThis study reveals regional differences in ITN ownership and use in Nigeria. Therefore, the findings from this analysis provide evidence that could inform the NMEP to better target future campaign and routine distribution of ITNs, to achieve universal access and increased use by 2020 in Nigeria. |
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Data Review Meetings in Five President’s Malaria Initiative-Funded Countries
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Hai, T., & Yé, Y. |
2019 |
English |
|
RHIS, Health Information Systems, Data, Malaria control, Malaria, Routine Health Information Systems, HIS, Data Quality |
As malaria continues to pose a public health burden, malaria-endemic countries increasingly rely on routine health information systems, including surveillance systems, and other tools to optimize malaria prevention and treatment, particularly at the subnational level. These systems identify areas or population groups most affected by malaria and target resources to communities most in need (World Health Organization, 2017). Routine health information systems often face data quality issues that limit their use by service providers and decision makers to improve health services (Chilundo, et al., 2004). To address these issues, national malaria control programs (NMCPs) from several malaria-endemic countries began conducting data review meetings at subnational levels (e.g., counties; health facilities) to review and improve the data quality of these systems.
NMCPs conduct data review meetings with subnational levels to give feedback on the quality of malaria data from routine health information systems and use the data to improve service delivery. These data review meetings are held regularly—often quarterly or monthly. Subnational levels that participate in these meetings range from the lowest level, or the health facility, to intermediate levels, such as districts, provinces, or states, depending on the country’s health infrastructure. Other stakeholders, including partners, may participate in and provide input for these meetings. Information on how countries conduct data review meetings is limited and not publicly available. MEASURE Evaluation—a project funded by the United States Agency for International Development and the U.S. President’s Malaria Initiative (PMI)—conducted an assessment to understand better the processes and tools used in data review meetings in five malaria-endemic countries.
Access a related guide for conducting malaria data review meetings. |
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Rwanda’s Improved Services for Vulnerable Populations Project: Impact Evaluation: Summary of End Line Findings
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Fehringer, J., Lance, P., Ndirangu, K., Benson, A., Angeles, G., Parker, L., Foley, S., Gobin, S., Varela, V. C., Morris, L., Cannon, A., Iskarpatyoti, B. |
2019 |
English |
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Orphans and Vulnerable Children, Rwanda, Impact Evaluation, Evaluation, OVC |
The Improved Services for Vulnerable Populations (ISVP) project, known locally as Twiyubake, aims to improve the health, nutrition, and well-being of the populations on which the project focuses—orphans and vulnerable children (OVC), people living with HIV/AIDS, and economically vulnerable families—by strengthening their capacity in those domains. The ISVP is led by Global Communities (GC), along with international nongovernmental organizations (NGOs) and local civil society organizations. GC and its partners work within the Rwandan Ministries of Health (MOH) and Gender and Family Promotion framework. ISVP is supported by the United States Agency for International Development (USAID) Rwanda Mission.
The USAID- and United States President’s Emergency Plan for AIDS Relief-funded MEASURE Evaluation project—with support from USAID/Rwanda and in collaboration with Incisive Africa and the National University of Rwanda, College of Medicine and Health Sciences, School of Public Health—conducted an impact evaluation of the ISVP project. The evaluation sought to measure the impact of the interventions on the health, education, and economic well-being of vulnerable children and their families. This summary report shares end line impact, trend, and cost-effectiveness results using data from the 2017 and 2018 surveys, and costing data collected from ISVP. A full-length end line report on the evaluation is available, as well as a report from the initial data collection. |
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Designing Interventions for Data Demand and Use
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MEASURE Evaluation |
2019 |
English |
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Tools, DDU, Tool, Data Demand and Use, Data |
This "decision tree" helps users identify tools that will best meet their needs when designing interventions for data demand and use. |
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L’histoire de l’élaboration de l’annuaire statistique 2018 du Mali
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MEASURE Evaluation |
2019 |
French |
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Health Information Systems, DHIS 2, HIS, Mali, Information System, HIS strengthening |
Les statistiques sur la santé de la population provenant des données de bonne qualité d’un système d’information sanitaire (SIS) national peuvent, de manière fiable, suivre la couverture et les lacunes des services sanitaires, ainsi que la réussite ou les limitations des efforts du gouvernement pour améliorer la santé de sa population. L’utilisation de ces informations peut faciliter la prise de décisions pertinentes par rapport aux politiques sanitaires, suggérer aux programmes de réduire ou d’intensifier certaines actions et guider l’allocation des ressources souvent limitées.
Au Mali, toutefois, le SIS n’avait pas atteint son utilité maximale. Des annuaires statistiques qui auraient pu fournir les données compilées de l’année précédente n’étaient habituellement validés que durant le dernier trimestre de l’année suivante—neuf mois après la fin de l’année que ces données reflétaient. Ceci signifiait que l’annuaire n’était ni utile pour prendre promptement des décisions ni pour le développement de plans opérationnels. En effet, l’annuaire statistique de 2017 n’a jamais été élaboré car les ressources financières étaient indisponibles.
Tout ceci changea en 2019. Pour la première fois, le Mali réussit à produire des données sanitaires validées de l’année précédente avant le 30 avril grâce à l’effort collaboratif mené par le Ministère de la Santé et des Affaires Sociales (MS) avec l’appui de MEASURE Evaluation, un projet financé par l’Agence des Etats-Unis pour le développement international (USAID). MEASURE Evaluation aida à mobiliser des ressources financières, avec le concours de Population Services International (PSI) dans l’élaboration des annuaires statistiques à travers un atelier national de validation. |
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Routine Health Information Systems Curriculum
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MEASURE Evaluation |
2019 |
English |
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Health Information Systems, HIS strengthening, RHIS, Routine Health Information Systems, Curriculum |
To ensure the delivery of good-quality health services to the people who need them, the World Health Organization (WHO) promotes strengthening the six building blocks of a health system: (1) governance and policy; (2) service delivery; (3) human resources; (4) health commodities; (5) health financing; and (6) health information systems (HIS). A strong HIS makes it possible to track progress on improving the other five health-system building blocks and, ultimately, to monitor the achievement of the health-related Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs).
Strong HIS that produce reliable, timely, and good-quality data help health program managers to monitor, evaluate, and improve health system performance and make evidence-informed decisions. Since the 1990s, knowledge and understanding of the role of HIS development in global health systems have improved. Despite this, use of information for evidence-informed decision making—particularly data produced by routine health information systems (RHIS)—is still very weak in most low- and middle-income countries. RHIS generate data collected at public and private health facilities and institutions, as well as at community-level healthcare posts and clinics. These data—generated at regular intervals of a year or less—cover health status, health services, and health resources. Some of the root causes of poor RHIS performance are ill-defined information needs; poor data quality; issues surrounding the use of information; limited human resource capacity; and the centralization and fragmentation of HIS. There is a need to build the capacity of developing countries to collect, manage, and interpret health data. And this, in turn, will require training on an unprecedented scale.
One focus of this training needs to be RHIS—the most common source of information on health services management and programs. Relevant and well-structured courses on RHIS are few, and are not tailored to the needs of developing countries. To address this gap, leaders in the field of RHIS—the USAID-funded MEASURE Evaluation project, in the United States; WHO, in Switzerland; the Free University of Brussels/European Agency for Development and Health (AEDES), in Belgium; the University of Oslo, in Norway; the National Institute of Public Health (INSP), in Mexico; the University of Queensland, in Australia; and the Public Health Foundation of India (PHFI)—developed the curriculum presented here.
Using practical case studies, participants in this core RHIS course will learn how to improve the performance of RHIS, by producing reliable data to inform decisions at all levels of the health system. They will also come to understand the important contribution of information and communication technology.
The full collection is also available online at https://www.measureevaluation.org/our-work/routine-health-information-systems/rhis-curriculum |
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What Works to Strengthen the Systems that Inform Health Services?
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MEASURE Evaluation |
2019 |
English |
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Systems strengthening, HIS strengthening, HIS, Information systems, Health Systems Strengthening, SOCI, Toolkit, Health Information Systems |
The Health Information System (HIS) Stages of Continuous Improvement (SOCI) Toolkit helps countries holistically assess and prioritize investments to strengthen their HIS. An assessment using the toolkit measures current and desired HIS status, and it maps a path for a system to improve. Using the toolkit, countries can increase the availability of timely data so they can make decisions with more confidence that better health outcomes will follow.
The SOCI toolkit complements efforts by the World Health Organization to strengthen the capacity of countries’ HIS and workforce to monitor progress toward universal health coverage and the United Nations’ Sustainable Development Goals for health. This brief shares more. |
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Facilitating Surveillance, Monitoring, and Evaluation in Malaria-Endemic Countries: A Compendium for National Malaria Programs
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MEASURE Evaluation |
2019 |
English |
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Malaria Surveillance, ITN, Malaria, What's New, Monitoring, Evaluation, SME, Surveillance |
Concerted efforts in malaria control have led to a significant decrease in the disease burden globally and specifically in sub-Saharan Africa (SSA). Countries there have scaled up proven malaria interventions, such as insecticide-treated nets (ITNs), indoor residual spraying (IRS), diagnostic testing, prompt and effective treatment of malaria cases, and intermittent preventive treatment in pregnancy (IPTp). A strong surveillance, monitoring, and evaluation (SME) system is needed to measure progress and achievement to inform future efforts and investments. This compendium is designed for national malaria program (NMP) personnel, who need to learn SME skills quickly and apply them immediately to their work. It is also intended to be a valuable resource for implementing partners working on malaria projects, students taking an SME course in an MPH program, and scientists interested in malaria SME. Relevant documents and guidance materials are referred to throughout the document. Readers are encouraged either to read through the compendium in its entirety or reference specific chapters, as needed.
Chapter 1 introduces the concepts of malaria SME. Chapters 2 and 3 look at the global burden of malaria and global efforts to control malaria. Chapter 4 discusses the role of data for decision making. Chapters 5 through 8 describe the development of an SME plan and a plan’s components: frameworks, indicators, and data sources. Chapter 9 discusses malaria surveillance—a concept particularly important as malaria transmission decreases and NMPs need to track each case closely. Chapter 10 describes key methods used for evaluating NMPs and provides references to key indicators, data sources, and practical examples. Chapter 11 discusses the nuts and bolts of data quality, data management, and data analysis. Chapter 12 focuses on what is needed to present, interpret, and use data correctly. Finally, Chapter 13 presents ethical concerns to think about in malaria SME. |
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Experiences and Lessons Learned: Implementing the Most Significant Change Method
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MEASURE Evaluation |
2019 |
English |
|
|
The most significant change (MSC) method is a participatory qualitative approach to monitoring and evaluation (M&E) of complex programs. MEASURE Evaluation, which is funded by the United States Agency for International Development (USAID), has implemented this technique in evaluations of health programs. This brief summarizes our experience and shares lessons learned in the application of MSC. |
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Feasibility of home-based HIV counselling and testing and linking to HIV services among women delivering at home in Geita, Tanzania: a household longitudinal survey
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Juma Adinan, Bridgit Adamou, Caroline Amour, Aisa Shayo, Paulo Lino Kidayi, Levina Msuya |
2019 |
English |
|
HIV, PMTCT, HIV care, HIV counseling and testing, Tanzania, Women |
BackgroundSubstantial number of women who deliver at home (WDH) are not captured in prevention of mother-to-child transmission (PMTCT) services. This delays HIV infection detection that negatively impacts endeavours to fight the HIV pandemic and the health of mothers and children. The study objective was to determine the feasibility of home-based HIV testing and linking to care for HIV services among WDH in Geita District Council, Tanzania.
MethodsA longitudinal household survey was conducted. The study involved all mentally-able women who delivered within 2 years (WDTY) preceding the survey and their children under the age of two. The study was conducted in Geita District Council in Geita Region, Tanzania from June to July 2017. Geita is among the region with high HIV prevalence and proportion of women delivering at home.
ResultsOf the 993 women who participated in the study, 981 (98.8%) accepted household-based HIV counselling and testing (HBHCT) from the research team. HIV prevalence was 5.3% (52 women). HBHCT identified 26 (2.7%) new HIV infections; 23 (23.4%) were those tested negative at ANC and the remaining three (0.3%) were those who had no HIV test during the ANC visit. Among the 51 HIV+ women, 21 (40.4%) were enrolled in PMTCT services. Of the 32 HIV+ participants who delivered at home, eight (25.8%) were enrolled in the PMTCT compared to 100% (13/13) of the women who delivered at a health facility.
ConclusionHBHCT uptake was high. HBHCT detected new HIV infection among WDH as well as seroconversion among women with previously negative HIV tests. The study findings emphasize the importance of extending re-testing to women who breastfeed. HBHCT is feasible and can be used to improve PMTCT services among WDH. |
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Improving Nutrition through Community-Based Approaches in Bangladesh
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Gustavo Angeles, Shusmita Khan, Mizanur Rahman, Nitai Chakraborty, Sharad Bartaki, & Gabriela Escudero |
2019 |
English |
BANGLADESH |
nutrition, Impact Evaluation, Evaluation |
This document is the baseline survey report for the evaluation of the United States Agency for International Development (USAID)/Bangladesh’s Improving Nutrition through Community-Based Approaches (INCA) activity. The evaluation is being conducted by the USAID-funded MEASURE Evaluation project at the request of USAID/Bangladesh, and is part of a larger set of monitoring and evaluation activities for the INCA project. INCA is a three-year effort to improve the nutritional status of women and children under age two in rural areas of 11 priority upazilas in the districts of Bhola, Laxmipur, and Noakhali. Caritas Bangladesh and United Purpose are implementing the project. It started in May 2017 and will be active through April 2020. Total funding is approximately USD$4.4 million.
The 2017 baseline survey is the first of two surveys to assess the performance and impact of INCA. The overall objectives of this external evaluation are (1) to inform USAID and other stakeholders about project achievements in terms of changes in key outcomes and impact at the target population level; (2) to learn about the effectiveness of the specific INCA intervention for eventual replication in other areas of the country; and (3) to inform the follow-up of the project.
The evaluation is based on a prospective, quasi-experimental, difference-in-differences (DID) design to assess project impact using data collected through representative household surveys in INCA intervention and comparison areas in this baseline survey, and a follow-up end line survey that will be implemented by the end of 2019. MEASURE Evaluation also conducted a short community survey during this baseline assessment and will repeat it in the end line survey to assess changes in health and nutrition service availability. |
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Bangladesh Maternal Mortality and Health Care Survey (BMMS) 2016: Final Report
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|
2019 |
English |
BANGLADESH |
BMMS, Maternal Mortality, Family Planning, Bangladesh Maternal Mortality and Health Care Survey, Bangladesh, Maternal mortality, Maternal and child health, Maternal health |
The Government of Bangladesh is committed to achieving its targets for Millennium Development Goal (MDG) 5: reducing the maternal mortality ratio (MMR) to 143 deaths per 100,000 live births by 2015 and increasing skilled attendance at birth to 50 percent by 2015 (United Nations Development Program [UNDP], 2015). The decline in MMR between 2001 and 2010 indicates remarkable progress. This progress is linked to fertility reduction, access to qualified maternal health care, and overall care-seeking during the antenatal period and during delivery (UNDP, 2015).
By the end of the third sector program, a revised maternal health strategy and standard operating procedures (SOPs) for maternal and newborn health were finalized. With the MDGs phasing out and the Sustainable Development Goals (SDG) phasing in (United Nations, 2015), the Fourth Health, Population and Nutrition Sector Programme (4th HPNSP) 2017–2022 has set the target of reaching an MMR of 121 per 100,000 live births in 2022 (Ministry of Health and Family Welfare [MOHFW], 2017). Within this context, the Bangladesh Maternal Mortality and Health Care Survey (BMMS) 2016 was carried out to assess how well the country is progressing toward these targets.
The BMMS 2016 was an activity under the Operational Plan of Training, Research, and Development of the National Institute of Population Research and Training (NIPORT) under the Health, Population and Nutrition Sector Development Program (HPNSDP) 2011–2016 (MOHFW, 2014).
The major objectives of the BMMS 2016 were 1) to provide a nationally representative estimate of the maternal mortality ratio (MMR) for three years preceding the survey (approximately 2014–2016); 2) to identify the causes of maternal deaths, and 3) to assess maternal healthseeking behavior indicators and compare them with the BMMS 2010 to assess how well the country is progressing toward national and global targets for maternal health since the 2010 survey. |
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Implementation of the Electronic Management Information System in Bangladesh: Experience and Lessons Learned
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2019 |
English |
BANGLADESH |
Bangladesh, electronic management information system, eMIS, Electronic Health Records, Family Planning |
In 2015, the Ministry of Health and Family Welfare (MOHFW) of Bangladesh undertook an initiative to develop and implement an electronic management information system (eMIS) to benefit community health service delivery. The initiative was implemented through a collaborative partnership among the United States Agency for International Development (USAID)-funded MEASURE Evaluation project, the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), MaMoni Health Systems Strengthening (now MaMoni MNCSP), and SIAPS (now MTaPS) and was supported by USAID.
The intent of the initiative was to replace cumbersome paper instruments, reduce data burden for health providers, improve data-driven service delivery and quality of care, and make management of health and family planning activities at the grassroots level more efficient and effective. The resultant eMIS provides comprehensive and interlinked electronic tools for use by community-level healthcare and family planning workers (health assistants [HAs] and family welfare assistants [FWAs]), union-level service providers (family welfare visitors [FWVs], sub-assistant community medical officers [SACMOs]), their supervisors (health inspectors [HIs], assistant health inspectors [AHIs], and family planning inspectors [FPIs]), and their managers at the upazila level. Data from eMIS get linked to the mainstream reporting system for use by managers, planners, and policymakers at the directorate and ministerial levels.
All tools created for the eMIS were vetted and approved by the Directorate General of Family Planning (DGFP) and the Directorate General of Health Services (DGHS). The district and upazila managers had overall responsibility for implementing the eMIS, while technical assistance was provided by the eMIS initiative through software development, the provision of equipment, and capacity building. Systems for Improved Access to Pharmaceutical and Services (SIAPS), another USAID project (now MTaPS), contributed in the area of logistics management.
This document describes in detail the information technology (IT) structure of the eMIS and the experience of implementing it across several upazilas and districts in Bangladesh. |
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Principled Health Information Systems: Ethics Beyond Data Security
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James C. Thomas, Andreas Reis, and Victoria Fleming |
2019 |
English |
Global |
Data ethics, HIS strengthening, HIS, Data use, Data security |
Low- and middle-income countries are creating and expanding digital data systems to monitor their health trends and guide their health programs. The construction of these systems is often regarded as purely technical, with little consideration given to ethical dimensions. Data security is a notable exception.
To identify a broader range of ethical concerns, we carried out a scoping review of the literature for sets of principles to guide the development and use of digital information systems relevant to population health. The 11 sets we identified named a total of 34 principles, of which data security was one. We organized the principles into four stages of health information system (HIS) development: HIS design, data collection, data storage, and data use. To accommodate these principles, countries must first be aware of them and identify the staff responsible for addressing them in the design of their digital data systems. |
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MEASURE Evaluation’s Small Grants for Family Planning: Strengthening Research Capacity around the World
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Bridgit Adamou |
2019 |
English |
Global |
capacity strengthening, capacity building, RHIS, Small grants |
Increasing family planning (FP) uptake in low- and middle-income countries (LMICs) requires a strong routine health information system (RHIS) and sound data. In turn, good data management can increase stakeholder ownership and subsequently increase FP uptake. Unfortunately, several knowledge gaps disrupt this virtuous cycle: how to improve the quality of FP data, address barriers to integration of FP data in RHIS, and encourage analysis and use of the data to improve FP outcomes.
Small grants to in-country research groups promote capacity and provide financial support for FP research conducted in LMICs. The small-grants model creates sustainability by working through host-country institutions to research relevant FP issues, disseminate findings to local researchers, and help develop strategies for improvements.
MEASURE Evaluation, which is funded by the United States Agency for International Development (USAID), implemented a successful small grants program from 2014–2019. During that time, 19 subagreements were signed with research organizations from 11 USAID FP priority countries. This paper documents experience gained from the small grants program. |
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Capacity of Sierra Leone’s National Malaria Control Programme for Monitoring and Evaluation: Baseline Assessment
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MEASURE Evaluation |
2019 |
English |
SIERRA LEONE |
Assessment, Monitoring, Evaluation, Malaria control, Malaria Surveillance, capacity strengthening, Monitoring, capacity building, Malaria |
MEASURE Evaluation, which is funded by the United States Agency for International Development and the U.S. President’s Malaria Initiative, assessed the monitoring and evaluation (M&E) capacity of Sierra Leone's National Malaria Control Program (NMCP). This assessment had the following specific objectives:
To understand the current capacity of the malaria program to conduct M&E activities
To assess the capabilities of individual staff members to carry out M&E functions
To determine gaps in malaria M&E capacity
To identify and prioritize interventions to strengthen M&E
To develop a capacity-building plan
The assessment consisted of a desk review of existing documentation and primary data collection through group assessment and individual assessment tools described in the Monitoring and Evaluation Capacity Assessment Toolkit. |
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Guide for Assessing the Impact of a Total Market Approach to Family Planning Programs
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Dominique Meekers, Sarah C. Haynes |
2019 |
English |
Africa, Asia, Global |
Family Planning, Total market approach, Impact Evaluation, Asia, TMA, Reproductive Health, Africa, contraceptive prevalence rate, Contraception |
A Total Market Approach (TMA) is an approach to coordinating family planning (FP) services among health planners and facilities, commodity suppliers, and funders from governmental, commercial, and private or nongovernmental sectors. With a TMA, these sectors work together to increase the market for and the availability of FP services and methods. Despite the growing popularity of TMA, the development of TMA strategies and their implementation are still in their infancy. As yet, there are no studies or agreed-upon approaches to assess the medium- and long-term impact of TMA on FP outcomes. This guide will describe a step-by-step approach for evaluating the impact of FP programs that are TMA-based. As such, it is complementary to earlier guides for designing and monitoring TMA programs. The United States Agency for International Development (USAID)-funded MEASURE Evaluation project produced this guide to help TMA implementers to properly plan for evaluations of the medium- to long-term impact of their TMA programs, which will also enable them to contribute to the evidence base on the impact of TMA programs.
The objectives of this guide are fourfold: (1) to compare definitions of TMA currently being used by implementing organizations; (2) to identify objectives and components of current or past TMA implementations for FP; (3) to outline methods for an impact evaluation of TMA programs; and (4) to demonstrate how a TMA might be evaluated for impact using an example from Cambodia. To achieve these objectives, we conducted a systematic review of current and past implementations of TMA programs. To supplement the findings of this review, we followed up with authors and conducted key informant interviews with implementers and supporters of TMA projects. |
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Performance of Routine Information System Management Assessment in Burkina Faso (2018)
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Mohamed Rahim Kebe, Cyrille Kouassi, Issaka Sawadogo, Romain-Rolland Tohouri, Jeanne Chauffour |
2019 |
English |
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Burkina Faso, Routine Health Information Systems, RHIS, Information systems, PRISM, HISS, Performance of Routine Information System Management, Health Information Systems |
A Performance of Routine Information System Management (PRISM) evaluation was carried out in 2018 with PRISM tools newly revised by the United States Agency for International Development (USAID)-funded MEASURE Evaluation project. The assessment covered 64 health facilities (HFs); five hospitals; four districts; one health region; and the central level, represented by the Directorate for Sectoral Statistics (DSS).
Burkina Faso has a national health management information system (HMIS), known as ENDOS. The system is based on District Health Information Software, version 2 (DHIS2); integrates data from the entire health pyramid; and supports data entry, analysis, and interpretation. It also integrates all data quality indicators.
Given the 2018 PRISM findings, RHIS strengthening efforts should focus on supervision visits that are both regular and systematic at all levels of the health system, alongside a consensual development of reports and plans for the tracking and implementation of recommendations. Instilling a data use culture is paramount. Each level of the health system should be encouraged to produce periodic reports or feedback bulletins, and standard operating procedures (SOPs) and data entry tasks should be extended to service delivery points (SDPs).
This poster was presented and exhibited at the Global Digital Health Forum, December 9–11, 2019 in Bethesda, MD, USA.
A French version of this poster is available at https://www.measureevaluation.org/resources/publications/gr-19-101-fr/
The French-language report on the PRISM Evaluation in Burkina Faso is available at https://www.measureevaluation.org/resources/publications/tr-20-420-fr |
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The One Health Electronic Platform in Burkina Faso
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Mohamed Rahim Kebe, Cyrille Kouassi, Issaka Sawadogo, Romain-Rolland Tohouri, Jeanne Chauffour |
2019 |
English |
|
GHSA, Global Health Security Agenda, Global health, One Health, Global health security, Burkina Faso, Disease |
MEASURE Evaluation—funded by the United States Agency for International Development (USAID)—began its work in Burkina Faso in March 2018 under the global health security agenda. In the aftermath of Ebola and other highly pathogenic infectious diseases and zoonoses that have plagued West Africa, USAID’s priority was to strengthen the Burkina Faso electronic health information system to include routine data on priority zoonoses that could affect humans, animals, and the environment. A result of this multisectoral coalition is the One Health electronic platform, which provides real-time data on unusual events and suspected cases to central-level directorates, laboratories, and the Center for Health Emergency Response Operations (CORUS). The national One Health steering committee insures the piloting of the electronic platform. Furthermore, Burkina Faso’s electronic health management information system—ENDOS—is integrated with the One Health platform. The areas of intervention of the MEASURE Evaluation project are the Center-South and Central Plateau regions, where end users have been trained on the use of the One Health electronic platform and are able to notify suspected cases in real time.
This poster was presented and exhibited at the Global Digital Health Forum, December 9–11, 2019, in Bethesda, MD, USA.
A French version of this poster is available at https://www.measureevaluation.org/resources/publications/gr-19-100-fr/
A French-language SOP on managing the One Health health information system is available at https://www.measureevaluation.org/resources/publications/tr-20-416-fr
A French-language report on the One Health enterprise architecture is available at https://www.measureevaluation.org/resources/publications/tr-20-406-fr |
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Assessment of the Performance of Routine Health Information System Management in Mali (2018)
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Aminata Traoré, Madina Ba Kouyaté, Abdoulaye Maiga, Adama Ouatara, Issaka Dembélé, Alamako Doumbia, Ismael Dembélé, Ouassa Berthe, Mamoutou Diabaté, Mamadou Alimou Barry, Jeanne Chauffour |
2019 |
English |
|
Mali, HIS, Health Information Systems, PRISM, Routine Health Information Systems, RHIS, Assessment |
The 2018 Performance of Routine Information System Management (PRISM) assessment in Mali measured changes in the status of the routine health information system (RHIS) in the years since the last evaluation, in 2013.
The 2018 assessment revealed significant progress in data use, data quality assurance, and evidence of data analysis at the district, regional, and central levels of the RHIS. However, the assessment also revealed weaknesses at the health facility (HF) level. Above all, data accuracy is a concern at that level—and only there—because that’s where all data are entered now.
Other weaknesses that emerged from the 2018 assessment relate to difficulties in archiving the health management information system (HMIS) tools and reports, poor sharing of normative RHIS management documents, instability and frequent turnover of health personnel, and security challenges in the north and center of the country. These problems have seriously affected the performance of the sites surveyed, especially at the most peripheral level (i.e., community health centers, or CSCom), not only in terms of data quality but also in terms of data use.
The assessment’s results showed that the promotion of a culture of information alone is not enough to change habits. Closer monitoring is necessary to strengthen staff’s capacity to work with the tools available to them and willingness to use the tools on a regular basis. The results showed that critical management functions exist but need to be strengthened, so that they better support the RHIS at all levels of the health pyramid: HF, district, region, and central. The 2018 assessment also pointed to the need to sustain the progress that Mali’s RHIS has achieved.
This poster was presented and exhibited at the Global Digital Health Forum, December 9–11, 2019 in Bethesda, MD, USA. |
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Assessment of the Performance of Routine Health Information System Management in Côte d’Ivoire (2018)
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Edwige Bosso, Franck Olivier Ba-Gomis, Léontine Gnassou, Félix Mominé Malé, Aoua Camara Aka, Alain Koukou; Adama Sanogo Pongathié, Mamadou Alimou Barry, Jeanne Chauffour |
2019 |
English |
|
Health Information Systems, Cote d'Ivoire, PRISM, RHIS, Routine Health Information Systems |
After two consecutive routine health information system (RHIS) performance assessments were conducted in Côte d’Ivoire in 2008 and 2012, the Ministry of Health and Public Hygiene (MSHP) implemented massive strengthening interventions. To evaluate their impact, a Performance of Routine Information System Management (PRISM) assessment was conducted in September 2018, using PRISM tools newly revised by the United States Agency for International Development- and United States President’s Emergency Plan for AIDS Relief (PEPFAR)-funded MEASURE Evaluation project. It concerned 234 health facilities (HFs), 24 districts, 12 health regions, and the central level, represented by the Directorate for Information Technology and Health Data (DIIS). Results for HFs show that data quality at that peripheral level remains low but has improved—along with management procedures—at higher levels (districts, regions, and central government). Likewise, data use is low at the HF level, average for districts and regions, and high at central level. Given the 2018 PRISM findings, RHIS strengthening efforts should focus on the HF level—where data are initially produced and gathered—because the quality of those data heavily determines the overall quality of the MSHP’s health data.
This poster was presented and exhibited at the Global Digital Health Forum, December 9–11, 2019, in Bethesda, MD, USA. |
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The Global Evaluation and Monitoring Network for Health (GEMNet-Health): An Institutional Partnership as a Vehicle for Capacity Building
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Kulatilaka, H., & Smith, J. |
2019 |
English |
|
|
The purposes of this paper are to (1) describe how GEMNet-Health has served as a global resource for teaching and training, research, and technical assistance while also strengthening the capacity of individual network members; (2) document the technical activities and materials that have been produced to date; and (3) explore how GEMNet-Health has added to the global knowledge base on partnership networks as vehicles for capacity building in the field of public health. |
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Lessons in Health Information System Strengthening: What Worked in Mali
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MEASURE Evaluation |
2019 |
English |
|
|
Since 2010, MEASURE Evaluation has worked with the United States Agency for International Development (USAID) mission in Mali to strengthen national- and community-level health information systems (HIS), with an emphasis on malaria monitoring and evaluation (M&E).
In collaboration with units and programs of the Mali Ministry of Public Health and Hygiene (MOH), MEASURE Evaluation streamlined data collection systems and strengthened governance and leadership and HIS management, to improve quality and use of health data. MEASURE Evaluation supported HIS strengthening by partnering with the MOH and working closely with United States Government (USG) implementing partners (IPs) and non-USG partners. The project also built MOH capacity to use and manage the HIS and use HIS data for decision making, by customizing electronic platforms, providing necessary hardware and software, and training and mentoring MOH staff. These approaches yielded the following gains:
Nine parallel systems (on non-web-based platforms that were previously only available in electronic version above the site level) were combined into one streamlined system that is available at all levels of the health system on the DHIS 2 platform.
HIS management and governance tools, resources, and coordinating bodies were established that have standard operating procedures, guides, steering committees, and technical working groups.
More than 2,200 staff members and providers at all levels of the health system were trained in DHIS 2 use, data use, and other relevant topics through training of trainers and cascade trainings. Select staff at the central level were also trained in the customization of DHIS 2.
One hundred percent of regional hospitals, 100 percent of district health facilities, and 98 percent of community health facilities reported in DHIS 2.
Mechanisms for data monitoring (e.g., data review meetings, data competitions, a quarterly health management information system bulletin, and supportive supervision visits) were established.
These accomplishments can be quantified, but it is also important to understand HIS users’ experiences and the context in which the system was strengthened and improved. To do so, in 2019, we conducted stakeholder interviews to capture perceptions and experiences of MOH staff who interact with Mali’s HIS. An analysis of these interviews yielded common themes of what worked in HIS strengthening in Mali. The objective of this document is to summarize lessons learned and highlight effective HIS strengthening approaches and interventions and their outcomes. |
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Indicators on the Status of a Health Information System
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MEASURE Evaluation |
2019 |
English |
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HIS, Health Information Systems, Indicators, HIS strengthening |
In an effort to document what works to strengthen health information systems (HIS), MEASURE Evaluation developed a validated, standard set of metrics and description of methods for use in HIS evaluation and strengthening.
Learn more here. |
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Health Information Systems Infographics
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MEASURE Evaluation |
2019 |
English |
|
HIS, Health Information Systems |
Health systems rely on health data so policy makers can understand what health issues people are facing in a given country, what health programs are working, what resources are available, and what changes should be made to optimize health. The systems that produce this data are as complex as the overall health systems they support; and they comprise data collected from the smallest health clinic to the national health ministry. Further, to be of any use in improving health, data collection is not enough. Someone must check their quality; someone must aggregate data from many sources; someone must analyze what the data are saying. Then, someone must put this learning to good use. The operation and interaction that occur daily within a health information system (HIS) is sometimes easier to grasp in visual terms. This collection of graphics tells part of the story of how an HIS performs and what it can contribute to health improvements. |
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A Synthesis Collection: How HIS Strengthening leads to improved health systems in five areas
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MEASURE Evaluation |
2019 |
English |
|
HIS, HIS strengthening, Health Information Systems |
The purpose of a health information system (HIS) is to get data into the hands of decision makers at all levels of the health system to improve the availability and quality of care. According to the HIS Strengthening Model, HIS strengthening interventions improve HIS performance, which leads to health systems better suited to meet the needs of the population.
For future planning, it’s important that the effects of specific interventions to improve HIS are well-documented along with impacts on health systems. These syntheses are discrete studies of packages of HIS interventions and their effect on improving health systems. For example, one synthesis documents how streamlining health systems indicators for M&E reduces redundancies in data collection, thereby easing the data collection burden on people whose main job is to provide high-quality healthcare. Another examines how functioning community-based referral systems can improve linkages to care in rural areas, improving continuity of care for orphans and vulnerable children. And another focuses on how strengthening feedback loops and data quality checks improves detection of infectious disease outbreaks, such as Ebola. These examples in this collection of syntheses makes a case for ongoing investments in evidence-based interventions. |
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Health Information Systems Interventions
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MEASURE Evaluation |
2019 |
English |
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HISSM, Intervention, Health Information Systems, HIS |
From 2014-202, MEASURE Evaluation supported more than 20 countries in implementing programs to improve health information systems. This included programs to allow different systems to exchange data (interoperability), training staff in data analysis, and improving methods to validate data. What we learned in this work provides a foundation for documenting successful models for strengthening health information systems. In the 11 countries in which USAID investments were highest, MEASURE Evaluation documented the project’s interventions and mapped them to the Health Information Systems Strengthening Model (HISSM). |
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Health Information Systems Assessment Tools
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MEASURE Evaluation |
2019 |
English |
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Tools, HIS, Assessment, Health Information Systems |
This spreadsheet was created to catalog and serve as a guide to several tools that serve to assess different aspects of health information systems (HIS). This spreadsheet describes each tool’s purpose, its prescribed uses, and the area of HIS that it is designed to assess. The spreadsheet contains a variety of publicly available tools. These tools were selected by performing a search of available HIS assessment tools and consulting with experts in the field. This spreadsheet was last updated in 2019. |
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Evaluation of Health Information System Interventions in Targeted Countries
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Elizabeth Millar, Eva Silvestre, Heather Davis, Francine Wood |
2019 |
English |
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HISSM, Health Information Systems, Intervention, HIS, Evaluation |
MEASURE Evaluation Phase IV implemented several studies during Phase IV of the project (2014-2020) to document the factors and conditions for improving health information system (HIS) performance (defined as data quality and data use). From improvements in staff capacity, to conducting monitoring and evaluation, to interventions to help reach global goals that combat HIV/AIDS, these studies examine interventions across the Health Information Systems Strengthening Model (HISSM). |
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Health Information Systems Learning Agenda
|
MEASURE Evaluation |
2019 |
English |
|
HIS, Learning Agenda, Health Information Systems |
The primary function of national health information systems (HIS) is to collect and analyze data to help providers and policymakers improve patient care, identify a population’s most important health needs, and decide how to address those needs. Another function of HIS is to make data available for accountability in health initiatives and to provide evidence of a country’s progress toward global Sustainable Development Goals. A dividend of work to improve the reliability of an HIS is that a country and its partners can then also use the data that the HIS generates to monitor and evaluate the performance of health programs. From this analysis, best practices for the conduct of those programs often come to light. The effort required for an HIS to satisfy all these demands is a challenge in countries where human, financial, and technological resources are scarce. From 2014-2020, MEASURE Evaluation Phase IV worked at the intersection of a country’s need for reliable health information and the capacity of the HIS there to generate it. During this Phase, MEASURE Evaluation had a mandate to strengthen HIS and, moreover, to share what we are learning as we go. MEASURE Evaluation's “learning agenda” sought to answer three fundamental questions:
What are the factors and conditions of HIS performance progress?
What are the stages of progression to a strong HIS and how are they measured?
What are the characteristics of a strong HIS?
Answers to these questions are described in this collection. |
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Health Information Systems Interoperability Maturity Toolkit
|
MEASURE Evaluation |
2019 |
English |
|
HIS, Interoperability, Health Information Systems |
This toolkit identifies major components of interoperability for health information systems (HIS) and lays out a path to meet goals in leadership and governance, human resources, and information technology to support digital health. The kit contains three main pieces: a maturity model, an assessment tool, and a users’ guide. It also offers a complete list of the references consulted in a literature review that was conducted as part of the toolkit’s development. The HIS interoperability maturity model identifies the major components of HIS interoperability and lays out an organization’s growth pathway through these components. Countries can use the assessment tool to determine their HIS interoperability maturity level systematically. Using the assessment results, countries can create a path toward strengthening their HIS interoperability and building resilient systems. This is Version 1.0 of the toolkit published in January 2019 with lessons learned from early adoption by Ghana and Uganda. |
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Lessons Learned in Health Information System Strengthening: What Worked in the Democratic Republic of the Congo
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Lavanya Gupta, Scott McKeown, Johanna Karemere, Olivier Kakesa, Ramine Bahrambegi |
2019 |
English |
|
HISSM, DRC, HIS, HISS, Democratic Republic of Congo, Data quality, HIS strengthening, Health Information Systems |
MEASURE Evaluation, a project funded by the United States Agency for International Development (USAID), works in 50 low- and middle-income countries, implementing 300 health system strengthening activities to generate high-quality health information.
Since 2014, MEASURE Evaluation has helped the National Malaria Control Program (NMCP) of the Democratic Republic of the Congo (DRC) streamline and improve routine malaria data collection, reporting, management, and use at all levels of its health system. The DRC previously reported malaria data in an Access-based system that limited the NMCP’s ability to collect and analyze them.
We provided technical and financial support and collaborated with the NMCP to achieve the following:
Supported the rollout of the electronic health information platform—District Health Information Software, version 2 (DHIS2)—at all levels of the health system: in all 178 health zones and 77 health facilities (designated as Centers of Excellence [COEs]) in 9 priority provinces of the U.S. President’s Malaria Initiative (PMI)
Integrated malaria indicators in DHIS2
Trained more than 400 staff in monitoring and evaluation (M&E), data collection, analysis, and use
Developed health information system (HIS) management resources and implemented data-review and data-quality-check mechanisms
Created and convened technical working groups (TWGs) to manage M&E and malaria intervention activities at the national and provincial level
We documented the outcomes of our work with the NMCP and identified effective HIS-strengthening interventions to improve the quality of health data, including routine malaria data. This poster, presented at the 2019 annual meeting of the American Society of Tropical Medicine and Hygiene (ASTMH), shares more. |
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Improved Reporting of Performance Data Supports Health Decision Making in Bangladesh
|
MEASURE Evaluation |
2019 |
English |
|
M&E, Bangladesh, Data, Data Quality, Monitoring, Evaluation |
MEASURE Evaluation contributed to institutionalizing regular health-sector performance reviews by the Ministry of Health and Family Welfare of Bangladesh and helped promote data use for program and policy decisions. This brief shares more. |
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Snowball Effect of Data Competition in Mali
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MEASURE Evaluation |
2019 |
English |
|
Data, Mali, Health Facilities, Health data, Health System, Routine data, DHIS 2, Data Quality |
In 2018, Mali held a friendly competition among health facilities to motivate all levels of the health system to improve the quality of health data and to make strategic use of those data. The first competition came as Mali had successfully adopted and deployed the District Health Information Software, version 2 (DHIS2) platform for management of health data across the health system.
What began in 2018 as a data quality incentive designed by the Mali Ministry of Health (MOH) has won enthusiastic adoption by health providers across the health system. Not only has it attracted more competitors (from 2018 to the second competition in 2019), it also has demonstrably improved the quality of health data across the board. The MOH intends to institutionalize the competition, has included it in its priority health management information system (HMIS) activities, and is planning a third competition in 2020.
In 2018, the competition rewarded eight health facilities (five community health centers [CSCom], two health districts [CSRef], and one hospital) for improving their data quality from 2017 to 2018. In 2019, the MOH rewarded 16 health facilities (10 CSCom, four CSRef, and two hospitals). Achievement in meeting the criteria for judging data quality (100% data completeness and 80% timeliness) improved significantly from the 2018 competition to the 2019 competition and the number of facilities competing grew from 65 in 2018 to 308 in 2019 (an almost fivefold increase). This brief shares more. |
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Preventing HIV among Guyana’s Key Populations: Guidelines
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MEASURE Evaluation |
2019 |
English |
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HIV, Guyana, Key Populations, KP, HIV/AIDS, HIV prevention |
These guidelines are designed to outline the public health response to HIV among key populations (KPs) in Guyana. The specific objectives are to:
Define the populations of interest
Define the combination prevention package for KPs
Update guidance on the operationalization of interventions
Define programme monitoring and evaluation (M&E) for KP prevention activities
The focus of these guidelines is on HIV prevention for KPs and priority populations. To meet the HIVision 2020 goal of eliminating HIV in Guyana, a multi-pronged approach that goes beyond prevention will be required. These guidelines highlight the approaches needed before care and treatment are given and linking with treatment for people who have HIV. |
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Family Planning Indicators Assessment and Data Quality Audit in Selected Health Facilities across Nigeria
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Olukemi Olugbade, Oluwayemisi Ishola, Olusegun Ricketts, Shakir Balogun, and Moreen Kamateeka |
2019 |
English |
Africa, NIGERIA |
Data Quality Audit, Indicators, Family Planning, Data quality assessment, DQA, Data Quality |
Promoting family planning (FP) is an important strategy for preventing high-risk births and infant deaths, reducing unplanned pregnancies and unsafe abortions, and decreasing the burden of infant and maternal mortality globally. To be successful, FP programs must use information systems to accurately track FP use and trends. Although use of District Health Information Software, version 2 (DHIS2) to manage and aggregate health information is becoming the norm across Nigeria, issues still confound the operationalization, availability, accuracy, consistency, timeliness, completeness, and integrity of FP data at health facilities and in DHIS2 by extension. The purpose of this study was to assess FP data quality in select health facilities in Nigeria.
The study used a mixed-methods approach. A total of 114 (103 public and 11 private) health facilities in six states (Bauchi, Delta, Enugu, Kano, Osun, and Nasarawa) were selected across Nigeria. |
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Engendering Evidence-Based Policy for Young People's Reproductive Health in India
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Sunita Nigam, Avantika Singh, and Vishakha Singh |
2019 |
English |
INDIA |
adolescent, behavior, Reproductive Health, attitude |
Young people, defined by the World Health Organization as people 10–24 years old, account for more than a quarter of India’s population (2014). The country has the opportunity to harvest economic and social gains from its young, working-age population if it invests in human capital development and overcomes such challenges as poor education and healthcare, gender discrimination, and lack of access to adolescent and youth reproductive health care.
This paper presents evidence for policymakers on the strengths and weaknesses of the health policy framework; service delivery mechanisms; and knowledge, attitudes, and practices of 10- to 24-year-olds related to reproductive health in India.
The research incorporated exploratory and descriptive approaches, using qualitative and quantitative data from primary and secondary sources. |
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Understanding “the Last 90” in Guyana’s HIV Treatment Cascade: A Facility-Based Assessment of the Viral Loads of Key Populations
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Reynolds, Z. |
2019 |
English |
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ART, HIV, Guyana, Key Populations, KP, HIV/AIDS, HIV care, HIV prevention |
According to the National Guidelines for Management of HIV-Infected and HIV-Exposed Adults and Children (Ministry of Public Health [MOPH], 2015), viral load testing began in Guyana in 2009. It is indicated for adults at six months after initiation of antiretroviral therapy (ART) and every six to 12 months thereafter for clients who are virally suppressed. This supports what the midterm evaluation of Guyana’s HIVision 2020 reports is the ultimate goal of the HIV treatment cascade (the steps a client takes from testing through viral suppression): “viral load suppression” (MOPH, 2017). One strategy outlined in the document is to “increase the proportion of people with HIV (on HAART [highly active antiretroviral therapy]) who have viral load suppression to 90% by 2020.” That strategy is in line with other global goals to ensure that 90 percent of people enrolled in care have a viral load that is below standard limits or even undetectable. Implementing the strategy in Guyana is particularly important in the era of treatment as prevention, to ensure that the virus is undetectable in clients and therefore untransmittable.
The most recent HIV treatment cascade analysis for Guyana, from 2016, reports that 68 percent of people on ART are virally suppressed (MOPH, 2017). These cascade data come from routine reports from health facilities. Although the information is valuable, it is incomplete, because that same cascade reports that 83 percent of clients on ART have a current viral load test.
MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—realized that filling this gap would be essential to a full understanding of the HIV cascade in Guyana. If the sample of clients who were missing VL measures could be assumed to represent all clients missing VL measures, then we could leverage estimates of viral suppression from a sample of clients who were missing VL data to obtain a more accurate, representative estimate of viral suppression among a larger population in the care and treatment program. Answering these questions would contribute to USAID’s goal of controlling the HIV/AIDS epidemic and the global 90-90-90 targets that PEPFAR has adopted.
Prior studies in Guyana have shown that the country’s key populations (KPs)—female sex workers (FSWs), men who have sex with men (MSM), and transgender women—face greater barriers to accessing services than the general population does. HIVision 2020 called for the country to pay special attention to KPs (MOPH, 2013). Not only are they engaged in higher-risk activities (National AIDS Programme Secretariat [NAPS] & MEASURE Evaluation, 2014), but also they face greater stigma than other HIV-positive clients. To better understand KPs’ engagement in HIV services and how they compare to non-KP clients, we chose to focus on KPs for this study. NAPS wanted to understand how KPs are progressing along the HIV cascade to viral load suppression.
Our purpose in assessing viral loads among KPs was to estimate the level of HIV viral suppression among KP members who were enrolled in care. We designed the study to (1) quantify the missing viral load data for KPs, and (2) sample people who were missing viral load data to estimate viral suppression for those populations. The Society Against Sexual Orientation Discrimination facilitated the two stages of the study with technical oversight by MEASURE Evaluation in close collaboration with NAPS. The study took place in early 2019 at five health facilities in Georgetown, Guyana.
The results of the study will help inform MOPH programs both for HIV-positive clients who are KP members and those who are not. It will illuminate gaps in data and show how viral load estimation can be improved at the health facility and national levels. |
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Monthly Malaria Bulletins Contribute to Improving Data Use for Malaria Control in Mali
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MEASURE Evaluation |
2019 |
English |
|
Data, Mali, Malaria control, Malaria, Data use |
As a close partner of the National Malaria Control Program (NMCP) in Mali for the past 10 years, MEASURE Evaluation has supported malaria control and prevention activities that have made a difference in collective efforts to combat the epidemic. Together, MEASURE Evaluation and the NMCP have improved the quality of malaria data available, in part by strengthening the capacity of NMCP staff in monitoring and evaluation.
Although the disease is preventable and curable, consistent and high-quality malaria data to guide program implementation and to measure achievements are in short supply. In response to the acute need for reliable malaria data at national and subnational levels, the NMCP, with the support of MEASURE Evaluation, created a monthly malaria bulletin to provide nationwide updates. This brief describes how the bulletin is helping improve data use for malaria control. |
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Mise en oeuvre d'une surveillance fondée sur les événements au Burkina Faso. Recours à l'approche « Une Seule Santé »
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Connolly, A.M., Sawadogo, I., Geers, E., & Eugene, M.Y.B. |
2019 |
French |
Africa, BURKINA FASO |
Burkina Faso, Global health security, One Health, GHSA, Surveillance, Disease |
De récentes flambées du syndrome respiratoire du Moyen-Orient, de la grippe aviaire et de la maladie à virus Ebola ont attiré l'attention au niveau local, national, régional et international quant aux capacités des pays à détecter les problèmes de santé publique émergents et à y remédier efficacement. Bon nombre de ces foyers ont impliqué des maladies zoonotiques, soit celles qui se transmettent de l'animal à l'homme.
Ces flambées ont amené les pays à développer de nouvelles stratégies d'intervention par le biais du Programme mondial de sécurité sanitaire (GHSA) lancé en 2014. Le GHSA a pour but de renforcer les compétences mondiales et nationales pour prévenir, détecter et surmonter les menaces de maladies infectieuses, à l'aide d'une approche multilatérale et multisectorielle. MEASURE Evaluation, un projet financé par l'Agence des États-Unis pour le développement international (USAID), travaille au Burkina Faso depuis mars 2018 en partenariat avec le Ministère des Ressources animales et halieutiques (MRAH), le Ministère de la Santé (MS) et le Ministère de l'Environnement, de l'Économie verte et du Changement climatique (MEEVCC) dans le but de renforcer la capacité du pays à détecter les maladies à potentiel épidémique et épizootique et à offrir une riposte en recourant à l'approche « Une Seule Santé ». Une Seule Santé est une approche collaborative, multisectorielle et transdisciplinaire qui fonctionne à l'échelle locale, régionale, nationale et internationale pour suivre et contrôler les menaces en matière de santé publique et comprendre comment certaines maladies se transmettent chez les personnes, les animaux et leur environnement commun (Une Seule Santé).
Au Burkina Faso, chacun des ministères responsables de la santé humaine et animale et de l'environnement possède un système de surveillance épidémiologique. Au sein du Ministère de la Santé, le système de surveillance et de riposte épidémiologique intégré (SSREI) veille à la surveillance des maladies, notamment celles à potentiel épidémique. Au niveau du MRAH, la surveillance des épizooties et la riposte y étant donnée sont coordonnées par le Réseau de surveillance épidémiologique des maladies animales (RESUREP). Le MEEVCC ne dispose pas d'un système de surveillance. Néanmoins, pour suivre les animaux vivant dans les parcs et les zones protégées, des formulaires de suivi écologique ont été instaurés afin de recueillir des renseignements sur les animaux sauvages, notamment concernant leur santé.
Depuis 2017, MEASURE Evaluation s'allie à d'autres partenaires pour aider le Burkina Faso à améliorer son système de surveillance dans le cadre de l'objectif global du projet visant à appuyer le gouvernement dans ses efforts de renforcement du système d'information sanitaire (SIS). Les objectifs spécifiques de MEASURE Evaluation concernant le renforcement du SIS sont les suivants : (1) aider le gouvernement à renforcer son système de détection précoce en développant un système SFE à base communautaire pour les maladies à potentiel épidémique et épizootique ; (2) renforcer la collecte, l'analyse et l'utilisation des données sanitaires de routine ; (3) accroître la capacité du pays à gérer le SIS ; et (4) développer une plateforme électronique facilitant l'identification, la notification et le suivi de toutes les maladies sous surveillance par le Ministère des Ressources animales et le Ministère de la Santé.
MEASURE Evaluation a offert son assistance au niveau national dans le développement d'une approche Une Seule Santé pour la SFE adaptée au contexte du Burkina Faso. Pour tester cette approche, la région Centre-Sud a été choisie comme zone d'intervention. Cette région comprend trois provinces : Zoundwéogo, Nahouri et Bazèga. Nahouri, dont la capitale est Po, a été choisie pour le test pilote des activités SFE recourant à l'approche Une Seule Santé. |
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Strengthening Health Information Systems in Nigeria—Building an OVC Information System
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MEASURE Evaluation |
2019 |
English |
NIGERIA |
Nigeria, HIS, HISS, HIS strengthening, Health Systems Strengthening, Health data |
MEASURE Evaluation, which is funded by the United States Agency for International Development, has been working in Nigeria since 2005 to improve the availability of high-quality data to support decision making at all levels of the health system. This work fulfilled two main objectives:
1) Support the Department of Health Planning, Research and Statistics of Nigeria’s Federal Ministry of Health to develop a master facility list to improve data quality and ultimately lead to better coordination of health services
2) Work with the Federal Ministry of Women’s Affairs and Social Development to develop a directory of orphans and vulnerable children (OVC) service providers and build capacity to use OVC data collection tools for the National OVC Management Information System (NOMIS)
We have mapped the HIS strengthening interventions to support each objective in two separate fact sheets. Each fact sheet superimposes on the HISSM depictions of MEASURE Evaluation’s activities in the enabling environment and information generation areas to support HIS performance in meeting the specific objective. By displaying key interventions across the HISSM, we see their strategic interaction, and how this combination of interventions works together to strengthen data quality and data use at all levels of the health system.
This fact sheet documents MEASURE Evaluation's work to support development of a directory of orphans and vulnerable children (OVC) service providers and capacity building to use OVC data collection tools for the National OVC Management Information System (NOMIS).
Follow the link to view the related document Strengthening Health Information Systems in Nigeria—Developing a Master Facility List
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La surveillance à base communautaire des maladies et zoonoses prioritaires au Sénégal: Proposition d’un modèle dans une approche “Une Seule Santé”
|
|
2019 |
French |
Africa, SENEGAL |
Global health security, Surveillance, GHSA, Senegal, One Health, Community, Africa, Community-Based Surveillance, Global Health Security Agenda |
Une activité de l’Agenda de Sécurité Sanitaire Mondiale (ASSM) visant à la surveillance à base communautaire (SBC) des zoonoses, dans le cadre de l’approche « Une Seule Santé », a été lancée au Sénégal et mise en oeuvre de septembre 2017 à juin 2019 avec l’appui de l’Agence des États-Unis pour le Développement International (USAID). Cette activité faisait partie de la phase IV du projet MEASURE Evaluation, soutenu par l’USAID, dans le cadre du paquet d’action 2 de l’ASSM. Cette activité concernait particulièrement la SBC des maladies prioritaires au Sénégal, dont huit maladies infectieuses humaines et six zoonoses. Il s’agit de la mise en oeuvre de la SBC dans quatre districts pilotes (Tambacounda, Koumpentoum, Podor et Pété), situés dans deux régions du Sénégal.
La mise en oeuvre de la phase pilote de la SBC s’est accomplie à travers la formation des agents communautaires à la détection de ces maladies dès qu’elles surviennent dans leur communauté respective et envoyer des messages texte (SMS) au poste de santé ou vétérinaire le plus proche. L’objectif de cette activité était d’obtenir une détection et une intervention précoce afin de limiter la transmission à large échelle des maladies concernées.
L’expérience acquise au cours de cette phase pilote nous permet de faire des recommandations en vue d’élaborer un modèle de surveillance à base communautaire suivant l’approche « Une Seule Santé » pour le Sénégal et éventuellement pour d’autres pays. |
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Monitoring the Outcomes of Orphans and Vulnerable Children Programs in Kenya: Findings from 2016–2018 Panel Data: Walter Reed Program/Henry M. Jackson Foundation Medical Research International
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Irit Sinai, Clement O. Odour, Dennis Akeyo, Cheikh M. Faye, Damazo T. Kadengye, Nelson Langat |
2019 |
English |
KENYA |
OVC programs, Indicators, OVC, Orphans and vulnerable children, Monitoring, PEPFAR |
This report presents findings from a panel study of beneficiary households receiving services from the Walter Reed Program/Henry M. Jackson Foundation Medical Research International (WRP/HJFMRI) project. WRP/HJFMRI is a United States President’s Emergency Plan for AIDS Relief (PEPFAR) project funded through the United States Department of Defense. The WRP/HJFMRI orphans and vulnerable children (OVC) program began in 2004 and operates in Bomet, Kericho, and Narok Counties in the Rift Valley region of Kenya. Key OVC program areas and intervention components of the project are education support, household economic strengthening, healthcare and nutrition, shelter, psychosocial care and support, and child protection services. This study was undertaken by MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID) and PEPFAR—at the request of PEPFAR and the USAID Kenya mission. This 2016–2018 panel study was designed to meet PEPFAR’s monitoring, evaluation, and reporting requirements, which include standard indicators. PEPFAR encourages the collection of data on these indicators every two years.
The panel study compared results from Round 1 (2016) and Round 2 (2018, with the same households). It measured changes in the well-being of OVC beneficiaries over the two years using nine essential survey indicators required by PEPFAR and two supplemental indicators.
Find other materials from Round 2 are here.
Materials related to Round 1 can be found here. |
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Monitoring the Outcomes of Orphans and Vulnerable Children Programs in Kenya: Findings from a 2018 Survey of Recently Enrolled Beneficiaries: MWENDO Project
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Irit Sinai, Clement O. Odour, Dennis Akeyo, Cheikh M. Faye, Damazo T. Kadengye, Nelson Langat |
2019 |
English |
KENYA |
PEPFAR, Monitoring, OVC programs, Indicators, OVC, Orphans and vulnerable children |
This report presents findings from a cross-sectional study of beneficiary households receiving services from Making Well-Informed Efforts to Nurture Disadvantaged Orphans & Vulnerable Children (MWENDO) in western Kenya, in areas not served by the AIDS, Population and Health Integrated Assistance Plus Program, Western Kenya, known as APHIAplus, in 2016. MWENDO is a five-year project funded by the United States Agency for International Development (USAID) and implemented by Catholic Relief Services that provides an umbrella of services to orphans and vulnerable children (OVC). Beneficiaries included in this study started receiving services from MWENDO in the past two years, and were not among the households that participated in a similar survey Round 1 conducted in 2016.
This study was undertaken by MEASURE Evaluation—a project funded by USAID and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—at the request of PEPFAR and the USAID Kenya mission. This 2018 cross-sectional study was designed to meet PEPFAR’s reporting requirements, which involves the collection of data for nine PEPFAR monitoring, evaluation and reporting OVC essential survey indicators. Two additional indicators were included. This was a cross-sectional study of 99 beneficiary households, randomly selected from a list of beneficiary households in the study areas.
Although the survey was not designed to assess the effectiveness of the MWENDO OVC project, it is useful for identifying potential needs and program gaps. It complements a panel study of MWENDO OVC beneficiaries, available here.
Find other materials from Round 2 are here.
Materials related to Round 1 can be found here. |
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Monitoring the Outcomes of Orphans and Vulnerable Children Programs in Kenya: Findings from 2016–2018 Panel Data: Timiza 90
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Irit Sinai, Clement O. Odour, Dennis Akeyo, Cheikh M. Faye, Damazo T. Kadengye, Nelson Langat |
2019 |
English |
KENYA |
OVC programs, Orphans and Vulnerable Children, PEPFAR, Indicators, Monitoring, OVC |
This report presents findings from a panel study of beneficiary households receiving services from the Timiza 90 project in Western Kenya. Timiza 90 is a United States President’s Emergency Plan for AIDS Relief (PEPFAR) project funded through the United States Centers for Disease Control and Prevention and is implemented by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) Kenya. Project activities are being implemented in Kisumu, Siaya, and Homa Bay Counties in Western Kenya through five local implementing partners.
This study was undertaken by MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID) and PEPFAR—at the request of PEPFAR and the USAID Kenya mission. This 2018–2018 panel study was designed to meet PEPFAR’s monitoring, evaluation, and reporting requirements, which include standard indicators. PEPFAR encourages the collection of data on these indicators every two years.
This panel study compared results from Round 1 (2016) and Round 2 (2018, with the same households). It measured changes in the well-being of OVC beneficiaries over the two years using nine essential survey indicators required by PEPFAR and two supplemental indicators.
Find other materials from Round 2 are here.
Materials related to Round 1 can be found here. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Kenya: Comparison of 2016 and 2018 Findings from the Panel Study of the Walter Reed Program/Henry Jackson Foundation Medical Research International Project
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MEASURE Evaluation |
2019 |
English |
KENYA |
Orphans and vulnerable children, Monitoring, PEPFAR, Indicators, OVC, OVC programs |
This panel study was designed to assess changes in outcomes of programs for orphans and vulnerable children (OVC), using the standardized essential survey indicators launched by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) in 2014, as part of its monitoring, evaluation, and reporting guidance. MEASURE Evaluation, funded by the United States Agency for International Development and PEPFAR, collected data from beneficiaries of the Walter Reed Program/Henry M. Jackson Foundation Medical Research International (WRP/HJFMRI) project. In Round 1 of this panel study, conducted in late 2016, 353 caregivers of OVC beneficiaries enrolled in WRP/HJFMRI OVC programs were interviewed. Of that group, 329 (93.2%) were interviewed again in Round 2, conducted in 2018. The caregivers were asked about themselves, their households, and all children under age 18 who were under their care (1,136 children in Round 1, and 1,026 in Round 2).
Find other materials from Round 2 are here.
Materials related to Round 1 can be found here. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Kenya: Comparison of 2016 and 2018 Findings from the Timiza 90 Panel Study
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MEASURE Evaluation |
2019 |
English |
KENYA |
PEPFAR, Monitoring, OVC programs, Indicators, OVC, Orphans and vulnerable children |
This panel study was designed to assess changes in outcomes of programs for orphans and vulnerable children (OVC), using the standardized essential survey indicators launched by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) in 2014, as part of its monitoring, evaluation, and reporting guidance. MEASURE Evaluation, funded by the United States Agency for International Development and PEPFAR, collected data from beneficiaries of the Timiza 90 OVC programs in western Kenya. In Round 1 of this panel study, conducted in late 2016, 209 caregivers of OVC beneficiaries enrolled in Timiza 90 were interviewed. Of that group, 184 (88%) were interviewed again in Round 2, conducted in 2018. The caregivers were asked about themselves, their households, and all children under age 18 who were under their care (718 children in Round 1 and 654 in Round 2).
Find other materials from Round 2 are here.
Materials related to Round 1 can be found here. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Kenya: Comparison of 2016 and 2018 Findings from the MWENDO Cross-Sectional Study
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MEASURE Evaluation |
2019 |
English |
KENYA |
Orphans and Vulnerable Children, PEPFAR, Indicators, Monitoring, OVC |
This cross-sectional survey was designed to assess the current status of programs for orphans and vulnerable children (OVC), using the standardized essential survey indicators (ESI) launched by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) in2014, as part of its monitoring, evaluation, and reporting guidance. PEPFAR requires ESI data to be collected every two years. MEASURE Evaluation, funded by the United States Agency for International Development (USAID) and PEPFAR, collected data from beneficiaries of the USAID-funded APHIAplus and Mwendo projects, in western Kenya. In the first round, conducted in 2016, 426 caregivers of OVC beneficiaries enrolled in APHIAplus Western Kenya were selected for interview from all households served by the project in the region, using a cluster sampling design. The 2018 survey was done independently of the previous survey. It consisted of interviews with 99 caregivers randomly selected from households that were not part of the 2016 survey and were served by three local implementing partners working with the Mwendo project. In both rounds, caregivers were asked about themselves, their households, and all children under age 18 years who were under their care (1,438 children in 2016 and 386 in 2018).
Find other materials from Round 2 are here.
Materials related to Round 1 can be found here. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Kenya: Comparison of 2016 and 2018 Findings from the MWENDO Panel Study
|
MEASURE Evaluation |
2019 |
English |
KENYA |
OVC, Orphans and Vulnerable Children, Indicators, OVC programs, PEPFAR, Monitoring |
This panel study was designed to assess changes in outcomes of programs for orphans and vulnerable children (OVC), using the standardized essential survey indicators launched by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) in 2014, as part of its monitoring, evaluation, and reporting guidance. MEASURE Evaluation, funded by the United States Agency for International Development (USAID) and PEPFAR, collected data from beneficiaries of the USAID-funded APHIAplus and MWENDO projects, in western Kenya. In Round 1 of this panel study, conducted in 2016, 426 caregivers of OVC beneficiaries enrolled in APHIAplus Western Kenya were interviewed. Of that group, 377 (88.5%) whose enrollment had since shifted from APHIAplus to MWENDO were interviewedagain for Round 2, conducted in 2018. The caregivers were asked about themselves, their households, and all children under age 18 who were under their care (1,438 in Round 1 and 1,348 in Round 2).
Find other materials from Round 2 are here.
Materials related to Round 1 can be found here. |
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Male Case-Finding Assessment in Namibia: Final Report
|
Mswia, R., Reynolds, Z., & Watson-Grant, S. |
2019 |
English |
|
HIV/AIDS, HIV, Men, ART, HIV prevention, Testing, Namibia |
The 2017 Namibia Population-Based HIV Impact Assessment (NAMPHIA) report and other country reports have indicated that men 20 to 39 years of age have the lowest coverage of antiretroviral therapy in the country. The objective of this study, conducted by MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—was to explore the factors affecting barriers to and facilitators of HIV testing and prevention services among young men in Namibia. In keeping with the USAID and PEPFAR goals of controlling the epidemic, the study aimed to determine the right places, the right times, and the right ways to engage young men in these services, and to make recommendations on improving this engagement based on the primary data collected. |
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Role of Male Sex Partners in HIV Risk of Adolescent Girls and Young Women in Mozambique
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Jenifer Chapman, Nena do Nascimento, and Mahua Mandal |
2019 |
English |
|
HIV, AGYW, Sexual Behavior, Young Women, Adolescent Girls, HIV prevention |
Adolescent girls and young women (AGYW) ages 15–24 years are disproportionately affected by HIV/AIDS, particularly in East and Southern Africa. One strategy to reduce HIV among AGYW, proposed through the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) Initiative, is to prevent and manage HIV among their male sexual partners. To implement this strategy and reach men, programs need information about AGYW's potential sexual partners at the local level.
To support DREAMS programming in Mozambique, we undertook a study to characterize this population of men in 3 districts with ongoing DREAMS programming. In mid-2017 we conducted 15 focus group discussions with AGYW (N=102) and a venue-based intercept survey of men (N=1,140). Male sexual partners of AGYW who took the survey were diverse in age, education level, and socioeconomic status. Older AGYW focus group participants sought partners who could provide for them financially. Multiple sexual partnerships and inconsistent condom use were widely reported, with AGYW emphasizing that gender norms disempowered them from negotiating condom use. Reported condom use varied by AGYW and male-partner demographic characteristics, as well as by their relationship type. Condom use rates were much higher than national and regional estimates. AGYW who were less educated/not-in-school, were pregnant, or single mothers were particularly disempowered in sexual relationships. Less educated men were less likely to use condoms than educated men, and condom use was least likely in marriage.
Study findings underscore the importance of reaching the diversity of male sexual partners of AGYW with HIV services as part of a strategy to reduce HIV risk among AGYW. They also support an enhanced focus on female-controlled HIV prevention methods that do not require negotiation with a male partner and special efforts to reach out-of-school/less educated AGYW, as well as pregnant AGYW and single mothers. |
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Assessment of Drivers of HIV Outcomes
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Zulfiya Charyeva, Allison Davis, Lauren Morris, Nena do Nascimento, Jenifer Chapman, Daan Velthausz, Rotafina Donco |
2019 |
English |
MOZAMBIQUE |
OVC programs, OVC, ART, MIS, PEPFAR |
In Mozambique, more than a million children are HIV-positive or otherwise vulnerable because of HIV. In response to this crisis, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) funds programs that serve orphans and vulnerable children (OVC) affected by HIV. These programs employ caseworkers who provide services to OVC and their families to their reduce vulnerability to HIV—such as by linking OVC to HIV testing services and HIV-positive children and adults to HIV care. PEPFAR seeks to understand how the operationalization of case management can be improved to increase knowledge of HIV status and encourage retention on antiretroviral therapy.
The COVida program was the context of this study. COVida supports roughly 300,000 OVC and caregivers per year to access high-quality comprehensive services nationally.
The purpose of this study was to learn more about the features of the COVida case management system and to make recommendations for improving the effectiveness and efficiency of case management in improving beneficiary outcomes. The study also estimated costs of conducting case work and identified the cost drivers of case management. It produced evidence-informed, actionable recommendations to programs in Mozambique on how to shift their strategies, and ultimately, their resources, to optimally balance quality and cost. |
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Rwanda’s Improved Services for Vulnerable Populations Project: Impact Evaluation. End Line Report
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Fehringer, J., Lance, P., Ndirangu, K., Benson, A., Angeles, G., Parker, L., Foley, S., Gobin, S., Varela, V.C., Morris, L., Cannon, A., Iskarpatyoti, B. |
2019 |
English |
Africa, RWANDA |
Evaluation, Data, Vulnerable populations, Rwanda |
MEASURE Evaluation, funded by the United States Agency for International Development, conducted a cluster-randomized impact evaluation of the “Improved Services for Vulnerable Populations” (ISVP) project, led by Global Communities in Rwanda.
There were three treatment groups:
Household economic strengthening (HES-only) group, which provides a core platform of financial interventions
Full ISVP group, which supplements the core platform of HES interventions with health, education, and skills-building services
Control group, receiving no ISVP interventions
The evaluation covered 12 districts. Initial data collection took place in mid-2017 and end line data collection in late 2018/early 2019. Methods were quantitative surveys at both time points of the same households and key informant interviews at end line with 36 community leaders and eight program staff.
Final household survey sample sizes were 1,374 for full ISVP, 1,270 for HES-only, and 1,169 for control. We estimated program impact using difference-in-differences estimation and conducted qualitative thematic analysis.
Results showed that, despite contamination and data collection timing limitations, the program was still able to effect significant change in health and economic strengthening. Each program group saw positive impact for seven outcomes and negative impact for one; the full ISVP also trended positive for an eighth outcome. If initial data collection had taken place prior to program start, the full ISVP likely would have shown impact on at least two other outcomes, outperforming HES-only.
Access a related summary report. |
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An Assessment of the Actionable Drivers of HIV Outcomes: A Study of the COVida Case Management System in Three Provinces in Mozambique
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MEASURE Evaluation |
2019 |
English |
|
OVC, HIV, Mozambique, Orphans and Vulnerable Children, HIV care, PEPFAR |
In Mozambique, more than a million children are HIV-positive or otherwise vulnerable because of the virus. In response to this crisis, the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) fund programs that serve orphans and vulnerable children (OVC) affected by HIV. These programs employ case workers who provide services to OVC and their families to reduce their vulnerability to HIV, such as linking OVC to HIV testing services and HIV-positive children and adults to HIV care. PEPFAR seeks to understand how case management can be improved to increase knowledge of HIV status and encourage retention on antiretroviral therapy.
COVida is a USAID-funded OVC program in Mozambique that supports roughly 300,000 OVC and caregivers per year to access high-quality comprehensive services nationally. The USAID- and PEPFAR-funded MEASURE Evaluation project conducted a study of COVida in 2019 to learn more about the features of the program’s case management system, with a view to making recommendations on how to improve the system’s effectiveness and efficiency and—ultimately—beneficiary outcomes. The study also estimated the costs of conducting casework and identified the cost drivers of case management. It produced evidence-informed, actionable recommendations for programs in Mozambique on how to shift their program implementation strategies and, ultimately, their resources to optimally balance quality and cost. This brief shares more. |
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Evaluating Programs for Prevention of Mother-to-Child Transmission of HIV Using Process Tracing: Guide and Sample Protocol
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Bobrow, E. A., Munson, A.J., & Davis, H. B. |
2019 |
English |
|
HIV, HIV prevention, Transmission, PMTCT |
This guide offers the following resources:
Information and references on previous evaluations of the Partnership for HIV-Free Survival (PHFS) conducted by MEASURE Evaluation
Background information on our concept and rationale for using the process tracing method to evaluate the PHFS approach
Information about the process tracing method as we understand it to be applied to public health evaluations
A sample protocol that can be adapted to evaluate prevention of mother-to-child transmission (PMTCT) of HIV programs in other countries using process tracing, including specific language from our protocol on evaluating PHFS using process tracing
Natural audiences for this guide are evaluators or researchers interested in the innovative method of process tracing in public health evaluations, in partnership with other stakeholders, such as government and nongovernmental implementers of PMTCT programs. We highly recommend that investigators develop protocols in a participatory manner, involving partners at the local, national, and international levels, and in conjunction with donors. It is essential to have input from key stakeholders, and to follow their guidance, particularly in designing procedures to inform and contact study participants in a culturally appropriate way. Careful planning and participation will help facilitate use of the generated evidence to improve programs and policies. |
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Helpful Hints: Expedited Data Quality Assessment
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MEASURE Evaluation |
2019 |
English |
|
Data quality assessment, Assessment, Data quality, Data |
An expedited data quality assessment (EDQA) is a novel method of organizing patient records and cleaning data found in patient files and health facility registers. Its advantages are that it can be done in five to six weeks rather than several months, and can serve as an intervention by allowing for correction of the data when source documents are found to be incomplete or inconsistent.
This new method has been used when stakeholders (researchers, implementing partners, etc.) need to clean patient files and to use these files to determine what patients may have been lost to follow-up for completing HIV treatment and care.
EDQA is similar to standard data quality assessments (DQAs) but is more rapid and intense. An EDQA is conducted in two stages: a pilot or “mini” DQA in selected health facilities to diagnose data quality issues, followed by a data-cleaning intervention to address those issues. An EDQA also assesses the quality of select indicators and diagnoses data reporting challenges. During an EDQA, facility registers are compared to source documents, such as patient files, electronic medical records, and laboratory records.
Results from an EDQA can be used to inform strategies for decreasing patient loss to follow-up (LTFU), for improving site-level data quality, and for strengthening data management practices, such as supportive supervision and routine data quality. To decrease LTFU, an EDQA can identify patients who should be contacted through community outreach to encourage them to return for treatment. So far, EDQA has been applied in several countries to an HIV indicator (TX_CURR) that shows the number of adults and children currently receiving antiretroviral therapy. It could be adapted and applied to other HIV indicators, such as continuity of care, prevention of mother-to-child transmission, or similar indicators requiring data from multiple sources.
To help implementers know what to expect in an EDQA and to offer help on selecting sites for investigation, this brief shares recommendations. |
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Helpful Hints: PLACE
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MEASURE Evaluation |
2019 |
English |
|
HIV/AIDS, Geospatial analysis, PLACE, HIV prevention, HIV |
The Priorities for Local AIDS Control Efforts (PLACE) method is a rapid assessment tool to improve HIV prevention and treatment coverage in areas where HIV transmission is most likely to occur. It was developed for local HIV program managers in resource-poor settings who want to know where to target resources to prevent new infections. The focus of the PLACE method is to identify gaps in current programs and assess whether people most likely to acquire and transmit HIV have been reached with appropriate prevention and treatment services.
The PLACE protocol has five steps:
To identify high-transmission areas in a given geographic location
To identify sites in high-transmission areas where people meet new sexual partners
To visit, map, and characterize sites in each area
To describe the characteristics of people socializing at these sites
To use findings to inform interventions and resource allocation
This brief shares recommendations to consider when planning and carrying out a PLACE assessment. Access additional PLACE resources at https://www.measureevaluation.org/resources/tools/hiv-aids/place. |
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Helpful Hints: Routine Data Quality Assessment
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MEASURE Evaluation |
2019 |
English |
|
RDQA, Routine data, Data quality assessment, Data Quality, Assessment |
The routine data quality assessment (RDQA) tool has two components:
The systems assessment is a qualitative approach to examining the overall structure and functions of a data management and reporting system.
The data verification process gauges the timeliness, completeness, and accuracy of data that are collected and reported in the system.
The tool’s user manual can be found here: https://www.measureevaluation.org/resources/publications/ms-17-117.
This brief shares practical tips on using the tool, based on MEASURE Evaluation’s application of RDQA since 2007 in scores of countries. These hints chiefly apply to the data verification component of the tool. |
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Best Practices for Gender in the Monitoring and Evaluation of HIV Programs
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MEASURE Evaluation |
2019 |
English |
|
M&E, AGYW, Monitoring, Evaluation, Gender, HIV, HIV prevention |
Gender is a critical component of efforts to control the HIV epidemic. Gender influences who is vulnerable to HIV and able to seek and access care and treatment, as well as norms around HIV prevention, treatment, and stigma. To reach epidemic control effectively, gender must be considered in HIV programs and policies, and thus in monitoring and evaluation (M&E).
MEASURE Evaluation, which is funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief (PEPFAR), created this brief to share best practices in gender M&E for HIV programming. We recommend including gender at every step of monitoring and evaluating the clinical cascade; using qualitative and quantitative gender data to inform and adapt HIV programming; paying special attention to priority populations; and keeping gender-based violence and structural considerations in the forefront of planning and interpretation to ensure advancement toward HIV epidemic control. This brief shares more. |
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The Importance of Gender in HIV Health Information Systems
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MEASURE Evaluation |
2019 |
English |
|
Gender, Health Information Systems, HIV, HIS, Gender Norms |
Addressing gender while strengthening HIV health information systems (HIS) ensures equity in access and benefits for women, men, girls, boys, and transgender people. This brief establishes the importance of addressing gender in HIS activities and suggests a series of action points that will promote the integration of gender in HIV HIS and ultimately improve HIV outcomes.
Access more briefs in this series. |
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Using DHIS2 Software to Track Prevention of Mother-to-Child Transmission of HIV: User Manual for the DHIS2 PMTCT Tracker
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Scott, F., Schmale, A., Moonzwe Davis, L., Johnson, S., & de la Torre, C. |
2019 |
English |
|
Antenatal Care, PMTCT, Transmission, Maternal health, HIV prevention, HIV, Postnatal care, DHIS 2 |
This manual is intended for users of MEASURE Evaluation’s DHIS2 Tracker for Prevention of Mother-to-Child Transmission of HIV (PMTCT) (hereafter called the PMTCT Tracker). Before using this manual, the PMTCT Tracker must be installed. A download link for the sample PMTCT tracker can be found at https://www.measureevaluation.org/resources/pmtct-tracker/
This manual is intended as a reference document for staff using the PMTCT Tracker for data capture, supervision, and reporting. It is also intended to be a training resource for staff who train others on how to use the PMTCT Tracker. Basing the training around the User Manual will ensure that trainees become very familiar with it, making it more likely that the manual is used as a reference after they have returned to their own clinic or facility.
Although it is important for a PMTCT Tracker user to work through and become familiar with the entire User Manual during the initial training, the User Manual has also been designed as a “how to” guide for quick reference after training participants become active users of the system. Each “how to” section provides self-contained, step-by-step guidance on carrying out a specific task. This is particularly important in cases in which a user may not be accessing the PMTCT Tracker on a regular basis and thus may need to be refreshed on how to carry out a given task.
Section 2 of the User Manual provides background on the PMTCT Tracker and introduces key concepts. Section 3 provides guidance on how to access and navigate the PMTCT Tracker, and Section 4 introduces key aspects of the data capture and audit function. Sections 5 and 6 guide the user through the steps for capturing and reviewing data about the PMTCT care for the mother and child. Section 7 guides the user through the steps for tracking and following up on PMTCT patients, and Section 8 explains how to view the PMTCT dashboards.
Although this User Manual is designed for the sample PMTCT Tracker it has been made available as a Word document, as well as a PDF file, so that it can be adapted and tailored for use with specific local implementations of the PMTCT Tracker.
The manual is also available for download in Word.
Additional guidance on how to establish a PMTCT tracker in a given country is available in MEASURE Evaluation’s Using DHIS2 Software to Track Prevention of Mother-to-Child Transmission of HIV: Guidance (Version 2) at https://www.measureevaluation.org/resources/publications/ms-18-127
Access the PMTCT tracker resources at https://www.measureevaluation.org/resources/pmtct-tracker/ |
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Priorities for Local AIDS Control Efforts (PLACE) Tool Kit
|
MEASURE Evaluation |
2019 |
English |
|
Spatial Analysis, HIV, PLACE, Mapping, Toolkit, HIV/AIDS, HIV prevention |
The Priorities for Local AIDS Control Efforts (PLACE) method aims to improve our understanding of the drivers of local HIV epidemics, identify gaps in services available to those most likely to acquire and transmit HIV, and provide evidence to support tailored interventions to reduce transmission. Achieving this goal is a challenge because many people don’t know they have the virus, making the local pattern of new infections almost impossible to detect.
PLACE was developed by MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—to meet that challenge. The first implementation manual was published in 2005. Since then, the scope of the PLACE method has been broadened. This 2019 update—expanding PLACE from a single manual to a suite of five guidance documents, templates, training slide decks, and other tools—can be used to guide PLACE studies in response to new opportunities.
The PLACE Tool Kit incorporates best practices for using new tools in testing for HIV and sexually transmitted infections; new capabilities for geospatial analysis and electronic data collection; and an increased urgency to find people who are unaware that they are HIV-positive and get them on treatment—particularly to find key populations and other vulnerable people who may be at increased risk of transmitting the virus to others if they are not successfully engaged in treatment.
The full collection is also available online at https://www.measureevaluation.org/resources/tools/hiv-aids/place.
The related PLACE mapping tool is downloadable at https://www.measureevaluation.org/resources/publications/tl-19-39. |
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Sexual Orientation and Gender Identity Measures for Global Survey Research: A Primer for Improving Data Quality
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Glick, J. L. & Andrinopoulos, K. |
2019 |
English |
|
Gender, SOGI, Men who have sex with men, Data collection, HIV, Sexual Orientation, Gender Identity, Data, Transgender, MSM |
Without existing standards for asking questions, data collectors or interviewers may rely on their own perceptions of clients to categorize people as members of a sexual and gender minority (SGM) population. This practice can lower the validity (truthfulness) of data. When self-report of sexual orientation or gender identity is elicited, using categories and terminology that align with the client’s or research participant’s perspective is critical. It is important to understand categories from the “lens,” or perspective, of sexual and gender minorities in each context, rather than universally applying a fixed global set of questions and responses.
The purpose of this report is to provide recommendations on how to develop closed-ended survey questions to measure sexual orientation and gender identity (SOGI) that are context specific, while, to the degree possible, also fulfilling global data reporting needs for HIV key populations. The report is written for all actors involved in the design of data-creation activities, including for surveillance, monitoring, evaluation, and broader research purposes. It begins with an overview of the current state of SOGI measurement in HIV programs. Next, it describes an inductive process for generating SOGI questions. The first step is to ensure a good understanding of SOGI concepts and review context-specific literature related to gender and sexuality. The second step is to review existing survey questions and assess their utility for the particular context and HIV-related issue under study. In some cases, a third step of conducting qualitative research may be warranted. The fourth and final step is to assess the potential questions through piloting and cognitive interviewing. The report provides instruction on each recommended step, and guidance on where to access additional information when necessary. |
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Evaluation of the Effects of HIV-Specific Investments in the Performance of the Health Information System in Côte d’Ivoire: Summary of Results
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Silvestre, E. and Davis, H. |
2019 |
English |
|
HIV, HIS, HIS strengthening, Health Information Systems, Cote d'Ivoire, Evaluation |
MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—has supported the Government of Côte d’Ivoire to strengthen its health management information system and HIV monitoring and evaluation (M&E) systems since 2004. Working closely with the Ministry of Health and Public Hygiene (Ministère de la Santé et de l’Hygiène Publique [MSHP]), MEASURE Evaluation has performed a leadership role in strategic planning and overall management of the health information systems (HIS). Under MEASURE Evaluation’s Learning Agenda activities, the project conducted an evaluation of HIS investments in Côte d’Ivoire. The evaluation was designed to demonstrate how HIS strengthening investments affect HIS performance, health system outcomes, and public health outcomes. It assessed the broader effects of HIV-specific HIS investments in the overall improvement of the larger health system and how they can improve HIV outcomes. This report shares more. |
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Integrating Early Childhood Development and Health in Eswatini, Lesotho, and Zimbabwe: A Scale-Up Assessment
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Cannon, A., Charyeva, Z., Millar, E., Gobin, S., & Morris, L. |
2019 |
English |
|
Orphans and Vulnerable Children, HIV/AIDS, OVC, HIV prevention, HIV, PMTCT, Child health, PEPFAR, Children |
USAID and PEPFAR funded the Orphans and Vulnerable Children Special Initiative, a special initiative for children under five years old affected by the epidemic. It was carried out in Eswatini (formerly Swaziland), Lesotho, and Zimbabwe and integrates early childhood development (ECD) with pediatric HIV treatment or prevention of mother-to-child transmission (PMTCT) of HIV.
To prepare for potential scale-up, the United States Agency for International Development (USAID) asked MEASURE Evaluation to assess the scalability of the ECD-integrated intervention in each country. The scale-up assessment had the following objectives:
1. Describe the intervention package and key beneficiaries and stakeholders.
2. Assess the interest and readiness of key stakeholders to scale up OVC integrated interventions.
3. Identify opportunities for and constraints to successful scale-up of OVC integrated interventions.
4. Develop recommendations for scale-up of OVC integrated interventions.
Integrating Early Childhood Development and Health in Eswatini, Lesotho, and Zimbabwe: A Scale-Up Assessment provides the results from MEASURE Evaluation scale-up assessments of the integrated interventions in Eswatini, Lesotho, and Zimbabwe; suggestions and recommendations related to scaling up these interventions in each country; and our lessons learned from working on these assessments. Whether to scale up an intervention is a decision to be made by local governments and donors in each country, based on factors such as intervention impact, cost, complexity, relevance to the country needs and priorities, ease of implementation, availability of funds, and others. This report aims to help stakeholders in each country design and implement the intervention at scale. |
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Virtual PLACE Worksheet 2: Stakeholder Consultation Decisions
|
MEASURE Evaluation |
2019 |
English |
|
|
This worksheet is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
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PLACE Worksheet 1: National Steering Committee and Stakeholder Engagement
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MEASURE Evaluation |
2019 |
English |
|
Geospatial analysis, PLACE, AIDS, HIV/AIDS, HIV prevention, Key Populations, HIV |
This worksheet is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
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Virtual PLACE (Priorities for Local AIDS Control Efforts): Interviewer Confidentiality Pledge
|
MEASURE Evaluation |
2019 |
English |
|
Geospatial analysis, PLACE, AIDS, HIV/AIDS, HIV prevention, Key Populations, HIV |
This interviewer confidentiality pledge is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
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Virtual PLACE Form C: Interview with a User of the Internet, Social Media, and Telephone to Meet Sexual Partners
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MEASURE Evaluation |
2019 |
English |
|
HIV/AIDS, HIV, HIV prevention, Geospatial analysis, AIDS, Key Populations, PLACE |
This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
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Virtual PLACE Form B: Visit to a Virtual Site or Phone Number
|
MEASURE Evaluation |
2019 |
English |
|
PLACE, AIDS, HIV, HIV/AIDS, Geospatial analysis, HIV prevention, Key Populations |
This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
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Virtual PLACE Form A: Interview with Community Informants
|
MEASURE Evaluation |
2019 |
English |
|
HIV/AIDS, HIV, HIV prevention, Geospatial analysis, AIDS, Key Populations, PLACE |
This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
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Virtual Priorities for Local AIDS Control Efforts (PLACE): Protocol for a Study of Social Media Sites
|
MEASURE Evaluation |
2019 |
English |
|
PLACE, AIDS, HIV, HIV/AIDS, Geospatial analysis, HIV prevention, Key Populations |
This manual describes how to use the Priorities for Local AIDS Control Efforts (PLACE) method for studies involving Internet sites, social media applications, and cellphones. The manual is also available in Word.
Access the full PLACE Tool Kit at https://www.measureevaluation.org/place. |
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Virtual PLACE Form C Fact Sheet for Informed Consent to Participate in an Interview about Internet, Social Media, and Telephone Use
|
MEASURE Evaluation |
2019 |
English |
|
Geospatial analysis, PLACE, AIDS, HIV/AIDS, HIV prevention, Key Populations, HIV |
This fact sheet is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
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Virtual PLACE Form A Fact Sheet for Informed Consent by a Community Informant
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MEASURE Evaluation |
2019 |
English |
|
Geospatial analysis, PLACE, AIDS, HIV/AIDS, HIV prevention, Key Populations, HIV |
This fact sheet is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
|
PLACE Form 3-5: Dried Blood Spot Tracking Form
|
MEASURE Evaluation |
2019 |
English |
|
Geospatial analysis, PLACE, AIDS, HIV/AIDS, HIV prevention, Key Populations, HIV |
This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
|
PLACE Form 3-4: Tester Venue Summary Form for Patron/Worker Interviews
|
MEASURE Evaluation |
2019 |
English |
|
PLACE, AIDS, HIV, HIV/AIDS, Geospatial analysis, HIV prevention, Key Populations |
This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
|
PLACE Form 3-3: Interviewer Outcome Log for Form C Interviews
|
MEASURE Evaluation |
2019 |
English |
|
HIV, Geospatial analysis, HIV/AIDS, Key Populations, AIDS, PLACE, HIV prevention |
This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
|
PLACE Form 3-2: Supervisor Form C Summary Form for a Specific Venue
|
MEASURE Evaluation |
2019 |
English |
|
Key Populations, AIDS, Geospatial analysis, PLACE, HIV prevention, HIV, HIV/AIDS |
This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
|
PLACE Form 3-1: Supervisor District Summary Form for Form C
|
MEASURE Evaluation |
2019 |
English |
|
PLACE, AIDS, HIV, HIV/AIDS, Geospatial analysis, HIV prevention, Key Populations |
This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
|
PLACE Form 2-1: Supervisor Summary Form for Interviews with Venue Informants
|
MEASURE Evaluation |
2019 |
English |
|
HIV, Geospatial analysis, HIV/AIDS, Key Populations, AIDS, PLACE, HIV prevention |
This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
|
PLACE Form 1-2: Supervisor Summary Form for Community Informant Interviews
|
MEASURE Evaluation |
2019 |
English |
|
PLACE, AIDS, HIV, HIV/AIDS, Geospatial analysis, HIV prevention, Key Populations |
This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
|
PLACE Form 1-1: Interviewer Tally Sheet for Community Informant Interviews
|
MEASURE Evaluation |
2019 |
English |
|
HIV, Geospatial analysis, HIV/AIDS, Key Populations, AIDS, PLACE, HIV prevention |
This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
|
PLACE Template for a List of Priority Prevention Areas
|
MEASURE Evaluation |
2019 |
English |
|
PLACE, AIDS, HIV, HIV/AIDS, Geospatial analysis, HIV prevention, Key Populations |
This template is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
|
Priorities for Local AIDS Control Efforts (PLACE): Quality Checklist for Form C
|
MEASURE Evaluation |
2019 |
English |
|
HIV/AIDS, Key Populations, PLACE, AIDS, Geospatial analysis, HIV, HIV prevention |
This checklist is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
|
Priorities for Local AIDS Control Efforts (PLACE): Quality Checklist for Form B
|
MEASURE Evaluation |
2019 |
English |
|
Geospatial analysis, PLACE, AIDS, HIV/AIDS, HIV prevention, Key Populations, HIV |
This checklist is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
|
Priorities for Local AIDS Control Efforts (PLACE): Quality Checklist for Form A
|
MEASURE Evaluation |
2019 |
English |
|
HIV/AIDS, Key Populations, PLACE, AIDS, Geospatial analysis, HIV, HIV prevention |
This checklist is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
|
Priorities for Local AIDS Control Efforts (PLACE): Master Venue List
|
MEASURE Evaluation |
2019 |
English |
|
HIV/AIDS, Key Populations, PLACE, AIDS, Geospatial analysis, HIV, HIV prevention |
The Priorities for Local AIDS Control Efforts (PLACE) method employs a master list of each venue identified by community informants. This list becomes the sampling frame for selecting venues for Form B and Form C interviews. The Master Venue List is created from the template provided after all the community informant interviews (Form A) are completed.
The full PLACE Tool Kit is available at https://www.measureevaluation.org/place. |
|
Template for a District Summary Spreadsheet for Use with the PLACE QGIS Mapping Tool
|
MEASURE Evaluation |
2019 |
English |
|
HIV, Geospatial analysis, HIV/AIDS, Key Populations, GIS, AIDS, PLACE, HIV prevention |
MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief—has developed a free Priorities for Local AIDS Control Efforts (PLACE) QGIS Mapping Tool. As of July 2019, the tool offered base map information and data templates for 14 countries: Angola, Burundi, Côte d’Ivoire, the Democratic Republic of the Congo, Ghana, Haiti, Kenya, Malawi, Mozambique, Rwanda, South Africa, eSwatini, Tanzania, and Uganda.
QGIS is a free and full-featured geographic information system (GIS). The mapping tool was designed to work specifically with the PLACE protocol (a sample is available here: https://www.measureevaluation.org/resources/tools/hiv-aids/place). The tool can be downloaded on the MEASURE Evaluation website at https://www.measureevaluation.org/resources/tools/hiv-aids/place/place-method/the-place-mapping-tool-a-plug-in-for-gis. |
|
PLACE Readiness Assessment Tool
|
MEASURE Evaluation |
2019 |
English |
|
PLACE, AIDS, HIV, HIV/AIDS, Geospatial analysis, HIV prevention, Key Populations |
This readiness assessment tool is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
|
Priorities for Local AIDS Control Efforts (PLACE): Fieldwork Implementation Guide
|
MEASURE Evaluation |
2019 |
English |
|
PLACE, AIDS, HIV, HIV/AIDS, Geospatial analysis, HIV prevention, Key Populations |
This guide is one part of a bigger package: the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit. The tool kit is available on the website of MEASURE Evaluation (a project funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief), here: https://www.measureevaluation.org/place.
The guide is also available is Word. |
|
Priorities for Local AIDS Control Efforts (PLACE): Data Use Agreement
|
MEASURE Evaluation |
2019 |
English |
|
HIV/AIDS, HIV, HIV prevention, Geospatial analysis, AIDS, Key Populations, PLACE |
This data use agreement is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
|
Priorities for Local AIDS Control Efforts (PLACE) Results Report Template
|
MEASURE Evaluation |
2019 |
English |
|
Key Populations, PLACE, AIDS, HIV/AIDS, HIV, HIV prevention, Geospatial analysis |
These guidelines should help you write a preliminary Priorities for Local AIDS Control Efforts (PLACE) report and maintain some consistency in content and format. The resource is also available in Word.
The full Priorities for Local AIDS Control Efforts (PLACE) Tool Kit is available at https://www.measureevaluation.org/place. |
|
Priorities for Local AIDS Control Efforts (PLACE): Interviewer Confidentiality Pledge
|
MEASURE Evaluation |
2019 |
English |
|
Geospatial analysis, PLACE, AIDS, HIV/AIDS, HIV prevention, Key Populations, HIV |
This interviewer confidentiality pledge is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
|
PLACE Form C: Interview with a Patron or Worker
|
MEASURE Evaluation |
2019 |
English |
|
Geospatial analysis, PLACE, AIDS, HIV/AIDS, HIV prevention, Key Populations, HIV |
This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
|
PLACE Form B: Interview with a Venue Informant
|
MEASURE Evaluation |
2019 |
English |
|
PLACE, AIDS, HIV, HIV/AIDS, Geospatial analysis, HIV prevention, Key Populations |
This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
|
PLACE Form A: Interview Instructions
|
MEASURE Evaluation |
2019 |
English |
|
HIV/AIDS, Key Populations, PLACE, AIDS, Geospatial analysis, HIV, HIV prevention |
This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
|
Priorities for Local AIDS Control Efforts (PLACE): Sample Protocol
|
MEASURE Evaluation |
2019 |
English |
|
Geospatial analysis, PLACE, AIDS, HIV/AIDS, HIV prevention, Key Populations, HIV |
This Sample PLACE Protocol is a template that can be adapted to support studies using the PLACE method in a variety of contexts. The protocol assumes a typical application of the PLACE method. It has sections on study rationale, objectives, methods, and data analysis.
This resource is available for download in Word. The full PLACE Tool Kit is available at https://www.measureevaluation.org/place. |
|
Priorities for Local AIDS Control Efforts (PLACE): Protocol Decisions Manual
|
MEASURE Evaluation |
2019 |
English |
|
HIV/AIDS, Key Populations, PLACE, AIDS, Geospatial analysis, HIV, HIV prevention |
This “Protocol Decisions Manual” is a guide for adapting the PLACE Sample Protocol (available with the full PLACE tool kit at https://www.measureevaluation.org/resources/tools/hiv-aids/place) to your local context. It explains the decisions that must be made along the way: where to implement PLACE, the specific objectives, fieldwork considerations, sample size, ethics, mapping readiness, selection of key indicators, and methods for data analysis and use. It also provides tools and worksheets to document those protocol decisions.
This resource is also available in Word. |
|
Priorities for Local AIDS Control Efforts (PLACE): Overview of the Tool Kit and the Method It Supports
|
MEASURE Evaluation |
2019 |
English |
|
Geospatial analysis, PLACE, AIDS, HIV/AIDS, HIV prevention, Key Populations, HIV |
This tool kit is a comprehensive resource for the design and implementation of the Priorities for Local AIDS Control Efforts (PLACE) method. MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—developed the method to increase local capacity to understand the drivers of local HIV epidemics, identify gaps in services among those most likely to acquire and transmit HIV, and provide evidence to support tailored interventions to reduce HIV transmission. The full PLACE collection is available at https://www.measureevaluation.org/place.
MEASURE Evaluation published an implementation manual in 2005. Since then, the scope of the PLACE method has been broadened in response to new tools in testing for HIV and sexually transmitted infections, capabilities for geospatial analysis technologies, electronic data collection, and an increased urgency to find people who are HIV-positive—particularly key populations and other vulnerable people who may be at increased risk of transmitting the virus to others if not successfully engaged in treatment.
Thus, the time is right for a 2019 update of the 2005 PLACE manual and tool kit to guide today’s implementation according to best practices long established and new opportunities. Today’s manual takes PLACE’s contribution to HIV epidemic response even further. In addition to providing maps of places to reach people who are at risk of acquiring and transmitting HIV, the method provides data for estimating the size of those populations, for estimating HIV prevention and adherence to treatment, and for estimating standard biobehavioral surveillance indicators.
The new PLACE manual offers guidance on linking to care participants in a PLACE study who test positive for HIV. The new manual also has an evidence-informed strategy for ethical implementation of the protocol, including a preliminary readiness assessment that gauges protocol safety and provides guidance on the conditions under which the study should not be implemented. The new tool kit includes a sample protocol that can be adapted for use in any setting, a description of important protocol decisions, and a detailed implementation guide.
This manual is also available in Word. |
|
Fact Sheet and Consent Form for Participation in the PLACE Study Patron/Worker Interview
|
MEASURE Evaluation |
2019 |
English |
|
Key Populations, PLACE, AIDS, HIV/AIDS, HIV, HIV prevention, Geospatial analysis |
This fact sheet and consent form for patron/worker interviews is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word. |
|
Fact Sheet for Informed Consent by a Venue Informant
|
MEASURE Evaluation |
2019 |
English |
|
HIV/AIDS, HIV, HIV prevention, Geospatial analysis, AIDS, Key Populations, PLACE |
This fact sheet for informed consent by a venue informant is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place.
It is also available in Word. |
|
Fact Sheet for Informed Consent by a Community Informant
|
MEASURE Evaluation |
2019 |
English |
|
HIV/AIDS, Key Populations, PLACE, AIDS, Geospatial analysis, HIV, HIV prevention |
This fact sheet for informed consent by a community informant is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place.
It is also available in Word. |
|
Comprendre l’influence des investissements dans le système d’information sanitaire sure les résultats de l’action sanitaire en Côte d’Ivoire : Etude qualitative
|
Silvestre, E., Davis, H., & Wood, F. |
2019 |
French |
|
HIS, Information system, Health Information Systems, Cote d'Ivoire |
L'information sanitaire est une des six fonctions essentielles d'un système de santé avec la prestation de services, les ressources humaines pour la santé, les produits médicaux, vaccins et technologies, le financement, et le leadership et la gouvernance (Figure 1, source : Agence des États-Unis pour le développement international [USAID], 2015). Les investissements réalisés dans un de ces domaines exerceront un impact sur d'autres fonctions essentielles du système de santé et seront affectés par celles-ci. L'évaluation des effets à grande échelle des investissements dans les systèmes d'information sanitaire (SIS) spécifiques au VIH sur l'amélioration globale du système de santé au sens large peut expliquer en quoi ces investissements peuvent aboutir à de meilleurs résultats en matière de lutte contre le VIH.
Des investissements importants ont été réalisés dans le SIS de la Côte d'Ivoire au cours des dix dernières années. En 2018, ces investissements ont été évalués pour mieux comprendre la manière dont ils affectaient le degré de performance du système, ses résultats et la santé publique. L'évaluation consistait en un examen documentaire aboutissant à un rapport de triangulation (MEASURE Evaluation, 2018) et une étude qualitative soutenue par les parties prenantes essentielles à l'échelle nationale et dont nous présentons les résultats ici. |
|
Measuring the Quality of HIV/AIDS Client-Level Data Using Lot Quality Assurance Sampling (LQAS)
|
Boone, D., Cloutier, S., & Lins, S. |
2019 |
English |
|
Data, HIV/AIDS, Data collection, HIV, Data Quality, LQAS |
Tools and methods for assessing data quality have significantly advanced, in part by the need for good HIV/AIDS data to inform programs. Most of the existing tools, however, focus on aggregate data at subnational levels. Very few tools measure the quality of data at the primary source– individual client documents at health facilities and beneficiary documents for community-based programs. Reviewing the quality of data in these types of documents is time consuming and resource intensive. A triage system using lot quality assurance sampling (LQAS), a rapid survey method, can be implemented to identify acceptable or unacceptable source documents using a small sample of records.
Measuring the Quality of HIV/AIDS Client-Level Data Using Lot Quality Assurance Sampling (LQAS) was developed to describe how to sample HIV/AIDS client or beneficiary records and classify them according to quality, with a quantifiable level of confidence. The LQAS method saves time, effort, and resources while yielding statistically sound results with quantifiable confidence and error. The intended audience for this guide is supervisory staff. When used as part of a routine system of data quality assurance, LQAS will improve HIV/AIDS data in source documents, allowing for improved client and beneficiary management. Since data quality issues will be identified and resolved at the source, aggregate data that are reported to national programs will be more accurate.
A companion Excel tool—the LQAS Triage System Data Collection and Analysis Tool—is available at https://www.measureevaluation.org/resources/publications/tl-19-51. |
|
PRISM: Performance of Routine Information System Management Series
|
MEASURE Evaluation |
2019 |
English |
|
RHIS, PRISM, Performance of Routine Information System Management, Tools, Routine Health Information Systems, Health Information Systems |
Using data to make evidence-informed decisions is still weak in most low- and middle-income countries. Especially neglected are data produced by routine health information systems (RHIS)—the data collected at public, private, and community-level health facilities and institutions. When routine data are lacking, or are not used, the results can be lower-quality services, weak infection prevention and control responses, lack of skilled health workers available where they are needed, and weak supply chains for drugs and equipment. These factors contribute to poor health outcomes for people.
MEASURE Evaluation, which is funded by the United States Agency for International Development (USAID), has provided technical and financial assistance to strengthen RHIS for more than 15 years. We have contributed to best practices at the global level and to the strengthening of RHIS data collection, data quality, analysis, and use at the country level. One of the project’s mandates is to strengthen the collection, analysis, and use of these data for the delivery of high-quality health services.
We developed the Performance of Routine Information System Management (PRISM) Framework and suite of tools in 2011 for global use in assessing the reliability and timeliness of an RHIS, in making evidence-based decisions, and in identifying gaps in an RHIS so they can be addressed and the system can be improved.
With USAID’s support, we have revised the PRISM Tools and developed other elements, based on the PRISM Framework, to create a broad array of materials: the “PRISM Series.” This new, more comprehensive PRISM Series is useful for designing, strengthening, and evaluating RHIS performance and developing a plan to put the results of a PRISM assessment into action.
Access the full collection, older versions of the PRISM tools, and additional resources at https://www.measureevaluation.org/resources/tools/health-information-systems/prism |
|
HIS Stages of Continuous Improvement Toolkit
|
MEASURE Evaluation |
2019 |
English |
|
Toolkit, Health Information Systems, HIS strengthening, HISS, HIS |
Strong health information systems (HIS) can collect, analyze, and use high-quality, timely data to strengthen health service delivery. A functioning HIS gets the right information into the right hands at the right time, enabling policymakers, managers, and individual service providers to make informed choices about everything from patient care to national budgets. Despite a growing emphasis on strengthening HIS and measuring how information systems contribute to improved health outcomes, understanding is limited on what interventions will work to improve HIS in various stages of development.
The HIS Stages of Continuous Improvement (SOCI) Toolkit was collaboratively designed to help countries or organizations holistically assess, plan, and prioritize interventions and investments to strengthen an HIS. The assessment measures current and desired HIS status across five core domains of an HIS, and 39 subcomponents, and maps a path toward improvement—thus assisting countries in ensuring the right information is available to the right people at the right time. HIS are essential not only to monitor and improve national and subnational programs, but also to demonstrate country progress on a global level. This tool aligns with World Health Organization efforts to strengthen country HIS and capacities to monitor universal health coverage and health Sustainable Development Goals.
The HIS SOCI Toolkit was jointly developed by the United States Centers for Disease Control and Prevention (CDC), the Health Data Collaborative digital health and interoperability working group, and the USAID-funded MEASURE Evaluation project. The toolkit also responds to one of MEASURE Evaluation’s Learning Agenda questions.
The full collection is also available online at https://www.measureevaluation.org/his-strengthening-resource-center/his-stages-of-continuous-improvement-toolkit |
|
Strategies for Geographic Targeting Using the Priorities for Local AIDS Control Efforts (PLACE) Method: Scorecards and Other Tools
|
MEASURE Evaluation |
2019 |
English |
|
HIV, PLACE, HIV prevention, Geography, Mapping |
After collecting data using MEASURE Evaluation’s Priorities for Local AIDS Control Efforts (PLACE) method, countries and stakeholders can use the innovative methods and visualization strategies presented in this manual to identify core geographic areas with relatively high levels of untreated HIV.
The scorecards and maps such as those prepared in this study help countries improve their efforts to reach people who have HIV but who do not know their status, people have not yet achieved viral suppression, and people who are suitable candidates for pre-exposure prophylaxis.
Access the full collection of Priorities for Local AIDS Control Efforts (PLACE) method resources at https://www.measureevaluation.org/place |
|
Malaria Epidemic Preparedness and Response Review and Planning Workshops: January‒March 2019
|
Ministry of Health, Republic of Kenya |
2019 |
English |
|
|
Epidemic preparedness and response (EPR) is one of the key strategic approaches to controlling malaria in Kenya. In collaboration with MEASURE Evaluation, Kenya's National Malaria Control Programme (NMCP) organised seven EPR workshops targeting county and sub-county malaria control and disease surveillance coordinators. The workshops were conducted for 127 sub-counties in 26 counties that fell in the epidemic-prone areas of the western highland and seasonal transmission zones. A total of 320 health managers from the 26 counties and 127 sub-counties were trained.
For the first time, the 2019 EPR planning and review workshops included sub-county malaria control and disease surveillance coordinators. The evaluations conducted during the workshops revealed important gaps in overall EPR training and monitoring. The workshops resulted in several recommendations to improve future EPR planning and review workshops and epidemic monitoring across all levels. |
|
Synthesis of Routine Health Information System Architecture Profiles of the U.S. President's Malaria Initiative (PMI) Priority Countries
|
MEASURE Evaluation |
2019 |
English |
|
RHIS, Health Information Systems, Malaria, Routine Health Information Systems |
MEASURE Evaluation developed two-page summary profiles of routine health information systems (RHIS) that capture malaria data in 17 of the countries supported by the U.S. President’s Malaria Initiative (PMI): Angola, Benin, Burkina Faso, Cameroon, Côte d’Ivoire, Ghana, Kenya, Liberia, Madagascar, Mali, Mozambique, Niger, Rwanda, Senegal, Sierra Leone, Uganda, and Zambia. Looking across the profiles, this synthesis identifies the commonalities, strengths, challenges, and gaps, and suggests priority areas to focus on further strengthening. |
|
Snapshot of the Strength of the Health Information System as a Source of HIV Data
|
MEASURE Evaluation |
2019 |
English |
|
HIV data, Health information systems, Data, HIV, HIS |
Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time.
MEASURE Evaluation, funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief, prepared 13 briefs to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic.
Access the full collection of briefs online at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data |
|
Children in Adverse Situations Indicators and Survey Tools
|
Hellen, Jacqueline; Parker, Lisa |
2019 |
English |
|
|
Household surveys provide useful data on the vulnerabilities faced by children in the general population, but often miss children who may be exposed to extreme adversity, such as children of female sex workers, street children, and children working in mines. Globally, data on these populations are limited.
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 of female sex workers, street children, and children working in mines. We have developed a holistic set of standard outcome indicators and corresponding survey tools deemed essential to expand the evidence base of these invisible children, to better understand their needs.
The collection is also available online at www.measureevaluation.org/our-work/ovc/children-in-adverse-situations-indicators-and-survey-tools/children-in-adverse-situations-survey-tools |
|
LQAS Triage System: Data Collection and Analysis Tool
|
MEASURE Evaluation |
2019 |
English |
|
Data Quality, Sampling, Health Information Systems, LQAS, Data collection, Tool, Data |
The Lot Quality Assurance Sampling (LQAS) Triage System is a method for assessing the completeness of data elements in source documents using a sample of client records. Concordance of data elements across data sources can also be assessed. Please see the guidance document "Measuring the Quality of HIV/AIDS Client-Level Data Using Lot Quality Assurance Sampling" for more details and directions, here: www.measureevaluation.org/resources/publications/ms-19-176 |
|
Monitoring the Outcomes of Orphans and Vulnerable Children Programs in Kenya: Findings from 2016–2018 Panel Data: MWENDO Project
|
Irit Sinai, Clement O. Odour, Dennis Akeyo, Cheikh M. Faye, Damazo T. Kadengye, Nelson Langat |
2019 |
English |
KENYA |
OVC, Indicators, PEPFAR, Orphans and vulnerable children, Monitoring, OVC programs |
This report presents findings from a panel study of beneficiary households receiving services from Making Well-Informed Efforts to Nurture Disadvantaged Orphans & Vulnerable Children (MWENDO), in Western Kenya. MWENDO is a five-year project funded by the United States Agency for International Development (USAID) and implemented by Catholic Relief Services that provides an umbrella of services to orphans and vulnerable children (OVC).
This study was undertaken by MEASURE Evaluation—a project funded by USAID and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—at the request of PEPFAR and the USAID Kenya mission. This 2016–2018 panel study was designed to meet PEPFAR’s monitoring, evaluation, and reporting requirements, which include standard indicators. PEPFAR encourages the collection of data on these indicators every two years.
When MWENDO began implementing OVC programs in 2017, it took over the support of OVC beneficiaries from its predecessor project—AIDS, Population and Health Integrated Assistance Plus Program, Western Kenya, known as APHIAplus. The panel study compared results from Round 1 (2016, APHIAplus beneficiaries) and Round 2 (2018, with the same households, now MWENDO beneficiaries). It measured changes in the well-being of OVC beneficiaries over the two years using nine essential survey indicators required by PEPFAR and two supplemental indicators.
Find other materials from Round 2 are here.
Materials related to Round 1 can be found here. |
|
Seven Steps to EnGendering Public Health Evaluations: Training Instructions
|
MEASURE Evaluation |
2019 |
English |
|
Evaluation, Gender, Health programs, Public Health, Training |
Because international development increasingly focuses on gender, evaluators need a better understanding of how to measure and incorporate gender—including its economic, social, and health dimensions—in their evaluations. This interactive training, consisting of a presentation and this tool, will help participants learn to better evaluate programs with gender components.
This tool is to be used with the associated training presentation, 7 Steps to EnGendering Evaluations of HIV programs with Adolescent Girls and Young Women. It provides instructions for carrying out the training, including suggested group activities. |
|
Improving GEND_GBV Data Quality to Enhance PEPFAR Program Performance
|
MEASURE Evaluation |
2019 |
English |
|
Gender-based violence, Data Quality, GBV, HIV, Gender, PEPFAR, HIV prevention |
Gender-based violence (GBV) is a key driver of the HIV epidemic. Preventing and responding to GBV is essential to meeting PEPFAR’s 95-95-95 goals. High-quality GBV data are vital to decision making to improve GBV and HIV programs. This job aid focuses on improving GEND_GBV data quality to enhance PEPFAR program performance.
To access the GEND_GBV Rapid Data Quality Review Tool and related resources, visit www.measureevaluation.org/resources/gend_gbv-rapid-data-quality-review-tool. |
|
Community Event-Based Surveillance of Priority Human and Zoonotic Diseases in Senegal: Suggestions for a Model One Health Project
|
MEASURE Evaluation |
2019 |
English |
Africa, SENEGAL |
Senegal, GHSA, Surveillance, Community-Based Surveillance, One Health, Global health security, Community, Global Health Security Agenda |
A United States Agency for International Development (USAID)–supported Global Health Security Agenda (GHSA) activity for community event-based surveillance (CEBS) of zoonotic diseases with a One Health approach was launched in Senegal and implemented from September 2017 through June 2019. The activity was part of the USAID-supported MEASURE Evaluation Phase IV project under the GHSA Action 2 package. The activity focused on CEBS of eight prioritized infectious human and six zoonotic diseases in Senegal. This activity is a follow-on implementation of CEBS in four pilot districts (Tambacounda, Koumpentoum, Podor, and Pété) in two regions of Senegal.
The establishment of the pilot CEBS was accomplished by training community health volunteers to detect these diseases as soon as they occurred in their respective communities and to send text messages to the nearest health or veterinary post. The objective of the activity was early detection and response to limit the possibility of any large-scale outbreak of the disease.
The experience gained during this pilot forms the basis for recommendations for a model CEBS with a One Health approach for Senegal and perhaps other countries. |
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Partenaires sexuels masculins d’adolescentes et de jeunes femmes en Haïti : Comportements sexuels à risque, utilisation des services liés au VIH et violence de la part du partenaire
|
MEASURE Evaluation |
2019 |
French |
|
Sexual Behavior, Haiti, HIV, PEPFAR, HIV prevention, Young Women, Adolescent Girls, AGYW |
L’objectif de cette étude, soutenue par l’Agence des Etats-Unis pour le développment international (USAID) et le Plan d’urgence du Président américan pour la lutte contre le SIDA (PEPFAR), était de fournir des informations du point de vue des partenaires sexuels masculins de filles adolescentes et de jeunes femmes (FAJF) pouvant faciliter l’élaboration de programmes de lutte contre le VIH ciblant les hommes. Les sujets examinés comprenaient les comportements sexuels à risque, l’utilisation des services de dépistage et de traitement du VIH et la dynamique des relations sexuelles, y compris la violence du partenaire intime. L’étude a été réalisée à la demande de l’USAID, en partenariat avec le Ministère de la Santé publique et de la Population (MSPP).
Une enquête sociale et comportementale transversale a été menée auprès de 500 partenaires masculins de FAJF1 dans la région de Delmas à Port-au-Prince (PaP) et de 300 partenaires masculins à St. Marc entre les mois de février et mars 2019. Les personnes interrogées ont été recrutées sur la base d’un échantillonnage piloté par les répondants. L’analyse inclut des calculs fréquentiels et bidimensionnels des poids d’échantillonnage de population ajustés ayant été conçus sous RDS Analyst.
This brief is also available in English. Access a related report and presentation. |
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Male Sexual Partners of Adolescent Girls and Young Women in Haiti: Sexual Risk Behavior, HIV Service Use and Partner Violence
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MEASURE Evaluation |
2019 |
English |
|
AGYW, Young Women, Haiti, Adolescent Girls, HIV prevention, Sexual Behavior, PEPFAR, HIV |
This study sought to provide information from the perspective of male sexual partners of adolescent girls and young women (AGYW) in Haiti, to inform HIV programming there for men. It examined sexual risk behavior, use of HIV testing and treatment services, and the dynamics of sexual relationships, including intimate partner violence. MEASURE Evaluation— funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief—conducted the study in partnership with the Ministry of Public Health and Population (MSPP), at USAID’s request and as one component of PEPFAR’s DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) project. Understanding factors that contribute to HIV risk and service use among male sexual partners of AGYW supports USAID’s goal of controlling the epidemic in Haiti and globally.
A cross-sectional social and behavioral survey was administered to 500 male partners of AGYW1 in the Delmas area of Port-au-Prince and to 300 male partners in St. Marc in February–March 2019. Respondents were recruited using respondent-driven sampling (RDS). Results were analyzed using frequency and bivariate calculations that were adjusted using population sampling weights constructed in RDS Analyst. This brief shares more and is also available in French.
Access a related report and presentation. |
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Male Sexual Partners of Adolescent Girls and Young Women in Haiti: A Survey of HIV Risk Behavior, HIV Service Use, and Partner Violence
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Andrinopoulos, K., Felker-Kantor, E., Michel, J., Francoise, K., & Desinor, O. |
2019 |
English |
|
PEPFAR, Adolescent Girls, Young Women, HIV prevention, Haiti, HIV, AGYW |
The goal of this study was to support the achievement of the 95-95-95 targets of the United States President's Emergency Plan for AIDS Relief (PEPFAR) by providing a robust understanding of HIV sexual risk behavior, HIV testing, and HIV treatment from the perspective of adult male sexual partners of adolescent girls and young women (AGYW). in Haiti. The research objectives were to:
Describe and identify modifiable determinants of HIV risk behavior and risky sexual partnerships.
Describe normative beliefs about HIV risk behavior, sexual partnerships, and HIV service use and their influence on personal HIV risk behavior.
Describe current HIV service use and preferences for HIV testing, determinants of HIV testing uptake, and, among HIV-positive participants, antiretroviral therapy treatment uptake and adherence.
Male sexual partners of AGYW are an important population to reach with effective HIV services in Haiti. The results of this study indicate a critical need to increase men’s knowledge of HIV treatment, access to condoms, and use of HIV testing services. Efforts to decrease physical and sexual violence and to better understand the role of equity in decision making with sexual partners are also needed. Additional research is warranted among HIV-positive men to understand how to link and retain them in care and to decrease the risk of transmission to their sexual partners.
HIV interventions in Haiti should use peer social norms to promote behaviors among men and should be tailored to their preferences by locating services in community settings and in places where men are more likely to socialize. HIV programs can effectively use social networks to reach high-risk heterosexual men and refer them to programs. Future studies to characterize the male partners of AGYW should consider using RDS to recruit participants.
Access a related research brief in English or French and a PowerPoint presentation. |
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Renforcer la surveillance communautaire basée sur les événements au Sénégal
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MEASURE Evaluation |
2019 |
French |
|
Global health security, Zoonotic, Senegal, One Health, Global health, Global Health Security Agenda |
Avec l’appui de l’USAID, MEASURE Evaluation a aidé le Sénégal à mettre en place un système de Surveillance à Base Communautaire (SBC) des 8 maladies prioritaires humaines dans 4 districts pilotes depuis 2016. Ce système a permis aux acteurs communautaires d’identifier précocement les maladies au sein de la communauté et d’informer à temps l’infirmier responsable de la zone pour une réponse rapide.
En 2017, MEASURE Evaluation a révisé le système de SBC pour inclure les 6 zoonoses prioritaires et adopter une approche « Une Seule Santé » qui tient compte d’autres secteurs non traditionnels de la santé.
L’approche Une Seule Santé met l’accent sur la collaboration multisectorielle et le partage de l’information entre les parties prenantes à tous les niveaux ; et permet une réponse rapide aux évènements liés à l’interface homme-animal-environnement pour prévenir la propagation des maladies. |
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Strengthening Community Event-Based Surveillance in Senegal
|
MEASURE Evaluation |
2019 |
English |
Africa, SENEGAL |
GHSA, Global health, Global health security, One Health, Global Health Security Agenda, Zoonotic, Senegal |
Since 2016, with the support of the United States Agency for International Development (USAID), MEASURE Evaluation has assisted Senegal to set up a community event-based surveillance (CEBS) system to monitor the eight priority human diseases in four pilot districts. This system has enabled community stakeholders to identify diseases when they emerge in the community and to inform the nurse in charge of the area to enable rapid response to disease threats.
In 2017, MEASURE Evaluation revised the CEBS system to include Senegal’s six priority zoonotic diseases and adopt a “One Health” approach that involves other non-traditional health sectors. The One Health approach focuses on multisectoral collaboration and information sharing among stakeholders at all levels. It also allows for rapid response to events —illnesses that emerge in the human-animal-environment interface—to prevent the spread of disease. This brief shares more. |
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Measuring Outcomes among Children in Adverse Situations Indicators and Survey Tools
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Hellen, Jacqueline; Parker, Lisa |
2019 |
English |
Africa, Asia, Latin America and the Caribbean |
|
Household 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 https://www.measureevaluation.org/our-work/ovc/children-in-adverse-situations-indicators-and-survey-tools—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. |
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Data Quality Assessment (DQA) for HIV Program Indicators in Burundi: Final Report
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Boone, D., Bisore, S., Hypax, M. Rwantabagu, J.P., & Ly, M. |
2019 |
English |
|
DQA, Indicators, Data, Data Quality, HIV, Burundi, HIV data, Data quality assessment |
The 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. |
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Implementing Event-Based Surveillance in Burkina Faso: Using the “One Health” Approach
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Connolly, A.M., Sawadogo, I., Geers, E., & Eugene, M.Y.B. |
2019 |
English |
|
Surveillance, One Health, Global Health Security Agenda, Burkina Faso, Global health, Global health security, GHSA |
Recent 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. |
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Glosario de Términos para la Evaluación Grupal del MECAT
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MEASURE Evaluation |
2019 |
Spanish |
|
Capacity Assessment, Monitoring, Evaluation, MECAT |
Este es un glosario de términos para evaluación grupal del MECAT.
Más: https://www.measureevaluation.org/pima/m-e-capacity/ |
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Conjunto de herramientas de diagnóstico de la capacidad de monitoreo y evaluación (MECAT). Evaluación grupal
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MEASURE Evaluation |
2019 |
Spanish |
|
Capacity Assessment, Monitoring, Evaluation, MECAT, MEASURE Evaluation PIMA |
Los datos generados por este diagnóstico se utilizarán para elaborar planes capacitación para reforzar la capacidad de la división para realizar sus funciones de MyE.
Más: https://www.measureevaluation.org/pima/m-e-capacity/ |
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Diagnóstico individual de la herramienta de diagnóstico de la capacidad de monitoreo y evaluación (MECAT)
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MEASURE Evaluation |
2019 |
Spanish |
|
Capacity Assessment, Monitoring, Evaluation, MECAT |
Para aquellos en cargos de MyE:
Considere cada declaración en la herramienta y use la escala para calificar su propio nivel de competencia.
Se trata de una auto-diagnóstico con el objetivo de identificar sus necesidades personales de desarrollo de capacidades, por lo que es importante que reflexione críticamente sobre su nivel de competencia y no subestime ni sobrevalore su nivel de competencia.
Al final del diagnóstico individual, resuma sus fortalezas y debilidades clave y enumere las acciones concretas que se deben tomar (por ejemplo, capacitación a corto/largo plazo, capacitación en el trabajo/fuera del trabajo, y/u otro enfoque de desarrollo de capacidades) para fortalecer competencias específicas consideradas críticas para su desempeño laboral y un cronograma para lograr mejoras.
MECAT: https://www.measureevaluation.org/pima/m-e-capacity/ |
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Implementing the Monitoring and Evaluation Capacity Assessment Toolkit in Central America: Adjustments and Lessons Learned
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MEASURE Evaluation |
2019 |
English |
|
Monitoring, Evaluation, MECAT, Capacity Assessment, MEASURE Evaluation PIMA |
Worldwide, 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 https://www.measureevaluation.org/pima/m-e-capacity/. |
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Community-Based Indicators for HIV Programs: Data Use Cases
|
MEASURE Evaluation |
2019 |
English |
|
HIV, Indicators, Community-based health information systems, Data, Community, Data use, Community-based, HIV/AIDS |
MEASURE Evaluation reached out to implementing organizations to learn about instances where community-based HIV data for key indicators informed programmatic actions, plans, or decisions, ideally leading to associated changes in resource allocation or beneficiary outcomes.
The data use examples provided in this brief detail cases where data collected for indicators in this collection have been used to inform decisions that led to reallocation of project inputs or that could be attributed to improved outputs or outcomes.
Access the full "Community-Based Indicators for HIV Programs" collection at www.measureevaluation.org/community-based-indicators. |
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Community-Based Indicators for HIV Programs: Home-Based Care
|
MEASURE Evaluation |
2019 |
English |
|
HIV/AIDS, HIV, Community-based, Indicators, Community-based health information systems, Community, HBC |
MEASURE Evaluation reached out to PEPFAR (United States President’s Emergency Plan for AIDS Relief)—and other donor-supported programs implementing at the community level that support home-based care activities, including LINKAGES—to obtain data collection tools. The tools received are those used by community workers in Nigeria, Ethiopia, South Africa, Uganda, Kenya, Côte d’Ivoire, the Democratic Republic of the Congo, and Botswana to track and monitor community home-based care and services. The most common data elements in these tools were incorporated into the indicators in this collection.
Access the full "Community-Based Indicators for HIV Programs" collection at www.measureevaluation.org/community-based-indicators. |
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Community-Based Indicators for HIV Programs: HIV Prevention
|
MEASURE Evaluation |
2019 |
English |
|
HIV/AIDS, HIV, HIV prevention, Community-based, Indicators, Community-based health information systems, Community |
MEASURE Evaluation reached out to PEPFAR (United States President’s Emergency Plan for AIDS Relief)—and other donor-supported programs implementing programs at the community level that support HIV prevention activities among key populations, including LINKAGES—to obtain data collection tools. The tools received are used by community workers in Nigeria, Ethiopia, South Africa, Uganda, Kenya, Côte d’Ivoire, the Democratic Republic of the Congo, and Botswana to track and monitor community HIV prevention interventions. The most common data elements among these tools were incorporated into the indicators in this collection.
Access the full "Community-Based Indicators for HIV Programs" collection at www.measureevaluation.org/community-based-indicators. |
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Community-Based Indicators for HIV Programs: Key Populations
|
MEASURE Evaluation |
2019 |
English |
|
HIV/AIDS, Key Populations, KP, Community, Indicators, Community-based health information systems, HIV, Community-based |
MEASURE Evaluation reached out to PEPFAR (United States President’s Emergency Plan for AIDS Relief)—and other donor-supported programs implementing programs at the community level to support key populations, including the PEPFAR-funded LINKAGES—to obtain data collection tools. The tools received are used by community workers in Nigeria, Ethiopia, South Africa, Uganda, Kenya, Côte d’Ivoire, the Democratic Republic of the Congo, and Botswana to track and monitor outreach provided to key populations—including testing, sensitization trainings, and behavior change communication activities. The most common data elements among these tools were incorporated into the indicators in this collection.
Access the full "Community-Based Indicators for HIV Programs" collection at www.measureevaluation.org/community-based-indicators. |
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Community-Based Indicators for HIV Programs: Prevention of Mother-To-Child Transmission
|
MEASURE Evaluation |
2019 |
English |
|
HIV/AIDS, Community, PMTCT, Indicators, HIV prevention, Community-based health information systems, HIV, Community-based |
MEASURE Evaluation reached out to PEPFAR (United States President’s Emergency Plan for AIDS Relief)—and other donor-supported programs that implement programs, at the community level, to support prevention of mother-to-child transmission activities—to obtain data collection tools. The tools collected are those used by community workers in Nigeria, Ethiopia, South Africa, Uganda, Kenya, Côte d’Ivoire, the Democratic Republic of the Congo, and Botswana to monitor household care and services provided to mothers and their infants and conduct behavior change communication activities for pregnant women and mothers (of infants) living with HIV. The most common data elements among these tools were incorporated into the indicators in this collection. Each indicator is accompanied by a definition. These definitions were specifically designed to inform data collection by community programs and agents.
Access the full "Community-Based Indicators for HIV Programs" collection at www.measureevaluation.org/community-based-indicators. |
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Community-Based Indicators for HIV Programs: Vulnerable Children
|
MEASURE Evaluation |
2019 |
English |
|
Vulnerable children, HIV/AIDS, OVC, HIV, Orphans and Vulnerable Children, Community-based, Indicators, Community-based health information systems, Community |
Community-based programs link many families to health and social services. These programs ensure that HIV-positive children have access and adhere to treatment and that HIV-positive caregivers can meet the needs of their children.
MEASURE Evaluation supports efforts to improve routine monitoring systems and collect information for case management, program monitoring, and identification of beneficiaries by vulnerable children programs. This collection of indicators is an important element of MEASURE Evaluation’s work to build capacity to monitor and evaluate community-based vulnerable children programs.
Access the full "Community-Based Indicators for HIV Programs" collection at www.measureevaluation.org/community-based-indicators. |
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Successful Support for Better HIV Data
|
MEASURE Evaluation |
2019 |
English |
|
DATIM, PEPFAR, HIS, Data, Accountability, HIV, Health Information Systems |
A 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. |
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Botswana Comprehensive Care for OVC
|
MEASURE Evaluation |
2019 |
English |
Africa, BOTSWANA |
|
Since 2016, the Botswana Comprehensive Care and Support for Orphans and Vulnerable Children (BCCOVC) Project—funded by the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—has supported the Government of Botswana (GOB) to deliver social services in seven PEPFAR priority sites. The BCCOVC project is implemented by Project Concern International (PCI) and builds on the previous PCI-implemented Tsela Kgopo OVC and Gender project (2011–2016). It supplements the core package of GOB services for orphans and vulnerable children (OVC): provision of food, school uniforms, clothes, shoes, and toiletry items to orphaned and vulnerable youth. Its goals are to increase uptake of HIV testing and other reproductive health services, strengthen economic opportunities for young people, and improve educational outcomes.
Access related resources here: https://www.measureevaluation.org/resources/evaluation-of-services-for-orphans-and-vulnerable-youth-in-botswana. |
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Botswana Comprehensive Care for OVC: Teen Club
|
MEASURE Evaluation |
2019 |
English |
Africa, BOTSWANA |
|
Since 2016, the Botswana Comprehensive Care and Support for Orphans and Vulnerable Children (BCCOVC) Project—funded by the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—has supported the Government of Botswana (GOB) to deliver social services in seven PEPFAR priority sites. The BCCOVC project is implemented by Project Concern International (PCI) and builds on the previous PCI-implemented Tsela Kgopo OVC and Gender project (2011–2016). It supplements the core package of GOB services for orphans and vulnerable children (OVC): provision of food, school uniforms, clothes, shoes, and toiletry items to orphaned and vulnerable youth. Its goals are to increase uptake of HIV testing and other reproductive health services, strengthen economic opportunities for young people, and improve educational outcomes.
Access related resources here: https://www.measureevaluation.org/resources/evaluation-of-services-for-orphans-and-vulnerable-youth-in-botswana. |
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Evaluation of Services for Orphans and Vulnerable Youth in Botswana: Qualitative Findings
|
|
2019 |
English |
Africa, BOTSWANA |
OVC programs, Orphans and Vulnerable Children, Children, Orphans and vulnerable children, Africa, OVC, Evaluation, Botswana |
Since 2011, the Botswana Comprehensive Care and Support for Orphans and Vulnerable Children (BCCOVC) project—funded by the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—has supported the Government of Botswana (GOB) to deliver high-quality social services in seven sites that PEPFAR has designated for priority. The GOB’s core package of services for orphans and vulnerable children (OVC) consists of psychosocial support and provision of food, school uniforms, clothes, shoes, and toiletry items. BCCOVC services supplemented this core package of services with the goals of increasing uptake of HIV testing and other reproductive health services, improving adherence to antiretroviral therapy (ART), strengthening economic opportunities for youth, and improving the rate of school completion.
To provide the evidence necessary to plan and implement services for the unique needs of adolescent OVC, the United States Agency for International Development (USAID) and the GOB requested that MEASURE Evaluation, with support from PEPFAR, evaluate how PEPFAR- and GOB-supported OVC interventions in Botswana affect the educational, economic, and health outcomes of adolescent OVC.
The evaluation used both quantitative and qualitative methods. This brief describes the main findings from the qualitative component of the evaluation.
Access related resources here: https://www.measureevaluation.org/resources/evaluation-of-services-for-orphans-and-vulnerable-youth-in-botswana. |
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Indicator Matrix and Guidance for Monitoring and Evaluating Programs Serving Orphans and Vulnerable Children
|
MEASURE Evaluation |
2019 |
English |
|
Child Health, Children, OVC programs, OVC, Orphans and Vulnerable Children |
The United States President’s Emergency Plan for AIDS Relief (PEPFAR) engaged the United States Agency for International Development (USAID)- and PEPFAR-funded MEASURE Evaluation project to develop and support the rollout of an overarching matrix that outlines the pathway to better outcomes for children affected by HIV. PEPFAR assembled a team of experts from its partner agencies and MEASURE Evaluation to design an indicator matrix that maps the current required PEPFAR orphans and vulnerable children (OVC) indicators and complements them with additional recommended foundational, process, output, and outcome indicators and the newly established PEPFAR global OVC graduation benchmarks (https://www.measureevaluation.org/resources/publications/tl-18-20).
The team’s work resulted in these two resources:
Monitoring and Evaluating Programs Serving Orphans and Vulnerable Children: An Indicator Matrix
Using the Indicator Matrix for Monitoring and Evaluating Programs Serving Orphans and Vulnerable Children: Guidance
The OVC indicator matrix has the following uses:
Guide OVC program stakeholders to measure what matters and to consider repurposing or selecting new or custom indicators that better inform project performance
Provide sample indicators that can be used to measure how OVC projects are contributing to the global 95-95-95 targets and prevention and mitigation goals
Demonstrate relationships among PEPFAR’s reporting requirements
The matrix consists of 12 tables, each of which focuses on a key project objective and contains a set of foundational, process, output, and outcome indicators that can be used to measure progress in achieving the respective objective.
The companion guidance manual introduces the matrix—explaining its purpose and how it can be used. It describes the process that may be followed for selecting indicators from the matrix and adapting and operationalizing them. It includes several helpful tools: for example, a sample agenda for a workshop to prioritize the indicators and a table that aligns the eligible essential OVC services with the matrix.
Access the full collection at https://www.measureevaluation.org/our-work/ovc/indicator-matrix-and-guidance-for-monitoring-and-evaluating-programs-serving-orphans-and-vulnerable-children |
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GEND_GBV Rapid Data Quality Review Tool
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MEASURE Evaluation |
2019 |
English |
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Gender-based violence, Data quality, GBV, Gender, Data, Tool |
This tool 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. It is also available in Excel and Word.
Access related resources at https://www.measureevaluation.org/resources/gend_gbv-rapid-data-quality-review-tool/ |
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GEND_GBV Rapid Data Quality Review Tool (Excel Version)
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MEASURE Evaluation |
2019 |
English |
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Data Quality, Gender, GBV, Gender-based violence, Data Quality Review |
This tool 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. It is also available in PDF and Word.
Access related resources at https://www.measureevaluation.org/resources/gend_gbv-rapid-data-quality-review-tool/ |
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Evaluation of Services for Orphans and Vulnerable Youth in Botswana: Quantitative Findings
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MEASURE Evaluation |
2019 |
English |
Africa, BOTSWANA |
OVC programs, Orphans and Vulnerable Children, PEPFAR, Children, OVC, Evaluation, Botswana |
Since 2016, the Botswana Comprehensive Care and Support for Orphans and Vulnerable Children (BCCOVC) Project—funded by the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—has supported the Government of Botswana (GOB) to deliver social services in seven PEPFAR priority sites. The BCCOVC project is implemented by Project Concern International (PCI) and builds on the previous PCI-implemented Tsela Kgopo OVC and Gender project (2011–2016). It supplements the core package of GOB services for orphans and vulnerable children (OVC): provision of food, school uniforms, clothes, shoes, and toiletry items to orphaned and vulnerable youth. Its goals are to increase uptake of HIV testing and other reproductive health services, strengthen economic opportunities for young people, and improve educational outcomes.
With support from the United States Agency for International Development (USAID), the USAID- and PEPFAR-funded MEASURE Evaluation project led an evaluation to determine whether OVC beneficiaries who have participated in one to two years of OVC services from the GOB and BCCOVC project have better health, economic, and educational outcomes than do OVC beneficiaries who received only the GOB’s OVC services. The study employed a two-arm quasi-randomized design. Data were collected from 2,358 youth in September–December, 2018, through household visits, with follow-up phone calls to 206 Form 5 students in February 2019 to collect data on educational outcomes. Quantitative data were analyzed to explore bivariate associations between the study arm and primary and secondary outcomes. Multivariate logistics and linear regressions were used to examine study outcomes, controlling for age, sex, school status, orphanhood, and primary caregiver. Results from the quantitative portion of the study are presented here. The study also had a qualitative component whose results are summarized in a brief available here: Access related resources here: https://www.measureevaluation.org/resources/evaluation-of-services-for-orphans-and-vulnerable-youth-in-botswana. The full report on the evaluation is also available on this web page. |
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Community-Based Indicators for HIV Programs
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MEASURE Evaluation |
2019 |
English |
|
CBIS, HIV/AIDS, Community, Community-based health information systems, HIV, Community-based |
Information from community-based health programs is important for understanding what HIV programs are doing to test, treat, and retain in care people who are living with HIV. To provide standard measures of performance, MEASURE Evaluation developed a collection of community-based indicators that help programs to inform HIV programming at the community level. The Community-Based Indicators for HIV Programs collection includes detailed indicator definitions, data use cases for selected indicators, additional resources, and a means to submit an indicator or make recommendations.
The online version of the collection is available at https://www.measureevaluation.org/community-based-indicators. |
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Evaluation of Services for Orphans and Vulnerable Youth in Botswana: Final Report
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Mandal, M., Cannon, A., Parker, L., Halldorsdottir, I., & Millar, E. |
2019 |
English |
Africa, BOTSWANA |
Evaluation, Botswana, Orphans and Vulnerable Children, Children, OVC, OVC programs |
This 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.
Access related resources here: https://www.measureevaluation.org/resources/evaluation-of-services-for-orphans-and-vulnerable-youth-in-botswana. |
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USAID Ghana's Strengthening the Care Continuum Project: Midterm Assessment
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Elizabeth Sutherland, Abby Cannon, Samuel Day, Justice Nonvignon, Shaylen Foley, Brittany Schriver Iskarpatyoti, Kwasi Torpey |
2019 |
English |
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Ghana, Continuity of Care, Key Populations, KP, HIV |
This study was a midterm performance assessment of the United States Agency for International Development (USAID Strengthening the Care Continuum Project in Ghana. This project is designed to provide and scale up accessible, high-quality HIV services to Ghana’s key populations (KPs)—men who have sex with men, female sex workers, and transgender people—and promote transition of service provision to the Government of Ghana. The study used primary and secondary data collection: reviews of program data, client and provider surveys, focus group discussions with service providers, and key informant interviews with stakeholders at the national and local service-delivery levels. It also drew on chart abstraction data for KPs enrolled in case management services, as well as costing data for the service delivery modalities undertaken by the Care Continuum project. The study found that the Care Continuum project is well regarded by clients, providers, and stakeholders for the services it provides. The study also noted the project’s contributions to a policy environment more favorable to high-quality HIV service delivery for KPs. Chart abstraction and program data reveal that retention of KPs in care and treatment programs is a challenge in Ghana. Gender could be better integrated in services for KPs, who are highly vulnerable to gender-based violence. Finally, costs per beneficiary of the “new” intervention modalities, case management, and the healthy living platform are high, in part, because of the recent rollout of these interventions. As these modalities scale up and serve more people, costs per beneficiary should decrease—a clear benefit, especially if scale-up brings improvements in retention in care and treatment of HIV-positive KPs. |
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Gender and HIV Key Populations: A Summary of Evidence-Based Interventions
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MEASURE Evaluation |
2019 |
English |
|
HIV/AIDS, PEPFAR, HIV, Gender, Key Populations, KP |
A gender analysis is an important planning tool for the development of effective HIV interventions to reach the 95-95-95 targets of the United States President’s Emergency Plan for AIDS Relief (PEPFAR). These goals are that by 2020, 95 percent of all people living with HIV will know their status, 95 percent of all those with diagnosed HIV infection will receive sustained antiretroviral therapy (ART), and 95 percent of all those receiving ART will have viral suppression. Beginning in 2014, PEPFAR guidance for conducting a gender analysis included a focus on these populations key to the epidemic: men who have sex with men (MSM), people who use drugs, transgender people, and sex workers (PEPFAR, 2014).
Mapping to “actionable” programmatic recommendations based on the findings of a gender analysis is arguably the most important and difficult step for PEPFAR operating units. For key populations, gender is but one component of their identity that contributes to social marginalization and increased vulnerability to acquiring the virus. HIV-related interventions for key populations have typically emphasized human rights more broadly, rather than specific gender-related barriers to reaching the targets. For this reason, it can be difficult for PEPFAR teams to design interventions that deal with the gender-related factors identified in their gender analyses. To address this need, MEASURE Evaluation—a project funded by the United States Agency for International Development and PEPFAR—conducted a literature review of HIV interventions acting on a gender-related factor for key populations. This brief summarizes the methods used for the review and presents a table that lists HIV interventions addressing a gender-related factor, organized by key population. |
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Scale-Up Assessment for the Mphatlalatsane Project—“Early Morning Star”—in Lesotho
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MEASURE Evaluation |
2019 |
English |
|
Lesotho, PMTCT, Orphans and Vulnerable Children, OVC, Child health, Children, HIV, Scale-up |
The HIV epidemic has a profound effect on children in sub-Saharan Africa, where more than 15.1 million children have lost one or both parents. In 2014, as part of its orphans and vulnerable children (OVC) programming, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) announced a special initiative for children under five years old affected by the epidemic.
The initiative funded interventions and research in southern Africa (Lesotho, Eswatini [formerly Swaziland], and Zimbabwe) to generate data on successful approaches that result in improved health, to establish evidence to improve and inform programming, and to determine the potential for program scale-up.
The programs integrated OVC programming with pediatric treatment and prevention of mother-to-child transmission (PMTCT) of HIV. Evaluations of each intervention generated data on successful approaches that improve health and early childhood development outcomes; the evaluations also established evidence to improve programs. However, evidence of effectiveness is not enough to ensurethat interventions become part of routine program implementation elsewhere. Achieving that end requires early planning and strong advocacy from multiple stakeholders. To prepare for potential scale-up after the results of the evaluation become available (scaleup pertains to efforts to reach more people with a proven practice, more quickly and more effectively), the United States Agency for International Development (USAID) asked its funded project—MEASURE Evaluation—to assess the scalability of the ECD-integrated intervention in each country.
This document outlines intervention and assessment results in Lesotho. The Mphatlalatsane project, or “Early Morning Star,” was implemented by Management Sciences for Health (MSH), in partnership with Stellenbosch University, University College London, and Oxford University. The aim was to increase HIV testing and treatment while improving early childhood development outcomes in the mountainous Mokhotlong District. The project was implemented through existing early childhood care and development (ECCD) centers to evaluate the intervention in a remote and hard-to-reach region.
This brief summarizes the background, data collection methods, analysis, findings, and recommendations of this scale-up assessment. |
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Enabling and Expanding the Scope of Public Health Decision Making in Uganda to Reduce Maternal Mortality: Concept Note and Use Case
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Kumar, M., Kim, T. E., Millar, E., Ongechi, K. S., & Weiss, W. |
2019 |
English |
|
Uganda, MCH, Public Health, Maternal health, Maternal mortality |
In Uganda, the maternal mortality ratio (MMR) was 336 maternal deaths per 100,000 live births in the seven-year period preceding the 2016 Uganda Demographic and Health Survey (UDHS) (Uganda Bureau of Statistics [UBOS] & ICF, 2018). This is a notable decrease from the MMR of 438 maternal deaths per 100,000 live births in the seven-year period preceding the 2011 UDHS (UBOS & ICF International, 2012). Even so, the country’s MMR is still much higher than the target for 2030 set by Sustainable Development Goal (SDG) 3 (United Nations [UN], 2015): fewer than 70 maternal deaths per 100,000 live births globally, and around 111 for Uganda (UN, 2015). Much work needs to be done in Uganda to close this significant gap and achieve the SDG 3 there.
A major cause of maternal mortality is postpartum hemorrhage (PPH) (Partnership for Maternal, Newborn & Child Health, 2011). Deaths owing to hemorrhage at a facility could perhaps be attributed to a stockout of uterotonics or lack of a provider trained to give a uterotonic. Typically in the low- and middle -income countries, a health management information system (HMIS) does not provide data on stockouts and training of health staff, yet these are important data elements. Data on maternal complications and cause of maternal mortality are also vital but rarely collected. These are important for understanding what types of complications and causes of death are most common in a particular area, which is helpful when planning trainings and delivery of commodities. As can be seen, preventing maternal mortality involves many aspects of a health system, and thus data from the different elements are needed to inform programs and policies.
The PPH use case presented in this document shows that typically, policymakers and program managers make two types of decisions, and these are based on the sources of data they use for decision making. |
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Digital data ethics in low- and middle-income countries: The road ahead
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Sam Wambugu, James C. Thomas, Denise Johnson, Christina Villella |
2019 |
English |
|
Privacy, Digital Health, Data security, EHealth, Data ethics, Data |
Background: Digital health contributes to strong health information systems, facilitating improved access to healthcare and quality of care, and decreased health system costs. Health data are at risk of tampering by malicious actors or inadvertent access if stored on porous and poorly maintained information systems. The thoughtful application of information technology in the health sector requires the careful integration of legal, technological, medical, and societal perspectives to safeguard the privacy of individuals and populations.
Methods: With support from the United States Agency for International Development (USAID), MEASURE Evaluation conducted an assessment of health data security, privacy, and confidentiality practices through a literature review and key informant interviews with stakeholders in the health sector in Kenya and Tanzania.
Results: Stakeholders in the two countries expressed a keen interest in the need to address the issues of data security, privacy, and confidentiality. All agreed that digital health data ethics, including security and privacy, are important but are uncharted territory in these countries. The study revealed several issues: inadequate capacity to effectively implement secure information systems; weak or non-existent legal frameworks for data protection; and lack of a dedicated unit in ministries of health, with appropriately skilled staff, to oversee data ethics. Participants in Kenya and Tanzania called for the establishment of an institutional framework for data governance that would oversee digital health data ethics issues.
Conclusions: Maintaining client confidentiality in the digital era is difficult, especially in the health sector where data are among the most sought-after by hackers. Study participants in Kenya and Tanzania stated that they need tools and expertise to help assess the preparedness of existing systems and their conformity with the changing digital health landscape; and awareness raising among health policy planners and decision makers on the need for guidance on digital data ethics. Discussions on these topics and lessons from digital health projects provide important evidence for developing or updating national digital health frameworks. This article highlights the importance of bringing data ethics to the forefront of efforts to integrate digital health in health service delivery management in low- and middle-income countries. |
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Impact Evaluation of the Mayer Hashi II Project in Bangladesh
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Rahman, M., Curtis, S., E-Ijdi, R., Haider, M., Imam, A., Ahmed, A., Bloom, S. |
2019 |
English |
BANGLADESH, Asia |
Family Planning, Child Mortality, Child survival, Contraception, Reproductive Health, Child Health, Bangladesh, Children, Impact Evaluation |
The USAID-supported Mayer Hashi Phase II (MH-II) project, implemented during October 2013 through September 2018 aimed to increase the use of effective family planning (FP) and reproductive health services, with a focus on the informed and voluntary use of long-acting reversible contraceptives (LARCs) and permanent methods (PMs). This external impact evaluation was conducted by MEASURE Evaluation to determine the impact of the MH-II project on LARC and PM use at the population level. The evaluation used household, provider, and facility surveys conducted in 2015 and 2017 in early (Phase I) and late (Phase III) implementation districts supplemented by qualitative interviews with district family planning managers in 2017 to contextualize results.
There were no increases in LARC and PM use or in intention to use LARCs and PMs at the population level in Mayer Hashi Phase I or Phase III program areas by 2017. The percentage of providers who were trained in LARCs and PMs and PPFP increased notably in both Phase I and Phase III areas, but changes in intermediate outcomes hypothesized along the program pathway were not realized. Contextual analysis identified chronic system weaknesses in provision of LARCs and PMs outside of the scope of the MH-II project and persistent low demand for LARCs and PMs as impediments to widespread increases in the use of LARCs and PMs. Future programs focusing on LARCs and PMs need to consider these larger system constraints in their design and in setting their expected outcomes. They also need to further engage the private sector given its growing role in health care. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Kenya: Report on a Workshop to Disseminate 2016–2018 Findings
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Sinai, I., Odour, C., Akeyo, D., & Kadengye, D. |
2019 |
English |
|
Monitoring, Workshop, OVC programs, Kenya, OVC, Orphans and Vulnerable Children |
In 2018, the orphans and vulnerable children (OVC) team of the United States President’s Emergency Plan for AIDS Relief (PEPFAR)/Kenya requested assistance from the United States Agency for International Development (USAID) and the USAID- and PEPFAR-funded MEASURE Evaluation project to conduct three panel studies and one cross-sectional survey for three ongoing PEPFAR OVC projects in western Kenya: Making Well-Informed Efforts to Nurture Disadvantaged Orphans & Vulnerable Children (MWENDO), a USAID-funded project of Catholic Relief Services; the Timiza 90 project of the United States Centers for Disease Control and Prevention (CDC); and the Walter Reed Program/Henry M. Jackson Foundation Medical Research International (WRP/HJFMRI) HIV project funded by the United States Department of Defense. This was the second round of data collection. MEASURE Evaluation completed the first one in 2016. In the three panel studies (one for each project) the same beneficiary households who were interviewed in 2016 were again interviewed. The main objective for the repeat survey was to evaluate the progress of the OVC projects over the two-year period. In addition, an independent cross-sectional survey (conducted for MWENDO only) was designed to provide a snapshot of the current status of MWENDO beneficiaries in areas not included in the 2016 survey. Fieldwork for the surveys was undertaken in October and November 2018.
MEASURE Evaluation conducted a workshop in Kisumu, Kenya, on March 20–21, 2019, to disseminate the results from the 2018 surveys. On the first day, program managers from the three projects met to review the findings from the four surveys and compare them with the 2016 findings. They discussed the findings extensively and brainstormed their implications. They then began developing management response plans for their projects. On the second day, they were joined by national- and county-level representatives from Kenya’s Department of Children Services and managers of other PEPFAR-supported OVC projects in Kenya. Findings were again shared, this time including recommendations developed on the first day. The three implementing partners then continued working on their management response plans, while participants from the Department of Children Services and representatives from other OVC programs established recommendations for improving other OVC activities in Kenya based on the findings. The groups then reconvened in plenary and presented their final work.
This report summarizes the two-day workshop.
Find other materials from Round 2 are here.
Materials related to Round 1 can be found here. |
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Assessing Scale-Up Potential for the Zimbabwe Expanded IMPACT Project
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MEASURE Evaluation |
2019 |
English |
ZIMBABWE |
OVC, OVC programs, PMTCT |
The HIV epidemic has a profound effect on children in sub-Saharan Africa, where more than 15.1 million children have lost one or both parents. In 2014, as part of its orphans and vulnerable children (OVC) programming, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) announced a special initiative for children under five years old affected by the epidemic.
The initiative funds interventions and research in Lesotho, Eswatini (formerly Swaziland), and Zimbabwe that integrate early childhood development (ECD) with pediatric HIV treatment or prevention of mother-to-child transmission of HIV (PMTCT). Evaluations of each intervention generate data on successful approaches that improve health and early childhood development outcomes; the evaluations also establish evidence to improve programs. However, evidence of effectiveness is not enough to ensure that interventions become part of routine program implementation elsewhere. Achieving that end requires early planning and strong advocacy from multiple stakeholders. To prepare for potential scale-up after the results of the evaluation become available (scale-up pertains o efforts to reach more people with a proven practice more quickly and more effectively), the United States Agency for International Development (USAID) asked MEASURE Evaluation to assess the scalability of the ECD-integrated intervention in each country. (MEASURE Evaluation is a project funded by USAID and PEPFAR.)
This document outlines interventions and assessment results in Zimbabwe. |
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Creating a Culture of Data Use in Tanzania: Assessing Health Providers’ Capacity to Analyze and Use Family Planning Data
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Mackfallen G. Anasel, Idda L. Swai, Orest S. Masue |
2019 |
English |
TANZANIA |
Data Quality, Qualitative Evaluation, Family Planning, Data use, Maternal health, Routine Health Information Systems, Routine data, Maternal and child health, DHIS 2 |
Tanzania has embarked on extensive health planning reforms that require all districts and selected health facilities to collect, process, analyze, and use data for informed decision making. To support these reforms, the Government of Tanzania, in collaboration with development partners, has invested heavily in strengthening its health management information system and connecting all local government authorities to DHIS 2, a web-based software for analyzing, reporting, and disseminating data for health programs. However, data quality issues continue to affect the planning process. The information used in priority setting for family planning (FP) and maternal and child health is incomplete or inaccurate, and staff capacity to analyze and set priorities is questionable.
The objectives of this study were to understand health providers’ capacity to analyze collected FP data and to document available evidence of health service providers using the collected data in their planning processes. The study employed a qualitative design to understand FP providers’ experiences with analyzing and using FP data for decision making. |
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Renforcer et améliorer les systèmes d’information sanitaire Progrès en Côte d’Ivoire
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MEASURE Evaluation |
2019 |
French |
|
Health Information Systems, Cote d'Ivoire, HIS strengthening, Health Systems Strengthening, HIS |
Un système national d’information sanitaire (SNIS) est la pierre angulaire de la capacité d’un pays à rassembler des données afin de comprendre les problèmes de santé. En Côte d’Ivoire, le projet MEASURE Evaluation—financé par l’Agence des Etats-Unis pour le développement international (USAID)—travaille avec le Ministère de la Santé et de l’Hygiène Publique (MSHP) et ses partenaires de mise en oeuvre depuis 2004 pour renforcer la performance et la gestion du SNIS. Le projet appuie la gouvernance du SNIS (environnement propice), le développement et déploiement d’outils et de produits qui répondent aux besoins en information sanitaire (génération de l’information) et le renforcement des capacités des utilisateurs du SNIS (l’élément humain). Tous ces éléments sont nécessaires à la performance du SNIS. Ce document donne un aperçu du travail accompli en vue de renforcer le système d’information sanitaire (SIS) de la Côte d’Ivoire jusqu’à la date de juin 2019. |
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Strengthening and Improving Health Information Systems: Progress in Côte d’Ivoire
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MEASURE Evaluation |
2019 |
English |
|
HISS, Cote d'Ivoire, HIS, HIS strengthening, Health Information Systems, Health Systems Strengthening |
A national health information system (HIS) is the backbone for a country’s capacity to gather data to understand health issues. In Côte d’Ivoire, MEASURE Evaluation—funded by the United States Agency for International Development—has worked since 2004 with the Ministry of Health and Public Hygiene (MSHP) and implementing partners to strengthen the performance and management of the country’s HIS. The project supports the governance of the HIS (enabling environment), the development and rollout of tools and products that respond to health information needs (information generation), and capacity development of HIS users (the human element). All of these elements are necessary for HIS performance. This document provides a snapshot of the work accomplished to strengthen HIS in Côte d’Ivoire as of June 2019. |
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Conjunto de herramientas del diagnóstico de la capacidad para monitoreo y evaluación: Guía de uso
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MEASURE Evaluation PIMA |
2019 |
Spanish |
|
M&E, MECAT, Capacity Assessment, MEASURE Evaluation PIMA, Monitoring, Evaluation |
El conjunto de herramientas de diagnóstico de la capacidad de monitoreo y evaluación (MECAT— por su sigla en inglés) es un conjunto de herramientas para orientar a las organizaciones1 mediante un proceso que evalúa la capacidad actual de MyE de una organización, identifica brechas e indica áreas para fortalecer la capacidad de la organización a fin de mejorar sus sistemas de MyE. El proceso de diagnóstico de MECAT utiliza cuatro métodos y herramientas de apoyo: (1) diagnóstico grupal; (2) diagnóstico individual; (3) entrevistas con informantes clave; y (4) una revisión de la documentación correspondiente. Con este enfoque, las organizaciones, los programas y equipos nacionales y subnacionales de salud pueden evaluar con exactitud las fortalezas y deficiencias de los programas, y planificar los pasos necesarios para fortalecer las funciones de MyE. |
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Descripción de la herramienta de evaluación de la capacidad de monitoreo y evaluación
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MEASURE Evaluation |
2019 |
Spanish |
|
MECAT, M&E, Monitoring, Evaluation, Capacity Assessment |
En todo el mundo, el uso de datos del sistema de salud para orientar las decisiones sobre cómo se asignan los recursos está aumentando rápidamente, y los ministerios de salud y programas nacionales de salud están buscando formas para garantizar que la calidad de los datos del sistema de salud sea confiable. Como resultado, la recopilación de datos, compaginación, informes y uso están cada vez más bajo escrutinio, y los esfuerzos para fortalecer los sistemas de información de salud (SIS) deben centrarse en la mejora del monitoreo y la evaluación (MyE) de programas de salud, comenzando con evaluaciones de línea basal relativas a la capacidad y el rendimiento estandarizadas. Para ayudar a satisfacer esta necesidad, MEASURE Evaluation, el proyecto emblemático de fortalecimiento de MyE y SIS de la Agencia de los Estados Unidos para el Desarrollo Internacional, y su premio asociado en Kenia, MEASURE Evaluation PIMA, (MEval-PIMA) han desarrollado un proceso y un conjunto de herramientas para llevar a cabo una evaluación de línea basal estándar de capacidad de MyE. El diseño de esta evaluación se enmarca en los “12 componentes” utilizado por el Programa Conjunto de las Naciones Unidas sobre el VIH/SIDA (ONUSIDA) para fortalecer los sistemas de MyE en todo el mundo (ONUSIDA, 2009; ONUSIDA, 2010). MEval-PIMA lo utilizó por primera vez en Kenia para fijar líneas basales en programas nacionales beneficiarios y en 17 territorios objetivo. Desde entonces el conjunto de herramientas se ha adaptado para su uso en evaluaciones en otros países para ayudar a los profesionales administrativos y de salud a tomar decisiones, monitorear el progreso, y diseñar intervenciones de capacidades para el constante mejoramiento de SIS.
El conjunto de herramientas de evaluación de la capacidad de monitoreo y evaluación (MECAT—por su sigla en inglés) es una serie de herramientas para orientar a las organizaciones a través de un proceso que evalúa la capacidad actual de MyE de una organización1, identifica brechas e indica áreas para fortalecer la capacidad de la organización a fin de mejorar el sistema de MyE.
Monitoring and Evaluation Capacity Assessment (MECAT) Toolkit |
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Quality of Tuberculosis Services Assessment in Nigeria: Report
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Kolawole Oyediran |
2019 |
English |
NIGERIA |
Service delivery, TB, Assessment, Tuberculosis, Quality of care |
According to the 2018 Global Tuberculosis Report released by the World Health Organization (WHO), tuberculosis (TB) is the tenth leading cause of death and is the leading cause of death from a single infectious agent. Heads of state committed to ambitious targets aimed at eliminating TB during the first-ever United Nations High-Level Meeting on Tuberculosis conducted in September 2018 at the United Nations General Assembly.
WHO has identified 30 countries where the TB burden is high, including Nigeria. The 2016 National Health Policy highlights TB as a priority public health challenge and targets “reduction in the tuberculosis prevalence rate and the tuberculosis mortality rate in Nigeria by ensuring universal access to high-quality, client-centered TB/leprosy diagnosis and treatment services.” Service quality remains a concern and has received very limited attention in the TB research agenda in Nigeria. Only a few studies, focused on small geographic areas, have been implemented or published, and there has been no prior nationwide study of the quality of TB services in Nigeria.
Studies show that good quality of care in TB services helps patients and their families address their health needs safely and effectively. Therefore, to enhance TB service use, there is a need to assess and improve the quality of TB services. A Quality of TB Services Assessment (QTSA) was conducted by MEASURE Evaluation in Nigeria to assess the quality of TB services in randomly selected health facilities. Its purpose was to identify where services were of high quality and where there were gaps and to ensure that TB patients were receiving the care that they deserve. The QTSA assessed three domains of quality of care: the structure of the health facility, the service delivery process, and the outcomes of service delivery. The results were used to develop programs or interventions to improve TB service delivery.
The QTSA tools adapted for use in Nigeria are available here: https://www.measureevaluation.org/resources/publications/tl-19-42
QTSA documents for other countries are available here: https://www.measureevaluation.org/our-work/tuberculosis/quality-of-tb-services-assessments |
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Quality of Tuberculosis Services Assessment in Nigeria: Tools
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MEASURE Evaluation |
2019 |
English |
NIGERIA |
Quality of care, TB, Tool, Service delivery, Tuberculosis |
The Quality of Tuberculosis Services Assessment (QTSA) is conducted with the support of four tools: the Facility Audit, the Provider Interview, the Patient Interview, and the Record Review. MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID)—developed these four tools with the assistance of colleagues at USAID.
The tools exist in a generic format that is adaptable to any country wishing to conduct a QTSA. For instance, some countries may have different names for their health administrative units (e.g., district, province, ward, or woreda) or the name of their TB registers (e.g., TB patient logbook or TB confirmed cases register). They are customized to fit the country priorities and context in which they will be used.
The generic QTSA tools are available at the following link: https://www.measureevaluation.org/resources/publications/tl-19-41/
This document presents only the pilot QTSA tools adapted for use in Nigeria. It provides detailed information about the structure and content of the tools. More information on the QTSA purpose, methods, or results can be found in the individual QTSA reports.
Nigeria’s QTSA report is available here: https://www.measureevaluation.org/resources/publications/tr-19-361/ QTSA documents for other countries are available here: https://www.measureevaluation.org/our-work/tuberculosis/quality-of-tb-services-assessments |
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Mali: A Statistical Yearbook, in Time
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MEASURE Evaluation |
2019 |
English |
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DHIS 2, Health Information Systems, HIS, Mali |
Population health statistics derived from high-quality data in a national health information system (HIS) can reliably track health service coverage or gaps in services and the success or shortcomings of government efforts to improve health for its citizens. Use of this information can inform smart decisions about health policies, suggest programs to curtail or scale up, and guide allocation of scarce resources.
In Mali, however, the power of its HIS had not been fully realized. Statistical yearbooks that could have provided compiled data from the prior year were typically only validated in the last quarter of the year following—a full nine months after the fact. This meant the yearbook was less relevant for timely decision making and developing operational plans. In fact, the 2017 statistical yearbook was not even developed—because financial resources weren’t available.
That changed in 2019. For the first time, Mali successfully produced validated records of the prior year’s health data before April 30—thanks to a cooperative effort mounted by the Mali Ministry of Health (MOH) with support from MEASURE Evaluation, funded by the United States Agency for International Development (USAID). MEASURE Evaluation helped mobilize financial resources, including help from PSI, for a national validation workshop to aid in developing the yearbooks.
Building on Mali’s successful national deployment of DHIS 2 (in only 16 months) as the national health data platform for all health levels, MEASURE Evaluation was able to: (1) support regional activities to compile data, (2) harmonize data from the regions and other multiple sources, and (3) support the national level to help avoid delays that had hampered this work in the past.
The two most notable achievements were: (1) the statistical yearbook was produced in timely fashion, developed with all stakeholders, taking into account data from the local health information system (SLIS), the epidemiological surveillance system, and the hospital information system (SIH); and (2) when the data is disseminated, it will provide feedback to field managers and make it possible to measure progress and identify areas for improvement. This brief shares more. |
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From Fragile to Resilient Health Systems: A Journey to Self-Reliance
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MEASURE Evaluation |
2019 |
English |
Global |
Health Systems Strengthening, self-reliance, Health System |
Preventable disease, emerging infectious disease, extreme weather-related disasters due to urbanization and environmental degradation, and complications of pregnancy and childbirth still claim far too many lives and challenge the ability of health systems to cope. Meanwhile, shrinking investments, flat country health budgets, population pressures, and complex emergencies challenge the global ability to achieve the United Nations’ Sustainable Development Goals.
Some of the world’s experts were convened by the United States Agency for International Development (USAID), which funds MEASURE Evaluation, to take on the topic at its conference in Washington, DC, in March 2019 at a meeting, From Fragile to Resilient Health Systems: A Journey to Self-Reliance. The group addressed multiple factors affecting how health systems are able to respond to routine health challenges and emergencies. For example, what percentage of the health burden are caused by natural and man-made disasters? Or is resilience equally or differentially important at household, community, and institutional or governmental levels? Other topics included consideration of what sectors should contribute to health system resilience and how to measure progress.
The meeting gathered experts from USAID, the World Health Organization, the U.S. Department of State, the USAID mission in the Democratic Republic of the Congo, the Bill & Melinda Gates Foundation, the World Bank, UNICEF, Save the Children, World Vision, International Rescue Committee, Johnson & Johnson, GlaxoSmithKline, Johns Hopkins University, Finland’s International Affairs Ministry, Harvard University, Carnegie Mellon University, and MEASURE Evaluation—with all of those perspectives shared in this report.
Videos of the presentations given at the meeting are online on MEASURE Evaluation’s YouTube channel at https://www.youtube.com/user/measureevaluation. |
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L’alignement d’éléments de données pour des programmes VIH cohérents : Réussite en Côte d’Ivoire
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MEASURE Evaluation |
2019 |
French |
Africa, COTE D'IVOIRE |
HIS, Interoperability, HIV/AIDS, HIV, HIV data, OVC programs, HIV care, HIS strengthening, PLHIV, OVC |
En Côte d’Ivoire, deux bases de données existent pour les programmes liés aux VIH. Le premier programme vient en aide aux orphelins et enfants vulnerables (OEV). Le deuxième programme, DREAMS, (“Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe”) est destiné aux adolescentes et jeunes femmes à risque de contracter le VIH. Ces deux programmes n’ont pas été lancés au même moment et ont donc été construits en utilisant des bases de données séparées. Le problème qui se pose à présent—maintenant que ces deux programmes fonctionnent en proximité l’un de l’autre à travers la Côte d’Ivoire—est que les plateformes d’information respectives des deux programmes ne peuvent pas communiquer entre elles.
MEASURE Evaluation, financé par l’Agence des Etats-Unis pour le développement international (USAID) et le Plan d’urgence du Président américain pour la lutte contre le SIDA (PEPFAR), fournira un appui pour le développement d’une liaison entre les bases de données OEV et DREAMS. Une fois ceci fait, les gestionnaires des programmes visant les enfants, adolescents et jeunes adultes pourront plus facilement discerner quelles personnes sont atteintes par leurs interventions et découvrir qui reçoit de l’aide deux fois et qui en contrepartie ne reçoit aucune aide. |
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L’intégration des systèmes d’information en Côte d’Ivoire améliorera la performance du système sanitaire
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MEASURE Evaluation |
2019 |
French |
COTE D'IVOIRE |
EMIS, HMIS, HIV, HIS strengthening |
En Côte d’Ivoire en 2004, le plan national de développement sanitaire n’était aligné à aucun cadre de suivi-évaluation; les prestataires de soins ne pouvaient pas suivre les clients d’un service à un autre de manière fiable; les districts sanitaires n’étaient pas capables de mesurer les tendances des maladies et les décideurs au niveau national ne pouvaient ni connaître la qualité ni la couverture des services sanitaires.
Cette situation était due d’une part à la non-standardisation des outils de collecte de données et le manque de vérifications de la qualité et de la complétude des données. D’autre part, cette situation était due à la fragmentation des systèmes de gestion des données qui servaient uniquement certains aspects du système sanitaire et non l’ensemble des services de santé.
Le projet MEASURE Evaluation, financé par l’Agence des Etats-Unis pour le développement international et le Plan d’urgence du Président américain pour la lutte contre le SIDA, travaille en Côte d’Ivoire depuis 15 ans. La Côte d’Ivoire a maintenant un système national de gestion des données sanitaires—DHIS 2—déployé et utilisé à travers le pays, ainsi qu’un système d’information de gestion logistique électronique utilisé par les clients de la nouvelle pharmacie de santé publique. Cette réalisation est l’aboutissement de nombreuses étapes entreprises par la Côte d’Ivoire. |
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MEASURE Evaluation Phase IV HIV TA Extender Achievements
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MEASURE Evaluation |
2019 |
English |
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HIS, HIV prevention, HIV, Health information systems, HIV data, HIV/AIDS |
In response to USAID’s request to support USAID missions and the USAID’s Office of HIV/AIDS, MEASURE Evaluation implemented a service package focused on monitoring and evaluation, health information systems strengthening, orphans and vulnerable children, adolescent girls and young women, and prevention of mother-to-child transmission of HIV. The goal was to deliver urgent short-term, strategic technical assistance to implement PEPFAR’s Country Operational Plan 2018. |
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Integrating Data Systems in Côte d’Ivoire Will Improve Health System Performance
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MEASURE Evaluation |
2019 |
English |
AFGHANISTAN |
HIV, HIS strengthening, HMIS, EMIS |
In Côte d’Ivoire in 2004, the national health strategic plan was not aligned to a monitoring and evaluation framework; health providers could not reliably track clients from one service to another; health districts could not measure disease trends; and national policy makers could not know health service quality or coverage.
In part, this situation was caused by non-standardized data collection tools and the lack of checks on data quality and completeness. It was also a result of fragmented data management systems that served one aspect of healthcare but not the full spectrum of health services.
This brief outlines the work of MEASURE Evaluation, funded by the United States Agency for International Development and the U.S. President's Emergency Plan for AIDS Relief, to help Côte d’Ivoire address these health data needs. Côte d’Ivoire now has a national health data management system—DHIS2—deployed and used nationwide and an electronic logistics management and supply chain system used by clients of the new public health pharmacy. |
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Two Things Are Not Always Better, but Two Things that Can Relate Are an Improvement
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MEASURE Evaluation |
2019 |
English |
Africa, COTE D'IVOIRE |
HIS, Interoperability, HIV/AIDS, HIV, HIV data, OVC programs, HIV care, HIS strengthening, HIV PREV, PLHIV, OVC |
In Côte d’Ivoire, two databases exist for HIV-related programs. One of the programs benefits orphans and vulnerable children (OVC). The other program, DREAMS, (“Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe”) is for adolescent girls and young women at risk for HIV. These two programs originated years apart, and their databases are separate. The problem now—as both programs are operating in proximity to each other across Côte d’Ivoire—is that their separate information platforms can’t talk to each other.
MEASURE Evaluation, funded by the United States Agency for International Development and the U.S. President’s Emergency Plan for AIDS Relief, is supporting development of a link between the OVC and DREAMS databases. This brief outlines the process for developing this link and expected results of these efforts. |
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Improving GEND_GBV Data Quality: Methods for Assessment
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MEASURE Evaluation |
2019 |
English |
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Data Quality, Gender-based violence, Data, Gender, GBV |
To better understand the data quality challenges, gaps, and successes of implementing partners (IPs) in capturing and reporting the PEPFAR MER indicator GEND_GBV, the United States Agency for International Development (USAID) and MEASURE Evaluation collaborated to conduct a rapid assessment of the collection and reporting of GEND_GBV in three countries. This brief describes the process that was taken to collect and analyze data. It can be used by IPs, USAID missions, and USAID/Washington to guide future rounds of data collection and GEND_GBV data improvements.
Access a related improvement action strategy and webinar recording. |
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Improving GEND_GBV Data Quality: Improvement Action Strategy
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MEASURE Evaluation |
2019 |
English |
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Data Quality, GBV, Gender, Gender-based violence, Data |
To better understand the data quality challenges, gaps, and successes of implementing partners (IPs) in capturing and reporting the PEPFAR MER indicator GEND_GBV, the United States Agency for International Development (USAID) and MEASURE Evaluation collaborated to conduct a rapid assessment of the collection and reporting of GEND_GBV in three countries. This document highlights common misconceptions and errors experienced in reporting GEND_GBV and provides actionable suggestions for improving GEND_GBV reporting.
Watch a webinar recording and access a related brief. |
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L’évolution de la stratégie de surveillance « Une seule santé » au Burkina Faso
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MEASURE Evaluation |
2019 |
French |
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Global health security, Surveillance, Burkina Faso, Infectious disease |
Le Burkina Faso s’est résolu à renforcer les capacités de ses systèmes de surveillance pour la santé humaine, animale (domestique et sauvage) et environnementale. Cet engagement s’est matérialisé par une démonstration du pays à se préparer pour faire face aux menaces sanitaires d’ordre humain, animal (domestique et sauvage) et environnemental, à les prévenir, à les détecter et à riposter. Il s’est agi également d’être en mesure d’anticiper et de réduire les impacts de ces potentielles menaces sur le développement social, culturel et économique du pays. Ce rapport décrit l’évolution de la stratégie de surveillance « Une seule santé » au Burkina Faso. |
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A Manual for Routine Monitoring of the Alternative Care System in Ghana
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MEASURE Evaluation |
2019 |
English |
GHANA |
Routine Health Information Systems, Routine data, Alternative Care, manual |
Globally, there are multiple efforts to reform child welfare systems to promote better care for children, with attention to preventing unnecessary separation of children from their families and ensuring the provision of alternative care for children deprived of parental care. In Ghana, the need for a strong monitoring and evaluation (M&E) system has been identified as necessary to provide timely, reliable, and accurate information to assess whether approaches and interventions are effective, to improve accountability and learning, and to inform planning and monitoring decisions about policies and programs. For example, data on children in formal alternative care can help identify the need for new childcare services and allow policymakers and service providers to make evidence-based decisions about care to better design and manage care reform programs, resulting in better outcomes for children.
The purpose of this manual is to provide guidance on how to collect and report data on children in formal alternative care in a standardised way, and to analyse, present, and make the data available for use. The manual describes the necessary data management procedures, and the roles and responsibilities of different stakeholders for generating high-quality data on alternative care. The guidelines present a range of indicators for alternative care, the sources of information, the frequency of reports on alternative care, and monitoring and review structures. As with all M&E manuals, it is intended to be a working document. |
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The PLACE Mapping Tool
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MEASURE Evaluation |
2019 |
English |
|
Geographic Information Systems, Mapping, PLACE, QGIS, Spatial Analysis, GIS |
The Priorities for Local AIDS Control Efforts (PLACE) method mapping tool allows users to produce the planning and coverage maps they need, even with limited knowledge of a geographic information systems (GIS).
Because the tool works as a plug-in with QGIS (a popular free and open-source GIS program), a researcher can use it to import data and display them in a basic fashion on a computer screen and in a printout. The tool also allows a GIS technician to work with the data later, if need be.
The tool can handle two types of geographic data:
Planning data (such as census or population data or HIV prevalence data, usually shown as a percentage or priority score, by district)
Prevention/outreach targeting data (discrete locations, such as venues where key populations gather, or information about condom distribution)
Output is generated automatically both as a PDF, which includes title and legend information that the user can customize, and a QGIS file, which can be used for further customization, future display, or further spatial analysis.
Learn more. |
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Questions as an Organizing Framework for Health Information Systems
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James C. Thomas, Manish Kumar |
2019 |
English |
|
Health Information Systems, Health Services, HIS, Data, Information systems |
A country’s health services are guided by an information system that reveals which health services are most needed and where. Among its many uses, a health information system (HIS) can show which programs are effective, and it can help a country coordinate with neighboring countries in combatting an epidemic that crosses their borders. The flow of data used for these purposes resembles a vast watershed that gives rise to a river—unconnected rivulets that coalesce together to form increasingly large flows. Individual data elements originate in a wide variety of institutions and settings. The data collectors add counts of individual patients or vials of medicine into aggregate numbers and send them to district, provincial, and national offices. The reach of an HIS is broad, ideally extending into any place where people are living. It is composed of subsystems designed to focus on components as disparate as patient diagnoses and the availability of hospital beds. Each subsystem has its own paper forms for data collection or, increasingly, its own digital system for data collection, storage, and analysis.
It is difficult to see an HIS as a whole or to understand it due to its complexity. This obscures which components most need strengthening and compromises the coordination and collaboration essential to establishing a strong HIS. A framework that shows how the parts fit together and function toward a larger purpose can lessen the confusion. A variety of frameworks has been proposed in the last 10 years or so to serve this purpose. In this paper we describe those frameworks, identify their limitations, and propose a new framework that is more informative and helpful. The frameworks previously proposed were based on a set of systems, a means of informing programs, and levels of health system governance. The system we propose is based on questions that an HIS needs to address. |
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Geographic access to emergency obstetric services: a model incorporating patient bypassing using data from Mozambique
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Emily B Keyes, Caleb Parker, Seth Zissette, Patricia E Bailey, Orvalho Augusto |
2019 |
English |
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Maternal health, Obstetric care, Maternal mortality, Obstetrics, Geography, Geospatial analysis, Mozambique |
Introduction: Targeted approaches to further reduce maternal mortality require thorough understanding of the geographic barriers that women face when seeking care. Common measures of geographic access do not account for the time needed to reach services, despite substantial evidence that links proximity with greater use of facility services. Further, methods for measuring access often ignore the evidence that women frequently bypass close facilities based on perceptions of service quality. This paper aims to adapt existing approaches for measuring geographic access to better reflect women’s bypassing behaviour, using data from Mozambique.
Methods: Using multiple data sources and modelling within a geographic information system, we calculated two segments of a patient’s time to care: (1) home to the first preferred facility, assuming a woman might travel longer to reach a facility she perceived to be of higher quality; and (2) referral between the first preferred facility and facilities providing the highest level of care (eg, surgery). Combined, these two segments are total travel time to highest care. We then modelled the impact of expanding services and emergency referral infrastructure.
Results: The combination of upgrading geographically strategic facilities to provide the highest level of care and providing transportation to midlevel facilities modestly increased the percentage of the population with 2-hour access to the highest level of care (from 41% to 45%). The mean transfer time between facilities would be reduced by 39% (from 2.9 to 1.8 hours), and the mean total journey time by 18% (from 2.5 to 2.0 hours).
Conclusion: This adapted methodology is an effective tool for health planners at all levels of the health system, particularly to identify areas of very poor access. The modelled changes indicate substantial improvements in access and identify populations outside timely access for whom more innovative interventions are needed.
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Best practices in availability, management and use of geospatial data to guide reproductive, maternal, child and adolescent health programmes
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Yordanos B Molla, Kristine Nilsen, Kavita Singh, Corrine Warren Ruktanonchai, Michelle M Schmitz, Jennifer Duong, Florina Serbanescu, Allisyn C Moran, Zoe Matthews, Andrew J Tatem |
2019 |
English |
|
Geospatial analysis, Child health, Newborn health, Maternal health, Reproductive Health, Adolescent health |
The commentary provides a set of considerations and some examples for reproductive, maternal, newborn, child and adolescent health (RMNCAH) programmes that wish to use geospatial data. |
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Geospatial analysis for reproductive, maternal, newborn, child and adolescent health: gaps and opportunities
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Zoe Matthews, Barbara Rawlins, Jennifer Duong, Yordanos B Molla, Allisyn C Moran, Kavita Singh, Florina Serbanescu, Andrew J Tatem, Kristine Nilsen |
2019 |
English |
|
Maternal health, Adolescent health, Geospatial analysis, Newborn health, Child health, Reproductive Health |
Reproductive, maternal, newborn, child and adolescent health (RMNCAH) indicators, such as the maternal mortality ratio, often serve as a litmus test for health system performance, because women’s and children’s health lies at the core of any health system.1The health and survival of women and children does not depend on a single intervention, but on packages of interventions delivered at all levels of the health system. Mapping and tracking RMNCAH therefore captures changes in wider health system performance. But mapping has traditionally been the domain of disease-specific tracking, providing useful, but limited snapshots of progress embedded in vertical intervention mechanisms. Although disease-specific spatial mapping and research are effective ways to identify geographic inequities and to inform service provision, geographic and spatial analyses of RMNCAH have the potential to provide a broader perspective. But such analyses, especially for routine RMNCAH care provision, have been underused despite their potential to inform programmes and policies in low/middle-income countries. This commentary also argues that visualisation of RMNCAH data provides a potent social accountability and decision-making tool. Given the topic’s importance, a supplement on the use of geographic information systems (GIS) in RMNCAH is long overdue. |
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How MEASURE Evaluation Has Benefitted PEPFAR and Ministries of Health
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MEASURE Evaluation |
2019 |
English |
|
Capacity Building, PEPFAR, HIS, Data, Health information systems, HIS strengthening, Data use, DATIM |
The President’s Emergency Plan for AIDS Relief (PEPFAR) aims to achieve epidemic control by taking effective interventions to scale, applying a continuous learning approach to program performance, and intensifying efforts to identify HIV/AIDS cases. MEASURE Evaluation’s work has advanced PEPFAR’s aim in two primary ways:
Supporting the implementation, management, and capacity building of the Data for Accountability, Transparency and Impact Monitoring (DATIM) system, and
Increasing the capacity of health information systems (HIS) and improving enabling environments for HIS improvement at global, regional, and country levels—especially in PEPFAR countries.
MEASURE Evaluation’s direct contributions to the implementation of DATIM and leveraging DATIM resources are extensive. Our work encompasses data exchange, help desk support to enhance system and data use, and capacity building for DATIM users, as well as administration and oversight of a constellation of DATIM subcontractors. This brief shares more. |
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Three Government Ministries— One Health
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Eric Geers |
2019 |
English |
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Global health security, Surveillance, Burkina Faso, One Health |
Surveillance for diseases with epidemic potential in Burkina Faso has traditionally involved the Ministry of Health (MOH) for human diseases and the Ministry of Animal Resources and Fisheries (MRAH) for animal diseases. The surveillance system was largely passive, relying principally on staff at health and veterinary facilities to report cases seen at their facilities. In 2017, the MOH in Burkina Faso mounted a pilot training project in three districts to explore expanded surveillance in communities, using community health agents (agents de santé de base communautaire, or ASBCs). MEASURE Evaluation, funded by the United States Agency for International Development (USAID), built on this test project by layering in a multisectoral, One Health surveillance approach, training additional agents working outside of the health sector in these communities.
To implement a One Health approach, MEASURE Evaluation worked with national, regional, provincial, and district technical representatives from three government ministries: The MOH, the MRAH, and the Ministry of Environment, Green Economy and Climate Change. This brief shares more. |
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Diagnóstico de las Capacidades en Monitoreo y Evaluación Sistema de Información de Salud de VIH en El Salvador
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MEASURE Evaluation |
2019 |
Spanish |
|
HIS, HIV, El Salvador, MECAT, Capacity Assessment, Monitoring, Evaluation |
Los esfuerzos que El Salvador ha realizado desde el diagnóstico de los Sistemas de Información en Salud (SIS), en el marco de la iniciativa mundial de la Red de la Métrica de Salud (RMS o HMN por sus siglas en inglés: Health Metrics Network) en el 2006, han surtido efectos importantes. Los esfuerzos para contar con SIS fuertes han sido liderados desde el Ministerio de Salud (MINSAL) con la participación de instituciones que generan estadísticas sanitarias y el apoyo de organismos cooperantes. El enfoque de estas acciones se ha centrado en el apoyo que se brinda a la gestión y evaluación de las políticas de los servicios de salud para asegurar el uso óptimo de recursos en ayuda a la toma de decisiones. El compromiso de elevar los niveles de salud de la población y la limitación de recursos ratifica la necesidad de poder contar con un SIS sólido, que funcione de forma sistémica, en un proceso que reúna, comparta, analice y favorezca la utilización de la información, preocupación que se ha materializado en el desarrollo de planes de fortalecimiento a corto, mediano y largo plazo que han contribuido a la toma de buenas decisiones.
El MINSAL está a cargo del Sistema Único de Información en Salud (SUIS) en el que se articulan diferentes subsistemas los cuales generan en línea y tiempo real, reportes que determinan ser un sistema sumamente rápido que contribuye en forma expedita a la toma de decisiones por parte de los gerentes de la institución, y de actores ligados al sector sanitario.
Como parte de la estrategia regional del Plan de Emergencia del Presidente de los Estados Unidos para el Alivio del Sida (PEPFAR) y la Agencia de los Estados Unidos para el Desarrollo Internacional (USAID) en Centroamérica, MEASURE Evaluation implementa actividades de fortalecimiento de los SIS en VIH teniendo como contraparte a los ministerios de salud de la región.
Para poder contar con un SIS que, utilizando datos de calidad, genere reportes que faciliten la toma de buenas decisiones, enfocados en alcanzar las metas de eliminación del VIH para el 2030, se requiere valorar el estado del rendimiento y la capacidad de monitoreo y evaluación (MyE) del sistema en áreas funcionales clave. Para ello, es necesario llevar a cabo un diagnóstico de este sistema, que en forma rápida permita elaborar una propuesta de plan de acción para reducir las brechas identificadas por áreas de capacidad.
En el presente documento se describen los antecedentes, objetivos, metodología, resultados, discusión, recomendaciones y conclusiones del Diagnóstico de las Capacidades de MyE del SIS del VIH en El Salvador. |
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Diagnóstico de las Capacidades en Monitoreo y Evaluación Sistema de Información de Salud de VIH en Honduras
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MEASURE Evaluation |
2019 |
Spanish |
|
MECAT, HIV, HIS, Monitoring, Evaluation, Capacity Assessment, Honduras |
Honduras ha venido llevando a cabo un proceso de reforma en la salud en pro de aumentar los efectos de la promoción y prevención en salud para el bienestar de la población, acorde con las recomendaciones de la Organización Panamericana de la Salud (OPS). La respuesta a la epidemia del VIH no elude dicha reforma, que implica un abordaje sistémico en el que los ajustes al sistema de información en salud están incluidos, como elemento fundamental en la generación de evidencias de la efectividad de las intervenciones estratégicas impulsadas por la Secretaría de Salud (SESAL).
Como parte de la estrategia regional de Plan de Emergencia del Presidente de los Estados Unidos para el Alivio del Sida (PEPFAR) y la Agencia de los Estados Unidos para el Desarrollo Internacional (USAID) en Centroamérica, MEASURE Evaluation implementa actividades de fortalecimiento del Sistema de Información en Salud (SIS) en VIH teniendo como contraparte a los ministerios de salud de la región.
La asistencia técnica encargada a MEASURE Evaluation en Honduras para poder contar con un SIS que, utilizando datos de calidad, genere reportes que faciliten la toma de buenas decisiones, que se enfoquen en alcanzar las metas de eliminación del VIH al 2030, requiere valorar el estado del rendimiento y la capacidad de monitoreo y evaluación (MyE) del sistema en áreas funcionales clave. Para ello, es necesario llevar a cabo un diagnóstico de este sistema, que en forma rápida permita elaborar una propuesta de plan de acción para reducir las brechas identificadas por áreas de capacidad.
En el presente documento se describen los antecedentes, objetivos, metodología, resultados, discusión, recomendaciones y conclusiones del Diagnóstico de las Capacidades de MyE del SIS del VIH en Honduras, realizado en mayo de 2018. |
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Diagnóstico de las Capacidades en Monitoreo y Evaluación Sistema de Información de Salud de VIH en Panama
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MEASURE Evaluation |
2019 |
Spanish |
|
HIV, HIS, MECAT, Monitoring, Evaluation, Capacity Assessment |
Panamá desde que realizó el diagnóstico de los Sistemas de Información en Salud (SIS), en el marco de la iniciativa mundial de la Red de la Métrica de Salud (RMS o HMN por sus siglas en inglés: Health Metrics Network) en el 2006, viene haciendo esfuerzos para contar con SIS fuertes, liderados por el Ministerio de Salud (MINSA) con la participación de instituciones que generan estadísticas sanitarias y el apoyo de organismos cooperantes. El enfoque de estas acciones ha estado en el apoyo que se brinda a la gestión y evaluación de laspolíticas de los servicios de salud para asegurar el uso óptimo de los recursos. La limitación de los recursos disponibles ratifica la necesidad de poder contar con un SIS sólido, funcionando de forma sistémica, en un proceso que reúna, comparta, analice y favorezca la utilización de la información, preocupación que se ha materializado en el desarrollo de planes de fortalecimiento a corto, mediano y largo plazo que contribuyan a la toma de buenas decisiones.
Como parte de la estrategia regional del Plan de Emergencia del Presidente de los Estados Unidos para el Alivio del Sida (PEPFAR) y la Agencia de los Estados Unidos para el Desarrollo Internacional (USAID) en Centroamérica, MEASURE Evaluation implementa actividades de fortalecimiento de los SIS en VIH teniendo como contraparte a los ministerios de salud de la región.
Para poder contar con un SIS que, utilizando datos de calidad, genere reportes que faciliten la toma de buenas decisiones, enfocados en alcanzar las metas de eliminación del VIH al 2030, se requiere valorar el estado del rendimiento y la capacidad de monitoreo y evaluación (MyE) del sistema en áreas funcionales clave. Para ello, es necesario llevar a cabo un diagnóstico de este sistema, que en forma ágil permita elaborar una propuesta de plan de acción para reducir las brechas identificadas por áreas de capacidad.
En el presente documento se describen los antecedentes, objetivos, metodología, resultados, discusión, recomendaciones y conclusiones del Diagnóstico de las Capacidades de MyE del SIS del VIH en Panama. |
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La surveillance à temps réel au niveau communautaire Un SMS pour identifier de façon précoce
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MEASURE Evaluation |
2019 |
French |
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Infectious disease, Surveillance, Senegal, Zoonotic, Information system |
mInfoSanté est un système d’alerte précoce (SAP) basé sur l’application opensource RapidPro. Il a été introduit au Sénégal en 2015, à la suite de l’épidémie de la maladie à virus Ebola en Afrique de l’Ouest en 2014, par le Centre des Opérations d’Urgence Sanitaire (COUS) du Ministère de la Santé et de l’Action Sociale (MSAS) avec l’appui de l’UNICEF pour faciliter le suivi des cas et la communication d’urgence.
mInfoSanté, introduit au début sous l’appellation « mEbola », est utilisé à ce jour au Sénégal au niveau des districts sanitaires et des postes de santé dans sept régions pour la surveillance épidémiologique et la communication d’urgence.
Avec le soutien de l’Agence des Etats-Unis pour le développement international (USAID), le project MEASURE Evaluation a adopté mInfoSanté pour la surveillance à base communautaire (SBC) des maladies et zoonoses prioritaires dans une approche « Une Seule Santé » dans six districts sanitaires de deux régions (Saint-Louis et Tambacounda). |
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Une Seule Santé en marche au niveau communautaire La Surveillance à base communautaire des zoonoses prioritaires dans une approche « Une Seule Santé »
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MEASURE Evaluation |
2019 |
French |
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Senegal, Infectious disease, Surveillance, Zoonotic |
Le Programme de Sécurité Sanitaire Mondiale (PSSM), est un partenariat de plus de 60 pays, organisations internationales et parties prenantes non-gouvernementales visant à renforcer la capacité des pays à mieux prévenir, détecter et riposter aux menaces des maladies infectieuses, et à élever la sécurité sanitaire mondiale au rang de priorité nationale et mondiale.
Au Sénégal, le Haut Conseil de la Sécurité Sanitaire Mondiale (HCSSM), coordonne la mise en oeuvre du PSSM depuis 2015. En 2016, MEASURE Evaluation, Financée par l’Agence des États-Unis pour le développement international (USAID), a aidé à la mise en place d’un système de surveillance à base communautaire (SBC) dans quatre districts pilotes en collaboration avec le Ministère de la santé du Sénégal. Par la suite, un nouveau financement de l’USAID, a permis d’étendre ce system de surveillance pour inclure les zoonoses prioritaires et adopter une approche Une Seule Santé dans les mêmes districts et deux additionnels.
Ces zoonoses prioritaires sont la rage, la grippe aviaire zoonotique, la tuberculose bovine, l’anthrax, les fièvres Hemorragiques (Marburg et Ebola) et la Fièvre de la Vallée du Rift. Cette initiative met l’accent sur la collaboration multisectorielle et le partage de l’information entre les parties prenantes à tous les niveaux. Ce système de surveillance permet une prise en charge des évènements liés à l’interface homme-animal-environnement. |
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La Boîte à Outils sur la Maturité de l’Interopérabilité des Systèmes d’Information Sanitaire : Guide de l’utilisateur
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MEASURE Evaluation |
2019 |
French |
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Health Information Systems, Toolkit, Interoperability, HIS, Health Systems Strengthening |
La Boîte à outils sur la maturité de l’interopérabilité des systèmes d’information sanitaire comprend un modèle de maturité relatif à l’interopérabilité des systèmes d’information sanitaire (SIS), soit un outil évaluant le degré de maturité, et ce guide destiné aux utilisateurs du modèle et de l’outil.
Le but de la Boîte à outils sur la maturité de l’interopérabilité des SIS est de permettre aux MS, à leurs partenaires de mise en oeuvre et à d’autres parties prenantes de déterminer les principaux domaines d’interopérabilité et les niveaux de maturité requis pour atteindre les objectifs d’interopérabilité des SIS. En recourant à une approche fondée sur un modèle de maturité, nous cherchons à déterminer les facteurs essentiels à la mise en place de SIS matures et interopérables, à les évaluer et à créer un parcours de développement pour nous appuyer sur un (ou des) système(s) solide(s) (maturité). Cette boîte à outils est tenue à la disposition des pays sous la forme de bien public afin d’atteindre les buts et objectifs de renforcement de leurs SIS. Alors qu’il est possible de créer des systèmes interopérables intersectoriels, cette boîte à outils a pour but d’améliorer la performance d’un SIS propre à un ministère de la Santé.
La Boîte à outils sur la maturité de l’interopérabilité des SIS est disponible en ligne sur https://www.measureevaluation.org/resources/ tools/health-information-systems-interoperability-toolkit. |
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Implementing Nigeria's Master Facility List: Software Requirements Specifications
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MEASURE Evaluation |
2019 |
English |
NIGERIA |
RHIS, Routine data, Routine Health Information Systems, electronic health management information system, EMIS, health management information system |
The purpose of this document is to describe Nigeria’s Health Facility Registry (HFR) in detail: the purpose and features of the system, the interfaces of the system, what the system will do, the constraints under which it must operate, and how the system will react to external stimuli. This document is intended to help both developers and end users understand the HFR’s functional and nonfunctional requirements.
Other resources to support the implementation of Nigeria’s Master Facility List are available here: https://www.measureevaluation.org/countries/nigeria/toolkit-for-implementing-the-health-facility-registry-in-nigeria/ |
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Implementing Nigeria's Master Facility List: Results of User Acceptance Testing
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MEASURE Evaluation |
2019 |
English |
NIGERIA |
MFL, Master facility list, health management information system, HMIS, electronic health management information system |
The development of Nigeria's Health Facility Registry (HFR) and processes for the management of the national Master Facility List (MFL) was a priority of Nigeria’s National Health Information System Strategic Plan (2014–2018). The MFL is a list of health facilities with administrative information that can be used to identify and contact the facility as well as services provided at that facility. The MFL’s shortcomings included the lack of processes and an associated information system to facilitate the ongoing management of health facility data. The development of the HFR addressed these gaps. The HFR was also designed to facilitate the easy identification of health facilities and will serve as a primary source for different information systems to get data on health facilities.
User acceptance testing (UAT) is a critical phase in the software development process. During UAT, a system’s clients test whether the system can handle required tasks under real-world scenarios and according to agreed-on specifications.
The first UAT of the HFR was conducted on December 12, 2017, based on initial system requirements. In 2018, MEASURE Evaluation continued to improve the HFR, making major enhancements and developing the second version of the system (HFR 2.0). In collaboration with the Federal Ministry of Health (FMOH), MEASURE Evaluation also developed standard operating procedures (SOPs) in October 2018 for managing the facilities in the HFR. Following the validation of the SOPs by the MFL technical working group, approval workflows were prepared to ensure the proper addition, update, and deletion of facilities according to the SOPs for the HFR.
Because of the major system improvements, another UAT was needed to ensure that all functionalities worked as expected. MEASURE Evaluation and the FMOH conducted a workshop from March 27–29, 2019, to review the system and perform the UAT.
Other resources that support Nigeria’s MFL are available here: https://www.measureevaluation.org/countries/nigeria/toolkit-for-implementing-the-health-facility-registry-in-nigeria/ |
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Health Facility Registry Data Collection Form for Hospitals and Clinics
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MEASURE Evaluation |
2019 |
English |
NIGERIA |
Master facility list, electronic health management information system, MFL, health management information system, HMIS |
The Health Facility Registry (HFR) is a customized, open source, web-based application that allows users to access the Master Facility List (MFL): a list of all healthcare facilities, public and private, in Nigeria. In addition to government stakeholders who oversee facility management and the provision of healthcare services, additional stakeholders who may be interested include the authorities responsible for budgeting and allocation, human resource managers, those overseeing supply chain management, insurance companies, researchers assessing health system performance, and donors planning coverage for public health interventions. The system requires Internet connectivity to be accessed and is available to the general public.
This is the form used to collect data from hospitals and clinics for entry into Nigeria's HFR and inclusion in the national MFL.
Other resources that support Nigeria’s MFL are available here: https://www.measureevaluation.org/countries/nigeria/toolkit-for-implementing-the-health-facility-registry-in-nigeria/ |
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Implementing Nigeria's Master Facility List: Manual for Public Access to the Health Facility Registry
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MEASURE Evaluation |
2019 |
English |
NIGERIA |
Master facility list, MFL, electronic health management information system, HMIS |
The Health Facility Registry (HFR) is a customized, open source, web-based application that allows users to access the Master Facility List (MFL): a list of all healthcare facilities, public and private, in Nigeria. In addition to government stakeholders who oversee facility management and the provision of healthcare services, additional stakeholders who may be interested include the authorities responsible for budgeting and allocation, human resource managers, those overseeing supply chain management, insurance companies, researchers assessing health system performance, and donors planning coverage for public health interventions. The system requires Internet connectivity to be accessed and is available to the general public.
The purpose of this manual is to provide a broad overview of the functions of the system that are available to anyone who is interested in querying the MFL. A complementary manual for HFR administrators reviews the additional functions required for curating the MFL, including adding new facilities, modifying records for existing facilities, and signaling the closure of facilities.
Other resources that support Nigeria’s MFL are available here: https://www.measureevaluation.org/countries/nigeria/toolkit-for-implementing-the-health-facility-registry-in-nigeria/ |
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Implementing Nigeria's Master Facility List: Manual for the Administration of the Health Facility Registry
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MEASURE Evaluation |
2019 |
English |
NIGERIA |
HMIS, MFL, electronic health management information system, Master facility list |
The Health Facility Registry is a customized, open source, web-based application that allows users to access the Master Facility List (MFL): a list of all healthcare facilities, public and private, in Nigeria. In addition to government stakeholders who oversee facility management and the provision of healthcare services, additional stakeholders who may be interested include the authorities responsible for budgeting and allocation, human resource managers, those overseeing supply chain management, insurance companies, researchers assessing health system performance, and donors planning coverage for public health interventions. The system requires Internet connectivity to be accessed and is available to the general public.
The purpose of this manual is to provide a broad overview of the functions that are available to administrators of the system who will add new facilities, modify records for existing facilities, and signal the closure of facilities. In addition, we will provide an overview of the workflows for the verification, validation, and publication of these requests. A complementary manual is available for public, nonadministrative users who want to query the MFL: “Implementing Nigeria’s Master Facility List: Manual for Public Access to the Health Facility Registry.”
This and other resources that support Nigeria’s MFL are available here: https://www.measureevaluation.org/countries/nigeria/toolkit-for-implementing-the-health-facility-registry-in-nigeria/ |
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Implementing Nigeria's Master Facility List: Software Design of the Health Facility Registry
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MEASURE Evaluation |
2019 |
English |
NIGERIA |
Master facility list, HMIS, electronic health management information system, MFL |
The health facility registry (HFR) for Nigeria’s Federal Ministry of Health was developed as an open-source web portal for displaying and exporting data on all hospitals, clinics, imaging centers, and laboratories in the country. These data constitute Nigeria’s Master Facility List (MFL).
Here we present the designs used or intended to be used to create the portal. A companion document—Implementing Nigeria’s Master Facility List: Software Requirements Specifications—provides the designs’ specifications. That and other resources that MEASURE Evaluation—funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief—has developed to support the implementation of Nigeria’s MFL are available here: https://www.measureevaluation.org/countries/nigeria/toolkit-for-implementing-the-health-facility-registry-in-nigeria/
This document provides a detailed description of the software architecture of the HFR system and will serve as a road map showing future developers how the HFR was designed and implemented. It specifies the structure and design of some of the modules discussed in the Software Requirements Specifications, cited above. It also displays some of the use cases that were transformed into sequence diagrams and use-case diagrams. |
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Implementing Nigeria's Master Facility List: Harmonization with the National Health Management Information System Facility List
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MEASURE Evaluation |
2019 |
English |
NIGERIA |
Master facility list, HMIS, electronic health management information system, MFL |
The purpose of the Health Facility Registry (HFR) is to serve as the unique source for health facility data: contact information, geocoordinates, services offered, and composition of health providers. During the development of a monitoring and evaluation framework for the implementation of Nigeria’s master facility list, a technical working group prioritized the integration of the HFR with the national health management information system. The goal of this is to allow facility updates with appropriate approvals to be pushed by means of an application programming interface from the HFR to the DHIS 2.
This report documents experience with the first step toward this integration—aligning the administrative units and health facility names between the two information systems. To that end, the Federal Ministry of Health in collaboration with its technical partners—the Health Information Systems Program and MEASURE Evaluation—initiated the health facility alignment process in October 2018. Different types of discrepancies were observed, and valiant efforts were made to seek verification of health facilities by state authorities. Unfortunately, remote reconciliation of discrepancies proved challenging. Even so, as a result of this activity, both the HFR and the DHIS 2 have been updated to include 41,454 facilities.
Other resources to support the implementation of Nigeria’s Master Facility List are available here: https://www.measureevaluation.org/countries/nigeria/toolkit-for-implementing-the-health-facility-registry-in-nigeria/ |
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Implementing Nigeria's Master Facility List: Guidelines
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MEASURE Evaluation |
2019 |
English |
NIGERIA |
MFL, Master facility list |
Healthcare services in Nigeria are provided by thousands of public and private health facilities around the country. The Government of Nigeria and other health system stakeholders routinely require information about the distribution of health facilities and the services that they offer. The most recent nationwide effort to list the health facilities in Nigeria was completed in 2013.
The World Health Organization defines a master facility list (MFL) as “a complete listing of health facilities in a country (both public and private) and is comprised of a set of identification items for each facility . . . and basic information on the service capacity of each facility.” Previous MFLs in Nigeria lacked processes for continuous updating or an information system to manage the MFL across states. They collected only a few parameters and several projects continued to create separate lists for their own purposes.
To ensure that Nigeria's MFL could be used across different applications, it had to be continuously accessible and up-to-date. Therefore, a health facility registry (HFR) was developed to manage the MFL. The HFR has built-in processes to address the continuous status changes of individual health facilities. It will facilitate the integration and interoperability of different applications being deployed for the national health information architecture in the country.
This document presents the definitions of the information contained in the MFL. It is an implementation guide on how to use this information. Other resources developed 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) to support the implementation of the MFL in Nigeria are available here: https://www.measureevaluation.org/countries/nigeria/toolkit-for-implementing-the-health-facility-registry-in-nigeria/ |
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Use of Routine Health Information System Data to Evaluate Impact of Malaria Control Interventions in Zanzibar, Tanzania from 2000 to 2015
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Ashton, R., Bennett, A., Al-Mafazy, A.-W., Abass, A. K., Msellem, M. I., McElroy, P. . . . Bhattarai, A. |
2019 |
English |
TANZANIA |
malaria, Zanzibar, Disease prevention, Malaria control, RHIS, HMIS |
Background
Impact evaluations allow countries to assess public health gains achieved through malaria investments. This study uses routine health management information system (HMIS) data from Zanzibar to describe changes in confirmed malaria incidence and impact of case management and vector control interventions during 2000–2015.
Methods
HMIS data from 129 (82%) public outpatient facilities were analyzed using interrupted time series models to estimate the impact of artemisinin-based combination therapy (ACT), indoor residual spray, and long-lasting insecticidal nets. Evaluation periods were defined as pre-intervention (January 2000 to August 2003), ACT-only (September 2003 to December 2005) and ACT plus vector control (2006–2015).
Findings
After accounting for climate, seasonality, diagnostic testing rates, and outpatient attendance, average monthly incidence of confirmed malaria showed no trend over the pre-intervention period 2000–2003 (incidence rate ratio (IRR) 0.998, 95% CI 0.995–1.000). During the ACT-only period (2003–2005), the average monthly malaria incidence rate declined compared to the pre-intervention period, showing an overall declining trend during the ACT-only period (IRR 0.984, 95% CI 0.978–0.990). There was no intercept change at the start of the ACT-only period (IRR 1.081, 95% CI 0.968–1.208), but a drop in intercept was identified at the start of the ACT plus vector control period (IRR 0.683, 95% CI 0.597–0.780). During the ACT plus vector control period (2006–2015), the rate of decline in average monthly malaria incidence slowed compared to the ACT-only period, but the incidence rate continued to show an overall slight declining trend during 2006–2015 (IRR 0.993, 95% CI 0.992–0.994).
Interpretation
This study presents a rigorous approach to the use of HMIS data in evaluating the impact of malaria control interventions. Evidence is presented for a rapid decline in malaria incidence during the period of ACT roll out compared to pre-intervention, with a rapid drop in malaria incidence following introduction of vector control and a slower declining incidence trend thereafter. |
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Enquêtes qualitatives sur les motivations des Comités de Veille et d’Alerte Communautaire impliqués dans la surveillance des maladies infectieuses au Sénégal
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Diop, D., Ba, A., Nguimfack, J., Moreland, S., & Sukumaran, S. |
2019 |
French |
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Global health security, Senegal, Infectious disease, Surveillance, Global health |
Contexte : les récentes épidémies de maladies infectieuses en Afrique ont fait ressortir le rôle important de la communauté dans la surveillance des maladies notamment dans la détection précoce et la réponse rapide. Le Ministère de la Santé et de l’Action Sociale (MSAS) du Sénégal avec l’appui de ses partenaires dont MEASURE Evaluation a initié en 2016 la phase pilote de la surveillance à base communautaire. Cette activité est venue s’ajouter au paquet de services des acteurs communautaire de santé (ACS) qui intervenaient dans la santé maternelle et néonatale. C’est dans ce contexte que MEASURE Evaluation a mené une étude évaluative de la motivation des membres des Comités de Veille et d’Alerte Communautaire (CVAC) impliqués dans la surveillance épidémiologique.
Objectifs : cette étude avait pour objectifs, d’identifier les facteurs qui motivent et ceux qui démotivent les membres de CVAC dans leur rôle d’acteurs communautaires de santé (ACS) en général et dans la recherche et la notification des maladies prioritaires en particulier ; et de formuler des recommandations sur les moyens de renforcer la motivation des CVAC dans leur activité de surveillance communautaire.
Matériels et méthodes : huit focus groups ont été réalisés dans les postes de santé sélectionnés dans les districts sanitaires de Tambacounda, Koumpentoum, Podor, et Pété. Les données ont été collectées avec un questionnaire individuel et un guide d’entretien structuré en thèmes. Les données du questionnaire individuel ont été analysées sous SPSS. Les focus groups ont été enregistrés sur des dictaphones puis transcrites. Les données transcrites ont été traitées avec le logiciel Atlas.ti. Cette étude a obtenu un avis éthique et scientifique favorable du Comité National d’Éthique pour la Recherche en Santé et l’autorisation administrative du MSAS. Chaque participant a signé un consentement avant le démarrage des focus groups.
Résultats : 65 membres de CVAC au total ont participé à l’étude. L’enquête sociodémographique a montré que les membres de CVAC sont majoritairement jeunes avec une moyenne d’âge de 35 ans, mariés pour la plupart (83 %), avec une proportion plus élevée de femmes (sex-ratio 0,5), et scolarisés (55 % ont été jusqu’au niveau secondaire). En ce qui concerne le niveau de connaissance des langues, la langue la plus parlée est le pulaar (58 %), cependant le français reste la langue la plus écrite (71 %) et la plus lue (68 %). Pour ce qui est des facteurs de motivation, ils sont essentiellement symboliques et relationnels. Il s’agit de la reconnaissance communautaire et institutionnelle, des formations reçues et des outils de travail mis à leur disposition, et du suivi par les personnels de santé (ICP et superviseurs). S’agissant des facteurs de démotivation, le principal grief est lié aux moyens de travail (outils de gestion, de sensibilisation, et téléphones portables). Il s’ajoute à cela le manque de considération sociale et institutionnelle que certains CVAC ont pu ressentir et l’incapacité des membres de CVAC à répondre aux sollicitations des populations (consultations médicales, médicaments, argent, etc.). Au regard des résultats de l’étude, il a été formulé comme recommandations d’assurer aux CVAC une reconnaissance institutionnelle et un suivi régulier par les personnels de santé, et de leur doter d’objets de reconnaissance unique et de téléphones portables plus performants et en plus grande quantité. |
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Formation sur la surveillance basée sur les évènements dans la communauté, District de Pô, Région Centre-Sud, Burkina Faso
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Issaka Sawadogo, Marie Yolande Eugene, Allison Connolly, Serge Nzietchueng et Eric Geers |
2019 |
French |
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|
Avec le financement de l’Agence des Etats-Unis pour le développement international (USAID), MEASURE Evaluation a aidé le gouvernement du Burkina Faso à renforcer son système de surveillance des maladies en utilisant l'approche « Une Seule Santé ». Le renforcement de la surveillance communautaire a été un aspect essentiel de l’amélioration du système de surveillance.
Pour soutenir cet effort, une formation en cascade sur la surveillance basée sur les événements inhabituels (SBE) a été organisée du 3 au 13 décembre 2018 à Manga, le chef-lieu de la région du Centre-Sud, et à Pô, dans la province de Nahouri.
Des membres du personnel du Ministère de la Santé (MS), du Ministère des Ressources Animales et Halieutiques (MRAH) et du Ministère de l'Environnement, de l'Économie Verte et du Changement Climatique (MEEVCC) ont pris part à cette formation. Les objectifs de la formation étaient les suivants:
établir un pool de formateurs régionaux et provinciaux dans le cadre de l’approche « Une Seule Santé » et
renforcer les capacités des agents des points de prestation et des acteurs communautaires des trois ministères de sorte qu’ils soient en mesure de conduire des activités SBE dans la communauté.
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Réalisations de l’implémentation de la surveillance basée sur les évènements au Burkina Faso, région Centre-Sud selon le modèle “Une Seule Santé”
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Issaka Sawadogo, Marie Yolande Eugene, Allison Connolly, Serge Nzietchueng et Eric Geers |
2019 |
French |
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Global health security, Surveillance, Burkina Faso, Information systems |
MEASURE Evaluation a été contractée en octobre 2017 par l’Agence des Etats-Unis pour le développement international (USAID) pour supporter les activités de renforcement des systèmes de surveillance au Burkina Faso. Ce projet vient soutenir les ministères en charge de la santé, des ressources animales et halieutiques et de l’environnement, de l’économie verte et du changement climatique pour apporter une réponse efficace aux menaces de santé publique.
Objectifs :
Renforcer le système de surveillance des maladies au Burkina Faso en utilisant l'approche « Une Seule Santé »
Améliorer la disponibilité de données sanitaires de qualité à tous les niveaux du système de santé
Accroître la coordination multisectorielle et la capacité de gestion du système d'information de surveillance face aux épidémies majeures
Améliorer la capacité des ministère
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Data for Impact: Semiannual Report Summary
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Data for Impact |
2019 |
English |
|
D4I, Data use, Data Quality, Data for Impact, Data |
Data for Impact (D4I) is a new 5-year cooperative agreement funded by the United States Agency for International Development and primed by the University of North Carolina at Chapel Hill. The project began in September 2018 and has reported accomplishments made during its first nine months in a one-page infographic. The infographic outlines project goals and objectives, country uptake of project expertise, and a broad look at some of the work done to date. |
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Sustaining the Impact: Population and Reproductive Health
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MEASURE Evaluation |
2019 |
English |
|
Reproductive Health, Population, Family Planning |
MEASURE Evaluation develops measures, tools, and guides to support strong data collection and monitoring and evaluation by family planning program implementers, donors, and stakeholders. MEASURE Evaluation conducts research and evaluation to inform program and policy decision making, develops methods to improve health information systems, and builds local capacity to conduct research. This brief shares more. |
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Quality of Tuberculosis Services Assessment in the Philippines: Tools
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MEASURE Evaluation |
2019 |
English |
PHILIPPINES |
Tuberculosis, Tool, Quality of care, Service delivery, TB |
The Quality of Tuberculosis Services Assessment (QTSA) is conducted with the support of four tools: the Facility Audit, the Provider Interview, the Patient Interview, and the Register Review. MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID)—developed these four tools with the assistance of colleagues at USAID.
The tools exist in a generic format that is adaptable to any country wishing to conduct a QTSA. For instance, some countries may have different names for their health administrative units (e.g., district, province, ward, or woreda) or the name of their TB registers (e.g., TB patient logbook or TB confirmed cases register). They are customized to fit the country priorities and context in which they will be used.
The generic QTSA tools are available at the following link: https://www.measureevaluation.org/resources/publications/tl-19-41/
This document presents only the QTSA tools adapted for use in the Philippines. It provides detailed information about the structure and content of the tools. More information on the QTSA purpose, methods, or results can be found in the individual QTSA reports.
The Philippines’ QTSA report is available here: https://www.measureevaluation.org/resources/publications/tr-19-350/ QTSA documents for other countries are available here: https://www.measureevaluation.org/our-work/tuberculosis/quality-of-tb-services-assessments |
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Quality of Tuberculosis Services Assessment in the Philippines: Report
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Soumya Alva and Suzanne Cloutier |
2019 |
English |
PHILIPPINES |
Tuberculosis, Service delivery, TB, Quality of care |
According to the 2018 Global Tuberculosis Report released by the World Health Organization (WHO), tuberculosis (TB) is the tenth leading cause of death and is the leading cause of death from a single infectious agent. Heads of state committed to ambitious targets aimed at eliminating TB during the first-ever United Nations High-Level Meeting on Tuberculosis conducted in September 2018 at the United Nations General Assembly.
WHO has identified 30 countries where the TB burden is high, including the Philippines. The country has one of the most severe epidemics, with an estimated 500 new cases per 100,000 population. This rate is higher than the 150 to 400 per 100,000 population in most of the 30 high-burden TB countries. In response, the Philippines has enacted a TB law, which called for the creation of a national strategic plan. The Republic of Philippines National Tuberculosis Control Program responded with the Philippine Strategic TB Elimination Plan, running from 2017 to 2022.
Studies show that good quality of care in TB services helps patients and their families address their health needs safely and effectively. Therefore, to enhance TB service use, there is a need to assess and improve the quality of TB services. A Quality of TB Services Assessment (QTSA) was conducted by MEASURE Evaluation in the Philippines to assess the quality of TB services in randomly selected health facilities. Its purpose was to identify where services were of high quality and where there were gaps and to ensure that TB patients were receiving the care that they deserve. The QTSA assessed three domains of quality of care: the structure of the health facility, the service delivery process, and the outcomes of service delivery. The results were used to develop programs or interventions to improve TB service delivery.
The QTSA tools adapted for use in the Philippines are available here: https://www.measureevaluation.org/resources/publications/tl-19-38
QTSA documents for other countries are available here: https://www.measureevaluation.org/our-work/tuberculosis/quality-of-tb-services-assessments |
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Suivi des résultats des programmes du PEPFAR pour les orphelins et les enfants vulnérables en RDC Résultats de l'enquête 2017 du Projet ELIKIA
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MEASURE Evaluation |
2019 |
French |
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Le Projet ELIKIA améliore les services et les passerelles pour les enfants affectés par le VIH et le SIDA. Cette initiative, qui vient en aide à près de 10 000 orphelins et enfants vulnérables (OEV), est mise en oeuvre par un consortium regroupant l'Education Development Center (EDC), Catholic Relief Services (CRS), Palladium et Caritas. La mise en œuvre du projet ELIKIA en RDC a débuté en septembre 2016 avec les objectifs suivants : 1. Réduire la vulnérabilité économique des ménages cibles de manière à ce qu'ils puissent répondre aux besoins élémentaires des enfants placés sous leur garde ; 2. Accroître l'utilisation de services essentiels par les orphelins et autres enfants vulnérables cibles et leur ménage ; 3. Renforcer les systèmes de protection sociale au niveau provincial et des districts. |
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Suivi des résultats du programme PEPFAR pour les orphelins et enfants vulnérables en République Démocratique du Congo: Résultats de l’enquête du Projet ELIKA 2018
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Walter Obiero, Patrick Kayembe, Michelle Winner |
2019 |
French |
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DRC, OVC, Evaluation, PEPFAR |
Le VIH frappe particulièrement la tranche de la population active, ceux âgés de 15 à 55 ans. Ces hommes et femmes laissent des orphelins dont le futur est compromis si les communautés ne s’impliquent pas. Le Plan d’urgence du président américain pour la lutte contre le sida (PEPFAR) collabore avec le gouvernement de la République Démocratique du Congo (RDC) pour renforcer les services aux orphelins et enfants vulnérables (OEV) et ceux qui en prennent soin. Le soutien du PEPFAR est axé sur la fourniture d'un ensemble complet d'interventions de base comprenant des soins de santé et des références pour la nutrition, la vaccination, la planification familiale et le viol, ainsi que le dépistage, les soins et traitement du VIH y compris les conseils visant l’adhérence à la thérapie antirétrovirale (ART), la promotion de la parentalité positive, l’encadrement des ménages à problème dans les formations « maison fidèle », la fourniture d'un soutien psychosocial aux ménages affectés, les activités de renforcement économique des ménages, telles que l'épargne et les transferts monétaires, la protection sociale par la référence pour l’obtention de l’acte de naissance et un soutien éducatif pour les enfants.
Reconnaissant la nécessité de mieux comprendre les effets de ses programmes sur le bien-être des OEV, PEPFAR a exigé en 2014 la production de rapports afin de suivre les résultats des projets dans les pays où il soutient les OEV. L'exigence implique la collecte de données sur neuf indicateurs clés des résultats, appelés indicateurs essentiels d'enquête (IEE) sur les OEV.
En RDC, le projet ELIKIA a démarré en avril 2016 avec le financement du PEPFAR. Ce rapport présente les résultats de l'enquête organisée par l’Ecole de Santé Publique de l’Université de Kinshasa (ESP-UNIKIN) en partenariat avec MEASURE Evaluation.
Au moment de l'enquête, le projet ELIKIA dans la province du Haut-Katanga en partenariat avec quatre partenaires locaux, fournissait des services à environ 2000 ménages hébergeant environ 9000 enfants bénéficiaires dans la ville de Lubumbashi.
Un échantillon aléatoire de 528 ménages a été sélectionné du registre des bénéficiaires, registre consolidé après l’exercice de vérification et traçage. A l’issue de la descente sur terrain, 495 ménages ont être retrouvés et les tuteurs de 2432 enfants bénéficiaires ont été interviewés sur eux-mêmes et sur les enfants dont ils avaient la charge.
Les outils d'enquête et la méthodologie utilisés ont suivi les directives précédemment élaborées par MEASURE Evaluation pour le compte de PEPFAR pour la collecte des IEE-OEV.
Les résultats des neuf IEE et les indicateurs supplémentaires demandés par USAID/RDC, présentés sous forme tabulaire ci-dessous, ont fourni un aperçu du bien-être des enfants et des ménages desservis par ELIKIA en début de l’année 2018. L’étude indique les domaines où les efforts devront être faits pour améliorer le bien-être des OEV. |
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Sustaining the Impact: Orphans and Vulnerable Children
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MEASURE Evaluation |
2019 |
English |
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OVC, Monitoring, Evaluation, Orphans and Vulnerable Children, OVC programs, Systems strengthening, HIV, PEPFAR |
Through programming for orphans and vulnerable children (OVC), the United States President’s Emergency Plan for AIDS Relief (PEFPAR) aims to mitigate the multidimensional and acute impacts of HIV and AIDS on children, by providing holistic, community-based care and support services.
Strengthening the systems that support vulnerable children and families ensures that children living with HIV receive the services they need and that children who are affected do not acquire the virus.
MEASURE Evaluation’s strategic approach MEASURE Evaluation improves programs for OVC by improving the quality and accessibility of data on programs and target populations. MEASURE Evaluation is building OVC monitoring and evaluation (M&E) capacity globally by developing indicators and tools, evaluating programs, triangulating data, and providing technical assistance and mentoring.
Our recent work includes a suite of activities covering routine monitoring, costing, size estimation, social service system strengthening, outcomes monitoring, and national OVC M&E system strengthening. This brief shares more. |
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Quality of family planning services in HIV integrated and non-integrated health facilities in Malawi and Tanzania
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Michael A. Close, Janine Barden-O’Fallon, and Carolina Mejia |
2019 |
English |
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Malawi, Quality of care, Family Planning, Tanzania, HIV |
Background: The integration of family planning (FP) and HIV-related services is common in sub-Saharan Africa. Little research has examined how FP quality of care differs between integrated and non-integrated facilities. Using nationally representative data from Malawi and Tanzania, we examined how HIV integration was associated with FP quality of care.
Methods: Data were drawn from Service Provision Assessments (SPAs) from Malawi (2013–2014) and Tanzania (2014–2015). The analytic sample was restricted to lower-level facilities in Malawi (n = 305) and Tanzania (n = 750) that offered FP services. We matched SPA measures to FP quality of care indicators in the Quick Investigation of Quality (QIQ). We conducted bivariate and multivariate analyses of 22 QIQ indicators to examine how integration status was related to individual QIQ indicators and overall FP quality of care at the facility- and client-level.
Results: The prevalence of HIV integration in Malawi (39%) and Tanzania (38%) was similar. Integration of HIV services was significantly associated (p < 0.05) with QIQ indicators in Malawi (n = 3) and Tanzania (n = 4). Except for one negative association in Tanzania, all other associations were positive. At the facility-level, HIV integration was associated with increased odds of being at or above the median in FP quality of care in Malawi (adjusted odd ratio (OR) = 2.24; 95% confidence interval (CI) = 1.32, 3.79) and Tanzania (adjusted OR = 2.10; 95% CI = 1.37, 3.22). At the client-level, HIV integration was not associated with FP quality of care in either country.
Conclusion: Based on samples in Malawi and Tanzania, HIV integration appears to be beneficially associated with FP quality of care. Using a spectrum of FP quality of care indicators, we found little evidence to support concerns that HIV integration may strain facilities and providers, and adversely impact quality outcomes. Rather, it appears to strengthen FP service delivery by increasing the likelihood of stocked FP commodities and achievement of other facility-level quality indicators, potentially through HIV-related supply chains. Further research is needed to assess FP quality of care outcomes across the various platforms of FP integration found in sub-Saharan Africa. |
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Data for Impact: What's the cost of evaluations and other surveys?
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Data for Impact |
2019 |
English |
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D4I, Evaluation, Data for Impact |
A core principle of Data for Impact (D4I) is to help countries focus on their knowledge gaps in health and to consider the full range of options to address those issues. The primary types of evaluations in D4I’s scope are process, outcome, impact, and economic evaluations and implementation science and operations research. D4I also conducts outcome monitoring surveys and implements formative studies to aid in intervention design and implementation. When planning any of these investigations, cost is an important consideration that may help determine the decision to do or plan for an evaluation or study.
Cost is dependent on many factors, including objective, design, method, sample size, geographic scope, and local context. Other factors that affect cost are, for example, the front-end work required to plan an evaluation or study—which can be substantial. This resource shares details to consider. |
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Facilitators, best practices and barriers to integrating family planning data in Uganda’s health management information system
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Stephen Ojiambo Wandera, Betty Kwagala, Olivia Nankinga, Patricia Ndugga, Allen Kabagenyi, Bridgit Adamou, and Benjamin Kachero |
2019 |
English |
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Data, HMIS, Family Planning, Uganda, Health information systems |
BackgroundHealth management information systems (HMIS) are instrumental in addressing health delivery problems and strengthening health sectors by generating credible evidence about the health status of clients. There is paucity of studies which have explored possibilities for integrating family planning data from the public and private health sectors in Uganda’s national HMIS. This study sought to investigate the facilitators, best practices and barriers of integrating family planning data into the district and national HMIS in Uganda.
MethodsWe conducted a qualitative study in Kampala, Jinja, and Hoima Districts of Uganda, based on 16 key informant interviews and a multi-stakeholder dialogue workshop with 11 participants. Deductive and inductive thematic methods were used to analyze the data.
ResultsThe technical facilitators of integrating family planning data from public and private facilities in the national and district HMIS were user-friendly software; web-based and integrated reporting; and availability of resources, including computers. Organizational facilitators included prioritizing family planning data; training staff; supportive supervision; and quarterly performance review meetings. Key behavioral facilitators were motivation and competence of staff. Collaborative networks with implementing partners were also found to be essential for improving performance and sustainability.
Significant technical barriers included limited supply of computers in lower level health facilities, complex forms, double and therefore tedious entry of data, and web-reporting challenges. Organizational barriers included limited human resources; high levels of staff attrition in private facilities; inadequate training in data collection and use; poor culture of information use; and frequent stock outs of paper-based forms. Behavioral barriers were low use of family planning data for planning purposes by district and health facility staff.
ConclusionFamily planning data collection and reporting are integrated in Uganda’s district and national HMIS. Best practices included integrated reporting and performance review, among others. Limited priority and attention is given to family planning data collection at the facility and national levels. Data are not used by the health facilities that collect them. We recommend reviewing and tailoring data collection forms and ensuring their availability at health facilities. All staff involved in data reporting should be trained and regularly supervised.
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Special Initiative for Orphans and Vulnerable Children Assessing the Scalability of an Early Childhood Development-Integrated Intervention in Eswatini
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MEASURE Evaluation |
2019 |
English |
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Eswatini, Orphans and vulnerable children, OVC, PMTCT, HIV |
The HIV epidemic has a profound effect on children in sub-Saharan Africa, where more than 15.1 million children have lost one or both parents. In June 2014, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) announced, as part of its orphans and vulnerable children (OVC) programming, a special initiative for children under age five affected by the epidemic. The initiative funds interventions and research in southern Africa—Lesotho, Eswatini (formerly Swaziland), and Zimbabwe—to generate data on approaches that improve health. Its goals are to establish evidence to improve and inform programming and determine the potential for program scale-up.
The programs integrate OVC programming with pediatric treatment and prevention of mother-to-child transmission (PMTCT) of HIV. Outcome evaluations of each intervention in the three countries seek to examine both early childhood development (ECD) and clinical aspects of interventions for a more holistic understanding of children’s needs. Evaluations of each intervention generate data on successful approaches that improve health and establish evidence to improve programs. However, evidence of effectiveness is not enough to ensure that interventions become part of routine program implementation elsewhere. Achieving that end requires early planning and strong advocacy from multiple stakeholders. To prepare for potential scale-up once the results of the evaluation become available, the United States Agency for International Development (USAID) asked its funded project—MEASURE Evaluation—to assess the scalability of the ECD-integrated intervention in each country. Scale up pertains to deliberate efforts to use a proven practice to reach more people more quickly and more effectively, to bring about lasting change.
This document concerns itself solely with Eswatini. The Eswatini program, implemented by mothers2mothers (m2m), trains “mentor mothers” to provide good quality early childhood development (ECD) services for vulnerable children ages 0–2 years and their parents and caregivers. |
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Vulnerabilidad al VIH y uso de servicios entre trabajadoras sexuales haitianas en la República Dominicana: Resultados de entrevistas a profundidad en Santo Domingo y Puerto Plata
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Katherine Andrinopoulos, Erica Felker-Kantor, and Jessica Brewer |
2019 |
Spanish |
DOMINICAN REPUBLIC, HAITI |
Sex Workers, HIV, HIV data, HIV/AIDS |
Las trabajadoras sexuales (TRSX) haitianas son una población importante para el VIH en la República Dominicana (RD), con una prevalencia estimada del VIH de 5,4% en comparación con 0,7% a nivel nacional. A pesar del mayor riesgo de contraer el VIH entre este grupo hay una brecha en el acceso y la utilización de los servicios relativos al VIH. Un estudio reciente en Santo Domingo mostró que sólo el 36,8% de las TRSX haitianas recibieron condones y lubricantes en los últimos seis meses, y sólo al 34,1% le habían hecho la prueba por el VIH en los últimos 12 meses. Actualmente, el modo principal de prestación de servicios del VIH para haitianas en la RD es a través de unidades móviles para hacerles la prueba del VIH. La investigación en la RD ha mostrado que las intervenciones multiniveles para TRSX, guiado por un enfoque de empoderamiento de la comunidad, son efectivas para aumentar el uso del condón y la adherencia al tratamiento contra el VIH. Adaptar este tipo de intervención para construir sobre las unidades móviles existentes y adaptarla a la experiencia de Haití, las TRSX pueden aumentar el uso de servicios relacionados con el VIH entre este grupo.
El propósito de este estudio fue proporcionar información descriptiva sobre las necesidades específicas del servicio del VIH (prevención, pruebas, tratamiento y retención) de las TRSX haitianas en la RD que se pueden utilizar para adaptar las intervenciones de este grupo. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Namibia Comparison of 2016 and 2018: Findings from the Project HOPE Namibia Panel Study
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MEASURE Evaluation |
2019 |
English |
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Orphans and vulnerable children, Namibia, Monitoring, Data, PEPFAR, OVC |
MEASURE Evaluation—funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—conducted a study of PEPFAR-funded programs for orphans and vulnerable children (OVC) in Namibia, using PEPFAR’s monitoring, evaluation, and reporting (MER) essential survey indicators (ESI). The study focused on the work of Project HOPE Namibia (PHN) and was designed to answer these two questions: (1) What is the well-being of OVC in PHN’s PEPFAR-funded OVC projects in six districts of Namibia? (2) Has the well-being of these children improved over time?
In Round 1 of this panel study, conducted in 2016, caregivers of OVC in 591 households were interviewed to assess the well-being of the children in their care. Of that group, caregivers in 545 PHN-beneficiary households were interviewed again in 2018, for Round 2, after verification of their status with PHN’s updated records and a community trace-and-verify exercise. We asked the caregivers about the PHN program services received or accessed and/or activities offered that aimed to improve the health and well-being of OVC in the household. Data collection used standard questionnaires programmed into an electronic data capture system. We measured OVC well-being by analyzing these data using the nine MER ESI.
This poster shares more. Access the related Monitoring the Outcomes of Orphans and Vulnerable Children Programs in Namibia: Findings from 2016–2018 Panel Data, Project HOPE Namibia report. |
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Monitoring the Outcomes of Orphans and Vulnerable Children Programs in Namibia: Findings from 2016–2018 Panel Data, Project HOPE Namibia
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Robert Mswia and Lizl Stoman |
2019 |
English |
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OVC, Data, Orphans and vulnerable children, Monitoring, PEPFAR |
This report presents panel data on outcomes of a program implemented by Project Health Opportunities to People Everywhere (HOPE) Namibia (PHN) and its partners to improve the well-being of orphans and vulnerable children (OVC) and beneficiary households in Namibia. These findings will support evidence-informed strategy, programming, and resource allocation by Namibian stakeholders: the United States President’s Emergency Plan for AIDS Relief (PEPFAR)/Namibia, the Namibian government (Ministry of Health and Social Services [MOHSS] and Ministry of Gender and Child Welfare [MGECW]), implementing partners, and others. They will also contribute to PEPFAR’s global evidence base on the effectiveness of PEPFAR’s OVC programming.
In 2014, PEPFAR introduced a set of outcome indicators for OVC programs, referred to as monitoring, evaluation, and reporting (MER) essential survey indicators (ESI), with the requirement that these indicators be collected every two years by a research organization external to the OVC program. These outcome indicators reflect internationally-accepted developmental milestones and collectively measure the holistic well-being of children over time. A standardized survey methodology and tools have been developed to collect these data in countries where PEPFAR is supporting OVC programs.
MEASURE Evaluation conducted the first round of the MER OVC ESI in November 2016 and the second round in September 2018 for PHN. |
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Scale to Track the Stages of Development of Community-Based Health Information Systems
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MEASURE Evaluation |
2019 |
English |
Global |
Community-based health information systems, Tool |
Governments and/or organizations can use this scale to assess, plan, and prioritize activities and investments to strengthen community-based health information systems (CBHIS). The tool can help governments and/or organizations determine at what stage their CBHIS is and what should be in place to get it to the next stage. Then they can use the tool to reassess the system’s status every one or two years.
The scale outlines seven domains: leadership and governance, system design, system management, data sources, data quality, and data use. Under each domain is a series of components with detailed descriptions of CBHIS maturity for each component across five stages. The scale can be used to develop a plan to strengthen the overall system and as an advocacy tool for investment to strengthen a given domain’s components.
The United States Agency for International Development (USAID)-funded MEASURE Evaluation project designed this tool as part of a broad effort to improve the health information systems of low- and middle-income countries: a crucial step toward stronger health systems generally and, ultimately, better health outcomes.
Access a related guide. |
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Analyzing, Interpreting, and Communicating Routine Family Planning Data in South Sudan
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Tobijo Denis Sokiri Moses, Zakaria Kenneth Kaunda, and Wani Bessensio Ezeron |
2019 |
English |
SOUTH SUDAN |
family planning, Data use, Routine data, Routine Health Information Systems |
South Sudan’s modern contraceptive prevalence rate stands at just 2.7 percent, with an unmet need for modern family planning (FP) at 30.8 percent. Multiple barriers contribute to low FP uptake in South Sudan: inadequate data collection tools and insufficient analysis, interpretation, and communication of data. Research from the Democratic Republic of the Congo shows that improved management of FP data enables stronger ownership of program results at the health facility and community levels, empowering community members and providers to increase FP uptake.
The purpose of the study was to explore how effectively FP data in the routine health information system (RHIS) are analyzed, interpreted, and communicated, and it discusses barriers to RHIS data use and ownership in two states in South Sudan, to inform policy and programmatic decision making.
The study used a cross-sectional observational design with quantitative and qualitative approaches to data collection and analysis. Data were collected from 178 health facilities across 17 counties in two states in South Sudan: Central Equatoria and Western Equatoria. |
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Using the Indicator Matrix for Monitoring and Evaluating Programs Serving Orphans and Vulnerable Children: Guidance
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MEASURE Evaluation |
2019 |
English |
Africa, Asia, Global, Latin America and the Caribbean |
PEPFAR, MER, OVC, OVC programs, Orphans and Vulnerable Children |
The United States President’s Emergency Plan for AIDS Relief (PEPAR) aims to mitigate the multidimensional and acute impact of HIV and AIDS on children through the provision of holistic, community-based care and support services. PEPFAR’s approach to orphans and vulnerable children (OVC) programming focuses on socioeconomic and health promotion, and access to interventions that reduce vulnerability, contribute to primary prevention of HIV, and support access to and retention in treatment.
Focusing on improving the ability of OVC programs to measure their impact, PEPFAR assembled a team of experts from its partner agencies and MEASURE Evaluation to design an indicator matrix that maps the current required PEPFAR OVC indicators and complements them with additional recommended foundational, process, output, and outcome indicators and the newly established PEPFAR Global OVC Graduation Benchmarks.
The purpose of this document is to describe the indicator matrix and guide PEPFAR country teams and implementing partners (IPs) to select custom indicators for performance monitoring. The document can also support the development or revision of current monitoring and evaluation (M&E) plans.
The OVC indicator matrix is available at: https://www.measureevaluation.org/resources/publications/tl-19-36. |
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Monitoring and Evaluating Programs Serving Orphans and Vulnerable Children: An Indicator Matrix
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MEASURE Evaluation |
2019 |
English |
Asia, Latin America and the Caribbean, Global, Africa |
Orphans and Vulnerable Children, OVC programs, OVC, MER, PEPFAR |
This matrix is intended to help United States President’s Emergency Plan for AIDS Relief (PEPFAR) country teams and implementing partners select custom indicators for performance monitoring, in addition to the MER OVC indicators. The matrix has the following aims:
Help stakeholders in programs for orphans and vulnerable children (OVC) to measure what matters, and to consider repurposing or selecting new or “custom” indicators that will better inform project performance
Provide sample indicators that can be used to measure how OVC projects are contributing to the global 95-95-95 and prevention targets
Demonstrate the relationships among PEPFAR’s reporting requirements
A companion to the matrix—“Using the Indicator Matrix for Monitoring and Evaluating Programs Serving Orphans and Vulnerable Children: Guidance,” available at https://www.measureevaluation.org/resources/publications/ms-19-167—explains how to use this tool. |
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Lessons in Health Information System Strengthening: What Worked in the Democratic Republic of the Congo
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MEASURE Evaluation |
2019 |
English |
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Health data, Health Information Systems, HIS strengthening, Health Systems Strengthening, Data Quality, Democratic Republic of Congo, Malaria, Health System, HIS |
Since 2014, MEASURE Evaluation has supported the National Malaria Control Program (NMCP) of the Democratic Republic of the Congo (DRC) to streamline and improve malaria data collection, reporting, management, and use, at all levels of the health system. Our approach prioritized building local capacity within nine provinces targeted by the President’s Malaria Initiative (PMI). It was driven by the need to intervene where data are generated, to promote good-quality data that could be used to make policy and service delivery decisions.
Our support has contributed to the following improvements:
Rollout of the electronic routine health information platform, DHIS 2, in all 178 health zones in nine PMI-targeted provinces
More than 400 staff trained at the national, provincial, health zone, and health facility levels in areas such as monitoring and evaluation (M&E) and the collection, reporting, and analysis of data
Development of HIS management resources such as the NMCP’s strategic and M&E plans, malaria M&E guidelines, and data collection tools
Development of nationally validated indicators and an NMCP central database, both of which are integrated in DHIS 2
Establishment of 77 centers of excellence (COEs) 1 in three PMI provinces
Implementation of (1) supportive supervision visits at the health facility, health zone, and provincial levels; (2) establishment of the MEASURE Evaluation Routine Data Quality Assessment (RDQA) Tool as a primary method to assess quality of routine data at the health zone and facility levels; and (3) data review meetings at all levels of the health system
Improved routine data timeliness and completeness at the health facility (COEs) and provincial level (PMI targeted provinces)
Development of M&E technical working groups and a malaria task force at the national and provincial levels to coordinate M&E and surveillance activities, address service delivery priorities, and improve data quality
Because MEASURE Evaluation Phase IV is coming to a close, we sought to document the outcomes of our work with the NMCP, by interviewing staff at the national, provincial, health zone, and health facility levels. The objective of this document is to summarize lessons learned through this data collection effort and highlight effective health information system (HIS) strengthening interventions and their outcomes in the DRC. |
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Measuring Outcomes among Children of Female Sex Workers Supported by PEPFAR Programs: Indicator List
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MEASURE Evaluation |
2019 |
English |
Global |
Children, Child health, OVC, Vulnerable children |
This indicator list is part of the Children in Adverse Situations Indicators and Survey Tools. |
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Measuring Outcomes among Street Children and Children Working in Mines Who Are Supported by PEPFAR Programs: Indicator List
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MEASURE Evaluation |
2019 |
English |
Global |
Children, Child health, OVC, Vulnerable children |
This indicator list is part of the Children in Adverse Situations Indicators and Survey Tools. |
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MEASURE Evaluation: Questionnaire for Street Children and Children Working in Mines, Ages 0 to 13 (Administered to the Person Most Knowledgeable or the Caregiver)
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MEASURE Evaluation |
2019 |
English |
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OVC, Children, Child health, Vulnerable children |
This resource is part of the Children in Adverse Situations Indicators and Survey Tools. It is also available for download in Word. |
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MEASURE Evaluation: Questionnaire for Adolescent Street Children and Adolescent Children Working in Mines (Ages 14 to 17)
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MEASURE Evaluation |
2019 |
English |
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Child health, Children, OVC, Vulnerable children |
This resource is part of the Children in Adverse Situations Survey Tools. It is also available for download in Word. |
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MEASURE Evaluation: Questionnaire for Female Sex Worker Caregivers, Ages 18 and Older
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MEASURE Evaluation |
2019 |
English |
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Children, Child health, OVC, Vulnerable children |
This resource is part of the Children in Adverse Situations Indicators and Survey Tools. It is also available for download in Word. |
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MEASURE Evaluation: Questionnaire for Children (Ages 0 to 9) of Female Sex Workers (Administered to the FSW Caregiver)
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MEASURE Evaluation |
2019 |
English |
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OVC, Children, Child health, Vulnerable children |
This resource is part of the Children in Adverse Situations Indicators and Survey Tools. It is also available for download in Word. |
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MEASURE Evaluation: Questionnaire for Adolescent Children (Ages 10 to 17) of Female Sex Workers
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MEASURE Evaluation |
2019 |
English |
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OVC, Children, Child health, Vulnerable children |
This resource is part of the Children in Adverse Situations Survey Tools. It is also available for download in Word. |
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Community-Based Health Information System Guide: Approaches and Tools for Development
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Dawne Walker |
2019 |
English |
Global |
HMIS, Environment, HIS strengthening, CBHIS, Community-based health information systems, HIS |
A community-based health information system (CBHIS) is a dynamic system that includes information on how data are collected, how they flow, how to assess and improve their quality, and how they are used. This system involves collection, management, and analysis of data on health and related services provided to communities outside of facilities.
Historically, health management information systems (HMIS) have been fragmented, owing to siloed funding and programs. Frequently, CBHIS and national HMIS do not have standardized data elements, which has hampered efforts to harmonize systems and include community health data in the national HMIS.
This guide does not cover specifics of the CBHIS and its different components. MEASURE Evaluation, which is funded by the United States Agency for International Development and the United States President’s Emergency Fund for AIDS Relief, developed this guide to focus instead on approaches, tools, and action items for developing areas under the enabling environment to work towards a harmonized health information system. We will look in depth at how to develop areas under leadership and governance, system design, and system management.
Access a related tool. |
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Evaluating Integration of Early Childhood Development Interventions in the m2m Program in Eswatini: Summary of the Results
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Health Communication Capacity Collaborative |
2019 |
English |
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PMTCT, Children, Evaluation, HIV, ART, Eswatini, Swaziland |
In 2014–2015 many countries—including Swaziland (now Eswatini)—introduced the World Health Organization’s Option B+ strategy of lifelong antiretroviral therapy (ART) for women diagnosed with HIV to prevent mother-to-child transmission (PMTCT) of the virus during pregnancy and breastfeeding. While PMTCT regimens were known to be highly effective, there was some concern that the growing population of HIV- and ART-exposed but uninfected children could be at risk of poorer outcomes, including developmental ones.
The United States Agency for International Development (USAID), through the United States President’s Emergency Plan for AIDS Relief (PEPFAR), proposed testing whether an early child development (ECD) intervention integrated in antenatal care/PMTCT programs could optimize outcomes in this population. ECD programs designed to promote responsive parenting-and-child early learning opportunities have been shown to have significant effects in improving the cognitive and motor skills of children ages 0–24 months, particularly among those with delayed development and malnutrition in low- and middle-income countries (LMICs).
USAID chose Eswatini as a site to test the effectiveness of such an intervention in the context of a national PMTCT program. It asked mothers2mothers (m2m) to implement the ECD program and the Health Communication Capacity Collaborative (HC3), also funded by USAID, was tasked with conducting an independent evaluation. USAID asked MEASURE Evaluation to edit and format this brief to promote dissemination of the evaluation’s findings, as part of its work developing a USAID-funded regional learning platform for research on orphans and vulnerable children. |
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Kenya Malaria Programme Review 2018
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National Malaria Control Programme, Ministry of Health |
2019 |
English |
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Malaria, Kenya |
The Malaria Programme Review (MPR) is a periodic joint programme management process for reviewing the progress and performance of a malaria programme in the context of national health and development plans. It is aimed at improving performance or redefining the programme’s strategic direction and focus. In 2009, Kenya conducted a comprehensive MPR of the National Malaria Strategy (NMS) 2001−2010. The ensuing recommendations led to the development of the NMS 2009−2017 with its goal set as the reduction of morbidity and mortality caused by malaria by two-thirds of the 2007/2008 levels by 2017. Subsequently in 2014, a mid-term review of the NMS 2009−2017 was done and this led to some key modifications. First, the initial period of the strategy was extended by one year to 2018 as part of the alignment to the health sector strategy 2013−2018. Secondly, the strategy was renamed Kenya Malaria Strategy (KMS) 2009−2018 in line with the devolution of health service delivery roles and responsibilities from national to county governments. Finally, the KMS objectives and strategies were amended for better performance and to align to the devolved status of the health services. The period of the revised KMS 2009–2018 ends in 2018. The strategy was hence due for an end-term review, which was undertaken in the MPR 2018.
The overall objective of the MPR was to undertake an evidence-based review of the country malaria situation and acomprehensive performance review of the KMS against its set targets. |
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Adolescent-Friendly Health Services in Public Health Facilities in Lusaka, Zambia
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Theresa Nkole, Mukatimui Kalima Munalula, and Joseph Mumba Zulu |
2019 |
English |
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Adolescent health, Sexual Behavior, Contraceptive Use, and Reproductive Health, Sexually Transmitted Infections (STIs) |
Adolescents have healthcare needs that are distinct from adult needs, particularly in the area of sexual reproductive health (SRH) and rights.
In Zambia, adolescents and young people represent 40 percent of the population. To increase adolescents’ access to and use of health services, the Ministry of Health developed National Standards and Guidelines for Provision of Adolescent-Friendly Health Services (AFHS) in 2009. Despite the recognition of the rights of young people to SRH information and services, adolescents still face challenges in accessing healthcare in public health institutions. Previous studies, particularly in Zambia, have focused on whether making facilities more youth-friendly will increase access and use. Because the government has already instituted AFHS, we sought to assess adherence to the standards and guidelines to identify the challenges, successes, and opportunities for strengthening adherence to the standards, thereby improving provision of AFHS and adolescent health outcomes.
This cross-sectional study was carried out in six public health facilities in Lusaka District, Zambia. Data collection entailed 11 focus group discussions (FGDs) with 70 adolescent girls and boys ages 10 to 19 years. The FGDs were intended to get information on adolescents’ perceptions of how services are provided. Interviews were also conducted with health facility staff and community members. There were 123 total study participants. |
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Pregnancy Decisions and HIV Testing among Adolescent Girls and Young Women Enrolled in the DREAMS Initiative in Northern Uganda: Qualitative Report
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Irit Sinai, Danielle Stein, Eve Namisango, Ismael Ddumba-Nyanzi, Lisa Marie Albert, Michelle Li |
2019 |
English |
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HIV, AGWY, Young women, PEPFAR, Pregnancy, DREAMS, Adolescent Girls |
Adolescent reproductive health is a major social issue in Uganda. According to the 2016 Uganda Demographic and Health Survey, 25 percent of adolescents ages 15−19 are already mothers or pregnant with their first child, leading to substantial negative consequences for the health, education, and economic development of these young mothers, their children, and their communities. Adolescent girls and young women (AGYW) are also at a particularly high risk for acquiring HIV. The Determined, Resilient, Empowered, AIDS-free, Mentored, Safe (DREAMS) initiative in Uganda attempts to change these dynamics, by educating AGYW and empowering them to delay their first pregnancy, space subsequent pregnancies, and avoid risky behaviors that can lead to early pregnancy and HIV acquisition.
DREAMS is a global health initiative funded by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and implemented by private implementing partners in 10 countries in sub-Saharan Africa, including Uganda. This study assessed the effects of DREAMS program interventions on decisions relating to the timing of pregnancies and sexual and reproductive health-related behaviors. Because of the interaction between HIV and pregnancy risk, we also looked at the effects of DREAMS on HIV prevention and testing, and on risky behaviors that can lead both to early pregnancy and contracting HIV.
The DREAMS initiative delivers a core integrated package of life skills and economic strengthening interventions addressing health, social, and structural factors associated with AGYW’s HIV risk. The initiative also seeks to prevent unplanned pregnancies. DREAMS began work in Uganda in 2015 and as of 2018 operates in 11 districts. The objective of this qualitative study by MEASURE Evaluation—funded by the United States Agency for International Development (USAID) and PEPFAR—was to examine the influence of DREAMS interventions on perceptions and behaviors of AGWY in northern Uganda.
Access the related quantitative report. |
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HIV Testing and Pregnancy Delay among Adolescent Girls and Young Women Enrolled in the DREAMS Initiative in Northern Uganda: Quantitative Report
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Karen Foreit, Veronica Varela, Chris Bernard Agala, Michelle Li, Lisa Marie Albert |
2019 |
English |
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Pregnancy, Adolescent Girls, Uganda, Young Women, AGWY, HIV |
In 2015, the United States President’s Emergency Plan for AIDS Relief (PEFAR) launched a targeted initiative—Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe Women (DREAMS)—to reduce HIV incidence among adolescent girls and young women (AGYW) ages 10 to 24 years in ten sub-Saharan African countries, including Uganda. The program provides HIV testing along with other interventions to address the structural drivers that directly and/or indirectly increase AGYW’s HIV risk, depending on beneficiaries’ characteristics.
DREAMS’ strategy aims to provide combinations of services (known as a “layering” approach”) tailored to meet the different needs of five priority subpopulations or “segments” of AGYW:
High-risk, in-school
Pregnant
Married
Have given birth by age 15
Involved in transactional sex
DREAMS currently operates in 11 districts in Uganda. In 2018, three years after program launch, the United States Agency for International Development (USAID)/Uganda asked MEASURE Evaluation to conduct secondary analyses of routinely-collected program data to assess the impact of the DREAMS initiative in four districts in Northern Uganda: Gulu, Lira, Omoro, and Oyam.
The aim of this study is to assess the impact of the DREAMS initiative with the following objectives:
Objective 1: Assess the influence of the family planning (FP) component of DREAMS on delay of subsequent pregnancies and contraceptive uptake among beneficiaries who had given birth by age 15, and
Objective 2: Quantify the coverage of HIV testing and retesting and compare HIV retesting among beneficiaries who were reported to have received family planning services with those who were not reported to have received family planning.
Access a related qualitative report. |
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A Guide to the Fundamentals of Economic Evaluation in Public Health
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Scott Moreland, Shaylen Foley, Lauren Morris |
2019 |
English |
Global |
Public Health, Economic evaluation |
Managers and decision makers in public health face choices in a world with limited resources. This Guide to the Fundamentals of Economic Evaluation in Public Health presents an overview of methods and tools that can help to inform public health decisions based on economic principles. Although the guide’s perspective is economic, the principles address health outcomes. The guide is intended for public health program planners, managers, and funders who are not familiar with economic evaluation but want to become familiar with its fundamentals. Some chapters provide more detail than others, especially in areas that may not be well known to many audiences: costing, cost-effectiveness analysis, and cost-benefit analyses. This is not a textbook; the intention is for readers to become familiar with the basic principles of economic evaluation; know when to use economic evaluation methods; be able to read an economic evaluation report; and be able to understand, at a general level, the approaches used and the conclusions reached. The guide will help program managers/decision makers know which approach is the most appropriate to use.
Evaluations of public health interventions, programs, or strategies look at their effectiveness in achieving the intended goal of improved health outcomes. Economic evaluation provides an additional element of understanding the cost factors of an intervention. The guide presents the main tools and approaches used in economic evaluation.
Throughout the guide, the authors have strived to provide concrete, real-world examples and case studies. Where judged to be appropriate, mathematical examples of the required calculations are given. The limitations of each approach as well as any ethical considerations are also discussed.
Access a related webinar recording. |
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Zimbabwe: Snapshot of the Strength of the Health Information System as a Source of HIV Data
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MEASURE Evaluation |
2019 |
English |
ZIMBABWE, Africa |
AIDS, Africa, Zimbabwe, HIV/AIDS, Health Information Systems, HIS |
Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time.
This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic.
Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. |
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Zambia: Snapshot of the Strength of the Health Information System as a Source of HIV Data
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MEASURE Evaluation |
2019 |
English |
Africa, ZAMBIA |
AIDS, HIS, Africa, Zambia, HIV/AIDS, Health Information Systems |
Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time.
This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic.
Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. |
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Tanzania: Snapshot of the Strength of the Health Information System as a Source of HIV Data
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MEASURE Evaluation |
2019 |
English |
Africa, TANZANIA |
AIDS, HIS, Africa, Tanzania, HIV/AIDS, Health Information Systems |
Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time.
This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic.
Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. |
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Rwanda: Snapshot of the Strength of the Health Information System as a Source of HIV Data
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MEASURE Evaluation |
2019 |
English |
Africa, RWANDA |
AIDS, Rwanda, Africa, HIV/AIDS, Health Information Systems, HIS |
Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time.
This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic.
Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. |
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Namibia: Snapshot of the Strength of the Health Information System as a Source of HIV Data
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MEASURE Evaluation |
2019 |
English |
Africa, NAMIBIA |
Namibia, HIS, HIV/AIDS, Health Information Systems, Africa, AIDS |
Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time.
This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic.
Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. |
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Malawi: Snapshot of the Strength of the Health Information System as a Source of HIV Data
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MEASURE Evaluation |
2019 |
English |
Africa, MALAWI |
Health Information Systems, HIS, HIV/AIDS, Africa, AIDS, Malawi |
Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time.
This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic.
Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. |
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Lesotho: Snapshot of the Strength of the Health Information System as a Source of HIV Data
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MEASURE Evaluation |
2019 |
English |
Africa, LESOTHO |
AIDS, Africa, Lesotho, HIV/AIDS, Health Information Systems, HIS |
Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time.
This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic.
Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. |
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Kenya: Snapshot of the Strength of the Health Information System as a Source of HIV Data
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MEASURE Evaluation |
2019 |
English |
Africa, KENYA |
Health Information Systems, Kenya, HIS, HIV/AIDS, Africa, AIDS |
Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time.
This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic.
Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. |
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Haiti: Snapshot of the Strength of the Health Information System as a Source of HIV Data
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MEASURE Evaluation |
2019 |
English |
HAITI, Latin America and the Caribbean |
Latin America, Health Information Systems, Haiti, HIS, HIV/AIDS, AIDS |
Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time.
This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic.
Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. |
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Kingdom of Eswatini: Snapshot of the Strength of the Health Information System as a Source of HIV Data
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MEASURE Evaluation |
2019 |
English |
Africa, SWAZILAND |
Kingdom of Eswatini, AIDS, Africa, Swaziland, HIV/AIDS, Health Information Systems, HIS |
Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time.
This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic.
Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. |
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Côte d’Ivoire: Snapshot of the Strength of the Health Information System as a Source of HIV Data
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MEASURE Evaluation |
2019 |
English |
Africa, COTE D'IVOIRE |
AIDS, HIS, Africa, Cote D’Ivoire, HIV/AIDS, Health Information Systems |
Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time.
This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic.
Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. |
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Uganda: Snapshot of the Strength of the Health Information System as a Source of HIV Data
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MEASURE Evaluation |
2019 |
English |
UGANDA, Africa |
AIDS, Africa, Uganda, HIV/AIDS, Health Information Systems, HIS |
Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time.
This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic.
Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. |
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Botswana: Snapshot of the Strength of the Health Information System as a Source of HIV Data
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MEASURE Evaluation |
2019 |
English |
Africa, BOTSWANA |
AIDS, Africa, Botswana, HIV/AIDS, Health Information Systems, HIS |
Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time.
This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic.
Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. |
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Caring for Armenia's Vulnerable Children: Institutionalizing a Platform for Cross-Sector Collaboration
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MEASURE Evaluation |
2019 |
English |
ARMENIA |
Alternative Care, care reform |
In Armenia, the MEASURE Evaluation project—funded by the United States Agency for International Development (USAID) and USAID’s Displaced Children and Orphans Fund—facilitated development of a governance structure for the reform of national policies and systems for the care of vulnerable children: “national care reform.” The governance structure was a country core team (CCT) established by Armenia’s Ministry of Labor and Social Affairs in June 2017.
Team members represent government partners and other stakeholders. Their task is to develop and strengthen the country’s leadership in assessing and ultimately accelerating national care reform. This brief explains the structure and roles of this CCT and the team’s usefulness as a platform for collaboration.
Read more about MEASURE Evaluation's work on alternative care for children here.
Read more about MEASURE Evaluation's work in Armenia here. |
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MEASURE Evaluation’s Strategy to Respond to National Malaria Control Program Needs in Surveillance, Monitoring, and Evaluation
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|
2019 |
English |
Africa, Asia, Latin America and the Caribbean |
PMI, National Malaria Control Program, Malaria control, Malaria, Malaria Surveillance |
The Malaria Technical Area (MTA) of the United States Agency for International Development-funded MEASURE Evaluation project—with support from the President’s Malaria Initiative (PMI)—has increased its country presence in priority countries to provide direct technical support to national malaria control programs (NMCPs). This support is provided through a MEASURE Evaluation-appointed malaria resident advisor (MRA). MRAs have extensive experience in malaria surveillance, monitoring, and evaluation (SME), and their responsibilities consist of overseeing MEASURE Evaluation’s in-country work, developing close relationships with the NMCP, and liaising with the MTA headquarters staff. Depending on the scope of the country’s portfolio, additional SME staff may provide support to the MRA and form the rest of the in-country team.
Each MRA has a tailored set of duties and challenges related to the needs of his or her assigned country’s NMCP. Although each MRA works to achieve the same goal of supporting the NMCP, there is limited direct interaction across countries. To promote the exchange of MRA experiences and lessons learned, MEASURE Evaluation hosted a meeting in October 2017 under the theme, “MEASURE Evaluation’s Malaria Technical Area: Transitioning to effective NMCP leadership in generating and using malaria information.” This four-day “cross-fertilization” meeting brought together MRAs and NMCP staff from the Democratic Republic of the Congo (DRC), Liberia, Madagascar, and Mali to discuss approaches and experiences in providing effective support to NMCPs. The meeting objectives were as follows:
Understand MTA in-country activities and how they link with NMCP needs in SME
Review country strategies to support NMCPs and identify best practices
Develop a platform to optimize and utilize team expertise across countries
This report summarizes the meeting, synthesizes best practices and lessons learned from providing technical support to NMCPs and collaborating with stakeholders, and presents a strategy for continued cross-country exchange of expertise and experience. |
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A Menu of Tools for Data Quality Assessment and Review
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MEASURE Evaluation |
2019 |
English |
|
Data, Data quality, tools |
Robust systems are essential to track progress toward health objectives, such as the United Nations Sustainable Development Goals, and to support evidence-based decision making. Different approaches may be followed, to assess and improve data quality and data management and to make informed decisions for planning to improve quality and to achieve expected health outcomes.
This document presents a menu of options for data quality assessment and is meant to provide guidance on which approach would be the most suitable for the data and system to be assessed. The scope of the assessment and the depth of data to be collected will depend on the purpose of the assessment. Data quality assessments will focus on one or more dimensions of data quality, such as accuracy, completeness, reliability, timeliness, confidentiality, precision, and integrity. |
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Strengthening the Performance of Kenya’s Health Information System: Improvements in Data Quality and Use at the County Level
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Millar, E. |
2019 |
English |
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HIS, MEASURE Evaluation PIMA, Capacity Assessment, Kenya, HIS strengthening, Learning Agenda, HISS, MECAT, Monitoring, Evaluation |
To shed light on how to strengthen HIS to meet the needs of the health sector, particularly by improving data quality and data use available for decision making, we studied the MEASURE Evaluation PIMA (MEval-PIMA) project's efforts to strengthen the organizational, technical, and behavioral components of routine health information systems in Kenya through participatory approaches with the county health management teams (CHMTs). Although the context of this study is specific to Kenya, we aimed to learn from the processes used for HIS strengthening within regional units of the health sector.
In 2014, MEVAL-PIMA undertook an assessment of M&E capacity in CHMTs from 17 counties using the MEVAL-PIMA-developed Monitoring and Evaluation Capacity Assessment Toolkit (MECAT) (https://www.measureevaluation.org/pima/m-e-capacity). The assessment sought to identify the status of behavioral, organizational, and technical capacity in the use of data for programming. Baseline scores were used to identify priorities and inform interventions and to establish a benchmark for measuring progress in project M&E. Shortly after the baseline assessments, changes in funding priorities led MEVAL-PIMA to shift their work to a subset of 10 counties identified as high-priority in the areas of reproductive health, malaria, HIV/AIDS, or a combination of the three.
Because MEVAL-PIMA conducted baseline assessments in 17 counties but then ended up working in only 10 counties, a good opportunity arose to capitalize on these initial investments and study the effect over time in comparison and intervention counties. Thus, this study aimed to assess how MEVAL-PIMA-supported interventions affected changes in data quality and data use compared with the comparison county. |
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Exploring gaps in monitoring and evaluation of male engagement in family planning
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Bridgit M. Adamou, Brittany S. Iskarpatyoti, Chris B. Agala, Carolina Mejia |
2019 |
English |
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Male Engagment, Men, Family Planning, Evaluation, Indicators, Monitoring |
Background: Male engagement is becoming more common in family planning (FP) strategies and interventions, yet effective monitoring and evaluation (M&E) of this approach lags. This review sought to understand how male engagement in FP is defined, identify gaps in M&E of male engagement and make recommendations.
Methods: We conducted key informant interviews and a desk review of peer-reviewed articles and gray literature, including national FP strategies and policies. We then facilitated an online forum with experts in the field of male engagement in FP to provide feedback on our proposed indicators for male engagement in FP to reach consensus on and validate key indicators.
Results: Although there is no universal definition of male engagement in FP, the most common definition is the inclusion of men in FP programming as FP clients, supportive partners, and agents of change. The most common approach was engaging men as clients exclusively, followed by engaging men as partners. Few papers reported on programs that engaged men across the full spectrum of the definition. There’s significant variation in the degree to which male engagement in FP is included in M&E, planning, and approaches. Few programs reported findings disaggregated by sex and by contraceptive method, making it difficult to determine the effect of programming on male use of methods. There is a dearth of indicators for measuring male engagement in FP in national strategies and policies. Other gaps are a lack of core indicators for male engagement, qualitative indicators, and indicator reference sheets for many commonly used indicators. Among over 100 indicators being used to monitor and evaluate male engagement in FP, 15 key indicators were identified and validated, with accompanying guidance.
Conclusions: As programming for male engagement in FP increases, coordinated efforts should be made to improve the systems that collect, analyze, and use data. |
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Thinking Strategically About Nutrition: Key Issues in the Context of HIV and Tuberculosis
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David K. Hales |
2019 |
English |
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TB, Nutrition, HIV, Strategic thinking, Tuberculosis |
The primary purpose of this document is to encourage a more robust dialogue on the value and process of thinking strategically about nutrition, particularly at the national level. This dialogue should involve the full range of stakeholders who have—or should have—an interest in the multisectoral benefits of an effective national nutrition program: government representatives from relevant ministries (e.g., health, agriculture, social services, and economic development), civil society representatives, funding organizations, and individual and community beneficiaries of nutrition programs.
MEASURE Evaluation, funded by the United States Agency for International Development (USAID), originally designed this document to explore the links between nutrition and HIV and tuberculosis (TB), because such a significant amount of development funding flows to these two diseases. However, as the global response to HIV and TB continued to evolve, it became increasingly clear that looking beyond these links to the larger strategic role of nutrition was equally important. References to the links between nutrition and HIV and TB are included in this document, because they are valuable examples of how an integrated approach is inherently more strategic, beneficial, and cost-effective.
The issues, questions, and discussion points presented here are designed to help spark more-strategic discussions about the larger role of nutrition in improving the overall quality of life for individuals, families, and communities. They can also facilitate discussions about specific approaches to engage stakeholders and build broader support for nutrition, including the design and implementation of multilateral and bilateral initiatives. |
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Performance of Routine Information System Management (PRISM) User's Kit: Analyzing Data from a PRISM Assessment
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MEASURE Evaluation |
2019 |
English |
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Information System, Routine Health Information Systems, Data, Health Information Systems, Health data, PRISM, Performance of Routine Information System Management, RHIS |
One of the mandates of the United States Agency for International Development (USAID)-supported MEASURE Evaluation project is to strengthen the collection, analysis, and use of routine health information system (RHIS) data for the delivery of high-quality health services. We developed the Performance of Routine Information System Management (PRISM) Framework and suite of tools in 2011 for global use in assessing the reliability and timeliness of an RHIS, in making evidence-based decisions, and in identifying gaps in an RHIS so they can be addressed and the system can be improved.
With USAID’s support, we have revised the PRISM Tools and developed other elements, based on the PRISM Framework, to create a broad array of materials: the “PRISM Series,” available here: https://www.measureevaluation.org/prism. This new, comprehensive PRISM Series is useful for designing, strengthening, and evaluating RHIS performance and developing a plan to put the results of a PRISM assessment into action.
To support the use of the PRISM Tools, we have developed a User’s Kit, which consists of three manuals in addition to this one:
Preparing and Conducting a PRISM Assessment, available here: https://www.measureevaluation.org/resources/publications/ms-18-140/
Using SurveyCTO to Collect and Enter PRISM Assessment Data, available here: https://www.measureevaluation.org/resources/publications/ms-18-143/
Moving from Assessment to Action, available here: https://www.measureevaluation.org/resources/publications/ms-18-142/
The User’s Kit guides all aspects of a PRISM assessment.
This manual—the third in the series—provides indicator breakdowns, step-by-step instructions, calculation tables, and an answer guide to the problem-solving questions of the Organizational and Behavioral Assessment Tool (OBAT)—including graphic representations and open-ended questions—for analysis of all PRISM data into indicators and scores. |
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Orphans and Vulnerable Children Caregiver Questionnaire Optional Module 7: Participation in Savings Groups
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MEASURE Evaluation |
2019 |
English |
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OVC, Orphans and vulnerable children |
This module on participation in savings groups is designed to be used with the caregiver questionnaire developed for MEASURE Evaluation's Orphans and Vulnerable Children survey toolkit. |
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Orphans and Vulnerable Children Caregiver Questionnaire Optional Module 5: Attitudes about HIV and AIDS
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MEASURE Evaluation |
2019 |
English |
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OVC, Orphans and vulnerable children |
This module on attitudes about HIV and AIDS is designed to be used with the caregiver questionnaire developed for MEASURE Evaluation's Orphans and Vulnerable Children survey toolkit. |
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Orphans and Vulnerable Children Caregiver Questionnaire Optional Module 4: Decision Making and Gender Roles
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MEASURE Evaluation |
2019 |
English |
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OVC, Orphans and vulnerable children |
This module on decision making and gender roles is designed to be used with the caregiver questionnaire developed for MEASURE Evaluation's Orphans and Vulnerable Children survey toolkit. |
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Orphans and Vulnerable Children Caregiver Questionnaire Optional Module 3: Household Dietary Diversity
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MEASURE Evaluation |
2019 |
English |
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OVC, Orphans and vulnerable children |
This module on household dietary diversity is designed to be used with the caregiver questionnaire developed for MEASURE Evaluation's Orphans and Vulnerable Children survey toolkit. |
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Orphans and Vulnerable Children Caregiver Questionnaire
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MEASURE Evaluation |
2019 |
English |
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OVC, Orphans and vulnerable children |
The caregiver questionnaire is intended for use as one of the orphans and vulnerable children (OVC) survey tools developed by MEASURE Evaluation, with support from the OVC technical working group of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The caregiver questionnaire addresses the household and the caregiver. Access additional modules. |
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Questionnaire for Orphans and Vulnerable Children Ages 10‒17 Years Optional Module 2: HIV Treatment and Disclosure
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MEASURE Evaluation |
2019 |
English |
Global |
Orphans and vulnerable children, OVC |
This module on HIV treatment and disclosure is designed to be used with the questionnaire for children ages 10-17 years developed for MEASURE Evaluation's Orphans and Vulnerable Children survey toolkit. |
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Questionnaire for Orphans and Vulnerable Children Ages 10‒17 Years Optional Module 1: Dietary Diversity
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MEASURE Evaluation |
2019 |
English |
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OVC, Orphans and vulnerable children |
This module on dietary diversity is designed to be used with the questionnaire for children ages 10-17 years developed for MEASURE Evaluation's Orphans and Vulnerable Children survey toolkit. |
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Questionnaire for Orphans and Vulnerable Children Ages 0‒9 Years Optional Module 2: Individual Dietary Diversity
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MEASURE Evaluation |
2019 |
English |
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OVC, Orphans and vulnerable children |
This module on individual dietary diversity is designed to be used with the questionnaire for children ages 0-9 years developed for MEASURE Evaluation's Orphans and Vulnerable Children survey toolkit. |
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Questionnaire for Orphans and Vulnerable Children Ages 0‒9 Years Optional Module 1: Immunizations
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MEASURE Evaluation |
2019 |
English |
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OVC, Orphans and vulnerable children |
This module on immunizations is designed to be used with the questionnaire for children ages 0-9 years developed for MEASURE Evaluation's Orphans and Vulnerable Children survey toolkit. |
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Orphans and Vulnerable Children Caregiver Questionnaire Optional Module 6: HIV Treatment and Disclosure
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MEASURE Evaluation |
2019 |
English |
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OVC, Orphans and vulnerable children |
This module on HIV treatment and disclosure is designed to be used with the caregiver questionnaire developed for MEASURE Evaluation's Orphans and Vulnerable Children survey toolkit. |
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Questionnaire for Orphans and Vulnerable Children Ages 10‒17 Years
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MEASURE Evaluation |
2019 |
English |
Global |
Orphans and vulnerable children, OVC |
The questionnaire for orphans and vulnerable children (OVC) ages 10-17 years is intended for use as one of the OVC survey tools developed by MEASURE Evaluation, with support from the OVC technical working group of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The questionnaire for children ages 10-17 years is administered directly to children with their informed assent and parental consent. Access additional modules. |
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Questionnaire for Orphans and Vulnerable Children Ages 0‒9 Years
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MEASURE Evaluation |
2019 |
English |
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OVC, Orphans and Vulnerable Children |
The questionnaire for orphans and vulnerable children (OVC) ages 0-9 years is intended for use as one of the OVC survey tools developed by MEASURE Evaluation, with support from the OVC technical working group of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The questionnaire for children ages 0-9 years is administered to the caregiver. Access additional modules. |
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Haitian Female Sex Workers in the Dominican Republic: A Qualitative Study of HIV Vulnerability and Service Use
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Katherine Andrinopoulos, Erica Felker-Kantor, Jessica Brewer |
2019 |
English |
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Haiti, Key Populations, HIV, Sex Workers |
Haitian female sex workers (FSWs) are an important key population for HIV in the Dominican Republic (DR), with an estimated HIV prevalence of 5.4 percent (Centers for Disease Control and Prevention [CDC] & the University of San Francisco Center for AIDS Prevention Studies [UCSF CAPS], 2015) compared to a 0.7 percent national rate (Joint United Nations Programme on HIV/AIDS [UNAIDS], 2017). Despite the higher HIV risk among this group, there is a gap in its access to and use of HIV services. A recent study in Santo Domingo showed that only 36.8 percent of Haitian FSWs had received condoms and lubricants in the past six months, and only 34.1 percent had tested for HIV in the past 12 months (CDC & UCSF CAPS, 2015). Currently, the main mode of HIV-service provision for Haitians in the DR is through mobile HIV-testing units. Research in the DR has shown that multilevel interventions for FSWs, guided by a community empowerment approach, are effective for increasing condom use (Kerrigan et al., 2006) and HIV-treatment adherence (Kerrigan et al., 2016). Adapting this type of intervention to build on the existing mobile units and tailoring it to the experience of Haitian FSWs may increase HIV-service use among this group.
The purpose of this study was to provide descriptive information on the specific HIV-service needs (prevention, testing, treatment, and retention) of Haitian FSWs in the DR that can be used to tailor interventions for this group. This report shares the study findings and provides recommendations. |
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Îngrijirea alternativă a copilului Buletin informativ: Martie 2019
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MEASURE Evaluation |
2019 |
Romanian |
ROMANIA |
Alternative Care, Orphans and Vulnerable Children |
Acesta este cel de-al treilea buletin informativ ”Îngrijirea Alternativă a Copilului”. Publicația oferă actualizări cu privire la activitățile la nivel de țară desfășurate începând cu luna octombrie 2018:
Utilizarea constatărilor din cadrul evaluărilor reformei naționale a sistemului de îngrijire
Activități de mentorat legate de monitorizare și evaluare
Informații din țările vizate privind contribuțiile vizitelor în teren la înțelegerea provocărilor în ceea ce privește calitatea și utilizarea datelor
Informații actualizate asupra funcționării sistemelor informaționale
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ԵՐԵԽԱՆԵՐԻ ԱՅԼԸՆՏՐԱՆՔԱՅԻՆ ԽՆԱՄՔ Լրատու: Մարտ 2019
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MEASURE Evaluation |
2019 |
Armenian |
ARMENIA |
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Ձեր ուշադրությանն ենք ներկայացնում «Երեխաների այլընտրանքային խնամք» ամսագրի 3-րդ համարը: Այս համարը պարունակում է տեղեկատվություն 2018թ. հոկտեմբերից մինչ օրս տարբեր երկրներում իրականացված գործողությունների վերաբերյալ, մասնվորապես՝
Երկրների այլընտրանքային խնամքի համակարգի բարեփոխումների մասնակցային ինքնագնահատման արդյունքների կիրառում
Մշտադիտարկմանն ու գնահատմանը (ՄԳ) ուղղված մենթորական գործունեություն
Դիտարկումներ ընտրված երկրներում իրականացված մարզային այցելություններից, որը թույլ կտա հասկանալ տվյալների որակի և կիրառման հետ կապված դժվարությունները։
Նորություններ տեղեկատվական համակարգերի աշխատանքի վերաբերյալ։
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Testing a Client Tracker for the Prevention of Mother-to-Child Transmission of HIV in Zimbabwe: Findings and Lessons Learned
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Allison Schmale, Lwendo Moonzwe, Francesca Scott, Samuel Johnson, Cristina de la Torre |
2019 |
English |
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PMTCT, HIV, Maternal health, HIV prevention, Zimbabwe, Child health |
This brief summarizes the findings and lessons learned from testing a client tracker for prevention of mother-to-child transmission of HIV (PMTCT) programs. MEASURE Evaluation developed the PMTCT Tracker on the DHIS 2 platform based on previously developed guidance. We subsequently tested the PMTCT Tracker in a health clinic in Zimbabwe to identify any issues that needed to be fixed or improved. In this report, we describe the PMTCT Tracker and present findings from the testing exercise. Findings from the testing exercise were used to refine the PMTCT Tracker before making it publicly available.
Access related guidance. |
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Understanding the Influence of Health Information System Investments on Health Outcomes in Côte d’Ivoire: A Qualitative Study
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MEASURE Evaluation |
2019 |
English |
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Health System, Cote d'Ivoire, HIS strengthening, HISS, Health Information Systems, HIS |
Health information is one of the six core functions of a health system, along with service delivery; human resources for health; medical products, vaccines, and technologies; financing; and leadership and governance. Investments in any one of these areas will affect and be affected by the other core functions of the health system. Assessing the broader effects of investments in HIV-specific health information systems (HIS) on the overall improvement of the larger health system can help explain how these investments can lead to improved HIV outcomes.
There have been substantial investments in Côte d’Ivoire’s HIS over the past decade. In 2018 these investments were evaluated to contribute to an understanding of how HIS strengthening investments affect HIS performance, health system outcomes, and public health outcomes. The evaluation consisted of a document review with a resulting triangulation report (MEASURE Evaluation, 2018), and a qualitative study informed by key stakeholders in the country, the results of which are presented in this report. |
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Rapid Costing Assessment of USAID-Funded Structural and Behavioral HIV Prevention Activities Part II: Results of a Quantitative Cost Analysis
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Stacie Gobin, Shaylen Foley |
2019 |
English |
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HIV prevention, Cost analysis, HIV, Data, Cost |
The United States President’s Emergency Plan for AIDS Relief has seen great variation in the unit expenditure data reported from partners implementing behavioral and structural HIV prevention programs, impacting the effective use of resources and challenging accurate budget planning. This activity was developed to improve understanding of the processes used to report costs and provide unit expenditure estimates of specific behavioral and structural HIV prevention interventions, with the long-term goal of helping the United States Agency for International Development better capture the costs of multifaceted HIV prevention programs and improve resource management.
Cost information is difficult to access and quantify, because financial systems rarely contain the required cost information. One issue is the lack of systematic collection of cost data.
Additionally, few institutions have systems capable of apportioning central costs to local activities or departments. Unlike health and social care systems in high-income countries, with formal assessment frameworks that incorporate economic evaluations, low- and middle-income country contexts present several limitations in conducting economic evaluation and applying the results to policymaking.
This paper describes challenges in collecting, analyzing, and interpreting cost data in structural and behavioral HIV prevention programs and offers recommendations to meet them. |
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Performance of Routine Information System Management (PRISM) Toolkit: PRISM Tools
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MEASURE Evaluation |
2019 |
English |
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Information System, PRISM, HISS, Performance of Routine Information System Management, RHIS, Toolkit, Health Information Systems, Routine Health Information Systems |
MEASURE Evaluation developed the Performance of Routine Information System Management (PRISM) Framework and suite of tools in 2011 for global use in assessing the reliability and timeliness of an RHIS, in making evidence-based decisions, and in identifying gaps in an RHIS so they can be addressed and the system can be improved. The framework acknowledges the broader context in which RHIS operate. It also emphasizes the strengthening of RHIS performance through a system-based approach that sustains improvements in data quality and use.
With USAID’s support, MEASURE Evaluation has revised the PRISM Tools and developed other elements, based on the PRISM Framework, to create a broad array of materials: the “PRISM Series.” This new, more comprehensive PRISM Series is useful for designing, strengthening, and evaluating RHIS performance and developing a plan to put the results of a PRISM assessment into action. The revised “PRISM Tools”—the PRISM Series’ core document—offers the following data collection instruments: the RHIS Overview Tool, the Performance Diagnostic Tool, the Electronic RHIS Performance Assessment Tool, the Management Assessment Tool, the Facility/Office Checklist, and the Organizational and Behavioral Assessment Tool.
These PRISM tools can be used together to gain an in-depth understanding of overall RHIS performance, to establish a baseline, and to rigorously evaluate the progress and effectiveness of RHIS strengthening interventions every five years, contributing to the national RHIS strategic planning process. Each PRISM tool can also be used separately for in-depth analysis of specific RHIS performance areas and issues.
The resource is also available as a downloadable Word file. Access additional PRISM resources. |
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Alternative Care for Children Newsletter: March 2019
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MEASURE Evaluation |
2019 |
English |
UGANDA, ARMENIA, MOLDOVA, REPUBLIC OF, GHANA |
Systems strengthening, Data Quality, Alternative Care, Data use, Information systems, M&E |
The March 2019 Alternative Care for Children Newsletter provides updates on country-level activities since October 2018. It covers the following:
The use of findings from the national care reform assessments
Mentorship activities related to monitoring and evaluation
Insights from select countries on the contributions of field-level site visits, to allow an understanding of challenges in data quality and use
Updates on information systems work
Learn more about MEASURE Evaluation’s alternative care work here. |
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Scale for Measuring the Health Information System Stages of Continuous Improvement
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MEASURE Evaluation |
2019 |
English |
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HIS, Health Information Systems, SOCI |
Countries or organizations can use this scale to assess, plan, and prioritize investments to strengthen a health information system (HIS), based on where the HIS is now and where they want it to be. The scale outlines five domains, 13 associated components, and 39 subcomponents, spelling out attributes of improvement across five stages of progress toward a high-functioning system. The scale can be used to develop a roadmap for HIS improvement aligned with an HIS strategic plan or a health systems plan.
Access the full toolkit. |
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Mapping the Stages of MEASURE Evaluation's Data Use Continuum to DHIS 2: An Example from the Democratic Republic of the Congo
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MEASURE Evaluation |
2019 |
English |
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DHIS 2, Data informed, DDU, Data use |
The use of good-quality health data for decision making is the key output of strengthened health information systems (HIS) and a cornerstone of a well-functioning health system. Data use is defined as “the analysis, synthesis, interpretation, and review of data as part of decision-making processes, regardless of the source of data” (Nutley & Reynolds, 2013). MEASURE Evaluation, which is funded by the United States Agency for International Development, has developed the data use continuum, which describes how data are used both to strengthen HIS and to improve health programs.
DHIS 2 is an electronic platform for the collection and analysis of health data. The Ministry of Health of the Democratic Republic of the Congo (DRC) adopted DHIS 2 as the country’s national health information system. The government began to pilot and roll out the system subnationally in 2014, scaling it up countrywide over three years. The U.S. President’s Malaria Initiative funded MEASURE Evaluation to conduct an assessment in 2017 that highlighted several barriers to the use of malaria data at multiple levels of the health system in the country. This assessment informed a series of interventions to strengthen the use of DHIS 2. This brief documents the key phases of the data use continuum and describes the ways in which the rollout and implementation of DHIS 2 in the DRC facilitated the use of data to improve the HIS and health programs. |
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“Every Newborn-BIRTH” protocol: observational study validating indicators for coverage and quality of maternal and newborn health care in Bangladesh, Nepal and Tanzania
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Louise T Day, Harriet Ruysen, et al. |
2019 |
English |
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Data, Newborn health, Maternal health, Health care, DHIS 2, Tanzania, Nepal, Maternal and child health, Health data, Bangladesh, MCH |
Background: To achieve Sustainable Development Goals and Universal Health Coverage, programmatic data are essential. The Every Newborn Action Plan, agreed by all United Nations member states and >80 development partners, includes an ambitious Measurement Improvement Roadmap. Quality of care at birth is prioritised by both Every Newborn and Ending Preventable Maternal Mortality strategies, hence metrics need to advance from health service contact alone, to content of care. As facility births increase, monitoring using routine facility data in DHIS2 has potential, yet validation research has mainly focused on maternal recall surveys. The Every Newborn – Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study aims to validate selected newborn and maternal indicators for routine tracking of coverage and quality of facility-based care for use at district, national and global levels.
Methods: EN-BIRTH is an observational study including >20000 facility births in three countries (Tanzania, Bangladesh and Nepal) to validate selected indicators. Direct clinical observation will be compared with facility register data and a pre-discharge maternal recall survey for indicators including: uterotonic administration, immediate newborn care, neonatal resuscitation and Kangaroo mother care. Indicators including neonatal infection management and antenatal corticosteroid administration, which cannot be easily observed, will be validated using inpatient records. Trained clinical observers in Labour/Delivery ward, Operation theatre, and Kangaroo mother care ward/areas will collect data using a tablet-based customised data capturing application. Sensitivity will be calculated for numerators of all indicators and specificity for those numerators with adequate information. Other objectives include comparison of denominator options (ie, true target population or surrogates) and quality of care analyses, especially regarding intervention timing. Barriers and enablers to routine recording and data usage will be assessed by data flow assessments, quantitative and qualitative analyses.
Conclusions: To our knowledge, this is the first large, multi-country study validating facility-based routine data compared to direct observation for maternal and newborn care, designed to provide evidence to inform selection of a core list of indicators recommended for inclusion in national DHIS2. Availability and use of such data are fundamental to drive progress towards ending the annual 5.5 million preventable stillbirths, maternal and newborn deaths. |
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Referral patterns through the lens of health facility readiness to manage obstetric complications: national facility-based results from Ghana
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Patricia E. Bailey, John Koku Awoonor-Williams, Victoria Lebrun, Emily Keyes, Mario Chen, Patrick Aboagye and Kavita Singh |
2019 |
English |
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Ghana, Emergency services, Maternal mortality, Obstetrics, Referral system |
Introduction: Countries with high maternal and newborn mortality can benefit from national facility level data that describe intra-facility emergency referral patterns for major obstetric complications. This paper assesses the relationship between referral and facilities’ readiness to treat complications at each level of the health system in Ghana. We also investigate other facility characteristics associated with referral.
Methods: The National Emergency Obstetric and Newborn Care Assessment 2010 provided aggregated information from 977 health facilities. Readiness was defined in a 2-step process: availability of a health worker who could provide life-saving interventions and a minimum package of drugs, supplies, and equipment to perform the interventions. The second step mapped interventions to major obstetric complications. We used descriptive statistics and simple linear regression.
Results: Lower level facilities were likely to refer nearly all women with complications. District hospitals resolved almost two-thirds of all complicated cases, referring 9%. The most prevalent indications for referral were prolonged/obstructed labor and antepartum hemorrhage. Readiness to treat a complication was correlated with a reduction in referral for all complications except uterine rupture. Facility readiness was low: roughly 40% of hospitals and 10% of lower level facilities met the readiness threshold. Facilities referred fewer women when they had higher caseloads, more midwives, better infrastructure, and systems of communication and transport.
Discussion: Understanding how deliveries and obstetric complications are distributed across the health system helps policy makers contextualize decisions about the pathways to providing maternity services. Improving conditions for referral (by increasing access to communication and transport systems) and the management of obstetric complications (increasing readiness) will enhance quality of care and make referral more effective and efficient.
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The Cost of Case Management in Orphans and Vulnerable Children Programs: Findings from Zambia
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MEASURE Evaluatio |
2019 |
English |
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OVC programs, Zambia, Case management, Orphans and vulnerable children, OVC, Cost management |
The USAID- and PEPFAR-funded MEASURE Evaluation project conducted a six-country study for insight on current approaches to case management delivery and the cost of those approaches.
This brief outlines the findings from the Zambia Family project in Zambia, implemented by Expanded Church Response, five partners, and 73 community-based organizations.
The complete study report—The Cost of Case Management in Orphans and Vulnerable Children Programs: Results from a Mixed-Methods, Six-Country Study—is available at https://www.measureevaluation.org/resources/publications/tr-19-327/. |
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The Cost of Case Management in Orphans and Vulnerable Children Programs: Findings from Tanzania
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MEASURE Evaluation |
2019 |
English |
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OVC programs, Orphans and vulnerable children, Case management, Tanzania, OVC, Cost management |
The USAID- and PEPFAR-funded MEASURE Evaluation project conducted a six-country study for insight on current approaches to case management delivery and the cost of those approaches.
This brief outlines the findings from the Kizazi Kipya project, in Tanzania, which Pact implements in collaboration with five partners and 48 civil society organizations.
The complete study report—The Cost of Case Management in Orphans and Vulnerable Children Programs: Results from a Mixed-Methods, Six-Country Study—is available at https://www.measureevaluation.org/resources/publications/tr-19-327/. |
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The Cost of Case Management in Orphans and Vulnerable Children Programs: Findings from Rwanda
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MEASURE Evaluation |
2019 |
English |
|
Cost management, Rwanda, OVC, OVC programs, Case management, Orphans and vulnerable children |
The USAID- and PEPFAR-funded MEASURE Evaluation project conducted a six-country study for insight on current approaches to case management delivery and the cost of those approaches.
This brief outlines the findings from the Turengere Abana program in Rwanda.
The complete study report—The Cost of Case Management in Orphans and Vulnerable Children Programs: Results from a Mixed-Methods, Six-Country Study—is available at https://www.measureevaluation.org/resources/publications/tr-19-327/. |
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The Cost of Case Management in Orphans and Vulnerable Children Programs: Findings from Uganda
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MEASURE Evaluation |
2019 |
English |
|
Uganda, OVC programs, Case management, Orphans and vulnerable children, OVC, Cost management |
The USAID- and PEPFAR-funded MEASURE Evaluation project conducted a six-country study for insight on current approaches to case management delivery and the cost of those approaches.
This brief outlines the findings from the Better Outcomes for Children and Youth project, in Uganda, which is implemented by World Education/Bantwana, in collaboration with four partner organizations and seven local civil society organizations.
The complete study report—The Cost of Case Management in Orphans and Vulnerable Children Programs: Results from a Mixed-Methods, Six-Country Study—is available at https://www.measureevaluation.org/resources/publications/tr-19-327/. |
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The Cost of Case Management in Orphans and Vulnerable Children Programs: Findings from South Africa
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MEASURE Evaluation |
2019 |
English |
|
Cost management, South Africa, OVC, OVC programs, Case management, Orphans and vulnerable children |
The USAID- and PEPFAR-funded MEASURE Evaluation project conducted a six-country study for insight on current approaches to case management delivery and the cost of those approaches.
This brief outlines the findings from the Government Capacity Building and Support project, in South Africa, which Pact implemented with support from three partners and the South African Department of Social Development.
The complete study report—The Cost of Case Management in Orphans and Vulnerable Children Programs: Results from a Mixed-Methods, Six-Country Study—is available at https://www.measureevaluation.org/resources/publications/tr-19-327/. |
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The Cost of Case Management in Orphans and Vulnerable Children Programs: Findings from Nigeria
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MEASURE Evaluation |
2019 |
English |
|
Cost management, OVC, Nigeria, OVC programs, Case management, Orphans and vulnerable children |
The USAID- and PEPFAR-funded MEASURE Evaluation project conducted a six-country study for insight on current approaches to case management delivery and the cost of those approaches.
This brief outlines the findings from the Systems Transformed for Empowered Actions and Enabling Responses (STEER) project, in Nigeria.
The complete study report—The Cost of Case Management in Orphans and Vulnerable Children Programs: Results from a Mixed-Methods, Six-Country Study—is available at https://www.measureevaluation.org/resources/publications/tr-19-327/. |
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Evaluating the performance of Côte d'Ivoire's RHIS in August 2018 (Evaluation de la performance du SISR de la Côte d’Ivoire en août 2018)
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Edwige Bosso, Franck Olivier Ba-Gomis, Léontine Gnassou, Félix Mominé Malé, Aoua Camara Aka, Alain Koukou; Adama Sanogo Pongathié, Alimou Barry, Jeanne Chauffour |
2019 |
French |
|
HIS, RHIS, HISS, Health System, Cote d'Ivoire, Health Information Systems, PRISM |
Following two performance evaluations of Côte d'Ivoire's routine health information system (RHIS) in 2008 and 2012, the Ministry of Health and Public Hygiene (MSHP) launched a number of interventions to strengthen the RHIS. In 2018, a follow-up evaluation of the RHIS was conducted to assess the impact of these interventions. This new evaluation was conducted in 234 health facilities, 24 districts, 12 health regions, and the central level represented by the Directorate for Information and Health Data (DIIS) using the PRISM tools revised in 2018. Results at the peripheral level (health facilities and districts) show that data quality is still weak at the facility level, although it has improved at higher levels (districts, regions, and the central level), as have data management procedures. Data use is weak at the health facility level and moderate at higher levels (districts, regions, and the central level). In light of the results of this new study, future interventions to strengthen the RHIS should focus on health facilities -- the loci of production of all national health data -- that determine the overall quality of the health system in Côte d'Ivoire.
French:
Après les évaluations de la performance du système d’information sanitaire de routine (SISR) réalisées en 2008 et 2012, des interventions de renforcement ont été mises en œuvre par le Ministère de la Santé et de l’Hygiène Publique (MSHP). Ainsi, une nouvelle évaluation du SISR a été réalisée pour apprécier l’impact de ces interventions.
Cette évaluation a été menée avec les outils du PRISM révisés en 2018 et a concerné 234 formations sanitaires (FS), 24 districts, 12 régions sanitaires et le niveau central représenté par la Direction de l’Informatique et de l’Information Sanitaire (DIIS).
Les résultats au niveau périphérique (FS et districts) montrent que la qualité des données reste faible au niveau des FS, mais qu’elle s’est améliorée aux niveaux supérieurs (districts, régions et niveau central), de même que les procédures de gestion des données. L’utilisation des données est faible au niveau des FS et moyenne aux niveaux supérieurs (districts, régions et niveau central).
A la lumière des résultats de cette étude, les interventions de renforcement du SISR devraient se focaliser sur les FS qui sont le lieu de production initiale de toutes les données et qui déterminent la qualité globale du système. |
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Tool for Assessing and Monitoring National Alternative Care Systems
|
|
2019 |
English |
Global |
Alternative Care, Child health, Child Health, Care for children, Children, Child survival |
Ensuring children grow up in protective family care, free from deprivation, exploitation, and danger is a priority for many countries. Significant improvements have been made in government systems and policies related to the well-being and development of vulnerable children, with particular attention to preserving and facilitating children's access to appropriate, protective, and permanent family care. The United States Agency for International Development (USAID) Displaced Children and Orphans Fund (DCOF), along with several other stakeholders, invest in strengthening government systems to ensure family-based care for children around the world. MEASURE Evaluation, with support from USAID/DCOF, developed this tool to support countries as they assess, address, and monitor national care system reform.
This tool applies the United Nations (UN) Guidelines for the Alternative Care of Children. The structure of the tool follows a framework that covers key areas of caring for children outside of family care: foster care, residential care, supervised independent living, kinship care, other forms of informal care, adoption, and family reunification and system deinstitutionalization. This tool also has questions related to preventing unnecessary child-family separation, which is a critical component of keeping children in family-based care. The tool applies a system strengthening framework. We present system components that are commonly agreed upon to be critical to sustainably and effectively strengthening national systems. |
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Data for Impact: The D4I Approach to Data Use
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Data for Impact |
2019 |
English |
|
Data visualization, Data use, Date use, D4I |
Data for Impact, a five-year cooperative agreement funded by the United States Agency for International Development (USAID), helps countries mobilize the power of data to improve programs, policies, and—ultimately—health outcomes.
D4I prioritizes data use in everything we do. At the beginning of an evaluation or assessment, we plan for data use by identifying and engaging all potential data users or stakeholders with an interest in the findings. |
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Data for Impact Approach to Institutional Strengthening
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Data for Impact |
2019 |
English |
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D4I, Data use |
Data for Impact, a five-year cooperative agreement funded by the United States Agency for International Development (USAID), helps countries mobilize the power of data to improve programs, policies, and—ultimately—health outcomes.
This approach document focuses on strengthening individual and institutional capacity to generate evidence for health decision making and to receive direct funding from USAID. At the foundation of this approach is our belief that individuals and institutions have existing capacity, and they should lead in their own capacity strengthening. |
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Using DHIS 2 Software to Collect Health Data in Bangladesh
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Tahmina Begum, Shaan Muberra Khan, Jannatul Ferdous, Muhammad Masud Parvez, Aminur Rahman, Feroza Akhter Kumkum, and Iqbal Anwar |
2019 |
English |
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DHIS 2, HIS, HMIS |
Accurate and high-quality data are important for improving program effectiveness and informing policy. As part of Bangladesh’s district health information system, which allows data to be entered at the community level and analyzed at the central, state, and district levels, the country adopted the web-based platform DHIS 2 in 2009. In Bangladesh, real-time health service use data, with particular attention to reproductive, maternal, newborn, child, and adolescent health (RMNCAH), are available from the community level to the tertiary hospital level. However, health data are being underused for health planning purposes, because of poor data quality and reporting.
The main objective of this study was to understand the user’s perceptions of and experiences with using DHIS 2 to collect and analyze RMNCAH data in Bangladesh and to identify facilitators and barriers to using these data at different levels of the healthcare system. The study used three qualitative research methods. Insights from this study are expected to contribute to the development of effective strategies for successful DHIS 2 implementation and, ultimately, the design of a responsive health management information system in Bangladesh. |
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The Cost of Case Management in Orphans and Vulnerable Children Programs Results from a Mixed-Methods, Six-Country Study
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Stacie Gobin, Shaylen Foley |
2019 |
English |
|
Case management, Cost-effectiveness, OVC programs, Orphans and vulnerable children, Cost, OVC |
Little is known about how much it costs to implement services for orphans and vulnerable children (OVC), such as case management. When cost estimate data are available, the ranges for unit expenditures are strikingly wide and it is difficult to compare across programs or intervention service areas. Case management—a cornerstone of OVC programming and the platform on which OVC services are delivered—is largely conducted by community-based case workers (CWs). Research shows that CWs contribute meaningfully to HIV service delivery, impacting the social determinants of health through the delivery of comprehensive suites of interventions. However, few cost analyses have attempted to disaggregate the costs of case management from other OVC program service areas.
To address this gap, the United States Agency for International Development (USAID)- and United States President’s Emergency Plan for AIDS Relief (PEPFAR)-funded MEASURE Evaluation worked with six OVC projects in six countries to gain insight on current approaches to OVC case management, map how costs can be linked to OVC case management activities, and determine the cost of OVC case management. To further inform and strengthen our understanding of the cost data, the study also qualitatively explored the context of the CWs’ experiences related to OVC case management.
Similar to previous studies of the cost of OVC programs, we found wide variations in annual case management costs, the cost per beneficiary, the proportion of total expenditures, and the relative distribution of spending by cost element. The differences were due to the differences in case management modalities and the variation in how implementing mechanisms chose to invest in case management versus in other project service areas. The contextual information provided by the interviews helped bolster and support the cost estimates found in this study. Without the parallel approach of collecting both quantitative and qualitative data, the contextual information to triangulate with the quantitative data would have been lacking, and the validity of the results would have decreased.
Access briefs sharing findings from Nigeria, South Africa, Uganda, Rwanda, Tanzania, and Zambia. |
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Health Information System Stages of Continuous Improvement Toolkit: Workbook
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MEASURE Evaluation |
2019 |
English |
|
SOCI, HIS, Health information systems |
The Health Information System (HIS) Stages of Continuous Improvement (SOCI) Toolkit measures the status and goals of an HIS across five stages, identifies gaps, and supports the development of roadmaps to improve HIS capabilities related to processes, people, and systems essential for achieving a country’s health goals.
This toolkit responds to these research questions:
1. What are the stages of HIS development?2. How can HIS be assessed and their maturity continuously improved to achieve better health outcomes?
The toolkit consists of a measurement scale with 39 HIS subcomponents across five stages detailing improvement across each subcomponent, a data collection tool with data analysis tabs, and a user guide. The scale outlines key components of HIS improvement and defines attributes of each subcomponent on a five-point Likert scale.
This is the workbook component of the toolkit. Access the full toolkit. |
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Health Information System Stages of Continuous Improvement Toolkit: User Guide
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MEASURE Evaluation |
2019 |
English |
|
HIS, SOCI, Health information systems |
This guide is a practical reference for anyone implementing the Health Information Systems Stages of Continuous Improvement Toolkit. It provides step-by-step instructions for implementation, from initial stakeholder engagement through dissemination of results.
Access the full toolkit. |
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Graduation Sustainability Assessment Tool for Orphans and Vulnerable Children Programs
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MEASURE Evaluation |
2019 |
English |
|
Orphans and Vulnerable Children, OVC |
This is the tool to assess whether graduated households are maintaining or improving their well-being after graduation.
Also available in Word. |
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Graduation Benchmarks Assessment Tool for Orphans and Vulnerable Children Programs
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MEASURE Evaluation |
2019 |
English |
|
Orphans and Vulnerable Children, OVC |
This is the tool by which households will be assessed for graduation from OVC projects. The tool provides guidance on which of the eight benchmarks should be assessed for which households or for which members of the household; provides questions for each benchmark to be answered by the caseworker carrying out the assessment; and contains instructions for scoring and determining whether the household is ready for graduation.
Also available in Word. The scoring sheet is also available in Word in A4 size and Letter size. |
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Graduation Verification Assessment Tool for Orphans and Vulnerable Children Programs
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MEASURE Evaluation |
2019 |
English |
|
OVC, Orphans and Vulnerable Children |
This is the tool to assess the process by which households are graduated from programs.
Also available in Word. |
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Graduation Benchmarks Indicator Reference Sheets for Orphans and Vulnerable Children Programs
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MEASURE Evaluation |
2019 |
English |
|
OVC, Orphans and Vulnerable Children |
The United States President’s Emergency Plan for AIDS Relief (PEPFAR) has established eight global minimum benchmarks that must be met for households to graduate from programs for orphans and vulnerable children (OVC). For each benchmark, an indicator reference sheet describes how the benchmark is defined and measured. |
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Graduation Data Quality and Sustainability Assessment for Orphans and Vulnerable Children Programs
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MEASURE Evaluation |
2019 |
English |
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OVC, Orphans and Vulnerable Children, Data Quality |
The objective of the data quality assessment is to assess the process by which households are graduated from programs and to support program improvement. The objective of the sustainability assessment is to assess whether graduated households are maintaining or improving their well-being after graduation. The document includes a method for carrying out graduation data quality and sustainability assessments and describes tools for carrying out these assessments.
Access the related Graduation Verification Assessment Tool and Graduation Sustainability Assessment Tool resources. |
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Impact of the Bangladesh Nongovernmental Organization Health Service Delivery Project
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Siân Curtis, Mizanur Rahman, Sharad Barkataki, Nitai Chakraborty |
2019 |
English |
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Contraception, family planning, Maternal Health, Antenatal Care |
The Nongovernmental Organization Health Service Delivery Project (NHSDP) was a flagship health service delivery project in Bangladesh funded by the United States Agency for International Development. NHSDP supported the delivery of an essential service package of reproductive, maternal, and child health services through a network of local nongovernmental organization (NGO) clinics that primarily targeted the poor and underserved in rural and urban areas.
The purpose of this evaluation was to monitor project outcomes and determine the impact of the NHSDP intervention on selected family planning and maternal and newborn health outcomes.
The findings of this impact evaluation will inform the design and implementation of the next phase of the NGO service delivery program. |
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Mapping a Path to Improve Uganda’s Health Information System Using the Stages of Continuous Improvement Toolkit
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MEASURE Evaluation |
2019 |
English |
|
Health Information Systems, HIS strengthening, HIS, Health Systems Strengthening, Uganda, SOCI |
A strong health information system (HIS) gets the right data in the right hands at the right time, enabling effective decision making to strengthen health systems and improve health outcomes. To strengthen a country-level HIS, the first step is to assess what gaps exist and what actions are needed to improve the HIS to better meet the health system’s information needs. Uganda’s Ministry of Health (MOH) is committed to ongoing strengthening efforts in HIS coordination and governance, especially through the development of an HIS strategic framework.
To develop a framework for the HIS, the MOH carried out an assessment to describe the status of the country’s HIS and map a path forward. The assessment enabled key stakeholders to determine elements of the HIS that need attention and priorities for progress to an HIS that is well-equipped to meet Uganda’s health information needs.
The MOH wanted to better understand essential components of HIS strengthening, determine the status of the country’s HIS, and identify the desired or goal status of the HIS across each essential component. Thus, a leadership team representing the ministry and supported by the United States Agency for International Development (USAID)-funded MEASURE Evaluation implemented the HIS Stages of Continuous Improvement (SOCI) Toolkit.1 Key stakeholders gathered for a two-day workshop to apply the tool to the HIS. They used the results to design a road map of actions needed for the HIS to progress. In mid-2019, Uganda will share an HIS strategy that will complement the 2018 eHealth strategy and provide a framework for the country’s HIS, moving forward. The process has been and will continue to be guided by the HIS/Data Management thematic technical working group (TWG) of the MOH and MOH leadership, through the Division of Health Information and Planning Department. |
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Evaluation of a School-Based Sexuality and HIV-Prevention Activity in South Africa: Midline Qualitative Report
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Mkhwanazi, N., Mandal, M., Biehl, H., & Durno, D. |
2019 |
English |
|
Youth, HIV prevention, AGYW, Evaluation, HIV, South Africa |
With support from the United States Agency for International Development (USAID) and in partnership with the South African National Department of Basic Education (DBE), the MEASURE Evaluation project is conducting an impact evaluation of the implementation of scripted lesson plans (SLPs) and supporting activities that were developed to increase the rigor and uniformity of a life skills program for in-school youth. The evaluation’s nested qualitative study explores the perceptions and acceptance of, and the comfort with the sexuality and HIV prevention education activity; and identifies the structural facilitators and barriers that affect the implementation of the activity at multiple levels.
The evaluation’s qualitative component was implemented in six schools across three districts. Qualitative data were collected from male and female learners in Grade 10 and from the parents/guardians of learners, Life Orientation (LO) educators, members of school governing bodies, and members of school management teams.
More learners in intervention schools than in control schools showed high interest in sexuality education. Learners in intervention schools could recall specific lessons compared with those in control schools, although respondents had limited ability to specify how they applied the knowledge gained to their own lives. Parents were generally comfortable knowing that their children were learning about sexuality and about HIV and pregnancy prevention in schools, but were not familiar with the content. LO educators in control schools said that they were not comfortable teaching the sexuality education part of the LO curriculum, but also reported that they found the LO guide useful. By contrast, LO educators in intervention schools reported that they did not find the LO guide helpful. |
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Advances in Solutions for Data Quality
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Jim Thomas and David Boone |
2019 |
English |
|
|
For data to be useful to improve health outcomes, they must be trusted by data users and program planners. The first page of this brief presents a picture of the global context of data quality—past, present, and future. The second page offers links to data quality resources.
The infographic begins with the global goal for data quality. It then outlines the data quality situation in 2013; moves into the next five years, with a list of strategic approaches and progress made (“2014–2018 Advances”); and ends with recommendations of areas on which global players should focus to improve data quality (“Next”).
The resources on the second page are categorized by human resources, data use, gender, geospatial data, data quality assessment, digital data, and scale. |
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Data Quality Assessment (DQA) for HIV Program Indicators in Burundi
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MEASURE Evaluation |
2019 |
English |
|
DQA, Assessment, Data Quality, HIV, Burundi, Data quality assessment |
As donor funding has increased for disease control and prevention projects in developing countries, so has the need to show a return on investment in the form of public health gains. Monitoring and evaluation of interventions are critical to demonstrate the effectiveness of health programs, but are dependent on data reported by health facilities that are often of poor quality. Resources have been devoted to improving data quality in health and disease programs, yet problems persist as countries struggle to develop and maintain capacity for data management, analysis, and use.
The number of patients on treatment is a valuable indicator to monitor the effectiveness of HIV programs; however, treating patients during their lifetimes and accurately recording the results are challenging. Longitudinal treatment records (registers) for patients who return repeatedly for evaluation and treatment need to be summarized periodically in static reports. Counting accurately becomes more difficult as patients come and go from active treatment cohorts, move from one health facility to another, stop treatment because of side effects, or become lost to follow-up.
With the advent of “test and start”—an effort to expand the number of HIV-positive people on treatment and reduce the “waiting list” (those enrolled in care but not yet on treatment)—more scrutiny has been given to treatment results. The findings of such examinations have not always met expected standards.
The United States Centers for Disease Control and Prevention (CDC) developed a new tool to address the need for data quality assurance for HIV and AIDS program indicators. Although this tool employs methods that are similar to existing tools (e.g., comparison between recounted and reported values, cross-checks between data sources), the CDC tool is more prescriptive about what comparisons and analyses to do and how to conduct them.
The Office of HIV/AIDS at the United States Agency for International Development (USAID) has allocated resources to address the data quality of HIV and AIDS indicators through the MEASURE Evaluation project. Several countries have implemented data quality assessments (DQAs) using the new CDC tool, including Burundi. This report summarizes the findings of a preliminary DQA in Burundi using the CDC tool. |
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PRISM Tools for Community Health Information Systems
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Tariq Azim, Jeanne Chauffour, Upama Khatri |
2019 |
English |
|
CHIS, HISS, PRISM, Community, Health Information Systems, Toolkit, Information System, RHIS, Routine Health Information Systems, Performance of Routine Information System Management |
MEASURE Evaluation developed the Performance of Routine Information System Management (PRISM) Framework and suite of tools in 2011 for global use in assessing the reliability and timeliness of a rountine health information system (RHIS), in making evidence-based decisions, and in identifying gaps in an RHIS so they can be addressed and the system can be improved.
This resource, PRISM Tools for Community Health Information Systems (PRISM Tools for CHIS), is an adaptation of the PRISM conceptual framework and its associated tools for designing, strengthening, and evaluating RHIS performance.
The PRISM conceptual framework emphasizes strengthening RHIS performance through better data quality and improved information use. PRISM broadens the analysis of RHIS performance to include three categories of determinants: behavioral determinants, technical determinants, and organizational determinants.
The PRISM framework is as applicable to a community health information system (CHIS) as it is to a national one. PRISM Tools for CHIS is an adaptation of the PRISM Tools specifically intended for evaluating the performance of a CHIS.
The resource is also available as a downloadable Word file. Access additional PRISM resources. |
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Quick Country Start-Up Package for Malaria Surveillance, Monitoring, and Evaluation Training
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MEASURE Evaluation |
2019 |
English |
|
Surveillance, SME, Malaria, Monitoring, Evaluation, Training |
Since 2010, MEASURE Evaluation has offered a suite of trainings to contribute to the strengthening of country-level malaria surveillance, monitoring, and evaluation (SME) systems. These trainings are supported by the United States Agency for International Development (USAID) and the U.S. President’s Malaria Initiative (PMI) and endorsed by the Roll Back Malaria Monitoring and Evaluation Reference Group (RMB MERG). Activities include annual regional malaria SME workshops in English and French, customized country-specific malaria SME workshops, and online malaria SME courses in English and French.
After 10 years of implementation, there is a need for MEASURE Evaluation to document the process based on lessons learned and provide countries with a reference document for implementing these trainings. Furthermore, as the project comes to a close, the reference document will serve as a quick startup guide for future country malaria SME workshop implementation, including step-by-step approaches, practical tools, and trouble shooting.
Read a related blog post. |
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Stakeholder Data Use and Dissemination Planning Tool: An Example from a Research Study in Haiti: Final Report
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MEASURE Evaluation |
2019 |
English |
|
Tool, Stakeholders, Haiti, Engagement, Date use |
An essential component of any public health research study is the effective translation of scientific findings into knowledge used by policy makers, practitioners, and other scientists. Effective knowledge translation is important to avoid the “know-do gap,” where useful scientific results fail to link to policy or programmatic action. The engagement of stakeholders by researchers is a process that can help prevent the know-do gap. Within the established steps of stakeholder engagement, fostering interaction among stakeholders about data use early in the project life cycle helps researchers plan for the effective dissemination of findings. This brief presents a tool that is administered during study sensitization meetings with stakeholders. Its purpose is to elicit the information needed to develop an effective data use and dissemination plan. |
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The Importance of Collecting and Using Valid Data on Reaching Partners through Index Testing for HIV: Results and Recommendations
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MEASURE Evaluation |
2019 |
English |
|
Testing, Data use, HIV, Tanzania, PLHIV, Zimbabwe, Data quality |
Recently, sub-Saharan countries have been incorporating and scaling up index testing as part of HIV testing services (HTS), to increase testing among people living with HIV. Tanzania and Zimbabwe aim for approximately 30 percent of all HIV-positive people who received HTS to be identified through index testing.5, 6 To better understand gaps in index testing and, thus, ways to improve programmatic efforts, MEASURE Evaluation—funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—examined sex and geographic differences in index testing and index testing yield in two countries: Tanzania and Zimbabwe. USAID and PEPFAR implementing partners in both countries provided MEASURE Evaluation with facility-based data covering the last two quarters in FY2018. This brief presents results of our analysis of individual-level data for 5,347 index clients in Zimbabwe and facility-level data for 23,331 index clients in Tanzania. |
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Third Kenya National Malaria Forum: Malaria Control in Devolved Kenya: Optimising Efforts Towards Elimination
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Ministry of Health, Kenya |
2019 |
English |
|
Kenya, Forum, Malaria |
The third Kenya National Malaria Forum (KNMF) was held as part of the Malaria Programme Review to bring together experts and stakeholders involved in malaria control, and to address specific needs that were relevant to contributing new knowledge from research and lessons learnt from implementing different malaria control interventions. Previous KNMFs were held to provide an opportunity for researchers, policy makers, and practitioners involved in malaria control to interact and share evidence to inform policy and practice. The third KNMF was held in the backdrop of a Malaria Programme Review, conducted to inform the development of a new Kenya Malaria Strategy (KMS). The meeting was hosted by the National Malaria Control Programme (NMCP), Ministry of Health, with support from partners, including the World Health Organization and the President’s Malaria Initiative, among others. Nearly 200 experts participated in the forum, representing national governments, 47 counties, international organizations and nongovernmental organizations, and academic and research institutions.
Overall, the third KNMF provided an opportunity for the steering committee tasked with spearheading the Malaria Programme Review, to learn from the experiences and lessons arising from the implementation of malaria control activities and draw useful insights to inform the development of the next KMS. In addition, it provided an avenue for stakeholders, especially those from research and academia, civil society organizations, and county governments, to contribute ideas and insights into the development of the KMS.
This report outlines the approach used in the planning of the third Kenya National Malaria Forum (KNMF) and the objectives and the outcome of the Forum held on 18–19 September, 2018. The report further provides key highlights from each of the presentations and recommendations to inform the development of the next Kenya Malaria Strategy (KMS). |
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Diagnóstico de la capacidad de monitoreo y evaluación del SIS-VIH (El Salvador)
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MEASURE Evaluation |
2019 |
Spanish |
|
MECAT, Capacity Assessment, El Salvador, Monitoring, Evaluation, HIV |
Con la presencia de 27 participantes de diversos sectores, la Comisión Nacional contra el VIH (CONAVIH) y el Programa Nacional ITS/VIH/sida (PNS), con la asistencia técnica de PEPFAR|USAID a través de MEASURE Evaluation, realizó el 4 de diciembre de 2018, un taller para valorar las capacidades en monitoreo y evaluación (MyE) del Sistema de Información en Salud (SIS) de VIH de El Salvador, para mejorar la medición de los avances del país en el cumplimento de las metas 90-90-90, a través del fortalecimiento de los SIS, alineadas a las necesidades de gestión de datos nacionales, regionales y mundiales.
Se utilizó la Herramienta para evaluar la capacidad de monitoreo y evaluación (MECAT, por sus siglas en inglés: Monitoring and Evaluation Capacity Assessment Toolkit), la cual valora (en una escala del 1 al 10) las 12 áreas de capacidad para un sistema nacional funcional de MyE de VIH propuestas por ONUSIDA.
MECAT: https://www.measureevaluation.org/pima/m-e-capacity |
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Characterizing Male Sexual Partners of Adolescent Girls and Young Women in Mozambique: An Intervention to Promote Data Use
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William Miller |
2019 |
English |
MOZAMBIQUE |
Sexual Behavior, Sexually Transmitted Infections (STIs), DREAMS, Sexual Behavior, Contraceptive Use, and Reproductive Health, AGYW |
Adolescent girls and young women (AGYW) ages 15–24 have been identified as a population extremely vulnerable to HIV. Whereas other countries in the region are experiencing a decline in HIV prevalence, Mozambique is facing high and sustained prevalence. HIV prevalence is notably higher among women, and this disparity is much starker among youth ages 15–24: the prevalence of HIV among females is more than three times that of males.
The United States President’s Emergency Plan for AIDS Relief, through the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) initiative (www.dreamspartnership.org), recognizes the importance of reaching AGYW. In Mozambique, comprehensive AGYW programs under the DREAMS initiative are under way in prioritized locations.
One of the programming strategies of DREAMS is to prevent HIV among male sexual partners of AGYW and reduce the infectiousness of those partners who are HIV-positive (by controlling their viral load), thereby reducing HIV incidence among AGYW. This approach requires information about the characteristics of AGYW’s sexual partners―who they are and how they can be reached. This information is lacking in Mozambique.
To fill this knowledge gap, the United States Agency for International Development in Mozambique asked MEASURE Evaluation to conduct a study that would characterize men who have recently engaged in sexual activity with AGYW, the relationship dynamics, and factors that influence men’s engagement with HIV and AIDS prevention and care services.
This report presents a description of the intervention, preliminary results, and recommendations for others wishing to conduct a similar data use activity. |
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Maternal postnatal care in Bangladesh: a closer look at specific content and coverage by different types of providers
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Eunsoo Timothy Kim, Kavita Singh, and William Weiss |
2019 |
English |
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Postnatal care, Maternal Health, Bangladesh |
Background The first 48 hours after birth is a critical window of time for the survival for both mothers and their newborns. Timely and adequate postnatal care (PNC) is being promoted as a strategy to reduce both maternal and newborn mortality. Whether or not a woman has received a postnatal check within 48 hours has been well studied, however, specific content and type of provider are also important for understanding the quality of the check. The objective of this paper is to understand who receives specific PNC interventions by type of provider in Bangladesh.
MethodsData from the 2014 Bangladesh Demographic and Health Survey (DHS) were used to study receipt of specific PNC interventions – breast exam, vaginal discharge exam, temperature check and counseling on danger signs – within 2 days of birth. Descriptive bivariate analyses and regression analyses using generalized estimating equations (GEE) were used to understand if receipt of an intervention differed by socio-economic and health-related factors. A key factor studied was the type of provider of the PNC.
ResultsThe proportion of women receiving specific interventions during maternal PNC was mostly low (41.81% for breast exam, 39.72% for vaginal discharge, 82.22% for temperature check, 55.56% for counseling on danger signs and 16.95% for all four interventions). Findings from the regression analyses indicated that compared to having postnatal contact with formal providers (doctors, nurses, midwives and paramedics), having postnatal contact with village doctors was significantly associated with lower probabilities of receiving a breast exam, vaginal discharge exam and receiving all four interventions. PNC provided by NGO workers and other community attendants was significantly associated with a lower probability of receiving a vaginal discharge exam but a higher probability of receiving counseling on danger signs.
ConclusionsDuring PNC, women were much more likely to receive a temperature check than counseling on danger signs, breast exams or vaginal discharge exams. Very few women received all four interventions. In the situation where Bangladesh is experiencing a shortage of high-level providers, training more types of providers, particularly informal village doctors, may be an important strategy for improving the quality of PNC.
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Data for Impact Starts with High-Quality Data
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Data for Impact |
2019 |
English |
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Data for Impact, Data visualization, Evaluation, D4I, Data use, Data quality assessment |
Data for Impact (D4I) works in low-resource settings to ensure that when information is needed, reliable data exist to answer the question. When good-quality data are available, people are able to conduct useful analyses and develop communication strategies and data visualizations that contribute to program and policy decision making. |
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Assessing Spatial Data Quality Using Five Data Anomalies: Speeding the Process for Master Facility Lists and Other Large Data Sets
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John Spencer, Becky Wilkes |
2019 |
English |
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Data, MFL, Spatial data, Master facility list, Data Quality |
With the increased ease of the collection of geographic data coordinates and the desire for accurate country master facility lists (MFLs) comes the need for tools and methods with which to rapidly assess the quality of large spatial data sets. Global health professionals who have had limited training in the use of geographic information systems may need guidance in assessing spatial data. Identifying data quality issues in data sets of this size is challenging, because of the complex relationship between the spatial components and the attributes of the data.
Informed by spatial data quality literature, this paper presents a framework for assessing common issues with spatial data and identifies five specific potential data anomalies that can be identified and further investigated to increase the quality of a spatial data set, such as an MFL. Focusing on these five anomalies will provide quantifiable results, which help in planning a practical, effective strategy for corrections. This approach yields not only a list of the locations that need to be corrected, but also feedback on what may be wrong with the data. |
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Sustainability Planning, Implementation, and Transition: A Case Study from the MEASURE Evaluation–Tanzania Associate Award
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MEASURE Evaluation–Tanzania |
2019 |
English |
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Tanzania, Sustainability, MEASURE Evaluation Tanzania |
The MEASURE Evaluation–Tanzania Associate Award (MEval-TZ) operated from 2015 to 2019 with funding from the United States Agency for International Development (USAID), the United States President’s Emergency Plan for AIDS Relief (PEPFAR), and the President’sMalaria Initiative (PMI). Its ambitious goal was to sustainably improve integration and effectiveness of monitoring and evaluation (M&E) systems to strengthen Tanzania’s health information systems (HIS). To achieve this goal, the project implemented activities categorized under three intermediate result areas covering both the Tanzania mainland and Zanzibar at several levels of the health system and with different HIS.
To support these goals, the project had a diverse set of activities, ranging from improving national M&E systems to developing a strong network of M&E professionals. The project pursued two crosscutting activities: gender integration and sustainability and collaboration. These aimed to ensure that all project activities benefitted from male and female participation and that they were sustainable.
MEval–TZ promoted local capacity building and sustainability as core features of its approach. This brief focuses on the project's sustainability planning, implementation, and transition. |
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Coverage of Malaria Interventions in Nigeria: Secondary Analysis of Data from National Surveys
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MEASURE Evaluation |
2019 |
English |
NIGERIA |
Malaria, Disease prevention, Malaria control, insecticide-treated nets |
Malaria is a major public health burden in Nigeria, posing a risk to the entire population. In 2014, the country reported more than 7.8 million confirmed cases of malaria and more than 6,000 malaria deaths. Malaria accounts for approximately 60 percent of outpatient visits and 30 percent of hospitalizations among children under five. Over the past decade, substantial efforts have been made in malaria control by the government and its partners to expand coverage of insecticide-treated nets, conduct intermittent preventive treatment in pregnancy, and improve and scale up malaria case management.
To further its efforts to reduce the malaria burden, the National Malaria Elimination Programme (NMEP) and its partners are working to scale up malaria interventions in line with the Nigeria's National Malaria Strategic Plan 2014–2020.
To measure progress of malaria control achievements in the past decade in Nigeria and to guide future investments, Nigeria has implemented several population-based surveys, including the Nigeria Malaria Indicator Survey in 2010 and 2015, and the Nigeria Demographic and Health Survey in 2008 and 2013.
In response to a request from the President's Malaria Initiative (PMI), MEASURE Evaluation, which is funded by the United States Agency for International Development, conducted this research study to provide further evidence to guide both PMI’s and NMEP’s efforts in malaria program implementation in Nigeria. |
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Experiences and Perceptions of Health Staff on Applying Information Technology for Health Data Management in Ghana
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Emmanuel Edum-Fotwe, Mercy Abbey, Ivy Osei, Abraham Hodgson |
2019 |
English |
GHANA, Africa |
Family Planning, Reproductive Health, EHealth, Mobile technology |
User perspectives and experiences are pertinent to the continued use of mobile technologies for health data collection and management. What users experience affects not only what can be accomplished, but also what attracts them to the mobile technology; and what attracts them to the mobile technology affects how willing they are to understand and continue using it. Since 2011, Ghana Health Service—in response to the expanding health information needs for the effective and efficient management of family planning and reproductive and child health service delivery at the district level—has implemented two forms of mobile technology to facilitate health data collection and management in four districts of the Central Region of Ghana. These mobile technologies have been praised for reducing costs and the physical effort required of health staff. The main study objective was to explore and document the experiences and perspectives of health staff and managers in the four districts on use of mobile technology to collect and manage health data in district health systems. |
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Data for Impact: The D4I Approach for Strong Health Data
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Data for Impact |
2019 |
English |
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Data quality assurance, Data use, Data Quality, Data Quality Audit, Data for Impact, Data informed, Data Demand and Use, D4I, Data quality assessment, Data visualization |
Data for Impact (D4I) is a five-year cooperative agreement funded by the United States Agency for International Development (USAID) that supports countries to mobilize the power of data as actionable evidence that can improve programs, policies, and—ultimately—health outcomes. D4I seeks to achieve the following results:
Build strong evidence needed for program and policy decision making through expanded use of existing data sources and with new data generated through innovative research designs and data collection strategies
Strengthen individual and organizational capacity to develop evidence for health decision making and to receive direct funding from USAID
Facilitate data use to improve global health programs and policies through compelling data visualization and communication strategies.
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Legacy Evaluation of the Partnership for HIV-Free Survival: Kenya, Lesotho, Mozambique, South Africa, Tanzania, and Uganda
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David K. Hales, Heather B. Davis, Alexandra J. Munson, Emily A. Bobrow |
2019 |
English |
Global, KENYA, LESOTHO, MOZAMBIQUE, SOUTH AFRICA, TANZANIA, UGANDA |
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The Partnership for HIV-Free Survival (PHFS) was designed to use basic quality improvement practices to reduce mother-to-child transmission of HIV and increase child survival through improvements in (1) antiretroviral therapy uptake and retention among HIV-positive pregnant women and mothers, (2) breastfeeding practices, and (3) overall mother-baby care. PHFS was implemented between 2012–2016 in six countries in Eastern and Southern Africa: Kenya, Lesotho, Mozambique, South Africa, Tanzania, and Uganda.
PHFS was a joint effort among the United States President’s Emergency Plan for AIDS Relief (PEPFAR), the United States Agency for International Development (USAID), the United Nations Children’s Fund (UNICEF), the World Health Organization, and ministries and departments of health in the participating countries. MEASURE Evaluation—funded by USAID and PEPFAR—conducted a legacy evaluation of PHFS in 2017–2018 in all six countries to review the project’s effects on prevention of mother-to-child transmission (PMTCT) programs and to better understand the critical factors that contributed to improved PMTCT performance in participating health facilities.
Access a related webinar recording and resources. |
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HIV Risk Assessment Prototype
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MEASURE Evaluation |
2019 |
English |
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Orphans and Vulnerable Children, Tools, OVC, HIV |
In this period of limited resources, there is a desire to reduce overall testing costs while strategically targeting for testing people most likely to be HIV-positive. The Office of the Global AIDS Coordinator recommends that an HIV Risk Assessment be applied to all children whose HIV status is unknown, to identify children at risk for HIV infection. MEASURE Evaluation developed an HIV Risk Assessment prototype that implementing partners may adapt to assess risk among orphans and vulnerable children. The prototype’s purpose is to improve the quality of data collected for reporting to the Data for Transparency and Impact (DATIM) system of the United States President’s Emergency Plan for AIDS Relief (PEPFAR).
This is the letter size version of the tool. Download the A4 size. |
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Health Information Systems: Analysis of country-level strategies, indicators, and resources
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Silvestre, E., & Wood, F. |
2019 |
English |
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Health Systems Strengthening, LMICs, Health information systems, HIS, HIS strengthening, HISSM |
This health information systems (HIS) country profile analysis summarizes the status of the HIS in 39 United States Agency for International Development (USAID) priority countries through 30 indicators. The results are presented for (1) all countries, (2) for United States President’s Emergency Plan for AIDS Relief (PEPFAR) countries, and (3) for focus countries where USAID is working to achieve the goal of preventing child and maternal deaths. The individual country profiles can be accessed at https://www.measureevaluation.org/his-strengthening-resource-center/country-profiles.
The report presents:
The 30 indicators and their definitions
The status of the HIS in the three categories of USAID priority countries for these indicators
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Decision Tree to Plan, Implement, Monitor, and Evaluate Programs for Orphans and Vulnerable Children
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MEASURE Evaluation |
2019 |
English |
Global |
Orphans and Vulnerable Children, OVC, M&E |
A step-wise guide to tools that can help countries plan, implement, monitor, and evaluate programs that address the needs of orphans and vulnerable children. This “decision tree” guides readers through relevant questions and describes how to answer them with ready-made tools. MEASURE Evaluation, funded by the United States Agency for International Development (USAID), works globally in low-resource settings to help countries improve their capacity to collect, analyze, and use health data for better health outcomes for people. The first page provides a graphic guide through a set of questions and appropriate tools. The second page gives an overview of each tool mentioned. |
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OVC Indicator Matrix: Measuring the Pathway to Better Outcomes for Children Affected by HIV
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M Cannon, C Fu, M Mendenhall |
2019 |
English |
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HIV, PEPFAR, Orphans and Vulnerable Children, OVC, Child Health, Children |
The United States President’s Emergency Plan for AIDS Relief (PEPFAR) engaged the United States Agency for International Development (USAID)- and PEPFAR-funded MEASURE Evaluation project to develop and support the rollout of an overarching matrix that outlines the pathway to better outcomes for children affected by HIV. Access the full collection of resources. |
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Strengthening Health Information Systems in Guinea
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MEASURE Evaluation |
2019 |
English |
GUINEA |
Health Systems Strengthening, health information system strengthening model, Health Information Systems, HISSM, HIS, HISS |
MEASURE Evaluation, funded by the United States Agency for International Development, has been working with Guinea’s Bureau for Strategy and Development, under the Ministry of Health and Public Hygiene, to update its previously siloed and donor-driven health information collection to a more streamlined system using the electronic DHIS 2 platform. Much of this work strengthens elements of the health information system (HIS) identified in MEASURE Evaluation’s Health Information System Strengthening Model.
This brief features a graphic that displays MEASURE Evaluation activities in the model’s “enabling environment” and “information generation” domains to integrate Guinea’s health systems and improve access to high-quality health data. By displaying interventions across the model, we see their strategic interaction, and how this combination of interventions strengthens data quality and data use at all levels of the health system. A table lists additional MEASURE Evaluation activities in Guinea that support HIS strengthening. Because of these interventions, we expect improvements in the quality of the data collected and an increase in the use of HIS data to generate health indicators and statistics and to inform decision making. |
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Strengthening Health Information Systems in Burundi
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MEASURE Evaluation |
2019 |
English |
BURUNDI |
HISS, health information system strengthening model, Health Information Systems, HISSM, Health Systems Strengthening, HIS |
MEASURE Evaluation, funded by the United States Agency for International Development, has been working with the Ministry of Health to strengthen Burundi’s monitoring and evaluation system through integration of multiple siloed data collection systems for routine data, HIV/AIDS data, and community-based data. Much of this work to integrate systems requires strengthening elements of the health information system (HIS) identified in MEASURE Evaluation’s Health Information System Strengthening Model (HISSM).
This brief features a graphic that depicts MEASURE Evaluation activities in the HISSM’s “enabling environment” and “information generation” domains to improve the integration of Burundi’s health systems and access to high-quality data. By displaying interventions across the model, we see their strategic interaction, and how this combination of interventions strengthens data quality and use at all levels of the health system. A table lists additional MEASURE Evaluation activities that support HIS strengthening in Burundi, by the year in which they began. because of these interventions, we expect improvements in the quality of the data collected and an increase in the use of HIS data to generate health indicators and statistics and to inform decision making. |
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Strengthening Health Information Systems in Bangladesh
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MEASURE Evaluation |
2019 |
English |
BANGLADESH |
health information system strengthening model, Health Systems Strengthening, HISSM, Health Information Systems |
MEASURE Evaluation, funded by the United States Agency for International Development, has been working in Bangladesh to support the Program Management and Monitoring Unit at the Ministry of Health and Family Welfare (MOH) to achieve improved strategic planning, assessment, and monitoring and evaluation of health systems and outcomes. A gap that had been identified and strategically addressed in Bangladesh was the lack of systematic population data, especially for rural areas. In order to produce higher-quality data and to support better health sector planning, MEASURE Evaluation has been working with the International Centre for Diarrheal Disease Research, Bangladesh to help the country’s Directorate General of Health Services and the Directorate General of Family Planning to strengthen the routine health information system of the MOH. Much of this work strengthens elements of the health information system (HIS) identified in MEASURE Evaluation’s Health Information System Strengthening Model.
This brief features a graphic that depicts MEASURE Evaluation’s activities in the model’s “enabling environment” and “information generation” areas and support of the electronic health management information system. By displaying interventions across the model, we see their strategic interaction, and how this combination of interventions strengthens data quality and data use at all levels of the health system. A table lists additional MEASURE Evaluation activities that support HIS strengthening in Bangladesh, by the year in which they began. Because of these interventions, we expect data quality to improve and the use of HIS data to generate health indicators, statistics, and trends for data-informed decision making to increase. |
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Strengthening Health Information Systems in Senegal
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MEASURE Evaluation |
2019 |
English |
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HIS, Health Information Systems, Senegal, HISS, Health Systems Strengthening |
MEASURE Evaluation, funded by the United States Agency for International Development, has been working with Senegal’s Ministry of Health and Social Action (MOH) and Division of Health and Social Information System (DHSIS) to improve the quality of the country’s early warning system for disease outbreaks. MEASURE Evaluation has been supporting the MOH’sefforts to achieve a more unified health information system (HIS)—an effort that includes the integration of community-level data and laboratory data to support a more efficient early warning system. Much of this work strengthens elements of the HIS identified inMEASURE Evaluation’s Health Information System Strengthening Model (HISSM), shown to the right.
MEASURE Evaluation’s work to support HIS strengthening in Senegal affects the enabling environment for the HIS and information generation—both areas outlined in the HISSM.
This fact sheet was updated October 2019. |
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Strengthening Health Information Systems in Côte d'Ivoire
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MEASURE Evaluation |
2019 |
English |
COTE D'IVOIRE |
Orphans and Vulnerable Children, Cote D’Ivoire, HISS, Health Systems Strengthening, Health Information Systems |
MEASURE Evaluation, which is funded by the United States Agency for International Development, has been working in Côte d’Ivoire to support health information system (HIS) strengthening and improve the availability and use of high-quality health data. Central to this work are efforts to upgrade and make interoperable several vertical subsystems that manage the country’s patient-level HIV data (SIGDEP 2), data for orphans and vulnerable children (OVC), data from the electronic logistics management system, and routine health data in DHIS 2. This work with the Ministry of Health and the National OVC Program strengthens elements of the HIS identified in MEASURE Evaluation’s Health Information System Strengthening Model (HISSM).
The graphic below superimposes on the HISSM descriptions of MEASURE Evaluation’s activities in the enabling environment and information generation areas to support harmonization of information needs and facilitate better data sharing across entities. By displaying key interventions across the model, we see their strategic interaction, and how this combination of interventions works together to strengthen data quality and data use at all levels of the health system. The table beneath the graphic lists additional MEASURE Evaluation activities that support HIS strengthening. Because of these interventions, we expect the quality of the data collected to improve and the use of HIS data to generate health indicators, statistics, and trends for data-informed decision making to increase. |
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Strengthening Health Information Systems in Mali
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MEASURE Evaluation |
2019 |
English |
MALI |
HISS, Health Information Systems, Mali, Health Systems Strengthening |
MEASURE Evaluation, which is funded by the United States Agency for International Development, has been supporting Mali’s Ministry of Health and Public Hygiene (MOH)—especially the National Malaria Control Program and the National Directorate of Health—in the unification of Mali’s health information system (HIS). The goal of this unification is for the HIS to yield better-quality data for effective health system planning and timely response to disease outbreak. Mali’s HIS comprises a system for local (sitebased) health information, the hospital information system, and the epidemiological surveillance system. These systems are managed by different governing bodies and were previously housed on a variety of platforms that were not able to communicate or share data. The local HIS had limitations preventing it from producing malaria-specific information or aiding in the detection of an Ebola outbreak. These limitations led to the creation of additional parallel information systems. These multiple reporting systems and duplicative indicators have resulted in a heavy burden of data collection for healthcare providers. MEASURE Evaluation’s work to support the MOH has strengthened both the “enabling environment” and “information generation” areas of the HIS identified in MEASURE Evaluation’s Health Information System Strengthening Model.
This fact sheet superimposes on the HISSM depictions of MEASURE Evaluation’s activities in the enabling environment and information generation areas to support better coordination of Mali’s HIS subsystems. By displaying key interventions across the model, we see their strategic interaction and how this combination of interventions works together to strengthen data quality and data use at all levels of the health system. The table lists additional MEASURE Evaluation activities that support HIS strengthening. |
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Strengthening Health Information Systems in Nigeria—Developing a Master Facility List
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MEASURE Evaluation |
2019 |
English |
NIGERIA |
Nigeria, Health Systems Strengthening, Health Information Systems, Health data |
MEASURE Evaluation, which is funded by the United States Agency for International Development, has been working in Nigeria since 2005 to improve the availability of high-quality data to support decision making at all levels of the health system. This work fulfilled two main objectives:
1) Support the Department of Health Planning, Research and Statistics of Nigeria’s Federal Ministry of Health to develop a master facility list to improve data quality and ultimately lead to better coordination of health services
2) Work with the Federal Ministry of Women’s Affairs and Social Development to develop a directory of orphans and vulnerable children (OVC) service providers and build capacity to use OVC data collection tools for the National OVC Management Information System (NOMIS)
We have mapped the HIS strengthening interventions to support each objective in two separate fact sheets. Each fact sheet superimposes on the HISSM depictions of MEASURE Evaluation’s activities in the enabling environment and information generation areas to support HIS performance in meeting the specific objective. By displaying key interventions across the HISSM, we see their strategic interaction, and how this combination of interventions works together to strengthen data quality and data use at all levels of the health system.
This fact sheet documents MEASURE Evaluation’s work to develop a master facility list to improve data quality and ultimately lead to better coordination of health services.
Follow the link to view the related document: Strengthening Health Information Systems in Nigeria—Building an OVC Information System
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Strengthening Health Information Systems in Madagascar
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MEASURE Evaluation |
2019 |
English |
MADAGASCAR |
Madagascar, Health Systems Strengthening, Health Information Systems, Health information systems, HISS |
Madagascar’s health information system (HIS) has faced challenges resulting from multiple vertical reporting systems and disease-surveillance systems that correspond to program-specific needs. In working toward a more unified HIS, Madagascar’s Ministry of Health (MOH) has been collaborating with partners, such as the Directorate for Malaria Control, to integrate reporting systems, reduce reporting redundancies, and address issues related to data quality. As part of this effort, the USAID-funded MEASURE Evaluation has been supporting the development and implementation of an electronic HIS to improve the availability and use of high-quality health data. MEASURE Evaluation’s involvement in the MOH’s efforts to improve the performance of Madagascar’s HIS have strengthened the “enabling environment” and “information generation” areas of the HIS, identified in MEASURE Evaluation’s Health Information System Strengthening Model (HISSM).
The illustration on this fact sheet superimposes on the HISSM depictions of MEASURE Evaluation’s activities in the enabling environment and information generation areas to support coordination of vertical information systems and harmonization of data collection. By displaying key interventions across the model, we see their strategic interaction and how this combination of interventions works together to strengthen data quality and data use at all levels of the health system. |
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Strengthening Health Information Systems in the Democratic Republic of Congo
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MEASURE Evaluation |
2019 |
English |
CONGO, THE DEMOCRATIC REPUBLIC OF THE |
Health Systems Strengthening, HIS, Democratic Republic of Congo, Health Information Systems |
MEASURE Evaluation, which is funded by the United States Agency for International Development, has been working in the Democratic Republic of the Congo (DRC) since 2009. A major ongoing activity is work with the Ministry of Public Health (MOPH) and the National Malaria Control Program to improve data quality and increase the use of malaria information at all levels of the health system. Much of this work with the MOPH strengthens elements of the health information system identified in MEASURE Evaluation’s Health Information System Strengthening Model (HISSM).
This fact sheet superimposes on the HISSM descriptions of MEASURE Evaluation’s activities in each intervention area (enabling environment and information generation) that supported the health ministry’s development of the Centers of Excellence. By displaying these interventions across the model, we can see their strategic interaction and how they combine to strengthen data quality and data use at all levels of the DRC’s health system. Because of these interventions, the health sector in the DRC should collect better-quality data and increase its use of HIS data to generate health indicators and statistics, identify trends, and conduct data-informed decision making. |
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FAQ: How Much Will an Evaluation Cost?
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MEASURE Evaluation |
2019 |
English |
Global |
Impact Evaluation, Evaluation, Cost |
When deciding whether to conduct an evaluation, and when planning for one, it is important to consider cost. The cost of an evaluation is dependent on many factors, including the objectives, design, methods, sample size, geographic scope, and local context for the work. Other factors that affect cost are particular to the process—for example, the front-end work required to plan an evaluation or study is often substantial and should be considered when budgeting. |
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Building a Strong and Interoperable Digital Health Information System for Uganda
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MEASURE Evaluation |
2018 (Revised in 2019) |
English |
UGANDA, East Africa, Africa |
Interoperability, Africa, EHealth, Technology, HIS, Uganda, Health Information Systems |
Uganda launched its National eHealth Policy and Strategy in May 2018. Leadership and governance, workforce development, enterprise architecture, health information systems integration, and interoperability are the strategy’s key areas of implementation. Most important, the strategy calls for “harmonized eHealth initiatives at all levels,” given the various digital health information systems (HIS) that have taken root in the country.
To understand how to prioritize investments and implementation toward interoperability within these systems, the Ministry of Health (MOH) of Uganda, with support from MEASURE Evaluation—funded by the United States Agency for International Development (USAID)—conducted a readiness assessment of the interoperability of Uganda’s HIS with in-country HIS stakeholders.
The assessment team focused on three major domains of an HIS: leadership and governance, human resources, and technology. They used the Health Information System Interoperability Maturity Toolkit, developed in 2017 by MEASURE Evaluation and the Health Data Collaborative’s Digital Health and Interoperability Working Group, with input from digital health stakeholders in Ghana and Kenya. A maturity model measures the ability of an organization or government entity, such as a health ministry, to continuously improve in a specific discipline until it reaches the desired level of development, or maturity. Using the results of the assessment, the team brainstormed activities that Uganda could prioritize to move the country toward a stronger, interoperable digital HIS. This brief describes the assessment process, results, and recommended actions. |
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Using DHIS2 Software to Track Prevention of Mother-to-Child Transmission of HIV: Guidance (Version 2)
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Cristina de la Torre, Samuel Johnson, Allison Schmale |
2018 (Revised September 2019) |
English |
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PMTCT, DHIS 2, HIV |
MEASURE Evaluation has published comprehensive guidance for developing an electronic solution using DHIS 2 to track patients across the prevention of mother-to-child transmission (PMTCT) of HIV continuum of care. Our goal is to increase retention of mothers and their infants through the pregnancy and breastfeeding periods, and to improve linkages and referrals across services. This guidance is customized to address the complexities related to the PMTCT continuum of care, but the approaches for planning, designing, and configuring a patient tracker in DHIS 2 apply to any health program. The guidance includes the following:
Instructions for conducting an initial assessment of the environment
Description of the decisions that must be made during the planning stage, such as defining the scope of the tracker; the data elements to be collected; and the overall data collection, entry, and management processes
Overview of the DHIS 2 Tracker program and the implications for developing a patient tracker
Discussion of technological options and issues that must be considered in the configuration process
Details on how to achieve a specific configuration for a PMTCT Tracker, including: defining services and potential outcomes, enabling different facilities to schedule visits or mark them as completed, setting up notifications, configuring reports and creating PMTCT indicators from
Access the PMTCT tracker resources at https://www.measureevaluation.org/resources/pmtct-tracker/ |
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Saving Lives, Transforming the Economy: Making “Treat All” Real and Saving 23,000 More Batswana from HIV by 2030
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MEASURE Evaluation |
2018 |
English |
|
Botswana, HIV prevention, ART, HIV, PLHIV, HIV care, HIV/AIDS, Cost |
Botswana has a considerable burden of HIV, with the third highest HIV prevalence globally. However, through bold leadership, the country is a global trailblazer in responding to the AIDS epidemic, and is on the cusp of realizing an AIDS-free generation.
In June 2016, informed by a rigorous investment analysis, a “Treat All” policy was launched to provide all people living with HIV (PLHIV) in Botswana–regardless of disease state—with free, publicly-financed lifesaving treatment. By “leaving no one behind”—a key principle of Botswana’s National Development Plan 2017–2023 (NDP 11)—this policy shift seeks to optimize investments in the national AIDS response and accelerate progress towards epidemic control, with a view to end AIDS as a public health threat by 2030.
To date, the implementation of the “Treat All” policy has focused on providing this free, publicly financed antiretroviral therapy (ART) only to citizens, leaving noncitizens behind. Botswana’s 170,000 noncitizens in residence constitute 7 percent of the country’s total population; of these, an estimated 30,000 are living with HIV. Most noncitizens originate from India, South Africa, Zambia, Zimbabwe, and the United Kingdom, and 80 percent of them are between the ages of 15 and 49: the age group that is most sexually active and economically productive. Only 29 percent of all noncitizens living with HIV are accessing HIV treatment.
Recognizing that multiple concurrent partnerships increase the spread of HIV through sexual networks, the government acknowledges that without fully implementing the Treat All strategy, by covering treatment both of citizens and noncitizens, there will be no epidemic control. Rather, the government would face more new HIV infections and a growing HIV expenditure.
To address the HIV treatment of noncitizens in Botswana, the government would need an additional total investment of US$18 million for the period 2018 through 2030—an average of US$1.4 million per year. This translates into an additional 1.2 percent of spending on the current ART program (estimated at US$103 million per year) and would help achieve 90-90-90 and 95-95-95 treatment targets by 2020 and 2030, respectively, among the noncitizen population.
Treating noncitizens is another way of protecting the citizen population. By treating noncitizens, Botswana can save 22,745 citizens from HIV infection and 1,373 citizens from tuberculosis (TB) infection. The country would also avert 6,741 deaths from AIDS. Compared with treating citizens only, this strategic investment yields 64 percent more new HIV infections averted, at a cost of only 1.2 percent more. Other benefits of enacting a policy change to provide access to HIV treatment for noncitizens are US$112 million in savings on HIV treatment (which the government would incur to treat citizens if infections are not averted) and US$4 million in savings on TB treatment (which would occur among noncitizens living with HIV who are not on treatment). Additionally, US$30 million in productivity gains would accrue to the economy owing to increased productivity yielded by treatment and avoided infections among previously untreated noncitizens living with HIV.
Overall, for every U.S. dollar invested in treating noncitizens, the country gets US$8 in return.
By not acting now, the government increases the risk of not meeting the Treat All goals for epidemic control. Moreover, the government will incur an additional US$116 million expenditure to treat HIV and TB infections. The country will be exposed to an additional 23,000 new HIV infections among citizens, as well as an economic loss of US$30 million in worker productivity owing to untreated HIV.
As a way forward, we recommend investment in treating both citizens and noncitizens through the Treat All program. This will accelerate epidemic control, improve financial sustainability of the Treat All program, and produce long-term healthcare savings. To implement this policy recommendation sustainably, potential pathways are to work with development partners to fund the initial phase of the program, followed by transition to full financing by the Government of Botswana as cost savings are realized. |
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Health Information Systems Data Use
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MEASURE Evaluation |
2018 |
English |
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Data use, Health Information Systems, HIS |
From 2014-2020, MEASURE Evaluation supported interventions to improve data-informed decision in a number of countries. To understand factors that contribute to successful data use in country health information systems, MEASURE Evaluation has published the following resources meant to be used by country governments, programs, and donors working to sustain a culture of informed decision making in health programs. |
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Health Information System Strengthening Model
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MEASURE Evaluation |
2018 |
English |
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Data, HIS strengthening, HISSM, Health System, Routine Health Information Systems, Health Systems Strengthening, Health Information Systems, RHIS, HIS, Information systems |
MEASURE Evaluation’s Health Information System Strengthening Model (HISSM) articulates how country-level health information systems (HIS) in low- and middle-income countries are designed, developed, and implemented to support health systems and improve health outcomes over time. It guides ongoing learning, depicts the elements of an HIS and the relationships among them, and illustrates external influences. The model is useful for countries at both national and subnational levels as a guide for the assessment, planning, and improvement of their HIS. An HIS is broadly defined to encompass health data sources, including health facility and community data collected as part of routine health information systems (RHIS) or health management information systems (HMIS); electronic health records for patient care; population-based data; human resources information; financial information; supply chain information; and surveillance. The HISSM includes every type of information that can be used for decision making in the health sector. This model was developed in collaboration with experts around the globe, using the Health Metrics Network (HMN) Framework as a foundation (HMN, 2008), to address four key objectives: (1) promote HIS as an essential function of a health system, (2) define HIS strengthening, (3) measure HIS performance, and (4) monitor and evaluate HIS interventions. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Kenya: Dissemination Workshop
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Susan Settergren and Walter Obiero |
2018 |
English |
KENYA, Africa |
OVC, Indicators, Monitoring, Orphans and vulnerable children, OVC programs, PEPFAR |
In 2016, the orphans and vulnerable children (OVC) team of the United States President’s Emergency Plan for AIDS Relief (PEPFAR)/Kenya requested assistance from MEASURE Evaluation (which is funded by the United States Agency for International Development [USAID] and PEPFAR) to conduct outcome monitoring surveys for three of its ongoing OVC projects in western Kenya: USAID’s AIDS, Population and Health Integrated Assistance plus Western Kenya (APHIAplus) project; the United States Centers for Disease Control and Prevention’s Timiza 90 project; and a project of the United States Department of Defense led by the Walter Reed Program/Henry M. Jackson Foundation Medical Research International. The first round of these household surveys collected data for the nine PEPFAR OVC Essential Survey Indicators and other related information. Reports for the three surveys can be found online here. Round 2 of the surveys occured in 2018.
On May 30–31, 2018, MEASURE Evaluation conducted a workshop in Kisumu, Kenya, to disseminate the first round of survey results and facilitate development of project management responses to the findings. This report presents a summary of the two-day workshop. |
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Gender-Integrated Routine Data Quality Assessment (RDQA+G) Tool
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MEASURE Evaluation |
2018 |
English |
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Routine data, Gender, Data Quality, Tool, RDQA |
The gender-integrated routine data quality assessment (RDQA+G) tool is the newest addition to MEASURE Evaluation’s suite of capacity building and self-assessment tools that strengthen the monitoring and evaluation of public health interventions. The RDQA+G builds on the routine data quality assessment (RDQA) tools. It enables national programs or donor-funded projects to evaluate their own data quality with a special focus on gender data (including sex and age disaggregation), while continuing to improve reporting performance and prepare for data quality audits. The RDQA+G facilitates the identification of problem areas for selected indicators related to gender and data quality, and guides the creation of M&E system strengthening action plans. The RDQA+G is a Microsoft Excel-based tool that consists of a checklist and an automated dashboard to assist in interpreting assessment results. This zipped file includes the tool, a related user manual, and a report on a pilot test of the tool.
Access the collection online at https://www.measureevaluation.org/our-work/gender/gender-integrated-routine-data-quality-assessment-rdqa-g-tool/gender-integrated-routine-data-quality-assessment-rdqa-g-tool |
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mHealth Data Security, Privacy, and Confidentiality
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Lauren Spigel, Samuel Wambugu, Christina Villella |
2018 |
English |
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MHealth, Data security, Privacy, Digital Health, Data |
Information technology is spreading fast, and its adoption in the health sector is gaining ground rapidly. Under the banner of eHealth, mHealth, or digital health, mobile technology (such as laptop computers, mobile phones, and tablets) has become an indispensable tool to increase health coverage. As countries strive toward universal health coverage, mobile wireless technologies—mHealth tools—in support of enumeration, registration, and unique identification of patients, along with maintenance of health records, will facilitate improved health system performance. Electronic forms and registry systems will enable routine monitoring of the coverage of essential interventions for individuals in relevant populations.
Because mobile technology is widespread, governments and organizations are harnessing their power to collect, collate, transmit, and present data in a timely fashion, thereby overcoming barriers inherent in paper-based systems. The rapid progression of technology enables the increased sharing of data between electronic systems. This can provide decision makers with valuable data and improve their ability to make critical decisions on health programs.
As healthcare organizations turn to mobile devices to improve efficiency and productivity, many are introducing risks that could all too easily result in a data breach and the exposure of protected health information. Organizations around the world are taking note and providing guidelines on how to safeguard electronic personal health information.
MEASURE Evaluation has published mHealth data security, privacy, and confidentiality guidelines and an accompanying checklist. The guidelines are intended to strengthen national health information systems (HIS), by providing a tool to guide decisions on security, privacy, and confidentiality of personal health information collected and managed using mobile devices. The checklist will help mHealth project managers and HIS officials from ministries of health assess security, privacy and confidentiality concerns of mHealth programs.
Access the full collection online at https://www.measureevaluation.org/our-work/mhealth/mhealth-data-security-privacy-and-confidentiality/ |
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Data Demand and Use Concepts and Tools: A Training Tool Kit
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MEASURE Evaluation |
2018 |
English |
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Data, Data Demand and Use, Data use, DDU |
This course aims to provide the conceptual basis for data use within an organization or program, or at the national, state, or district levels of government. Included in the course are several tools created by MEASURE Evaluation to facilitate the use of data in decision making. Specific learning objectives include:
Improving the understanding of the role of data in decision making, the context of decision making, the determinants of data use, and the importance of data sharing and feedback
Building skills for applying data demand and using tools
The course is intended to be delivered to teams of individuals from the same organization or government level. Each team should include both data users and data producers. Data users are health professionals, policymakers, and other key health decision makers who use data to inform the design, implementation, monitoring, and improvement of health programs. Data producers are professionals who acquire and analyze health data and prepare them for distribution to audiences of users. These include monitoring and evaluation (M&E) specialists, data clerks, or researchers. The team approach has proven effective because it ensures that all of those involved understand their respective roles in data demand and use, and how the roles interact with each other. |
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Routine Monitoring of PEPFAR Orphans and Vulnerable Children Programs
|
MEASURE Evaluation |
2018 |
English |
|
OVC, Orphans and Vulnerable Children, HIV, PEPFAR, Monitoring |
As part of its Monitoring, Evaluation, and Reporting (MER) guidance, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) released Version 2.3 in September 2018, which includes revised indicators for orphans and vulnerable children (OVC) programs. These indicators are intended for routine monitoring of service delivery (OVC_SERV) and HIV status (OVC_HIVSTAT) and are to be reported biannually by all global implementing partners.
The purpose of routinely collecting the MER OVC indicators is to ensure that OVC project beneficiaries receive substantive, timely, and continuous support. Updates in this version highlight the importance of the HIV risk assessment for those who do not know their status and need to be tested and the inclusion of minimum graduation benchmarks. Minimum graduation benchmarks provide definitions for success, which the OVC program, caregivers, and OVC can agree to work toward.
MEASURE Evaluation has developed a set of resources to support the collection of the PEPFAR MER OVC routine monitoring data. These resources are intended for all OVC program stakeholders—for example, USAID mission staff, PEPFAR implementing partner staff, and the community-based organizations responsible for providing services and monitoring OVC programs.
Access the online version of the collection at https://www.measureevaluation.org/our-work/ovc/routine-monitoring-of-pepfar-orphans-and-vulnerable-children-programs |
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Indicateurs basés sur les enquêtes auprès des ménages pour la lutte contre le paludisme
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|
2018 |
French |
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Le but de ce manuel est de fournir des spécifications détaillées pour les indicateurs de contrôle du paludisme qui peuvent être mesurés à travers les enquêtes auprès des ménages et les données nécessaires à leur construction, ainsi que les problèmes liés à leur interprétation. Des détails sur les méthodes de collecte de données requises pour estimer ces indicateurs au moyen d'enquêtes nationales sur les ménages sont également fournis. Ce manuel vise à optimiser la cohérence interne et la comparabilité des indicateurs et des types de méthodes de collecte de données utilisés dans les pays et dans le temps. |
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Evaluation de l’infrastructure informatique des trois ministères concernés par l’approche « Santé Unique » au Burkina Faso
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Mohamed Rahim Kebe, Cyrille Kouassi, Romain Tohouri, Jeanne Chauffour |
2018 |
French |
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Evaluation, Burkina Faso, One Health, Technology, ICT, Global health |
Le renforcement du système d’information sanitaire (SIS) dans les pays en développement est de plus en plus basé sur des outils sophistiqués et des logiciels nécessitant une infrastructure en technologies de l’information et de la communication (TIC) adéquate permettant la capture facile, le transfert, le stockage, le traitement et l’analyse des données tout en pouvant aussi soutenir une large diffusion de l’information produite pour éclairer le processus de prise de décisions.
Le choix du Burkina Faso pour l’instauration d’une plateforme électronique de gestion des données de la surveillance selon l’approche « Santé Unique » a nécessité un audit de l’état des infrastructures TIC existantes au sein des trois ministères concernés par cette approche : le Ministère de la santé, le Ministère de l’environnement, de l’économie verte et du changement climatique et le Ministère des ressources animales et halieutiques
L’outil d’évaluation des infrastructures TIC, développé par MEASURE Evaluation, a permis d’évaluer les capacités des différents niveaux du système de santé afin de fournir une indication sur l’état actuel de son infrastructure TIC ainsi que sur les actions nécessaires pour son amélioration selon les objectifs à atteindre.
Une auto-évaluation mixte avec des méthodes qualitatives et quantitatives a permis de collecter les données auprès du personnel de gestion des données de chaque structure de la pyramide sanitaire. Elle a aussi pu déterminer les bases de développement d’une architecture intégrée du SIS qui permettraient une interopérabilité entre les sous-systèmes d’une approche « Santé Unique » au Burkina Faso et de formuler des recommandations pour une mise à niveau de l’infrastructure soutenant le SIS du Burkina Faso.
English:
Assessment of the information technology infrastructure of the three ministries involved in the "One Health" approach in Burkina Faso
Health information systems (HIS) strengthening in developing countries is becoming increasingly dependent on more sophisticated tools and software that require an adequate information and communication technology (ICT) infrastructure that allows data to be easily captured, transferred, stored, reviewed, and analyzed all the while supporting a broad dissemination of the information produced in order to inform data-based decision making processes. Setting-up an electronic "One Health" platform that would manage disease surveillance data in Burkina Faso required an assessment of the state of existing ICT infrastructures used by the three ministries involved in the "One Health" approach, namely the Ministry of Health, the Ministry of the Environment, Green Economy, and Climate Change, and the Ministry of Livestock and Fisheries.
The ICT infrastructure assessment tool, developed by MEASURE Evaluation, allowed the country team to evaluate the different health system levels' capacities in order to provide an indication on the current state of its ICT equipment and system, as well as the necessary actions that must be undertaken to improve it and meet the project's objectives.
A mixed-methods self-evaluation enabled the team to gain insight from data management staff within each structure of the health system pyramid. The assessment also determined the elements required to develop an integrated HIS architecture that would allow interoperability within all sub-systems working on the "One Health" approach in Burkina Faso, and to issue recommendations for an upgrade of the infrastructure supporting the HIS in Burkina Faso. |
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Documenting Health Data Quality Practices within USAID Supported Implementing Partners and Health Facilities Receiving MEASURE Evaluation–Tanzania’s Technical Assistance
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MEASURE Evaluation–Tanzania |
2018 |
English |
|
MEASURE Evaluation Tanzania, Data Quality, Health data, DQA |
Since 2008, the United States Agency for International Development (USAID) has tasked MEASURE Evaluation–Tanzania (MEval-TZ)—an associate award of the leader project MEASURE Evaluation, based at the University of North Carolina, Chapel Hill, NC, USA—with conducting annual data quality assessments (DQAs) within selected HIV testing, care, and treatment programs. MEval-TZ conducted the study reported here to learn how the activities we implemented have changed health information systems (HIS). The aim of this study was to document drivers of and barriers to the effectiveness of DQA activities to strengthen data quality. The study also sought to help us understand of the contribution of the DQAs to the strengthening of HIS in the target regions/districts. As part of its learning agenda, MEval-TZ needed to identify data and metrics that could be used to assess the effects of the monitoring and evaluation (M&E) system strengthening activities conducted by the project, primarily at the subnational level. Furthermore, the study aimed to identify recommendations for improvement of data quality in Tanzania and globally. This report shares more. |
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Improving Use of Health Data through Data Use Champions
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MEASURE Evaluation–Tanzania |
2018 |
English |
|
MEASURE Evaluation Tanzania, Data use, Health data |
The MEASURE Evaluation–Tanzania (MEval-TZ) project had an overarching objective to build sustainable capacity in use of quality health data for evidence-informed decision making and programming. A key area of this work was technical assistance and building capacity of regional and council health management teams (R/CHMT) in the analysis, interpretation, and use of routine health data for decision making purposes.
R/CHMTS are government employees charged with overall responsibility for coordinating, supervising, monitoring, and coordinating health service delivery. The core members of this team are the regional and district/council medical officer of health, the health secretary, the health management information system focal person, the AIDS control coordinators, and the child health coordinator. Since 2014, MEval-TZ has identified, built the capacity of, and supported a total of 40 data use champions from 26 councils spread across eight regions: Dar es Salaam, Mwanza, Mbeya, Iringa, Njombe, Morogoro, Dodoma, and Singida.
This brief provides an overview of this work. |
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Applied Monitoring and Evaluation Postgraduate Course Launched in Tanzania
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MEASURE Evaluation– Tanzania |
2018 |
English |
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Monitoring, Evaluation, MEASURE Evaluation Tanzania, Capacity Building |
Capacity building for monitoring and evaluation (M&E) is the foundation of MEASURE Evaluation–Tanzania’s work—funded by the United States Agency for International Development (USAID)—and is systematically woven into the project’s workplans, benchmarks, and deliverables. The project creates products to support systems at the national and subnational levels of government for health areas related to HIV and malaria. M&E systems for measuring the effectiveness of this work and the required human skills to conduct M&E are,therefore, critical.
MEASURE Evaluation–Tanzania (MEval-TZ) assists the government to develop and implement M&E plans, guidelines, programming in the DHIS 2 health data platform, supervision, data quality, and data review—all through the lens of capacity building.
Beyond capacity building for specific M&E activities, professionals in the field expressed a need for more systematic access to learning opportunities and platforms to share knowledge and experiences. Training in M&E was limited, even though the emphasis on data-informed decision making continues to grow and the introduction of electronic data collection and real-time data reporting creates a market for those with master’s level training.
In response, MEval-TZ partnered with Muhimbili University of Health and Allied Sciences (MUHAS), and the Global Evaluation and Monitoring Network for Health (GEMNet-Health), coordinated by the parent project, MEASURE Evaluation, to support faculty in the development of a two-year degree program: Project Management, Monitoring, and Evaluation in Health (PMMEH) This brief shares more. |
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MEASURE Evaluation–Tanzania’s Technical Assistance for Malaria Surveillance in Mainland Tanzania and Zanzibar: Progress 2016–2018
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MEASURE Evaluation–Tanzania |
2018 |
English |
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Malaria Surveillance, MEASURE Evaluation Tanzania, Malaria |
The United States Agency for International Development (USAID) funds the MEASURE Evaluation–Tanzania (MEval-TZ) project, which counts among its work the provision of technical assistance for malaria surveillance in both Mainland Tanzania and Zanzibar. Malaria is considered a major public health problem in both Mainland and Zanzibar. According to the United States President’s Malaria Initiative (PMI), all residents are at risk. Malaria prevalence is lower in Zanzibar (<1 percent); on the mainland, more than 26 percent of all outpatient clinic visits are attributable to malaria, resulting in an estimated 7.7 million confirmed cases annually.
This brief provides an overview of the work and progress. |
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Adaptation of the DHIS 2 to Manage Program Data on Most Vulnerable Children in Tanzania
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MEASURE Evaluation–Tanzania |
2018 |
English |
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Most Vulnerable Children, MVC, Child Health, DHIS 2, MEASURE Evaluation Tanzania |
Most vulnerable children (MVC) are defined in Tanzania as children under the age of 18 years living under extreme conditions, characterized by severe deprivation that endangers health, well-being, and long-term development. The exact number of MVC in Tanzania is unknown, but it has been estimated that up to 71 percent of children in Tanzania suffer two or more instances of severe deprivations of their basic needs. Children’s vulnerability is intertwined with social, cultural, and economic factors, plus the effects of the HIV epidemic. Developing appropriate responses to assist MVC requires information on their numbers as well as reach, coverage, and effectiveness of existing services.
The vision of the United Republic of Tanzania is to ensure that MVC receive the care, protection, and support required to reach their full potential. In line with this vision, the Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC), through the Department of Social Welfare (DSW), developed the National Costed Plan of Action for Most Vulnerable Children 2013–2017 (NCPA II). NCPA II outlined activities to enhance the well-being of MVC by protecting their rights and preventing and reducing the incidence or effects of economic hardship and health risks.
This brief provides an overview of the adaptation of the DHIS 2 to manage program data on MCV in Tanzania. |
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The MEASURE Evaluation–Tanzania Small Grants Program: Building Capacity and Informing HIV/AIDS Programs
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MEASURE Evaluation–Tanzania |
2018 |
English |
|
MEASURE Evaluation Tanzania, Capacity Building |
Small grants are one mechanism to promote research capacity and provide financial support for health research conducted in low-income countries. When host country teams research issues, develop strategies, and implement solutions, those actions promote sustainability, a goal championed by the United States Agency for International Development (USAID).
MEASURE Evaluation–Tanzania (MEval-TZ), funded by USAID, administered small grants to local universities and nongovernmental organizations (NGOs) in Tanzania to contribute to Result 3 of the project: an increased evidence base for community health and social service programs through conducting research and building research capacity. This brief provides an overview of the small grants program. |
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Strengthening Data Quality for Better Health Policies, Programs, and Services in Tanzania
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MEASURE Evaluation–Tanzania |
2018 |
English |
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Data Quality, DQA, Monitoring, Evaluation, MEASURE Evaluation Tanzania |
Since 2008, MEASURE Evaluation–Tanzania (MEval-TZ) has conducted annual data quality assessments (DQAs) and provided monitoring and evaluation (M&E) capacity building through customized trainings and mentoring among more than 40 implementing partners (IPs). These groups worked in HIV prevention, care, and treatment; most vulnerable children; home-based care; and HIV testing and counseling programs. Through DQAs, the project assessed strengths and weaknesses in data collection, compilation, and reporting from health facilities to the district, regional, and national levels; strengthened M&E systems and the quality of data reported; and built M&E sustainability by strengthening the capacity of IP M&E staff, members of regional and council health management teams, and health facility staff to conduct routine DQAs without reliance on external support. This brief shares more. |
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DHIS 2 Functions and Data Use for Health Information System Strengthening: Development and Application of a Practical Training Package
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MEASURE Evaluation–Tanzania |
2018 |
English |
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Data use, Data, MEASURE Evaluation Tanzania, DHIS 2 |
A national health information system (HIS) is the backbone of efforts to gather data to understand a country’s health issues. MEASURE Evaluation–Tanzania (MEval-TZ) has worked with the Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC) since 2014 to strengthen the performance and management of the country’s HIS.
MEval-TZ’s overarching goal has been to improve the systems that monitor and evaluate health and social service programs while enhancing local capacity to sustain and use these systems. Since the beginning of the project, MEval-TZ has supported the health management information system (HMIS) unit of the MOHCDGEC to institutionalize the DHIS 2 software for HMIS through training and capacity building at the national, regional, and district levels and by developing and implementing tools and resources to enhance system use. This document is a snapshot of the project’s work to help the ministry develop a training package for DHIS 2 functions and data use for HIS strengthening. The package is a standard, practical training resource for building the skills and competence of health system staff to employ DHIS 2 to analyze and use system data to improve evidence informed decision making at local and national levels. |
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Documenting Health Data Quality Practices in Tanzania
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MEASURE Evaluation–Tanzania |
2018 |
English |
|
DQA, MEASURE Evaluation Tanzania, Data, Data Quality, HIS, Health Information Systems |
Since 2008, MEASURE Evaluation–Tanzania (MEval-TZ) has been conducting annual data quality assessments (DQAs) within selected HIV testing, care, and treatment programs. The DQAs aim to identify strengths and weaknesses in data collection, aggregation, and reporting at all levels, from health facilities to intermediate reporting levels of implementing partners (IPs) to the national headquarters of those partners and ultimately to USAID. The assessments also aim to improve the capacity of IPs and health facilities to collect and report good-quality data and to carry out internal DQAs. After each round of DQAs, MEval-TZ supported IPs and health facilities to develop action plans to address gaps that have been identified in their health information systems (HIS).
MEval-TZ conducted this study to describe key facilitators of and barriers to the effectiveness of DQAs in strengthening data quality, to understand the contribution of the DQAs in strengthening HIS, to assess the effects of MEval-TZ’s monitoring and evaluation (M&E) system strengthening activities at the subnational level, and to identify successes and opportunities for improving data quality interventions. |
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Assessment of Tanzania’s District-Level HIV Referral Systems: Linking Communities and Facilities
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Cristina de la Torre, Charles Mushi, Marylad Ntiro, Allison Schmale, Charles Matiko, Willis Odek |
2018 |
English |
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Tanzania, Referral Systems, MEASURE Evaluation Tanzania, HIV/AIDS, HIV |
Health systems are increasingly relying on community-based organizations (CBOs) and community workers to provide care and support services to individuals affected by HIV and AIDS. Community health workers can deliver a range of services to improve clients’ well-being, provide direct care and treatment, and give support throughout the continuum of care. Additionally, community workers often identify clients in need of services and track them to return them to care.
Strong linkages between community and health facility providers help clients obtain the critical services they need in a timely fashion. Referral systems are an important mechanism for creating strong linkages. Referrals facilitate moving clients through the health care system and exchanging health information between providers. A good referral system helps clients gain access to services, encourages clients to seek care and support, and can also help providers track the services that clients receive and then follow up on client health care needs.
In Tanzania, various national HIV guidelines call for strong referral systems between the community and clinical services to ensure patients receive adequate health care at all levels. To assess the status of referral systems, MEASURE Evaluation conducted an assessment from February to April 2016 in three districts in Tanzania: Kinondoni, Kyela, and Waging’ombe. |
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25 Districts in Uganda: 2018 PLACE Assessments
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MEASURE Evaluation |
2018 |
English |
|
PLACE, Uganda, HIV |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief provides an overview of the 25 district reports. |
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Tororo: 2018 PLACE Assessment
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MEASURE Evaluation |
2018 |
English |
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PLACE, HIV, Uganda |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from Tororo. |
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Sembabule: 2018 PLACE Assessment
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MEASURE Evaluation |
2018 |
English |
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PLACE, HIV, Uganda |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from Sembabule. |
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Rakai: 2018 PLACE Assessment
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MEASURE Evaluation |
2018 |
English |
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HIV, PLACE, Uganda |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from Rakai. |
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Omoro: 2018 PLACE Assessment
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MEASURE Evaluation |
2018 |
English |
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PLACE, HIV, Uganda |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from Omoro. |
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Ntungamo: 2018 PLACE Assessment
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MEASURE Evaluation |
2018 |
English |
|
PLACE, HIV, Uganda |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from Ntungamo. |
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Namayingo: 2018 PLACE Assessment
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MEASURE Evaluation |
2018 |
English |
|
Uganda, HIV, PLACE |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from Namayingo. |
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Mukono: 2018 PLACE Assessment
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MEASURE Evaluation |
2018 |
English |
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PLACE, HIV, Uganda |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from Mukono. |
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Moyo: 2018 PLACE Assessment
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MEASURE Evaluation |
2018 |
English |
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PLACE, Uganda, HIV |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from Moyo. |
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Mbale: 2018 PLACE Assessment
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MEASURE Evaluation |
2018 |
English |
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Uganda, HIV, PLACE |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from Mbale. |
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Mayuge: 2018 PLACE Assessment
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MEASURE Evaluation |
2018 |
English |
|
PLACE, Uganda, HIV |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from Mayuge. |
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Lwengo: 2018 PLACE Assessment
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MEASURE Evaluation |
2018 |
English |
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Uganda, HIV, PLACE |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from Lwengo. |
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Luwero: 2018 PLACE Assessment
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MEASURE Evaluation |
2018 |
English |
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PLACE, Uganda, HIV |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from Luwero. |
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Kyenjojo: 2018 PLACE Assessment
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MEASURE Evaluation |
2018 |
English |
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PLACE, Uganda, HIV |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from Kyenjojo. |
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Kyegegwa: 2018 PLACE Assessment
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MEASURE Evaluation |
2018 |
English |
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Uganda, HIV, PLACE |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from Kyegegwa. |
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Kotido: 2018 PLACE Assessment
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MEASURE Evaluation |
2018 |
English |
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HIV, PLACE, Uganda |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from Kotido. |
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Kole: 2018 PLACE Assessment
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MEASURE Evaluation |
2018 |
English |
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PLACE, Uganda, HIV |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from Kole. |
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Kiryandongo: 2018 PLACE Assessment
|
MEASURE Evaluation |
2018 |
English |
|
Uganda, HIV, PLACE |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from Kiryandongo. |
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Kiruhura: 2018 PLACE Assessment
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MEASURE Evaluation |
2018 |
English |
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Uganda, HIV, PLACE |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from Kiruhura. |
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Kakumiro: 2018 PLACE Assessment
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MEASURE Evaluation |
2018 |
English |
|
PLACE, Uganda, HIV |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from Kakumiro. |
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Isingiro: 2018 PLACE Assessment
|
MEASURE Evaluation |
2018 |
English |
|
PLACE, Uganda, HIV |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from Isingiro. |
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Busia: 2018 PLACE Assessment
|
MEASURE Evaluation |
2018 |
English |
|
PLACE, Uganda, HIV |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from Busia. |
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Bunyangabu: 2018 PLACE Assessment
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MEASURE Evaluation |
2018 |
English |
|
Uganda, HIV, PLACE |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from Bunyangabu. |
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Bukomansimbi: 2018 PLACE Assessment
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MEASURE Evaluation |
2018 |
English |
|
PLACE, Uganda, HIV |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from Bukomansimbi. |
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Apac: 2018 PLACE Assessment
|
MEASURE Evaluation |
2018 |
English |
|
Uganda, PLACE, HIV |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from Apac. |
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Agago: 2018 PLACE Assessment
|
MEASURE Evaluation |
2018 |
English |
|
PLACE, Uganda, HIV |
In 2018, building on previous Priorities for Local AIDS Control Efforts (PLACE) method studies (conducted in 2003, 2013–2014, and 2016), Makerere University, in Kampala, conducted a new round of PLACE assessments, with MEASURE Evaluation’s support. It was an opportunity for district-level partners to collaborate on identifying people living with HIV but not yet diagnosed and linking them to care. This brief shares the results from the Agago district. |
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Zanzibar Health Sector HIV and AIDS Strategic Plan III, 2017–2022 (ZHSHSP III) Monitoring and Evaluation Plan
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Zanzibar Integrated HIV, Hepatitis, Tuberculosis and Leprosy Programme |
2018 |
English |
|
MEASURE Evaluation Tanzania, HIV/AIDS, Zanzibar, HIV, Monitoring, Evaluation |
According to the Tanzania HIV Impact Survey (THIS), 2016–2017, HIV prevalence in the general population of Zanzibar is less than 1 percent (NBS, 2017). Kaskazini Unguja and Mjini Magharibi regions have the highest HIV prevalence (0.6%), followed by Kusini Pemba (0.3%). The THIS 2017 data show significant reductions in HIV prevalence from the Tanzania HIV and AIDS and Malaria Indicator Survey (THMIS) of 2011/12, which estimated an HIV prevalence of 1.2 percent and 0.3 percent in Unguja and Pemba islands, respectively. However, estimates from the general population mask the HIV problem in Zanzibar, which typically is classified as having a concentrated HIV epidemic, with high HIV prevalence among key populations (KPs). The key populations include people who inject drugs (PWID), men who have sex with men (MSM), and sex workers (SWs) who are also characterized as hidden and hard-to-reach population with high risk of acquiring HIV infection. For example, according to the Integrated Bio-Behavioural Surveillance Survey (IBBSS) conducted in 2011–2012, HIV prevalence amongst SWs, PWID, and MSM was 19.3 percent, 11.3 percent, and 2.6 percent, respectively. The Third Zanzibar Health Sector HIV and AIDS Strategic Plan, 2017–2022 (ZHSHSP III) was designed to respond to the HIV epidemic and identified gaps and challenges in the health sector response in Zanzibar.
This Third Zanzibar Health Sector HIV and AIDS Strategic Plan, 2017–2022 (ZHSHSP III) Monitoring and Evaluation Plan (ZHSHSP III M&E Plan) has been developed to guide stakeholders on how to monitor and evaluate implementation of the ZHSHSP III and determine whether its goals and objectives are being met. The M&E plan has a total of 70 indicators, with indicators for each of the four thematic areas (TAs) defined in the Strategic Plan, namely: (1) prevention of HIV transmission – 32 indicators; (2) care, treatment, and support for PLHIV – 15 indicators; (3) crosscutting technical interventions – 8 indicators; and (4) health systems strengthening – 15 indicators. The guidance includes definition of indicators for the measurement of expected results (impact, outcomes, and outputs), sources of data, frequency of data collection, baseline level, and targets for each indicator and institutions that are responsible for collecting and reporting the data.
Effective implementation of this M&E plan will provide strategic information for planning and decision-making purposes, including any necessary course correction measures required for the attainment of the health-sector goal to ensure “universal access” to good quality, integrated HIV- related services in Zanzibar. The goal is aimed at eliminating HIV as a public health concern by 2030. |
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Tanzania Health Sector HIV and AIDS Strategic Plan IV, 2017–2022 (HSHSP IV) Monitoring and Evaluation Plan
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National AIDS Control Programme (Tanzania) |
2018 |
English |
|
MEASURE Evaluation Tanzania, HIV/AIDS, Tanzania, Monitoring, Evaluation, HIV |
The Tanzania HIV Impact Survey (THIS), 2016–2017 (THIS, 2017), showed adult HIV prevalence of 4.7 percent compared to 5.1 percent in 2012. However, even with this decline, the study found that nine out of the 26 regions in the country had HIV prevalence above the national average. Moreover, the study showed a higher HIV prevalence in urban (7.5%) than in rural areas (4.5%) and among women (6.2%) than men (3.1%). Against this background, the Fourth Health Sector HIV and AIDS Strategic Plan, 2017 ‒2022 (HSHSP IV) has been developed with the aim of fast-tracking combination prevention strategies to reduce HIV incidence and eliminate the AIDS epidemic as a public health threat by 2030. The goals of HSHSP IV are to be met through the implementation of the “maximum coverage technical efficiencies” scenario, which matches the country’s epidemiology and current funding landscape. The scenario entails the maximisation of efforts and coverage of HIV prevention and treatment services, with a focus on key and vulnerable populations.
This Health Sector HIV and AIDS Monitoring & Evaluation Plan 2017–2022 (HSHSP IV M&E Plan) has been developed to guide stakeholders on how to monitor and evaluate implementation of the HSHSP IV and determine whether its goals and objectives are being met. The guidance includes definition of indicators for the measurement of expected results (impact, outcomes and outputs), sources of data, frequency of data collection, baseline level, and targets for each indicator and institutions that are responsible for collecting and reporting the data.
The HSHSP IV has 75 indicators in total. The number of indicators by the five strategic areas defined in the strategic plan is as follows: (1) HIV testing services – 4 indicators; (2) HIV prevention services – 15 indicators; (3) treatment, care, and support for PLHIV – 21 indicators; (4) health system strengthening – 26 indicators; and (5) crosscutting interventions – 9 indicators. Seven indicators are identified as core HSHSP IV indicators. The M&E plan underscores the importance of using standard national data collection and reporting tools. |
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Zanzibar National HIV and AIDS Monitoring and Evaluation Plan: 2016/17–2020/2
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Zanzibar AIDS Commission |
2018 |
English |
|
Zanzibar, Monitoring, Evaluation, HIV, MEASURE Evaluation Tanzania |
The Third Zanzibar National Strategic Plan for HIV and AIDS, 2016/17–2020/21 (ZNSP III) provides a roadmap for the prevention and mitigation of the effects of HIV and AIDS over the next five years. Its mission is “to support the national HIV response to reduce [the] impact of the epidemic on the country’s socio-economy through better coordination, access to quality services, leadership, resource mobilization, and financing for effective implementation of the planned interventions.” The realisation of this mission calls for ongoing tracking of the services available, the populations they serve, and their quality.
This Zanzibar National HIV and AIDS Monitoring and Evaluation (M&E) Plan, 2016/17–2020/21 (ZNSP III M&E Plan) has been developed to guide stakeholders on how to monitor and evaluate implementation of the ZNSP III, and determine whether its goals and objectives are being met. The guidance includes definitions of indicators for the measurement of expected results (impacts, outcomes, and outputs), sources of data, frequency of data collection, baseline level and targets for each indicator, and the institutions responsible for collecting and reporting the data.
The ZNSP III M&E Plan has 49 indicators with a varied number of indicators for each of the five key result areas (KRA) defined in the strategic plan: (1) KRA 1: HIV prevention, care, and treatment programs for the general population strengthened and scaled up – 25 indicators; (2) KRA 2: Programmes targeting KPs and vulnerable populations improved – 9 indicators; (3) KRA 3: Research, knowledge management, and M&E programmes strengthened – 6 indicators; (4) KRA 4: Alternative and sustainable financing models established – 2 indicators; and (5) KRA 5: Institutional management and integration of services at all levels, enabling environment and impact mitigation interventions strengthened – 7 indicators. |
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Factors That Influence the Use of Routine Health Information in Family Planning Services in Lagos, Nigeria. A Prospective Review of The Use of Family Planning Data
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Abayomi Joseph Afe, Timothy Akinmurele, Adeola Olatoun, Abimbola Oduola, Ganiyu Agboola and Maduakolam Onyema |
2018 |
English |
|
Routine Health Information Systems, Family Planning, RHIS, Health information, Nigeria |
Background: The poor utilization of data generated from the RHIS in RH/FP has made it difficult to address some of the challenges associated with the uptake of RH/FP services.
Objectives: The literature on health information systems in FP is replete with complaints of the neglect of existing information, yet remarkably little is known regarding the factors that influence acting on routine health information generated in family planning services in Nigeria. The following are the research Questions; what are the factors that facilitate the use of routine health information in FP services and What are the factors that hinder the use of routine health information in FP service?
Methods: This was a prospective cross sectional mixed method study carried out over a period of 12 months in three Local government areas in Lagos, southwest Nigeria.
Results: There was a very high level (n=374, 88%) of awareness on RHI indicators among the respondents. Over 90% of the respondents reported that Integrating FP into other health interventions, such as HIV, immunizations, deliveries, and post-abortion care (n=388, 91.3%), availability of staff skilled in record-keeping (n=403, 94.8%), management or supervisor’s interest in data quality and data use (n=394, 92.7%), receiving feedback from higher levels on reports sent with collected FP data (n=399, (93.9%). The commonest hindrances to the use of RHI include poor quality data (n=396; 93.2%), incomplete data (n=399; 93.9%), noninvolvement of policy makers in data collection (n=391; 92.0%) and lack of feedback from higher levels on how data generated has been put to use (n=423; 93.6%).
Conclusion: It is hoped that promoting the factors identified as facilitators of RHI and removing those categorized as hindrances in this study would encourage the use of routine health information and ultimately improve family planning services in the state and the nation as a whole. |
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Measuring malaria diagnosis and treatment coverage in population-based surveys: a recall validation study in Mali among caregivers of febrile children under 5 years
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Ruth A. Ashton, Bakary Doumbia, Diadier Diallo, Thomas Druetz, Lia Florey, Cameron Taylor, Fred Arnold, Jules Mihigo, Diakalia Koné, Seydou Fomba, Erin Eckert, and Thomas P. Eisele |
2018 |
English |
|
Mali, ACT, Child Health, Malaria, Children |
Background: Nationally-representative household surveys are the standard approach to monitor access to and treatment with artemisinin-based combination therapy (ACT) among children under 5 years (U5), however these indicators are dependent on caregivers’ recall of the treatment received.
Methods: A prospective case–control study was performed in Mali to validate caregivers’ recall of treatment received by U5s when seeking care for fever from rural and urban public health facilities, community health workers and urban private facilities. Clinician-recorded consultation details were the gold standard. Consenting caregivers were followed up for interview at home within 2 weeks using standard questions from Demographic and Health Surveys and Malaria Indicator Surveys.
Results: Among 1602 caregivers, sensitivity of recalling that the child received a finger/heel prick was 91.5%, with specificity 85.7%. Caregivers’ recall of a positive malaria test result had sensitivity 96.2% with specificity 59.7%. Irrespective of diagnostic test result, the sensitivity and specificity of caregivers’ recalling a malaria diagnosis made by the health worker were 74.3% and 74.9%, respectively. Caregivers’ recall of ACT being given had sensitivity of 43.2% and specificity 90.2%, while recall that any anti-malarial was given had sensitivity 59.0% and specificity 82.7%. Correcting caregivers’ response of treatment received using a combination of a visual aid with photographs of common drugs for fever, prescription documents and retained packaging changed ACT recall sensitivity and specificity to 91.5% and 71.1%, respectively.
Conclusions: These findings indicate that caregivers’ responses during household surveys are valid when assessing if a child received a finger/heel prick during a consultation in the previous 2 weeks, and if the malaria test result was positive. Recall of ACT treatment received by U5s was poor when based on interview response only, but was substantially improved when incorporating visual aids, prescriptions and drug packaging review. |
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La surveillance à base communautaire des maladies et zoonoses prioritaires au Sénégal: Guide de Formation ICP-CPV-CPE
|
MEASURE Evaluation |
2018 |
French |
|
Global health, Zoonotic, Surveillance, Global health security |
La surveillance à base communautaire (SBC) est une collecte organisée et rapide d'informations provenant de la communauté, généralement des symptômes de maladies qui pourraient constituer un risque potentiel pour la santé publique. Il a été démontré que la SBC peut compléter efficacement le système national de surveillance des maladies en formant les acteurs communautaires à identifier des cas au sein de leur propre communauté, ce qui constitue un potentiel énorme pour la détection précoce et la lutte contre les maladies à potentiel épidémique. Le renforcement de la surveillance épidémiologique dans le contexte de la sécurité sanitaire mondiale est un axe stratégique majeur.
Le présent guide de formation a été développé avec les matériels disponibles de l’Organisation Mondiale de la Santé (OMS) et de l’Organisation Mondiale de la Santé Animale (OIE), guidé par le Règlement Sanitaire International (RSI), mais aussi avec les guides techniques disponibles dans les secteurs de la santé humaine et animale au Sénégal.
Ce guide est destiné à la formation des infirmiers chef de poste (ICP), des chefs de poste vétérinaire (CPV) et des chefs de poste du secteur de l’environnement (CPE) sur la surveillance à base communautaire des maladies et zoonoses prioritaires au Sénégal. A l’issue de leur formation, ces professionnels de la santé devraient être en mesure d’assurer pleinement leur rôle dans la SBC des maladies et zoonoses prioritaires et de former les membres des comités de veille et d’alerte communautaire (CVAC) placés sous leur responsabilité.
Pour atteindre cet objectif, six modules de formation ont été développés, partant de l’introduction au programme de formation à la description des rôles et responsabilités des différents acteurs (professionnels et communautaires) impliqués dans la SBC. Une part importante a été réservée à la description des maladies prioritaires y compris les zoonoses sous surveillance à l’échelle communautaire, et à l’utilisation de la plateforme électronique –mInfoSanté– pour la transmission des données de surveillance et le partage d’information entre les secteurs clés impliqués dans la surveillance dans une approche One Health (santé, élevage et environnement).
Les sessions de formations seront facilitées par les équipes cadres des districts sanitaires, et les services départementaux de l’élevage et de l’environnement. Elles seront supervisées par les niveaux régionaux et centraux des trois secteurs clés en collaboration avec l’équipe de MEASURE Evaluation. |
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La surveillance à base communautaire des maladies et zoonoses prioritaires au Sénégal: Guide de formation des Comités de Veille et d’Alerte Communautaire (CVAC)
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MEASURE Evaluation |
2018 |
French |
|
Zoonotic, Global health security, Global health |
Les récentes épidémies de maladies infectieuses en Afrique ont fait ressortir le rôle important des acteurs communautaires de santé dans la surveillance des maladies notamment dans la détection précoce et la réponse rapide. Le Sénégal a mis en place un système de surveillance communautaire des maladies prioritaires, qui permet aux acteurs communautaires d’identifier précocement les maladies au sein de la communauté et d’envoyer un signal à l’infirmier, au chef de poste vétérinaire, ou au chef de poste du secteur de l’environnement pour favoriser la réponse rapide et éviter la propagation des maladies. L’OMS définit le signal comme un ensemble de données et/ou informations considérées par le système d’alerte précoce et riposte comme présentant un risque potentiel pour la santé humaine.
Le présent guide de formation est destiné à la formation des membres des comités de veille et d’alerte communautaire (CVAC) sur la surveillance des maladies et zoonoses prioritaires au Sénégal. Il a pour objectifs spécifiques de permettre à ces acteurs de: (1) comprendre les concepts clés de la surveillance à base communautaire ; (2) pouvoir identifier les 8 maladies humaines prioritaires, les messages clés relatifs à ces maladies et les moyens de prévention ; (3) pouvoir identifier les 6 zoonoses prioritaires chez l'homme et l'animal, les messages clés relatifs à ces maladies et les moyens de prévention ; (4) comprendre les règles de base, les formalités et les techniques de communication requises lors d'une visite à domicile ; (5) pouvoir utiliser la plateforme mobile mInfoSanté pour envoyer des signaux et recevoir une retro information ; (6) maitriser leurs rôles et responsabilités en tant que acteur communautaire.
Les sessions de formations seront facilitées par les infirmiers chefs de postes, les chefs de postes vétérinaires et ceux du secteur de l’environnement. Elles seront supervisées par les districts sanitaires, les services départementaux de l’élevage et de l’environnement en collaboration avec l’équipe de MEASURE Evaluation. |
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MEASURE Evaluation Mozambique Overview
|
MEASURE Evaluation |
2018 |
English |
Africa, MOZAMBIQUE |
MER, AGYW, DREAMS, Mozambique, OVC |
MEASURE Evaluation has worked in Mozambique for 10 years.
Since 2016, MEASURE Evaluation has supported the DREAMS Initiative (a program to help girls develop into “determined, resilient, empowered, AIDS-free, mentored, and safe” women) and also HIV-affected orphans and vulnerable children (OVC). MEASURE Evaluation conducted a male characterization study to better understand the sexual partners of adolescent girls and young women (AGYW). The study aimed to improve the delivery of HIV prevention services and thus contribute to the reduction of infection rates among AGYW in Mozambique.
We also have collected information in Mozambique on the effects of girls’ clubs and savings clubs for AGYW (e.g., optimal length of participation, number of sessions, and retention) to empower young women and keep them HIV-free and to improve this approach for the future. Some effects of these clubs were increased school attendance, confidence, and self-efficacy; changing attitudes toward early marriage; reducing early pregnancy; increasing access to sexual reproductive health services; and changing attitudes of parents and male peers toward girls’ roles.
Our OVC assistance included technical support to collect the Monitoring, Evaluation, and Reporting (MER) Essential Survey Indicators, through guidance on study design, implementation, and data interpretation. This allows for monitoring of U.S. government OVC investments.
The project also has implemented Sample Vital Registration with Verbal Autopsy (SAVVY) activities to strengthen civil registration and vital statistics data in Mozambique for more reliable information on health and mortality. |
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Strengthening Systems for the Monitoring and Evaluation of HIV Status of Orphans and Vulnerable Children
|
MEASURE Evaluation |
2018 |
English |
|
Orphans and Vulnerable Children, MER, HIV, Systems strengthening, OVC |
In fiscal year 2017, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) introduced a new Monitoring, Evaluation, and Reporting (MER) indicator to collect information on the HIV status of orphans and vulnerable children (OVC). This was done to help gauge the contributions of OVC to the 90-90-90 goals.1 The new indicator is called OVC_HIVSTAT. The United States Agency for International Development (USAID)- and PEPFAR-funded MEASURE Evaluation conducted a mixed methods study in three countries to collect qualitative data about the monitoring and evaluation (M&E) systems in place for the collection, management, and use of OVC_HIVSTAT data. Performance, data quality, and contextual factors were considered when choosing the three countries for the in-depth study. The countries selected were Côte d’Ivoire, South Africa, and Zimbabwe. Six implementing partners (IPs) across the three countries were visited between November 2017 and February 2018; 32 qualitative interviews were conducted with IP staff and more than 60 community workers participated in workshops on data collection related to HIV risk assessment. MEASURE Evaluation collected and reviewed HIV risk assessments, indicator reference sheets, and standard operating procedures from each IP. Transcripts and notes were analyzed, and preliminary findings were disseminated during a global webinar for the six OVC IPs and their stakeholders on March 14, 2018.
This summary report describes the challenges that the IPs are facing. For example, several OVC programs visited have been slow to adopt the rationale for universal HIV risk assessment as a prerequisite for testing. Although a range of implementation strategies were observed, stigma related to asking questions about HIV risk often prevents community workers from conducting formal HIV risk assessments inside the households. The data collection forms were often problematic, poorly understood by community workers, and open to multiple interpretations by data entry clerks. The guardians of newly detected HIV-positive children were reluctant to report the test results to the community workers. Moreover, once the HIV test results were reported, weak data management protocols contributed to inconsistent documentation of the results. Last, OVC programs faced challenges reporting updated antiretroviral therapy (ART) retention status at regular intervals.
Our analysis of these challenges led to a series of recommendations both for USAID missions and IPs to strengthen M&E systems related to the collection, management, and use of OVC_HIVSTAT data.
Access related resources. |
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Orphans and Vulnerable Children Monitoring, Evaluation, and Reporting (MER) Indicators: Facilitator's Guide
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MEASURE Evaluation |
2018 |
English |
|
MER, PEPFAR, Monitoring, Evaluation, OVC, Orphans and Vulnerable Children |
This is a facilitators guide to go along with course materials available here: www.measureevaluation.org/our-work/ovc/routine-monitoring-of-pepfar-orphans-and-vulnerable-children-programs. The course materials are detailed in this document with a section for each module. |
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Impact Evaluation of Interventions to Strengthen Health Facility Operation and Management Committees in Nepal: Summary of the End Line Report
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MEASURE Evaluation |
2018 |
English |
|
Nepal, Impact Evaluation |
The Health Policy Project (Palladium) and MEASURE Evaluation, funded by the United States Agency for International Development (USAID), implemented the Gender, Policy, and Measurement (GPM) Program. This program partnered with the USAID-funded SuaaharaProject (2011–2016), a community-focused organization in Nepal that is dedicated to improving the health of pregnant and lactating women and children younger than two years of age. Suaahara worked closely with the Government of Nepal (GON) to strengthen policiesand programs that aim to improve the health and nutritional status of this target group. It also worked with health facilities (HFs) to improve health counseling and care services, and to connect families with services for reproductive health; maternal, newborn, and child health(MNCH); and family planning (FP).
Suaahara and GPM collaborated to integrate gender and social inclusion (GESI) and community participation components in existing GON guidelines, processes, and training for the Health Facility Operation and Management Committees (HFOMCs). These committees are the local oversight bodies for HFs. The Strengthening HFOMCs through a Community Engagement Approach project (hereafter called Strengthening HFOMCs) tested two capacity strengthening approaches.
This technical brief describes the overall design of the evaluation, summarizes key findings from the end line impact analysis using baseline and end line data, and provides conclusions and recommendations for use by the Government of Nepal, USAID, and others addressing the work of HFOMCs
Access the full report here. |
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Interventions to Strengthen the Health Facility Operations and Management Committees in Nepal: Final Report
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Jessica Fehringer, Mary Allegra Paul, Dirgha Ghimire, Jeevan Raj Lohani, Prem Bandhari, Diwakar Basnet, B. C. Kalpana, Kamana Uprety |
2018 |
English |
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Health Facilities, Nepal, Evaluation, Impact Evaluation |
Women, girls, and members of disadvantaged groups (DAGs) in Nepal face structural barriers and discrimination that affect their access to education, economic opportunities, healthcare, and ultimately, health outcomes. Recognizing these inequalities, the Government of Nepal (GON) prioritized the incorporation of gender equality and social inclusion (GESI) in the country’s health policies, programs, and plans. Part of the government’s GESI integration strategy is to make the Health Facility Operation and Management Committees (HFOMCs)―the local oversight bodies for health facilities (HFs)―more inclusive and equitable. The strategy seeks to increase the HFOMCs’ responsibility for participatory planning, informed by the needs and demands of target groups, and to create trust between healthcare providers and communities through regular meetings and other interactions.
The United States Agency for International Development (USAID)’s Gender, Policy, and Measurement (GPM) Program partnered with the Suaahara Project, a community-focused organization in Nepal, and the GON to strengthen the HFOMCs by testing two capacity strengthening approaches.
This report shares results from the impact evaluation assessing the intervention approaches.
Access a summary here. |
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Evaluation of Health Programs: A Postgraduate Overview Course – Module 6 Syllabus: Evaluating Results
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MEASURE Evaluation |
2018 |
English |
Global |
GEMNet-Health, Evaluation, Health programs, Curriculum, Maternal and child health, Monitoring, Evaluation, M&E |
As part of an effort to strengthen postgraduate education on evaluation of health programs, the Global Evaluation and Monitoring Network for Health (GEMNet-Health) and MEASURE Evaluation have embarked on developing competency-based curriculum materials for a master’s degree level, overview course on evaluation.
This stand-alone module covers the competencies of:
Selecting appropriate quantitative and qualitative method(s) for evaluating program results;
Recognizing common challenges in evaluating results such as confounding, bias, selection, and statistical power;
Interpreting and discussing results;
Critically reviewing evaluation results; and
Discussing practical constraints in interpreting evaluation results.
To visit the main postgraduate evaluation curriculum page, please click here. |
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Evaluation of Health Programs: A Postgraduate Overview Course – Module 1 Syllabus: Evaluation as a Strategic Tool for Public Programs and Policies
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MEASURE Evaluation |
2018 |
English |
Global |
M&E, Evaluation, Monitoring, Evaluation, GEMNet-Health, Health programs, Maternal and child health, Curriculum |
As part of an effort to strengthen postgraduate education on evaluation of health programs, the Global Evaluation and Monitoring Network for Health (GEMNet-Health) and MEASURE Evaluation have embarked on developing competency-based curriculum materials for a master’s degree level, overview course on evaluation.
This stand-alone module covers the competencies of:
Discussing evaluation in the context of public policy;
Analyzing policy cycle/results chain;
Assessing the role of evaluation for policymaking and the link of strategic information to evaluation;
Discussing practical constraints in evaluation research; and
Identifying and listing the ethical and political implications of evaluation work.
To visit the main postgraduate evaluation curriculum page, please click here. |
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Evaluation of Health Programs: A Postgraduate Overview Course – Postgraduate Evaluation Curriculum
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MEASURE Evaluation |
2018 |
English |
Global |
GEMNet-Health, M&E, Health programs, Maternal and child health, Curriculum, Monitoring, Evaluation, Evaluation |
As part of an effort to strengthen postgraduate education on evaluation of health programs, the Global Evaluation and Monitoring Network for Health (GEMNet-Health) and MEASURE Evaluation have embarked on developing competency-based curriculum materials for a master’s degree level, overview course on evaluation.
The outline of the modular curriculum materials is presented here, along with a summary of the curriculum development approach followed.
To visit the main postgraduate evaluation curriculum page, please click here. |
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Strengthening Kenya’s Health Referral Systems
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MEASURE Evaluation |
2018 |
English |
|
MEASURE Evaluation PIMA, HIS, HIS strengthening, Health Information Systems, Kenya, Health Systems Strengthening |
One of the aims of the United States Agency for International Development (USAID)-funded MEASURE Evaluation PIMA (MEval-PIMA) Intermediary Result 2—improving the availability and use of quality health information at national and subnational levels—was to strengthen the health referral systems in Kenya to ensure continuity and cost-effectiveness of care. MEval-PIMA worked with health sector stakeholders to address gaps in the referral system. Initially, this was a sector-wide approach using the World Health Organization (WHO) health systems building blocks. However, in MEval-PIMA Year 3, PEPFAR narrowed the project’s focus to HIV linkages and referrals.
This brief provides an overview and lessons learned for strengthening Kenya's health referral systems. |
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Strengthening Civil Registration and Vital Statistics in Kenya
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MEASURE Evaluation |
2018 |
English |
|
Kenya, Health Information Systems, CRVS, HIS, MEASURE Evaluation PIMA |
The strategic objective of the United States Agency for International Development (USAID)-funded MEASURE Evaluation PIMA (MEval-PIMA) was to build sustainable monitoring and evaluation (M&E) capacity for Kenya’s overall healthcare system, by using evidence-baseddecision making to improve the system’s effectiveness. MEval-PIMA sought to do this through four main intermediary results. The objectives were to increase the availability of high-quality health information at the national and subnational levels, improve the capacity of Kenya’s health information system (HIS) to make those data available to decision makers, and strengthen the national HIS. The initial assessments of the HIS found these three major challenges to achieving these objectives:
Absence of systematic and consistent implementation of processes and procedures to ensure clean and complete data at each tier of the healthcare system
Lack of tools, including guidelines, standards, and data collection forms
Limited demand for and use of information generated by these systems
MEval-PIMA set out to address these challenges and improve Kenya’s HIS, by supporting four information systems: the community health information system (CHIS), the child protection information management system (CPIMS), the civil registration and vital statistics system (CRVSS), and the referral system (through referral system strengthening [RSS]). This brief focuses on the CRVSS strengthening efforts and performance. |
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Performance of Routine Information System Management (PRISM) User's Kit: Using SurveyCTO to Collect and Enter PRISM Assessment Data
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MEASURE Evaluation |
2018 |
English |
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Performance of Routine Information System Management, Survey CTO, Health Information Systems, Data, Information System, RHIS, Routine Health Information Systems, PRISM, Health data |
One of the mandates of the United States Agency for International Development (USAID)-supported MEASURE Evaluation project is to strengthen the collection, analysis, and use of routine health information system (RHIS) data for the delivery of high-quality health services. We developed the Performance of Routine Information System Management (PRISM) Framework and suite of tools in 2011 for global use in assessing the reliability and timeliness of an RHIS, in making evidence-based decisions, and in identifying gaps in an RHIS so they can be addressed and the system can be improved.
With USAID’s support, we have revised the PRISM Tools and developed other elements, based on the PRISM Framework, to create a broad array of materials: the “PRISM Series,” available here: https://www.measureevaluation.org/prism. This new, comprehensive PRISM Series is useful for designing, strengthening, and evaluating RHIS performance and developing a plan to put the results of a PRISM assessment into action.
To support the use of the PRISM Tools, we have developed a User’s Kit, which consists of three manuals in addition to this one:
Preparing and Conducting a PRISM Assessment, available here: https://www.measureevaluation.org/resources/publications/ms-18-140/
Analyzing Data from a PRISM Assessment, available here: https://www.measureevaluation.org/resources/publications/ms-18-141/
Moving from Assessment to Action, available here: https://www.measureevaluation.org/resources/publications/ms-18-142/
The User’s Kit guides all aspects of a PRISM assessment.
The data entry function for PRISM has been developed in Version 2.41 of SurveyCTO (2018). SurveyCTO is a software platform based on Open Data Kit (ODK) with enhanced functionality for designing forms, collecting data, monitoring data quality, analyzing data, and more. Its security features include transport encryption, device-side and server-side data redundancy, support for easy survey data encryption with a user-defined public/private key pair, and the option for unencrypted data to be restricted to cold room computers (computers totally disconnected from the Internet and all other networks). This manual—the second in the series—provides guidance for new and returning users of SurveyCTO interested in using the software for a PRISM assessment.
Download related modules by clicking the links below.
Module 1Module 2aModule 2bModule 3 Part 1Module 3 Part 2Module 4Module 5Module 6All modules |
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Qualitative Methods in Evaluation of Public Health Programs, a Curriculum on Intermediate Concepts and Practices: Participants’ Guide
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Fehringer, J.A., Pilar Torres-Pereda, P., Dako-Gyeke, P., Archer, E., Mejia, C., Millar, L., Schriver Iskarpatyoti, B., Bobrow, E.A. |
2018 |
English |
Global |
Evaluation, Qualitative Evaluation, Data use, Gender, Gender Norms, Curriculum, Data Quality, Data Demand and Use, Data Quality Review |
Health organizations around the globe regularly make evidence-based decisions for effective health programming. Qualitative evaluation fulfills an important role in rigorous evaluation of programs. The strength of qualitative evaluation is its ability to provide valuable insight into complex issues, which quantitative methods may not provide. Qualitative data sources can answer the “why” behind program successes or challenges. Additionally, qualitative data illuminate the uniquely human side of health programming and bring to light important contextual factors, such as culture, gender, or societal norms. Qualitative evaluation may be used to complement quantitative data, answer a question not accessible quantitatively, or provide a cost-effective data source when one would not otherwise be available.
This course is meant to assist health professionals in using qualitative evaluation skills in sound and rigorous evaluation of their programs. The sessions go beyond basic concepts to explore important considerations of qualitative methods in the context of rigorous evaluation. Through session content and participatory exercises, participants will gain basic skills in rigorous qualitative data collection, analysis, and use.
This participants’ guide contains handouts and information the participants will need throughout the course. The course consists of 12 sessions covering intermediate level skills and knowledge in qualitative evaluation. The course curriculum is designed for participants who have a basic knowledge of program evaluation and qualitative methods. The intended audience is professionals from the monitoring and evaluation and health and development fields. The syllabus provides an overview of the ten-day (8.5 working days) training workshop, including presentations, facilitator and participant guides, practical sessions, case studies, and sample agendas.
A complete collection of resources for MEASURE Evaluation's Qualitative Methods in Evaluation of Public Health Programs Curriculum can be found here. |
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Qualitative Methods in Evaluation of Public Health Programs, a Curriculum on Intermediate Concepts and Practices: Facilitators’ Guide
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Fehringer, J.A., Pilar Torres-Pereda, P., Dako-Gyeke, P., Archer, E., Mejia, C., Millar, L., Schriver Iskarpatyoti, B., Bobrow, E.A. |
2018 |
English |
Global |
Gender Norms, Data Quality, Gender, Evaluation, Data Quality Review, Qualitative Evaluation, Data Demand and Use, Curriculum, Data use |
Health organizations around the globe regularly make evidence-based decisions for effective health programming. Qualitative evaluation fulfills an important role in rigorous evaluation of programs. The strength of qualitative evaluation is its ability to provide valuable insight into complex issues, which quantitative methods may not provide. Qualitative data sources can answer the “why” behind program successes or challenges. Additionally, qualitative data illuminate the uniquely human side of health programming and bring to light important contextual factors, such as culture, gender, or societal norms. Qualitative evaluation may be used to complement quantitative data, answer a question not accessible quantitatively, or provide a cost-effective data source when one would not otherwise be available.
This course is meant to assist health professionals in using qualitative evaluation skills in sound and rigorous evaluation of their programs. The sessions go beyond basic concepts to explore important considerations of qualitative methods in the context of rigorous evaluation. Through session content and participatory exercises, participants will gain basic skills in rigorous qualitative data collection, analysis, and use.
The course curriculum is designed for participants who have a basic knowledge of program evaluation and qualitative methods. The intended audience is professionals from the monitoring and evaluation and health and development fields.
This facilitators’ guide is part of a package of training materials for the qualitative evaluation course. It explains how to present the sessions outlined in the syllabus: a separate, shorter document that provides an overview of the course. It is accompanied by a participants’ guide as well, that has handouts and information the participants will need throughout the course. The course consists of 12 sessions covering intermediate level skills and knowledge in qualitative evaluation. The total duration of the course is 8.5 working days (the sample agenda spreads this over 10 days total). Sessions range in length, but typically take about three hours to complete.
A complete collection of resources for MEASURE Evaluation's Qualitative Methods in Evaluation of Public Health Programs Curriculum can be found here. |
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Qualitative Methods in Evaluation of Public Health Programs, a Curriculum on Intermediate Concepts and Practices: Syllabus
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Fehringer, J.A., Pilar Torres-Pereda, P., Dako-Gyeke, P., Archer, E., Mejia, C., Millar, L., Schriver Iskarpatyoti, B., Bobrow, E.A. |
2018 |
English |
Global |
Data Quality Review, Data Demand and Use, Data Quality, Gender Norms, Qualitative Evaluation, Evaluation, Curriculum, Data use, Gender |
Health organizations around the globe regularly make evidence-based decisions for effective health programming. Qualitative evaluation fulfills an important role in rigorous evaluation of programs. The strength of qualitative evaluation is its ability to provide valuable insight into complex issues, which quantitative methods may not provide. Qualitative data sources can answer the “why” behind program successes or challenges. Additionally, qualitative data illuminate the uniquely human side of health programming and bring to light important contextual factors, such as culture, gender, or societal norms. Qualitative evaluation may be used to complement quantitative data, answer a question not accessible quantitatively, or provide a cost-effective data source when one would not otherwise be available.
This syllabus covers a training that is meant to assist health professionals in using qualitative evaluation skills in sound and rigorous evaluation of their program. The sessions go beyond basic concepts to explore important considerations of qualitative methods in the context of rigorous evaluation. Through session content and participatory exercises, participants will gain basic skills in rigorous qualitative data collection, analysis, and use.
This syllabus provides an overview of the ten-day (8.5 working days) training workshop, including presentations, facilitator and participant guides, practical sessions, case studies, and sample agendas.
A complete collection of resources for MEASURE Evaluation's Qualitative Methods in Evaluation of Public Health Programs Curriculum can be found here. |
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Reaching key populations through key venues: Insights from the Jamaica HIV Prevention Program
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Sharon S. Weir , J. Peter Figueroa, Marion Scott, Lovette Byfield, Carol Jones Cooper, Marcia C. Hobbs |
2018 |
English |
|
HIV prevention, PLACE, HIV, Jamaica, Key Populations |
IntroductionHIV prevention strategies often include outreach to female sex workers at social venues identified as places where people meet new sexual partners. Patrons and staff at these venues may include female sex workers, their clients, as well as others who have high rates of new sexual partnerships. Few studies have compared HIV/STI among venue-based and general populations, across types of venues, or by sub-group of the venue population. Program planners often assume that the prevalence of infection is highest among female sex workers and considerably lower among other people at these venues, but there are few empiric studies assessing the prevalence of infection by sex worker status and type of venue.
MethodsIn 2011, we used the PLACE method to identify public venues where people meet new sexual partners across Jamaica. The study team visited all venues with reported sex work as well as a 10% random sample of other venues and subsequently interviewed and tested a probability sample of 991 venue patrons and workers for HIV and other STI.
ResultsCommunity informants identified 1207 venues. All venues where sex work was reported (735 venues) and a random sample of the remainder (134 of 472) were selected for onsite visits. Of these, 585 were found and operational. At a stratified random sample of venues, survey teams interviewed and tested 717 women and 274 men. 394 women reported recent sex work and 211 of these women reported soliciting clients on the street. Women exchanging sex for money were more likely to be infected with HIV (5.4% vs 1.0%; OR = 5.6, 95% CI = 1.8,17.3) or syphilis (11.7% vs. 5.8%, OR = 2.2, 95% CI = 1.7,4,0) than other women, but not significantly more likely to be infected with gonorrhea (8.4% vs 7.8%; OR = 1.1,95% CI = 0.6,1.9), chlamydia (16.2% vs 21.6%;OR = 0.7,95% CI = 0.5,1.0) or trichomoniasis (23.0% vs 17.0%, OR = 1.5,95% CI = 0.9,2.2). Women at venues were more likely to report sex work and multiple partners than women interviewed in a 2008 national population-based household survey commissioned by the Ministry of Health.
ConclusionsIn Jamaica, although the highest HIV prevalence was among street-based sex workers, the risk of HIV and STI extends to men and women at high risk venues, even those who do not self-identify as sex workers. Findings confirm the appropriateness of outreach to all men and women at these venues.
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Building a Strong and Interoperable Health Information System for Ghana
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MEASURE Evaluation |
2018 |
English |
|
Health Systems Strengthening, HIS, HISS, Interoperability, Ghana, Assessment, Health Information Systems |
In April 2018, the Ghana Health Service (GHS), with technical support from MEASURE Evaluation—funded by the United States Agency for International Development (USAID)—conducted a readiness assessment of the interoperability of the country’s health information system (HIS). This assessment used the HIS Interoperability Maturity Toolkit, developed in 2017 by MEASURE Evaluation and the Health Data Collaborative’s digital health and interoperability working group, with input from key digital health stakeholders in Ghana and Kenya. This brief provides an overview of the assessment and findings. |
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Sustainability Planning for MEASURE Evaluation–Tanzania
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Hobson, R. D., Yourkavitch, J., & Bishwakarma, R. |
2018 |
English |
|
Sustainability, MEASURE Evaluation Tanzania, Tanzania |
MEASURE Evaluation Phase IV was conceptualized during an increased focus on sustainable outcomes, with both the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the United States Agency for International Development (USAID) prioritizing sustainability in their guiding strategies. USAID’s Global Health Bureau developed a Framework for Sustained Development in 2014,1 and PEPFAR 3.0 developed a Sustainability Index in 2015. Thus, it was important for MEASURE Evaluation Phase IV to include a crosscutting focus on sustainability, recognizing the need for national- and regional-level country-led partnerships that optimize the following attributes:
Engagement and cooperation
Commitment and responsibility
Capabilities
Mutual accountabilities
The MEASURE Evaluation–Tanzania Associate Award (TZ AA) brought these dimensions into context within health information system (HIS) strengthening. From its beginning in 2015, the TZ AA project committed to strengthening local ownership and the sustainability of its HIS interventions, dedicating an entire activity (TZA-03) to promoting sustainable approaches and increasing self-reliance. |
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Evaluation rapide des systèmes de surveillance des maladies à potentiel épidémique et épizootique dans une région du Burkina Faso
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Eric H. Geers, Issaka Sawadogo, Serge Nzietchueng, M. Yolande B. Eugene |
2018 |
French |
|
Zoonotic, Burkina Faso, Evaluation, Global health |
Dans le cadre de la mise en oeuvre de l’approche « Une Seule Santé » au Burkina Faso, le projet de MEASURE Evaluation a fait une évaluation rapide pour comprendre les systèmes de surveillance des maladies à potentiel épidémique (MPE) dans les structures opérationnelles des trois ministères : Ministère de la santé, des ressources animales et halieutiques et de l’environnement. L’évaluation a consisté à : (i) analyser l’organisation des systèmes de surveillance des maladies dans chacun des trois ministères concernés en termes de structuration, des ressources humaines, de circuit de collecte et de transmission des données, des outils utilisés, de traitement et analyse des données ainsi que le cadre institutionnel et (ii) apprécier le dispositif mis en place pour assurer la surveillance des maladies au niveau communautaire dans chacun des trois ministères en termes de stratégie, des ressources humaines, des outils et des procédures. |
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Îngrijirea alternativă a copilului Buletin informativ Noiembrie 2018
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MEASURE Evaluation |
2018 |
Romanian |
|
Alternative Care, Care for children, Child Health, Children, Moldova |
Bine ați venit la cel de-al doilea buletin informativ ”Îngrijirea Alterativă a Copilului”. Această publicație oferă actualizări bianuale după atelierele de evaluare privind reforma sistemului de îngrijire care au avut loc în Armenia, Ghana, Moldova și Uganda. Buletinul informativ este menit să fie un instrument util pentru promovarea comunicării și a schimbului de cunoștințe între țări. De asemenea, există o pagină web a acestei publicații, care include pagini dedicate țării Dvs. Vă rugăm să vizitați www.measureevaluation.org/our-work/youth-and-adolescents/alternative-care. |
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Երեխաների այլընտրանքային խնամք Ամսագիր Նոյեմբեր, 2018թ
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MEASURE Evaluation |
2018 |
Armenian |
|
Children, Armenia, Alternative Care, Care for children, Child Health |
Ձեր ուշադրությանն ենք ներկայացնում «Երեխաների այլընտրանքային խնամք» ամսագրի 2-րդ համարը։ Այնտեղ կգտնեք թարմ տեղեկություններ այլընտրանքային խնամքի համակարգի բարեփոխումների վերաբերյալ Հայաստանում, Գանայում, Մոլդովայում և Ուգանդայում անցկացված գնահատման աշխատաժողովներին հաջորդած վեցամսյա ժամանակահատվածի մասին։ «Երեխաների այլընտրանքային խնամք» ամսագիրը ծառայում է որպես երկրների միջև շփումն ու գիտելիքի փոխանակումը խթանող օգտակար գործիք։ Այդ աշխատանքները լուսաբանող վեբ հարթակում կան ձեր երկիրը երկայացնող էջեր։ Այցելելու համար օգտվե՛ք՝www.measureevaluation.org/our-work/youth-and-adolescents/alternative-care. |
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Strengthening Systems for the Alternative Care of Children: Findings from Armenia, Ghana, Moldova, and Uganda
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MEASURE Evaluation |
2018 |
English |
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Systems strengthening, Alternative Care, Child health, Care for children, Children, Assessment |
The assessment of alternative care for children was novel in four ways: It was a self-assessment by governments and key alternative care stakeholders rather than an external evaluation; this created more buy-in and ownership of findings. The approach was from a systems lens to provide a holistic view of the problem. Countries were assessed according to international standards in the United Nations Guidelines for the Alternative Care of Children. Countries engaged with one another to discuss the assessment tool and share learnings from the assessment.
With each country having assessed its care system, MEASURE Evaluation supported the lead ministry in charge of alternative care to facilitate a workshop in each country to set priorities and create action plans. This report presents findings from all four countries, by system component and areas of care, and summarizes recommendations for strengthening alternative care systems. |
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Implementing Nigeria's Master Facility List: Standard Operating Procedures for Maintaining Nigeria's Health Facility Registry
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MEASURE Evaluation |
2018 |
English |
NIGERIA |
MFL |
The Master Facility List (MFL) is a complete list of all health facilities that are providing health services in a country. The health facilities are identified by location and a unique facility identifier. With support from the United States Agency for International Development (USAID), the Federal Ministry of Health released a paper-based MFL in 2013. The continuous updating of this list has been constrained by several challenges, including the lack of a centralized online information system and the lack of clearly defined processes for updating the MFL.
To address the need for a centralized online information system to manage MFL processes, in collaboration with the Federal Ministry of Health, MEASURE Evaluation, which is funded by USAID, developed the Health Facility Registry (HFR) system. The HFR has been populated with the MFL. The HFR contains the list of hospitals and clinics that have been validated at the state level. To maintain the process of updating the MFL, a standard operating procedure was needed to guide the registration of new health facilities and to update the list of health facilities already registered, whenever necessary. The standard operating procedure will allow federal regulatory authorities and all responsible offices and agencies to have a standard process and procedures through which to engage with the HFR. These entities will be able to add new facilities, deactivate facilities that are no longer operational, and upgrade the facility level.
This manual outlines the processes and actions needed to facilitate the addition of a new facility in the HFR.
Other resources to support the implementation of Nigeria’s MFL are available here: https://www.measureevaluation.org/countries/nigeria/toolkit-for-implementing-the-health-facility-registry-in-nigeria/ |
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Development of a Monitoring and Evaluation Framework for Master Facility Lists and Health Facility Registries in Nigeria
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MEASURE Evaluation |
2018 |
English |
NIGERIA |
MFL, M&E, Health Facilities, Master facility list |
A master facility list (MFL) is a complete account of all of the health facilities in a country that provide health services, listed by their location and a unique identifier. Nigeria’s Federal Ministry of Health (FMOH), with support from the United States Agency for International Development (USAID), released a paper-based MFL in 2013. However, continuous updating of this list has been constrained by such challenges as the lack of a central online information system and the absence of clearly defined processes for updates.
Late in 2016, the FMOH, with support from USAID, restarted the project, by merging the 2013 MFL with 18 other facility lists, which are maintained by different organizations, to produce an updated, harmonized facility list. To address the need for a central online information system to manage MFL processes, the USAID-funded MEASURE Evaluation developed a health facility registry (HFR) system for the FMOH.
The FMOH Directorate of Health Planning Research and Statistics, with technical support from MEASURE Evaluation, developed the national MFL/HFR monitoring and evaluation framework, presented in this brief, to monitor nationwide rollout and implementation. |
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Consolidarea sistemelor de îngrijire alternativă a copilului: Constatări din Armenia, Ghana, Moldova și Uganda
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MEASURE Evaluation |
2018 |
Romanian |
|
Alternative Care, Care for children, Child health, Children |
Evaluarea sistemului de îngrijire alternativă a copilului a fost o inovație din patru considerente. A fost o autoevaluare realizată de către guvern și actorii-cheie din sistemul de îngrijire alternativă și nu una externă; acest lucru a creat mai multă implicare și sentimentul de proprietate asupra constatărilor. Abordarea a fost una sistemică pentru a oferi o imagine holistică asupra problemei. Țările au fost evaluate conform standardelor internaționale din Liniile Directoare ONU cu privire la Îngrijirea Alternativă a Copiilor. Acestea s-au angajat într-un dialog comun, pentru a discuta instrumentul de evaluare și pentru a face schimb de lecții învățate ca urmare a evaluării. |
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Monitoring Well-Being Outcomes among Kizazi Kipya Project Beneficiaries in Tanzania
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Chapman, J. L., Brugh, K., Mujaya, S, Kahwa, A, Hickmann, M, & Charyeva, Z. |
2018 |
English |
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Monitoring, Tanzania, HIV, PEPFAR, OVC, Orphans and Vulnerable Children |
The impetus behind this evaluation was twofold. First, the United States Agency for International Development (USAID) mission in Tanzania wanted to better understand the impact of the savings groups implemented by the Kizazi Kipya project on the well-being of orphans and vulnerable children (OVC) households (HHs) supported by the United States President’s Emergency Plan for AIDS Relief (PEPFAR). Second, USAID/Tanzania, together with the Kizazi Kipya project, were required in 2017 to report to the Office of the Global AIDS Coordinator on a new set of outcome indicators, which could only be obtained through an external HH survey of the beneficiary population. There were two evaluation questions:
What is the change in PEPFAR monitoring, evaluation, and reporting (MER) indicators of well-being among Kizazi Kipya beneficiaries over time?
Under what circumstances does caregiver participation in a savings group contribute to changes in the uptake of HIV testing, retention in HIV care, and adherence to HIV medication among caregivers and children?
Access a related poster at www.measureevaluation.org/resources/publications/gr-18-025/. |
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Improving Data Quality through Implementation of Centers of Excellence in the Democratic Republic of the Congo
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MEASURE Evaluation |
2018 |
English |
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Data Quality, Malaria, Data, Democratic Republic of Congo |
In the Democratic Republic of the Congo (DRC), malaria is the principal cause of morbidity and mortality, accounting for more than 40 percent of all outpatient visits and for 19 percent of deaths among children under age five. Only 30 percent of the population has access to health services.
Given that most people in the DRC live in high-transmission zones, estimates are that the DRC accounts for 11 percent of all malaria cases in sub-Saharan Africa. Persistent problems with data quality at the service delivery level in the DRC impede the country’s ability to make evidence-informed decisions for improved malaria response. To reduce malaria-related illness and death, the United States President’s Malaria Initiative (PMI), which supports nine malaria-endemic provinces in the DRC, sought a way to improve data collection, analysis, and use to fight malaria.
MEASURE Evaluation, funded by the United States Agency for International Development (USAID) and PMI, was asked to organize an activity to address data quality issues. The MEASURE Evaluation DRC team considered that others had tried a top-down approach to improve data quality and instead, in 2016, elected to pilot an approach from the other end of the health infrastructure—the service delivery point. Thus began an effort to develop centers of excellence (COEs) to model good data quality practices and to see what this approach might yield. |
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Health Information Systems (HIS) Interoperability Maturity Model Mapping Tool
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MEASURE Evaluation |
2018 |
English |
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Health Information Systems, Tools, HIS, Interoperability, Mapping |
Over the past decade, several tools have been created by implementers in the digital health space to help country governments and other stakeholders implement health information systems (HIS). The purpose of this resource is to map those tools to the domains and subdomains of the Health Information Systems Interoperability Maturity Model in the HIS Interoperbility Maturity Toolkit (www.measureevaluation.org/resources/tools/health-information-systems-interoperability-toolkit/health-information-systems-interoperability-toolkit). Countries may use and apply these tools to improve their HIS and to advance along the subdomains of the maturity model over time. |
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Diagnóstico de la capacidad del monitoreo y evaluación de VIH (Honduras)
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MEASURE Evaluation |
2018 |
Spanish |
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Honduras, Monitoring, Evaluation, Capacity Assessment, MECAT, HIV |
Con la presencia de 51 participantes de diversos sectores, la Secretaría de Salud (SESAL) y miembros de la CONASIDA, a través del proyecto MEASURE Evaluation, se llevó a cabo el 8 y 9 de mayo 2018, un taller para valorar las capacidades en monitoreo y evaluación (MyE) con que cuentan los actores claves de la respuesta nacional de Honduras en el marco de las recomendaciones de lineamientos internacionales para controlar la epidemia de VIH como problema de salud pública.
Durante el taller se aplicó la Herramienta para evaluar la capacidad de Monitoreo y Evaluación MECAT (por sus siglas en inglés: Monitoring and Evaluation Capacity Assessment Toolkit), la cual utiliza las 12 Áreas de Capacidad para un Sistema Nacional Funcional de MyE de VIH. |
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Diagnóstico de la capacidad del monitoreo y evaluación de VIH (Panamá)
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MEASURE Evaluation |
2018 |
Spanish |
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Monitoring, Evaluation, MECAT, HIV, Capacity Assessment |
Con la presencia de 49 participantes de diversos sectores, el Ministerio de Salud (MINSA) y el PNVIH a través de MEASURE Evaluation, llevó a cabo el 10 y 11 de mayo de 2018, un taller para valorar las capacidades en monitoreo y evaluación (MyE) con que cuentan los actores clave de la respuesta nacional de Panamá, en el marco de las recomendaciones de lineamientos internacionales para controlar la epidemia de VIH como problema de salud pública.
Durante el taller se aplicó la Herramienta para evaluar la capacidad de Monitoreo y Evaluación MECAT(por sus siglas en inglés: Monitoring and Evaluation Capacity Assessment Toolkit), la cual utiliza 12 Áreas de Capacidad para un Sistema Nacional Funcional de MyE de VIH. |
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Diagnóstico de las Capacidades en Monitoreo y Evaluación: Sistema de Información de Salud de VIH en Guatemala
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MEASURE Evaluation |
2018 |
Spanish |
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Monitoring, Evaluation, MECAT, Guatemala, HIV, Capacity Assessment, Health Information Systems |
Guatemala realiza esfuerzos para fortalecer la implementación de sistemas de información de salud (SIS) de VIH a través del Ministerio de Salud Pública y Asistencia Social (MSPAS) con el apoyo de organismos cooperantes. En la actualidad, existen alrededor de 16 subsistemas de información que generan datos relacionados con el VIH. Para mejorarlos, se han evaluado y se han elaborado planes de acción con actividades puntuales para mejorar la recepción, registro, análisis y reportes de informes dentro de los sistemas.
Como parte de la estrategia regional de Plan de Emergencia del Presidente de los Estados Unidos para el Alivio del Sida (PEPFAR) y la Agencia de los Estados Unidos para el Desarrollo Internacional (USAID) en Centroamérica, MEASURE Evaluation implementa actividades de fortalecimiento de las SIS en VIH teniendo como contraparte a los ministerios de salud de la región.
La asistencia técnica encargada a MEASURE Evaluation en Guatemala para poder contar con un SIS que, utilizando datos de calidad, genere reportes que faciliten la toma de buenas decisiones, que se enfoquen en alcanzar las metas de eliminación del VIH al 2030, requiere valorar el estado del rendimiento y la capacidad de monitoreo y evaluación (MyE) del sistema en áreas funcionales clave. Para ello, es necesario llevar a cabo un diagnóstico de este sistema, que en forma ágil permita elaborar una propuesta de plan de acción para reducir las brechas identificadas por áreas de capacidad.
La metodología del diagnóstico consistió en la aplicación de la herramienta para evaluar la capacidad de MyE MECAT (por sus siglas en inglés: Monitoring and Evaluation Capacity Assessment Toolkit) (MEASURE Evaluation PIMA, 2017), la cual utiliza las 12 áreas de capacidad proporcionados por el Equipo de Referencia Mundial en Monitoreo y Evaluación (MERG por sus siglas en ingés: Monitoring and Evaluation Reference Group) para un Sistema Nacional Funcional de MyE de VIH (ONUSIDA, 2009). |
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What are the factors and conditions of HIS performance progress?
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MEASURE Evaluation |
2018 |
English |
|
Health Systems Strengthening, HIS, Learning Agenda, Health Information Systems |
A national health information system (HIS) encompasses all sources of health data that a country needs to plan and implement its national health strategy. Examples of data sources are electronic health records on patient care, health facility data, surveillance data, census data, population surveys, vital event records, human resource records, financial data, infrastructure data, and logistics and supply data (MEASURE Evaluation, 2017a). A strong HIS is essential for a country to meet its health goals.
A strong HIS should be well-defined, comprehensive, functional, adaptable and scalable, and resilient (MEASURE Evaluation, 2018a). The system should be able to collect, manage, analyze, and disseminate health data in a timely manner, so that managers can make decisions, track progress, and provide feedback on HIS performance to improve data quality and use. Health information is critical for monitoring, tracking, and solving some of the world’s most important health threats. We need to know if we are making progress in eradicating and preventing disease if we are to plan for and allocate resources and evaluate the effectiveness of health interventions.
This document presents factors and conditions that allow an HIS and the interventions that act on it to work toward improved performance, defined as data quality and data use. This discussion outlines factors and conditions that favor a system’s improvement.
What are the stages of progression to a strong HIS and how are they measured?
What are the characteristics of a strong health information system? |
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Strengthening Tanzania's Routine Health Information System: Incorporating Family Planning Quality Assessment Indicators
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Donald Kasongi, Hadija Malimusi, and George Kwilasa |
2018 |
English |
TANZANIA |
RHIS, family planning, HIS strengthening, Indicators, Tanzania, quality |
Background: Universal access to family planning (FP) services significantly improves maternal health outcomes by ensuring that those who need but cannot access FP services, most of whom are poor and marginalized women, will receive them. In Tanzania’s Lake Zone area, even with the increase of FP interventions by the public and nongovernmental organization sectors, there are great disparities in FP outreach between urban and rural areas. The team explored the benefits of incorporating FP quality assessment indicators in a decentralized routine health information system (RHIS) in rural districts in the Lake Zone. The overall question was, what are the benefits of incorporating indicators related to FP quality assessment in a decentralized RHIS in rural farming districts around Lake Victoria?
Methods: The study was conducted in Magu District, Mwanza Region, using mixed methods. The study collected quantitative and qualitative data through questionnaire-guided individual interviews, key informant interviews, and focus group discussions. Data sets from primary and secondary sources were analyzed to demonstrate the potential for integration of FP indicators in the RHIS and DHIS 2, the district’s software platform for health information.
Findings: Most respondents (66%) considered RHIS to be a highly effective resource in decision making for improving FP services; 28 percent asserted that RHIS was a moderately effective tool. About a quarter (24%) of all respondents mentioned the absence and inadequacy of FP-related services at health facilities and the low demand for and uptake of FP at health facilities as a constraint to assessing the quality of FP services in an RHIS. Respondents mentioned low data literacy among service providers assigned to the RHIS (22%), delays in data transmission to the RHIS (16%), and inadequate financial and human resources for providing comprehensive FP services (14%) as critical gaps in the current RHIS’ ability to assess the quality of FP services. Close to half (40%) of the respondents asserted that incorporating FP quality assessment indicators into the RHIS would trigger use of FP.
Although the RHIS-DHIS 2 infrastructure has been established in Magu District, evidence of the system’s functionality is limited, as exhibited by the gaps we identified in the completeness, timeliness, representation, and accuracy of the data captured in the system. The lack of FP-related services and commodities at health facilities limits the information system’s effectiveness. Limited training opportunities were mentioned as causes of low data literacy among service providers, while inadequate financial and human resource for providing comprehensive FP services hinders the effectiveness of the RHIS.
Most facility-based service providers and community health workers affirmed that incorporating explicit assessment indicators of FP quality in routine data collection would likely stimulate demand at the facility level and trigger local government action through council health management teams (CHMTs) regarding human and financial resources as well as technical materials.
Recommendations: The information system needs review to incorporate explicit and stand-alone indicators for capturing FP patterns and trends that can be presented to a CHMT without additional technical analysis. To improve FP uptake, health service providers and community health workers should be incentivized, particularly with periodic in-service trainings to upgrade knowledge and skills. There is a need to explore and invest in technology options for data transmission that are appropriate and cost-effective for rural settings. Guaranteeing a steady supply of FP commodities and appropriate counseling space would motivate and engage clients effectively, ensuring health facility readiness. CHMTs should receive regular trainings to enhance evidence-based decision making and focus on outcomes.
Conclusion: The ministry emphasis on strengthening the RHIS by incorporating explicit and stand-alone FP quality assessment indicators at the health facility level seeks to promote health system accountability within a decentralized governance system. Despite the heterogeneity and challenges of technology and infrastructure, local government authorities have opportunities to improve the basic determinants of an effective RHIS that can inform the DHIS 2 in a timely and accurate manner. |
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Système national des services sociaux pour les orphelins et les enfants vulnérables: Outil pour la gestion, l'analyse et l'utilisation des données
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MEASURE Evaluation |
2018 |
French |
Global |
OVC, Alternative Care, HIV/AIDS |
Le renforcement des systèmes est reconnu à l'échelle mondiale comme une étape logique et efficace dans l'amélioration de la performance, de la qualité et de la pérennité de la prestation de services. L'initiative MEASURE Evaluation financée par l'USAID et le PEPFAR a développé un cadre de planification, de suivi et d'évaluation pour, en partie, combler les lacunes existantes dès lors qu'il s'agit de démontrer l'impact que le renforcement des systèmes peut avoir sur la santé infantile, en fournissant des indicateurs et des conseils pour mesurer la performance des systèmes. Ces indicateurs mesurent les résultats des interventions axées sur le renforcement des systèmes dans cinq domaines clés étant définis par le PEPFAR comme étant des composantes du renforcement du système des services sociaux : (1) structures en matière de leadership et de gouvernance ; (2) effectifs des services sociaux ; (3) financement ; (4) systèmes de gestion de l'information et redevabilité ; et (5) mécanismes de coordination et réseaux. MEASURE Evaluation a publié un document de référence complet définissant ces indicateurs et offrant des conseils quant à leur application dans un pays ou dans le cadre d'un programme.
Il s'agit d'un outil Excel appuyant la gestion, l'analyse et l'utilisation des données lors de la mise en œuvre des indicateurs. Cet outil doit être utilisé pour recueillir et stocker des informations ayant trait à l'ensemble des indicateurs. Il doit également être utilisé pour faciliter l'interprétation et l'application des résultats permettant de renforcer le système.
Version anglaise: National Social Service Systems for Orphans and Vulnerable Children: Tool for Data Management, Analysis, and Use
Système national des services sociaux pour les orphelins et les enfants vulnérables: Cadre de planification et de suivi et évaluation |
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Système national des services sociaux pour les orphelins et les enfants vulnérables: Cadre de planification et de suivi et évaluation
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MEASURE Evaluation |
2018 |
French |
CAMEROON |
Alternative Care, Orphans and Vulnerable Children, HIV/AIDS |
Depuis 2003, le Plan d'urgence du Président Américain pour la Lutte contre le SIDA (PEPFAR) a dépensé plus de deux milliards de dollars dans le cadre d'initiatives visant à réduire l'impact du VIH et du SIDA parmi les orphelins et les enfants vulnérables (OEV). Au cours des dernières années, pour veiller à la pérennité et à l'appropriation de ces initiatives, le PEPFAR a accru son financement en faveur d'initiatives ayant pour but de renforcer le système des services sociaux dans les pays affectés par le VIH pour améliorer la protection et les soins dont bénéficient les enfants. Plutôt que de se focaliser uniquement sur des initiatives remédiant à des préoccupations spécifiques à la protection de l'enfance de manière isolée (telles que le VIH/SIDA, le travail des enfants, la création de revenus à l'échelle des ménages ou l'éducation), les initiatives de renforcement du système doivent générer un système capable de remédier à un grand nombre de vulnérabilités interconnectées. Bien que les programmes du PEPFAR venant en aide aux OEV soient amenés à s'intéresser principalement au bien-être et à la protection des enfants affectés par le VIH, les investissements du PEPFAR en faveur des systèmes nationaux des services sociaux amélioreront durablement leur capacité à rendre service aux enfants et aux ménages confrontés à diverses formes de vulnérabilités, notamment le VIH, ainsi qu'à certaines circonstances dont il a été prouvé qu'elles augmentaient le risque d'acquisition du VIH, comme le manque d'éducation, la maltraitance des enfants et la pauvreté.
À l'échelle mondiale, il est reconnu que le renforcement des systèmes constitue une étape logique et efficace vers l'amélioration de l'efficacité, de la qualité et de la pérennité de la prestation de services. Dans le cadre du PEPFAR, les investissements réalisés dans le renforcement des systèmes garantissent l'efficacité et la pérennité des efforts déployés par ce plan d'urgence pour prévenir le VIH et mettre les enfants séropositifs et leurs parents/tuteurs en relation avec des structures de dépistage, de soins et de traitement. En tant que telle, l'initiative MEASURE Evaluation financée par l'USAID et le PEPFAR a développé le cadre d'action présenté ici pour combler une partie des lacunes existantes dès lors qu'il s'agit de démontrer l'impact que peut avoir le renforcement des systèmes sur le bien-être et la santé des enfants, en fournissant des indicateurs et en formulant des conseils pour mesurer la performance des systèmes. Ce cadre d'action a pour but de soutenir les gouvernements et les partenaires de mise en œuvre du PEPFAR dans le suivi et l'évaluation des efforts de renforcement des systèmes. Ces indicateurs mesurent les résultats des interventions liées au renforcement des systèmes dans cinq domaines clés étant définis par le PEPFAR comme les composantes du renforcement des systèmes des services sociaux : (1) structures de leadership et de gouvernance ; (2) effectifs des services sociaux ; (3) financement ; (4) systèmes de gestion de l'information et de redevabilité ; et (5) mécanismes de coordination et réseautage. Ce document définit ces indicateurs et propose des conseils pour les appliquer à l'échelle d'un pays ou d'un programme.
Version anglaise: National Social Service Systems for Orphans and Vulnerable Children – Framework for Planning and Monitoring and Evaluation
Système national des services sociaux pour les orphelins et les enfants vulnérables: Outil pour la gestion, l'analyse et l'utilisation des données |
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MEASURE Evaluation’s Health Information System Learning Agenda
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MEASURE Evaluation |
2018 |
English |
|
HIS, Health Information Systems, Learning agenda, HIS strengthening |
MEASURE Evaluation works with more than 20 countries to improve HIS management, governance, and performance. In July 2014, the United States Agency for International Development asked MEASURE Evaluation to build an evidence base for which investments in HIS are effective and useful. The result has been MEASURE Evaluation’s HIS Learning Agenda, a collaborative and adaptive approach to documenting and applying results for HIS strengthening. The Learning Agenda frames its work by seeking to answer three questions:
What are the factors and conditions of HIS performance progress?
What are the stages of HIS progression to a strong HIS and how are they measured?
What are the characteristics of a strong HIS?
This brief reviews each question and provides information on the Learning Agenda and related resource center. |
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Rapport de l’analyse des données de routine de la cohorte des femmes enceintes séropositives vues en consultation prénatale jusqu’à l’accouchement
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Edwige Abitche-Bosso, Serge Evrard Bogui, Arnaud Kouadio Bah, Franck Olivier Ba Gomis, Léontine Gnassou, Alimou Barry, Jeanne Chauffour |
2018 |
French |
COTE D'IVOIRE |
Maternal health, AIDS, Routine data, HIV, PMTCT, Data use, HIV/AIDS, Sexual Behavior, Contraceptive Use, and Reproductive Health, Antenatal care |
Depuis la dernière enquête de sérosurveillance sentinelle du VIH chez la femme enceinte qui a eu lieu en 2008, la Côte d’Ivoire utilise, pour ses estimations dans l’outil SPECTRUM, des données de littérature pour le taux d’abandon du traitement VIH chez la femme enceinte séropositive (VIH+). Ces données d’estimation sont ensuite utilisées par le pays pour la planification stratégique en matière de lutte contre le VIH/SIDA. Dans le souci d’améliorer ces estimations cette année, le MSHP a souhaité utiliser les données de routine de la PTME. C’est dans ce cadre que le projet MEASURE Evaluation a apporté une assistance technique au MSHP pour conduite cette étude.
L’objectif de cette étude est d’améliorer l'utilisation des informations relatives au VIH/SIDA pour la prise de décision basée sur l’évidence.
Méthodologie de l’étude : 134 structures de santé réparties dans 62 districts de 19 régions sanitaires ont été sélectionnées sur une base d’échantillonnage raisonné selon un critère. Les données sur une cohorte des femmes enceintes VIH+ sous traitement du dernier trimestre 2016 jusqu’à leur accouchement dans les registres PTME de suivi mère-enfant des sites sélectionnés ont été collectées du 23 avril au 15 mai 2018, puis analysées.
Résultats : Sur un total de 2654 femmes enceintes VIH+ notifiées dans le rapport VIH obtenu à l’issue de la validation des données du dernier trimestre 2016 :
68% des dossiers de femmes enceintes VIH+ ont été retrouvés
96% des femmes enceintes VIH+ ont été mises sous traitement ARV au cours de cette grossesse
94% des femmes enceintes VIH+ sous ARV ont suivi régulièrement le traitement ARV
6% des femmes enceintes VIH+ sous ARV ont pris de façon irrégulière leurs ARV
0.2% des femmes enceintes VIH+ sous ARV ont abandonné le traitement
Des informations sur l’accouchement sont disponibles pour 75% des 1799 femmes enceintes VIH+
81,8% des examens par PCR ont été réalisés dans les 6 premières semaines suivant les naissances
4,2% de ces examens par PCR réalisés chez ces enfants exposés étaient positifs.
Utilisation des données : Ces données ont été utilisées dans SPECTRUM et ont permis la validation des estimations 2018 par le Pays et l’ONUSIDA à Genève, les estimations décentralisées par région et par district pour le VIH. |
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Alternative Care for Children Newsletter (November 2018)
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MEASURE Evaluation |
2018 |
English |
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Care for children, Uganda, Alternative Care, Service delivery, Moldova, Child health, Ghana, Children, Armenia |
The alternative care for children newsletter provides updates following assessment workshops on care reform that were conducted in Armenia, Ghana, Moldova, and Uganda. The newsletter is meant to be a useful tool to foster communication and knowledge sharing across countries. A web page related to this work and features country pages is located at www.measureevaluation.org/our-work/youth-and-adolescents/alternative-care. |
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Pilot Testing a Gender-Integrated Routine Data Quality Assessment Tool in Kenya
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MEASURE Evaluation |
2018 |
English |
KENYA, Global |
Routine data, Routine Health Information Systems, Gender, Data Quality, Data quality assessment |
Reducing the incidence and impact of HIV in Kenya is a significant priority for the Kenyan government. In addition to increasing access to HIV testing and treatment, addressing the needs of orphans and vulnerable children and reducing the burden of gender-based violence are critical pathways in HIV-prevention efforts. Collecting age- and sex-disaggregated data and gender-sensitive indicators provides fundamental knowledge to assess the needs of diverse populations, their access to services, and the country’s progress toward controlling the HIV epidemic.
MEASURE Evaluation, in collaboration with the United States Agency for International Development and implementing partners, pilot-tested a new tool to collect and analyze information from a gender perspective: Routine Data Quality Assessment, Plus Gender (RDQA+G). This brief summarizes the results of the RDQA+G pilot test, conducted as part of a larger initiative to assess gender and HIV data quality, build capacity, and identify best practices for improving data quality in Kenya. Gender-specific results are emphasized here to illustrate the capacity and utility of the modified assessment tool. |
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Comparative Analysis of Data Quality Assessment Tools
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MEASURE Evaluation |
2018 |
English |
|
HIV/AIDS, DQA, Tools, Data Quality, HIV, Data quality assurance, PEPFAR, Data |
The advent of the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) 15 years ago brought significantly increased investments in disease control and prevention in developing countries. As more funds became available, so did the need to show returns on investment in the form of public health gains. Monitoring and evaluation (M&E) of interventions is critical for demonstrating the effectiveness of health programs but is dependent on data reported from health facilities that are often of poor quality. Resources have been devoted to improve data quality in health and disease programs, but problems persist as countries struggle to maintain capacity for data management, analysis, and use.
The number of patients on treatment is a very high-profile and useful indicator for monitoring the effectiveness of HIV programs. Treating patients over their lifetime and accurately recording these results is a challenge, however. Longitudinal treatment records (registers) for patients who return repeatedly for treatment and evaluation need to be summarized periodically in static reports. Counting accurately becomes more challenging as patients come and go from active treatment cohorts, move from one site to another, stop treatment as a result of side effects, or become lost to follow-up.
With the advent of “test and start”—an effort to expand the rolls of those on treatment and reduce the “waiting list” (those enrolled in care but not yet on treatment)—more scrutiny has been applied to treatment results, and the findings have not always been up to standard.
Several new tools have been developed to try to meet the need for data quality assurance, particularly for HIV and AIDS. The tools all use similar methods for gauging the accuracy of reporting, though many differences exist between them regarding the objectives and scope of their methodologies. This comparative analysis of data quality tools seeks to aid in the understanding of their similarities and differences as well as the selection of the appropriate tools and methods for assessing and improving data quality within a particular context. |
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Outil d'évaluation rapide du système d’information sanitaire de routine: Module saisie de données
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MEASURE Evaluation |
2018 |
French |
|
Health Information Systems, Routine Health Information Systems, Rapid Assessment, RHIS, Tools |
L'outil d'évaluation rapide du SISR est conçu pour identifier les lacunes dans les systèmes d'information de santé de routine pendant le processus de planification du secteur de la santé afin que les insuffisances puissent être traitées dans la planification stratégique. L'outil d'évaluation rapide du SISR est allié à l'outil d'évaluation et de planification du S&E de l'OMS; Alors que l'outil d'évaluation et de planification du S&E cherche à évaluer l'adéquation du système d'information sanitaire global (SIS), l'outil d'évaluation rapide du SISR se concentre sur les systèmes de données de routine. Les outils s'appuient sur la méthodologie de renforcement de la plateforme de suivi et d'évaluation décrite dans le document «Suivi, évaluation et révision des stratégies nationales de santé: une plate-forme d'information et de responsabilisation menée par les pays». L'outil d'évaluation rapide du SISR a été élaboré par le projet MEASURE Evaluation de l'USAID en collaboration avec le Département de l'information, des preuves et de la recherche de l'OMS. Des contributions substantielles ont également été apportées par d'autres départements et programmes de l'OMS, des ministères de la santé, des experts régionaux et des partenaires mondiaux et nationaux.
L’outil d’évaluation rapide du système d’information sanitaire de routine: Guide d'implémentation
Outil d'évaluation rapide du système d’information sanitaire de routine: Module analyse et tableaux de bord |
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Outil d'évaluation rapide du système d’information sanitaire de routine: Module analyse et tableaux de bord
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MEASURE Evaluation |
2018 |
French |
|
Health Information Systems, Routine Health Information Systems, Rapid Assessment, RHIS, Tools |
L'outil d'évaluation rapide du SISR est conçu pour identifier les lacunes dans les systèmes d'information de santé de routine pendant le processus de planification du secteur de la santé afin que les insuffisances puissent être traitées dans la planification stratégique. L'outil d'évaluation rapide du SISR est allié à l'outil d'évaluation et de planification du S&E de l'OMS; Alors que l'outil d'évaluation et de planification du S&E cherche à évaluer l'adéquation du système d'information sanitaire global (SIS), l'outil d'évaluation rapide du SISR se concentre sur les systèmes de données de routine. Les outils s'appuient sur la méthodologie de renforcement de la plateforme de suivi et d'évaluation décrite dans le document «Suivi, évaluation et révision des stratégies nationales de santé: une plate-forme d'information et de responsabilisation menée par les pays». L'outil d'évaluation rapide du SISR a été élaboré par le projet MEASURE Evaluation de l'USAID en collaboration avec le Département de l'information, des preuves et de la recherche de l'OMS. Des contributions substantielles ont également été apportées par d'autres départements et programmes de l'OMS, des ministères de la santé, des experts régionaux et des partenaires mondiaux et nationaux.
L’outil d’évaluation rapide du système d’information sanitaire de routine: Guide d'implémentation
Outil d'évaluation rapide du système d’information sanitaire de routine: Module saisie de données |
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Country-Led, Holistic Data Quality Assurance: Institutionalizing Data Quality through a National Technical Working Group and the Data Quality Review
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MEASURE Evaluation |
2018 |
English |
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Data, Health data, Tools, Routine data, Data Quality Review, Data Quality |
Data quality review (DQR) is a method to rapidly evaluate the quality and adequacy of health data used for planning. The DQR aims to institutionalize data quality assessment as a systematic and routine aspect of health sector and program planning and provide a minimum standard of quality for health data. It is intended to be applied across program areas to provide a holistic picture of a country’s data quality from health facility-based information systems and identify areas in need of strengthening. The method and indicators for the DQR have been developed in consultation with international health program experts from leading donor and technical assistance agencies, such as the World Health Organization (WHO), the United States Agency for International Development (USAID), Gavi Vaccine Alliance, and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), with consensus on a minimum standard for data quality.
The DQR is a suite of tools and guidelines. The DQR electronic tools facilitate data collection and analysis. The guidelines provide instructions for collecting the data, preparing the data for analysis, conducting the data verifications, analyzing and interpreting results, and indicating how and when to apply the methods. The electronic analysis tools facilitate data analysis and presentation, as well as the identification of problematic data points and subnational reporting units.
The DQR contributes to the vision of the United States Agency for International Development (USAID) of improving the evidence base for public health monitoring, evaluation, and planning, by improving the quality of routine health data. The USAID- and PEPFAR-funded MEASURE Evaluation assisted in the development of the DQR and tested approaches to improve country ownership and leadership of data quality assurance. A routine, holistic, and country-led system of data quality assurance can help institutionalize data quality in countries. This document provides guidance for establishing a technical working group (TWG) for holistic data quality centered around the DQR. It includes best practices for the TWG as well as implementation steps for the DQR. The TWG is modeled after the successful example of the interagency coordinating committees (ICCs) established for immunization in many countries. |
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L’outil d’évaluation rapide du système d’information sanitaire de routine: Guide d'implémentation
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MEASURE Evaluation |
2018 |
French |
|
RHIS, Routine Health Information Systems, Health Information Systems |
L'Organisation mondiale de la Santé (OMS) et MEASURE Evaluation – financé par l’Agence des Etats-Unis pour le développement international (USAID) – ont identifié et harmonisé des normes pour la gestion des données des systèmes d'information de santé de routine (SISR). Les normes, c'est-à-dire les meilleures pratiques, favorisent la production de données précises et opportunes pour la planification, le suivi et l'évaluation (S&E) des programmes. L'outil d'évaluation rapide du SISR a été élaboré pour aider les gestionnaires et évaluateurs du système d’information sanitaire (SIS) à identifier ses lacunes et faiblesses (aspects des systèmes d'information des établissements sanitaires et des communautés qui n'atteignent pas la norme identifiée) en vue de renforcer le SISR et d'améliorer les données. L'outil d'évaluation rapide du SISR compare le SISR d'un pays aux normes mondiales et indique où les ressources doivent être investies afin d’améliorer le système.
Outil d'évaluation rapide du système d’information sanitaire de routine: Module analyse et tableaux de bord
Outil d'évaluation rapide du système d’information sanitaire de routine: Module saisie de données |
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Real-time Epidemiological Surveillance in Mali: Data Quality for Good Decision Making to Prevent and Respond to Epidemics
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MEASURE Evaluation |
2018 |
English |
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Health data, Data Quality, Health Information Systems, Data, HIS, Mali |
From the beginning of the response to the Ebola epidemic in Mali in 2014, the country’s Ministry of Public Health and Hygiene has prioritized strengthening the reporting system of key diseases that have the potential to become epidemics.
In 2016, MEASURE Evaluation, funded by the United States Agency for International Development (USAID), in collaboration with the National Directorate of Health (DNS) and the Division of Disease Prevention and Control in the Ministry of Health, set up real-time epidemiological surveillance and reporting in DHIS 2 for better evidence-informed decision making.
MEASURE Evaluation assisted to adapt DHIS 2 to cover the chief diseases, conditions, and priority events the country selected: hemorrhagic fever, measles, meningitis, yellow fever, cholera, and anthrax, among others.
Mali uses DHIS 2 at all levels of the health system (central, intermediate, and operational), except for health facilities located in conflict zones (about four percent of all health facilities). DHIS 2-based epidemiological surveillance data is now available to all users regardless of their decision-making level (community, district, regional, and central). MEASURE Evaluation and the DNS developed a user monitoring plan, implemented one year after DHIS 2 deployment, that features post-training follow-up visits and supervision.
Two years after the implementation of DHIS 2, however, data quality issues became a major challenge for the DNS. Poor data quality limited Mali’s ability to use data for decision making because the data did not meet quality standards—such as completeness, timeliness, accuracy, and reliability. This brief discusses efforts to improve data quality. |
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Promoting Good Data Through a Data Competition in Mali
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MEASURE Evaluation |
2018 |
English |
|
HIS, Health Information Systems, Health data, Mali |
The quality of health data is fundamental to a health information system (HIS). In 2013, the HIS in Mali was assessed using the Performance of Routine Information System Management (PRISM) tool and it was determined that Mali should deploy an integrated platform to improve the HIS. A plan to strengthen the HIS then became part of the country’s Ten-Year Health and Social Development Program (PRODESS II).
Soon after, in August 2015, the country chose the DHIS 2 platform to house its health data—a big step forward toward a stronger HIS. The platform first was deployed nationwide at the district, regional, and national levels and in the health facility level in 2016. The implementation of DHIS 2 has resulted in improvements in data collection, data transmission, processing, analysis, security, availability, and data quality.
To take advantage of the enthusiasm among decision makers and others in the health sector, and to reinforce the value of good-quality data, Mali initiated a competition in December 2017 among all data producing units at all levels of the health system. The goal was to foster the production of high-quality data, promote excellence in skills, foster a culture of data use, and provide consistency in data management. Other goals were to create friendly competition among health units and to motivate health units to be timely in reporting data.
MEASURE Evaluation, funded by the United States Agency for International Development (USAID), had assisted with the deployment of DHIS 2 and helped plan the competition, assisting representatives from the central level of the health system to establish rules for the competition, judging, and awarding of prizes to the winners. This brief shares more details. |
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What are the stages of progression to a strong HIS and how are they measured?
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MEASURE Evaluation |
2018 |
English |
|
Health Information Systems, Data Quality, HIS, Learning Agenda, Data use |
Strong health information systems (HIS) are essential for a country to meet its health goals. Health information is critical for monitoring, tracking, and solving some of the world’s most important health threats. We need to know if we are making progress in eradicating and preventing disease, to plan for and allocate needed resources, and to evaluate the effectiveness of health interventions. A national HIS encompasses all sources of health data to answer these questions and to help a country plan and implement its national health strategy.
Examples of HIS data sources are records on patient care, health facility data, surveillance data, census data, population surveys, vital event records, human resource records, financial data, infrastructure data, and logistics and supply data (MEASURE Evaluation, 2017a). A strong HIS should be well-defined, comprehensive, functional, adaptable and scalable, and resilient. The system should be able to collect, manage, analyze, and disseminate health data in a timely manner so that managers can make decisions, track progress, and provide feedback on HIS performance to improve data quality and use.
To accomplish these tasks, it is essential for HIS stakeholders to know the state of their system on the continuum to a strong HIS and to understand what is needed to achieve an optimized HIS. This document defines five stages of progression to a strong HIS, as described in our HIS Stages of Continuous Improvement (SOCI) tool kit. The five stages are: (1) emerging/ad hoc, (2) repeatable, (3) defined, (4) managed, and (5) optimized.
What are the characteristics of a strong health information system?
What are the factors and conditions of HIS performance progress? |
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Validating the Effectiveness of a Rapid Assessment Tool for Routine Health Information Systems
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MEASURE Evaluation |
2018 |
English |
|
Routine Health Information Systems, RHIS, Health Information Systems |
The World Health Organization (WHO), with the United States Agency for International Development (USAID)-funded MEASURE Evaluation, has identified and harmonized standards for data management of Routine Health Information Systems (RHIS). Standards, or best practices, promote the production of timely, accurate data for use in program planning, monitoring, and evaluation. An assessment tool, the RHIS Rapid Assessment Tool, has been developed to help identify gaps and weaknesses (aspects of health facility and community information systems that do not reach the identified standard) and, thus, to strengthen RHIS and improve the data. The tool compares a country RHIS to the global standards, and indicates where resources should be invested to improve the system.
The standards in the RHIS Rapid Assessment Tool were identified largely from expert meetings convened by MEASURE Evaluation and WHO in 2012–2014. In May 2012, MEASURE Evaluation hosted the International Workshop on Guidelines for Data Management Standards in Routine Health Information Systems, in Johannesburg, South Africa. RHIS experts gathered from around world to identify standards and best practices for RHIS, particularly for data management—the element of RHIS that had been identified as the most problematic globally following implementation of the Health Metrics Network (HMN) Country Assessment Tool in more than 85 countries (2008). The discussions were organized around four thematic areas: (1) user’s data and decision support needs; (2) data collection, processing, analysis, and dissemination of Information; (3) data integration and interoperability; and (4) governance of RHIS data management. The standards were field-tested in Nigeria and Bangladesh by MEASURE Evaluation in 2013–2014.
In June 2014, WHO hosted the Technical Consultation on Monitoring Results with Health Facility Information Systems, which took place in Glion-sur-Montreux, Switzerland. The workshop output was developed into a toolkit according to an organizing framework for the key components of a country health facility information system. Those components were (1) governance, an overarching component; (2) data collection and management; (3) data quality and analysis; and (4) data dissemination and use. Within each section, key action steps are identified for countries and provided with examples of available tools and resources to support country action. A checklist of key items and attributes is provided to facilitate monitoring of progress toward defined standards. The checklist is also available as a separate spreadsheet. WHO and MEASURE Evaluation decided to harmonize the two resulting lists of standards, which then became the RHIS Rapid Assessment Tool. The two source documents are available at the following links:
WHO Health Facility and Community Information System Toolkit
MEASURE Evaluation Guidelines on Data Management Standards
The RHIS Rapid Assessment Tool facilitates comparison of country RHIS with global standards, to identify gaps and weaknesses in the system as part of strategic planning for RHIS. The tool was tested in four country workshops (Madagascar, Malawi, Myanmar, and northern Syria) to validate its effectiveness. Workshop organizers then provided feedback and recommendations to help modify the tool to better meet the needs of users. The Republic of the Gambia provided feedback without testing the tool in a workshop setting.
This document describes the validation process and its results. |
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Performance of Routine Information System Management (PRISM) User's Kit: Preparing and Conducting a PRISM Assessment
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MEASURE Evaluation |
2018 |
English |
Global |
Information System, PRISM, Health Information Systems, Routine Health Information Systems, HISS, Performance of Routine Information System Management, RHIS |
One of the mandates of the United States Agency for International Development (USAID)-supported MEASURE Evaluation is to strengthen the collection, analysis, and use of routine health information system (RHIS) data for the delivery of high-quality health services. We developed the Performance of Routine Information System Management (PRISM) Framework and suite of tools in 2011 for global use in assessing the reliability and timeliness of an RHIS, in making evidence-based decisions, and in identifying gaps in an RHIS so they can be addressed and the system can be improved.
With USAID’s support, we have revised the PRISM Tools and developed other elements, based on the PRISM Framework, to create a broad array of materials: the “PRISM Series,” available here: https://www.measureevaluation.org/prism. This new, more comprehensive PRISM Series is useful for designing, strengthening, and evaluating RHIS performance and developing a plan to put the results of a PRISM assessment into action.
To support the use of the PRISM Tools, we have developed a User’s Kit, which consists of three manuals in addition to this one:
Using SurveyCTO to Collect and Enter PRISM Assessment Data, available here: https://www.measureevaluation.org/resources/publications/ms-18-143/
Analyzing Data from a PRISM Assessment, available here: https://www.measureevaluation.org/resources/publications/ms-18-141/
Moving from Assessment to Action, available here: https://www.measureevaluation.org/resources/publications/ms-18-142/
The User’s Kit guides all aspects of a PRISM assessment.
This manual—the first in the series—provides details on designing, preparing, and conducting an assessment. The process has three phases: (1) designing a PRISM assessment, (2) preparing a PRISM assessment, and (3) collecting PRISM data. |
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Performance of Routine Information System Management (PRISM) User's Kit: Moving from Assessment to Action
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MEASURE Evaluation |
2018 |
English |
Global |
Information system, RHIS, PRISM, Performance of Routine Information System Management, Routine Health Information Systems, HISS, Health information systems |
One of the mandates of the United States Agency for International Development (USAID)-supported MEASURE Evaluation is to strengthen the collection, analysis, and use of routine health information system (RHIS) data for the delivery of high-quality health services. We developed the Performance of Routine Information System Management (PRISM) Framework and suite of tools in 2011 for global use in assessing the reliability and timeliness of an RHIS, in making evidence-based decisions, and in identifying gaps in an RHIS so they can be addressed and the system can be improved.
With USAID’s support, we have revised the PRISM Tools and developed other elements, based on the PRISM Framework, to create a broad array of materials: the “PRISM Series,” available here: https://www.measureevaluation.org/prism. This new, more comprehensive PRISM Series is useful for designing, strengthening, and evaluating RHIS performance and developing a plan to put the results of a PRISM assessment into action.
To support the use of the PRISM Tools, we have developed a User’s Kit, which consists of three manuals in addition to this one:
Preparing and Conducting a PRISM Assessment, available here: https://www.measureevaluation.org/resources/publications/ms-18-140/
Using SurveyCTO to Collect and Enter PRISM Assessment Data, available here: https://www.measureevaluation.org/resources/publications/ms-18-143/
Analyzing Data from a PRISM Assessment, available here: https://www.measureevaluation.org/resources/publications/ms-18-141/
The User’s Kit guides all aspects of a PRISM assessment.
A main strategy for strengthening an RHIS is to develop and reinforce a country’s long-term planning for an integrated health information system, which includes all data sources, health metrics, and tools. This manual—the fourth in the series—supports that effort. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Haiti: Zanmi Lasante/Partners in Health 2018 Survey Findings
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Settergren, S. K., Philippe, R., & St. Louis, J. V. |
2018 |
English |
|
Orphans and Vulnerable Children, Data, AIDS, HIV, OVC, Haiti, HIV/AIDS, PEPFAR |
The AIDS epidemic in Haiti has left many children in the country vulnerable to HIV, often without parents to care for them. Recognizing the enormous need for programs and services for orphans and vulnerable children (OVC), the United States President’s Emergency Plan for AIDS Relief (PEPFAR) has partnered with the government of Haiti to strengthen services for OVC and their households. Since 2010, PEPFAR OVC support has included services such as HIV testing and linkages to care and treatment, potable water, immunizations, access to healthcare and psychosocial support, provision of school fees and supplies, dietary assessment and nutritional support, HIV prevention and life skills programs, and assistance with income generating activities for foster families and caregivers.
To better understand the effects of its programs on the well-being of OVC, PEPFAR launched a global reporting requirement in 2014 to monitor the outcomes of selected projects in Haiti and other countries where it provides support for OVC. The requirement involves the collection of data for nine outcome indicators, referred to as the PEPFAR monitoring, evaluation, and reporting (MER) OVC essential survey indicators (ESIs). In 2016, the United States Agency for International Development (USAID)/Haiti requested assistance from the USAID- and PEPFAR-funded MEASURE Evaluation project to conduct surveys to collect the required data for two of its ongoing OVC programs: the Zanmi Lasante/Partners in Health (PIH) project, funded through the United States Centers for Disease Control and Prevention, and the USAID Bien Et ak Sante Timoun (BEST) project. This report presents the findings from the survey that MEASURE Evaluation with its local research partner, Société d'Etudes et de Formation en Information Stratégique (SEFIS), conducted for the PIH project in 2018. Survey results for the BEST project are reported here. |
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Who are the male partners of adolescent girls and young women in Swaziland? Analysis of survey data from community venues across 19 DREAMS districts
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Zahra Reynolds, Ann Gottert, Erin Luben, Bheki Mamba, Patrick Shabangu, Nsindiso Dlamini, Muhle Dlamini, Sanyukta Mathur, Julie Pulerwitz |
2018 |
English |
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DREAMS, Adolescent Girls, HIV, AGYW, Young Women, Swaziland |
BackgroundAdolescent girls and young women (AGYW, ages 15–24) are at high risk of HIV in Swaziland. Understanding more about their male sexual partners can inform HIV prevention efforts for both.
MethodsUsing the PLACE methodology across all 19 DREAMS implementation districts, 843 men ages 20–34 were surveyed between December 2016-February 2017. Surveys were conducted at 182 venues identified by community informants as places where AGYW and men meet/socialize. Descriptive and multivariate analyses examined characteristics and risk behaviors of male partners of AGYW.
ResultsMen’s average age was 25.7. Sixty-three percent reported female partners ages 15–19, and 70% reported partners ages 20–24 in the last year; of those, 12% and 11% respectively had five or more such partners. Among the 568 male partners of AGYW, 36% reported consistent condom use with their current/last partner. Forty-two percent reported testing for HIV in the last year; 6% were HIV-positive, and of those, 97% were currently on treatment. One-third (37%) reported being circumcised; among uncircumcised, 81% were not considering it. In multivariate analyses, men who reported three or more AGYW partners in the last year were more likely to be HIV-positive (aOR 3.2, 95% CI 1.1,8.8). Men were also less likely to disclose their HIV status to adolescent versus older partners (aOR 0.6, 95% CI 0.4,0.9) and partners more than 5 years younger than themselves (aOR 0.6, 95% CI 0.4,0.9). Results also revealed relatively high unemployment and mobility, substantial financial responsibilities, and periodic homelessness.
ConclusionsMost men identified through community venues reported relationships with AGYW, and these relationships demonstrated substantial HIV risk. Challenging life circumstances suggest structural factors may underlie some risk behaviors. Engaging men in HIV prevention and targeted health services is critical, and informant-identified community venues are promising intervention sites to reach high-risk male partners of AGYW.
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Lesotho: ASSIST Project 2017 Survey Findings
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Settergren, S. K., Hoohlo, N., & Rathabaneng-Hoohlo, N. |
2018 |
English |
|
|
The HIV epidemic in Lesotho has left one-third of the children in the country vulnerable to the virus, often without parents to care for them. Recognizing the enormous need for programs and services for orphans and vulnerable children (OVC), the United States President’s Emergency Plan for AIDS Relief (PEPFAR) has partnered with the Government of Lesotho to strengthen services for OVC and their households. PEPFAR support has focused on delivery of a comprehensive set of core interventions that include healthcare and referrals for nutrition; linkages to HIV testing, care, and treatment, including integration of adherence to antiretroviral therapy (ART) in routine household monitoring; promotion of positive parenting; economic strengthening activities for households, such as group savings and loans, cash transfers, and food subsidies; and educational support for children.
Recognizing the need to better understand the effects of its programs on the well-being of OVC, PEPFAR launched a global reporting requirement in 2014 to monitor the outcomes of selected projects in Lesotho and the other countries where it provides support for OVC. The requirement involves the collection of data for nine outcome indicators, referred to as the PEPFAR monitoring, evaluation, and reporting (MER) OVC Essential Survey Indicators (ESIs). In 2016, the United States Agency for International Development (USAID)/Lesotho requested assistance from the USAID- and PEPFAR-funded MEASURE Evaluation project to conduct a survey that would collect the required data for the Applying Science to Strengthen and Improve Systems (ASSIST) Project, its largest OVC project, implemented by University Research Co. LLC in partnership with six local implementing partners. This report presents findings from the survey that MEASURE Evaluation, along with its local research partner, Nonyana Hoohlo and Associates, conducted for the ASSIST Project in September 2017. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Haiti: Bien Et ak Santé Timoun (BEST) 2018 Survey Findings
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Settergren, S. K., Phillipe, R., & St. Louis, J. V. |
2018 |
English |
|
Data, AIDS, HIV/AIDS, OVC, HIV, Haiti, PEPFAR, Orphans and Vulnerable Children |
The AIDS epidemic in Haiti has left many children in the country vulnerable to HIV, often without parents to care for them. Recognizing the enormous need for programs and services for orphans and vulnerable children (OVC), the United States President’s Emergency Plan for AIDS Relief (PEPFAR) has partnered with the government of Haiti to strengthen services for OVC and their households. Since 2010, PEPFAR OVC support has included services such as HIV testing and linkages to care and treatment, potable water, immunizations, access to healthcare and psychosocial support, provision of school fees and supplies, dietary assessment and nutritional support, HIV prevention and life skills programs, and assistance with income generating activities for foster families and caregivers.
To better understand the effects of its programs on the well-being of OVC, PEPFAR launched a global reporting requirement in 2014 to monitor the outcomes of selected projects in Haiti and other countries where it provides support for OVC. The requirement involves the collection of data for nine outcome indicators, referred to as the PEPFAR monitoring, evaluation, and reporting (MER) OVC essential survey indicators (ESIs). In 2016, the United States Agency for International Development (USAID)/Haiti requested assistance from the USAID- and PEPFAR-funded MEASURE Evaluation project to conduct surveys to collect the required data for two of its ongoing OVC programs: the USAID Bien Et ak Santé Timoun (BEST) project and the Partners in Health (PIH) project, funded through the United States Centers for Disease Control and Prevention. This report presents the findings from the survey that MEASURE Evaluation, with its local research partner Société d’Etudes et de Formation en Information Stratégique (SEFIS), conducted for the BEST project in March 2018. Survey results for the PIH project are reported here. |
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Using Social Media Data to Understand Changes in Gender Norms
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Brittany Iskarpatyoti, Heather Biehl, and John Spencer |
2018 |
English |
Global |
Twitter, Social Media, Gender Norms, nonroutine data |
As access to digital devices grows around the globe, social media platforms have emerged as tools to better understand a broad array of health issues. Social media have been harnessed to surveil infectious disease; forecast asthma exacerbations; monitor mental health following traumatic events; and gauge attitudes and beliefs about medical conditions, products, and treatments.
Gender norms—the socialized expectations about women, men, boys, and girls and the power dynamics between them—are a frontier for social media research. Although many national and international programs seek to change harmful gender norms to achieve equities in health, few collect data on social attitudes. Because social media allow people to share details about their lives, these platforms may provide insights into attitudinal and behavioral aspects of gender inequality and capture information that is difficult and costly to obtain through surveys.
We explored the feasibility of using large social media data sets to track changes in attitudes toward and gender norms related to sexual relationships between younger women and older men (“blessers” or “sugar daddies”) and gender-based violence (GBV) against women and girls in 10 sub-Saharan African counties (Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe). This study assessed the challenges and limitations of using social media data to track changes over time in attitudes and gender norms, the type of information that can be gathered from Twitter to track changes in gender norms, and the emerging themes and thematic variations from tweets about age-discordant relationships or GBV.
Find related guidance here: Using Social Media Data to Understand Changes in Gender Norms: Guidance |
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Using Social Media Data to Understand Changes in Gender Norms: Guide
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MEASURE Evaluation |
2018 |
English |
Africa, Global |
Twitter, Gender, Gender Norms, Social Media, Gender-based violence |
As technology becomes increasingly accessible around the globe, social media has emerged as a tool to help researchers and health workers and administrators understand a broad array of health issues. It has been harnessed to surveil infectious disease, forecast asthma exacerbations, monitor mental health following traumatic events, and gauge attitudes and beliefs about medical conditions, products, and treatments. Gender norms—the socialized expectations about women, men, boys, and girls and the power dynamics between them—constitute one frontier for social media research. Although many national and international programs seek to change harmful gender norms to achieve equities in health, few collect data on societal attitudes. Because social media provides people with an opportunity to share aspects of their lives, it may have the potential to provide insights into attitudinal and behavioral aspects of gender inequality and to capture information that is difficult and costly to obtain through regular surveys.
A MEASURE Evaluation study explored the feasibility of using large social media data sets to track changes in attitudes toward, and gender norms regarding, sexual relationships between younger women and older men and gender-based violence against women and girls in sub-Saharan Africa. After reviewing several possible social media platforms, including Facebook, Snapchat, and Instagram, we selected Twitter for its data availability and ease of access. We assessed existing methods for extracting data from Twitter and analyzing metrics to understand the challenges and limitations of using social media data. We also reviewed ethics and data security considerations with each method.
The purpose of this document is to provide guidance on collecting, analyzing, and interpreting Twitter data on gender norms. We will discuss when social media can be useful in monitoring, evaluation, and research; what data are available; and methodological challenges including generalization, biases, protecting individual privacy, and considering ethical implications.
This guidance is written for monitoring and evaluation officers or data users with some background in Microsoft Excel.
Find the related report here: Using Social Media Data to Understand Changes in Gender Norms |
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Caracterizando Parceiros Sexuais Masculinos de Raparigas Adolescentes e Mulheres Jovens em Moçambique
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MEASURE Evaluation |
2018 |
Portuguese |
MOZAMBIQUE |
Sexual Behavior, Adolescent Girls |
Mundialmente, as raparigas adolescentes e mulheres jovens (AMJ), de 15 à 24 anos, são desproporcionalmente afectadas pelo HIV/SIDA (Karim, Baxter, & Birx, 2017; Dellar, Dlamini & Karim, 2015). Em países com epidemias generalizadas do HIV na África Subsaariana, a adolescência marca um aumento na prevalência do HIV e o surgimento, e expansão dramática, das disparidades de género no HIV (Idele, et al., 2014). Estimativas recentes de sete países africanos descobriram que a prevalência do HIV entre mulheres com idades de 15 à 25 é mais do que o dobro de suas contrapartes masculinas (Brown, et al., 2018).
Apesar do mandato epidemiológico urgente e dos direitos humanos para ajudar as AMJ a permanecerem livre do SIDA, a programação nessa área tem tido um sucesso limitado. Menos da metade das AMJ que vivem com o HIV conhecem o seu status do HIV (Brown, et al., 2018), e o aumento da utilização de tratamento e as taxas de supressão viral global entre os adolescentes e os jovens, especialmente entre as mulheres, são extremamente baixas (Lamb, et al., 2014, Auld, et al., 2014, Denison, et al., 2015). Além disto, enquanto outros grupos etários tiveram declínios de mortes relacionadas com o SIDA, os adolescentes pelo contrário, tiveram as mortes relacionadas com a SIDA aumentarem em cerca de 50 por cento, entre 2005 e 2012 (Idele, et al., 2014).
Uma estratégia é prevenir que os parceiros sexuais masculinos das AMJ, que são HIV negativos, adquiram o HIV, e também reduzir a infecciosidade dos parceiros masculinos que são seropositivos. Esta estratégia requer informações sobre as características dos parceiros sexuais masculinos das AMJ, de modo que o Plano de Emergência do Presidente dos Estados Unidos para o Alívio do SIDA (PEPFAR), através da Iniciativa Determinada, Resiliente, Capacitada, Livre de SIDA, Aconselhada e Segura (DREAMS) —http: // www. dreamspartnership.org— convocou missões da Agência dos Estados Unidos para o Desenvolvimento
Internacional (USAID) no exterior para resolver esta lacuna de conhecimento através de estudos sobre as características dos parceiros sexuais masculinos das AMJ. A USAID/Moçambique solicitou a MEASURE Evaluation (Avaliação MEASURE), financiada pela USAID e pelo PEPFAR, para estudar as características de homens que se envolveram recentemente em relações sexuais com as AMJ. Este trabalho segue as linha dos esforços da MEASURE Evaluation para controlar a epidemia do HIV. O estudo resultante buscou respostas para as seguintes questões de pesquisa:
1. Quem são os parceiros sexuais das AMJ?
2. Se os comportamentos sexuais de risco entre as AMJ e os seus parceiros masculinos estão associados à certas características do parceiro sexual?
3. Em que medida os parceiros sexuais masculinos das AMJ estão usando, ou estão dispostos a usar, os serviços de HIV/AIDS?
Find the English language version of this brief here: https://www.measureevaluation.org/resources/publications/fs-18-286 |
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Caracterização dos Parceiros Sexuais Masculinos das AMJ em Moçambique: Descobertas Principais
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Jenifer Chapman, Nena do Nascimento, Mahua Mandal, Sarah Treves-Kagan, Ariane Dinis, Ana Costa |
2018 |
Portuguese |
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As raparigas adolescentes e mulheres jovens (AMJ) com idades de 15 à 24 anos foram identificadas como uma população extremamente vulnerável ao HIV. Menos da metade das AMJ que vivem com HIV sabem seu status de HIV, e as taxas de aumento na utilização de tratamento e a supressão viral entre adolescentes e jovens, especialmente mulheres, são extremamente baixas no mundo. As AMJ correm o risco de adquirir o HIV predominantemente através da transmissão sexual de parceiros masculinos HIV-positivos. Para impedir que as AMJ adquiram o HIV, uma estratégia é prevenir o HIV entre os parceiros sexuais masculinos e reduzir a infecciosidade dos parceiros HIV positivos. No entanto, pouco se sabe globalmente sobre as características dos parceiros sexuais das AMJ, o que limita os esforços para alcançá-los com serviços de HIV e, portanto, limita os esforços para reduzir o HIV entre os mesmos. O Fundo de Emergência do Presidente dos Estados Unidos para o Alívio da SIDA (The United States President’s Emergency Fund for AIDS Relief, PEPFAR), através da Iniciativa Determinada, Resiliente, Capacitada, Livre da SIDA, Aconselhada e Segura (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe, DREAMS), apelou às missões do Governo dos EUA no estrangeiro para colmatar esta lacuna de conhecimento, por meio de estudos a fim de caracterizar os parceiros sexuais masculinos.
USAID/Moçambique solicitou à MEASURE Evaluation (Avaliação MEASURE) que realizasse um estudo fornecendo conhecimentos sobre as características dos homens que se envolveram recentemente em actividades sexuais com as AMJ, a dinâmica dos relacionamentos e os factores que influenciam o envolvimento dos homens nos serviços de prevenção e tratamento de HIV/SIDA.
Find the English language version of this publication here: https://www.measureevaluation.org/resources/publications/tr-18-259 |
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Performance of Routine Information System Management (PRISM) Training Kit: Facilitator's Manual
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MEASURE Evaluation |
2018 |
English |
Global |
Information System, PRISM, Performance of Routine Information System Management, RHIS, Health Information Systems, Routine Health Information Systems |
One of the mandates of the United States Agency for International Development (USAID)-supported MEASURE Evaluation is to strengthen the collection, analysis, and use of routine health information system (RHIS) data for the delivery of high-quality health services. We developed the Performance of Routine Information System Management (PRISM) Framework and suite of tools in 2011 for global use in assessing the reliability and timeliness of an RHIS, in making evidence-based decisions, and in identifying gaps in an RHIS so they can be addressed and the system can be improved.
To support the use of the PRISM Tools, we have developed a curriculum of nine training sessions, which are outlined in this manual for training facilitators and supported by nine PowerPoint slide decks available here: https://www.measureevaluation.org/prism. The Facilitator’s Manual presents the learning objectives for each session, as well as the topics covered; a session plan (including session duration); the teaching method to use; materials needed for the session; and activities, such as group work.
A companion Participant’s Manual is available here: https://www.measureevaluation.org/resources/publications/ms-18-139/ |
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Performance of Routine Information System Management (PRISM) Training Kit: Participant's Manual
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MEASURE Evaluation |
2018 |
English |
Global |
Performance of Routine Information System Management, PRISM, Health Information Systems, Information System, RHIS, Routine Health Information Systems |
One of the mandates of the United States Agency for International Development (USAID)-supported MEASURE Evaluation is to strengthen the collection, analysis, and use of routine health information system (RHIS) data for the delivery of high-quality health services. We developed the Performance of Routine Information System Management (PRISM) Framework and suite of tools in 2011 for global use in assessing the reliability and timeliness of an RHIS, in making evidence-based decisions, and in identifying gaps in an RHIS so they can be addressed and the system can be improved.
To support the use of the PRISM Tools, we have developed a curriculum of nine training sessions, which are outlined in this manual for training facilitators and supported by nine PowerPoint slide decks available here: https://www.measureevaluation.org/prism. The Participant’s Manual contains the following materials: a glossary, the training schedule, a brief overview of each training session and its key slides and graphics, group exercises, and a training evaluation form. Participants are encouraged to keep this manual as one of the main references for the PRISM assessment training.
A companion Facilitator’s Manual is available here: https://www.measureevaluation.org/resources/publications/ms-18-138/ |
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Using the Spatial Quality and Anomalies Diagnosis (SQUAD) Tool to Identify and Correct Data Anomalies in Master Facility Lists: Global Operational Guide
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John Spencer and Becky Wilkes |
2018 |
English |
Global |
global positioning system, Spatial Quality and Anomalies Diagnosis, MFL, Master facility list, GPS, GIS, SQUAD, Spatial data, Geographic Information Systems |
A master facility list (MFL) is a catalog of health facilities that helps Ministry of Health officials know the name of each facility, where each one is located, and other important information. The MFL facilitates service delivery planning and helps locate health facilities near the populations who need them. Ensuring that the data in the MFL are correct—and identifying and troubleshooting errors—are critical but problematic, because the database has thousands of records and the use of a geographic information system (GIS) is required to check the location of each facility.
MEASURE Evaluation, funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR), created the Spatial Quality and Anomalies Diagnosis (SQUAD) Tool to assess data quality issues in these large data sets. The tool performs a data quality check on the data set, rapidly and automatically looking for anomalies in the data that need to be investigated.
This document is a resource for developing an action plan to improve data in an MFL through the use of the SQUAD Tool. It provides detailed instructions on how to prepare the data for use with the tool and how to run the SQUAD Tool with a typical country MFL. It also provides recommendations on specific steps to follow to prioritize actions and resolve errors found in the output list provided by the tool.
The status of health facilities is always changing as new health facilities come into existence and others close or move. Because of the dynamic nature of the MFL, it is recommended that the SQUAD Tool be regularly used, in line with the local MFL governance policy.
Access additional SQUAD resources. |
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Measuring Impact Qualitatively
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Susan Pietrzyk, Reeti Hobson, Lwendo Moonzwe, and Debra Prosnitz |
2018 |
English |
Global |
manual, Impact Evaluation, mixed methods, Qualitative Evaluation |
Based on a document review of 32 USAID-funded HIV/AIDS-related evaluation reports from the USAID Development Experience Clearinghouse (DEC) and participant research, the Measuring Impact Qualitatively paper provides insights and strategies for evaluators undertaking performance- and impact-focused evaluations. In outlining some of the ways in which integrating qualitative research methods into evaluations occurs in perfunctory ways, the paper advocates expanding discussions and moving beyond the status quo with end line performance evaluations.
The way forward, the paper suggests, centers on improving recognition that the use of qualitative research methods within evaluations cannot simply be quick and simplistic or a last-minute addition or afterthought; yet, improving qualitative research methods within evaluations is not overly complicated. To this end, the paper provides logical, common sense suggestions that emerged from reviewing 32 evaluation reports and thinking through choices, strengths, and weaknesses. The paper concludes that the endeavor to “measure impact qualitatively” is less about developing a new framework and much more about recognizing that evaluations have long sought to conceptualize, understand, and assess impact in qualitative terms. The improvements needed involve ensuring that (1) the use of qualitative research methods is thoughtful and attentive to detail, explanatory text, and transparency; and (2) the evaluation considers gender appropriately. |
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Decision Tree for Estimating or Calculating 90-90-90 among Key Populations
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MEASURE Evaluation |
2018 |
English |
Global |
Decision tree, HIV, HIV/AIDS, HIV counseling and testing |
A step-wise guide to tools that can help countries estimate how many people in their country are at risk of acquiring HIV and should be tested. That number is the “first 90” of the HIV treatment cascade that describes the global goal that 90 percent of people in a country know their HIV status, that 90 percent of those who test positive are on antiretroviral therapy (ART), and that 90 percent of people on ART achieve viral suppression. This “decision tree” guides readers through relevant questions and describes how to answer them with ready-made tools. MEASURE Evaluation, funded by the United States Agency for International Development (USAID), works globally in low-resource settings to take a holistic look at health information systems and help countries improve their capacity to collect, analyze, and use health data for better health outcomes for people. The first page of this “tree” provides a graphic guide through questions and appropriate tools to estimate the “first 90.” The second page gives more detail on each tool mentioned.
Access MEASURE Evaluation's other decision trees here. |
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Improving Gender Equity and Health Outcomes: By Addressing Gender in Health Information Systems
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Shelah Bloom |
2018 |
English |
Global |
Learning Agenda, HIS, M&E, Gender |
Gender dynamics play a key role in factors that influence health and well-being. Decades of global research have demonstrated that gender equity affects a range of health outcomes. These studies have been very important to lay the groundwork for understanding gender norms and increasing investment in policy and programs to reduce inequities resulting from social expectations. Therefore, as countries around the world invest or are encouraged to invest in both gender and HIS, it is important to consider how these issues intersect. The focus of this synthesis report—which is part of a series—is twofold: to demonstrate how HIS is strengthened by addressing gender, and to show that addressing gender in HIS improves gender equity and health outcomes.
MEASURE Evaluation, funded by the United States Agency for International Development (USAID), helps countries improve HIS management, governance, and performance. In July 2014, USAID asked MEASURE Evaluation to implement activities to justify and build an evidence base for which investments in HIS are effective and useful. In response, we developed an HIS Learning Agenda (MEASURE Evaluation, 2015), to explore what works to strengthen HIS. See other syntheses related to the Learning Agenda here. |
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Global Digital Health Resources and Maturity Models: A Summary
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MEASURE Evaluation |
2018 |
English |
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Health data, Maturity Model, Data, HIS, Health information systems |
Recently, the importance of maturity model-based digital health assessment tools has grown. These tools are useful to establish a systematic basis of measurement to (1) describe current maturity level of digital health systems in terms of human resources, business processes, technology, and organizational capabilities; (2) facilitate users’ ability to set goals for future levels of maturity; and (3) inform the development of improvement plans to realize the next maturity level toward a stronger digital health system. for a country to meet its public health targets.
Maturity models typically consist of several (three to six) stages of maturity that characterize an improvement process and encompass a broad collection of organizational activities and structures. They often provide abstract descriptions of maturity levels and broad assessment criteria for a range of users. A multidimensional maturity model focuses on people, processes, technology, and organizational capabilities. The elements defined in the model can help carry out assessments of existing digital health capabilities. This knowledge can help an organization understand where it is on the path and where to go next. This information can help an organization visualize the future workforce, business processes, and technology capability requirements. It can offer a holistic view of how an organization can plan, develop, use, and organize its information and digital systems to achieve a higher level of maturity while building on its strengths and addressing weaknesses.
As maturity models based on digital health assessment tools proliferate, users of these tools need help to understand when and how to use these tools. To address this question, MEASURE Evaluation, funded by the United States Agency for International Development (USAID), worked with digital health practitioners from the Digital Health and Interoperability Technical Working Group of the Health Data Collaborative, the World Health Organization, the USAID-funded Maternal and Child Survival and Digital Square projects, and Health Enabled to summarize the purpose, methods, and intended use of six of the key global digital health resources and maturity models.
Access the full toolkit.
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What Are the Characteristics of a Strong Health Information System?
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MEASURE Evaluation |
2018 |
English |
|
HIS, Data use, HIS strengthening, Data Quality, Data Demand and Use, Learning agenda |
To safeguard and promote the health of its citizens, a country must identify health needs within its borders, prepare strategies to address those needs, and gather resources to enact plans. A country’s national health information system (HIS) provides the health data it needs to plan and implement a health strategy.
A strong HIS must then use available data to meet health goals. It should collect, manage, analyze, and disseminate health data in a timely manner, so that managers can track progress and provide feedback on HIS performance to improve data quality and use for making sound decisions. To do all of this, an HIS must be well-defined, comprehensive, functional, adaptable and scalable, and resilient.
MEASURE Evaluation—a five-year cooperative agreement funded by the United States Agency for International Development (USAID)—works with countries to strengthen their HIS so that they have those four attributes.
In July 2014, USAID asked MEASURE Evaluation to build a base of evidence showing which investments in HIS management, governance, and performance are effective and useful. In response, the project developed the HIS Learning Agenda. The purpose of this Learning Agenda is to explore what works to strengthen HIS by addressing a series of questions. This brief addresses our answers to the following question: What are the characteristics of a strong HIS?
What are the factors and conditions of HIS performance progress?
What are the stages of progression to a strong HIS and how are they measured? |
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Tuberculosis in Nigeria: Rapid Assessment of Infectious Disease Surveillance and Reporting
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Olusola Aruna, Ifeanyi Nsofor, and Kola Oyediran |
2018 |
English |
NIGERIA |
Reporting, Tuberculosis, Infectious disease, Surveillance, Rapid Assessment |
Background: Effective infection control requires a functioning surveillance system. The Integrated Disease Surveillance and Response (IDSR) strategy was developed and adopted in 1998 for Africa as a comprehensive public health approach. Subsequently, Nigeria adopted the IDSR Technical Guidelines, which defined operations and procedures for reporting priority diseases, including tuberculosis (TB).
Objective: The objective of the assessment was to investigate and report on the challenges of TB notification through the IDSR strategy.
Methods: This mixed-methods rapid assessment included a desk review, review of facility-level data, and qualitative interviews collected primarily through key informant interviews with purposively sampled managers and health workers at all levels of IDSR and TB program implementation.
Results: The assessment revealed that TB cases are being notified through the IDSR, but also through the national system, using different definitions and procedures and without integration of the data reported by each system. A major observation was that health facilities, especially private facilities, failed to comply with mandatory reporting of priority diseases. Additional challenges hampering effective implementation included inadequately trained human resources and poor infrastructure.
Conclusion: Improving the effectiveness of IDSR and TB reporting, and ensuring availability of strong data for decision making, requires improved education on IDSR, engagement of the private sector in surveillance, and strengthened systems for logistics and diagnosis. |
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Health Informatics in Low- and Middle-Income Countries: Short Course for Health Information System Professionals: Course Syllabus
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MEASURE Evaluation, GEMNet-Health |
2018 |
English |
|
Health informatics, GEMNet-Health, Digital Health, Curriculum, EHealth |
“Health Informatics for Low- and Middle-Income Countries: Short Course for Health Information System Professions” was the result of an effort by the United States Agency for International Development (USAID)-funded MEASURE Evaluation and the Global Evaluation and Monitoring Network for Health (GEMNet-Health).
For each unit of the course, this syllabus outlines the learning objectives, teaching methods, materials needed, a unit plan, and activity descriptions for the unit. Each unit’s plan provides suggested times for the sessions in the unit. These timelines were created with the assumption of a five day course. The course can be adapted to fit longer or shorter timelines. The unit lectures and activities can be found on the course’s landing page on the MEASURE Evaluation website at https://www.measureevaluation.org/health-informatics-short-course. |
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Երեխաների այլընտրանքային խնամքի համակարգի հզորացում Բացահայտումներ Հայաստանից, Գանային, Ուգանդային և Մոլդովայից
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MEASURE Evaluation |
2018 |
Armenian |
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Uganda, Systems strengthening, Alternative Care, Children, Child health, Moldova, Care for children, Armenia, Ghana |
Միացյալ Նահանգների միջազգային զարգացման գործակալության (ԱՄՆՄԶԳ) Տեղահանված և ծնողազուրկ երեխաների հիմնադրամը (DCOF) աջակցում է MEASURE Evaluation ծրագրին հզորացնելու երեխաների խնամքի և պաշտպանության համակարգի բարեփոխումները մշտադիտարկելու, գնահատելու և վերհանված խնդիրներին արձագանքելու կառավարությունների կարողությունները Հայաստանում, Գանայում, Մոլդովայում և Ուգանդայում՝:
2017 թվականի վերջում և 2018 թվականի սկզբին MEASURE Evaluation ծրագիրն աջակցեցերկրն երիի հիմնական թիմերին (ԵՀԹ)` յուրաքանչյուր երկրում իրականացնելու այլընտրանքային խնամքի համակարգի բարեփոխումների մասնակցային ինքնագնահատում: Կիրառված նահատման գործիքն ի սկզբանե մշակվել էր ԱՄՆ ՄԶԳ / DCOF-ի և MEASURE Evaluation ծրագրի կողմից՝ հիմնվելով ՄԱԿ-ի երեխաների այլընտրանքային խնամքի ուղեցույցի վրա և նպատակ ուներ գնահատելու երեխաների այլընտրանքային խնամքի համակարգերը:
Յուրաքանչյուր երկիր տեղայնացրել է այս գործիքը՝ հիմնվելով Լոնդոնում կայացած աշխատաժողովի ընթացքում գործիքի վերանայման քննարկումների վրա (մանրամասների համար, այցելեք՝ https://www.measureevaluation.org/resources/publications/wp-17-39): Հարյուր վաթսուն հինգ մարդ է մասնակցել չորս երկրներում կազմակերպված գնահատման աշխատաժաղովներին (Հայաստանում` 66 մասնակից, Գանայում՝ 28, Մոլդովայում` 26, Ուգանդայում `45), պետական և ոչ պետական կառույցները, հասարակական կազմակերպությունները (ՀԿ) և միջազգային և դոնոր կազմակերպությունները լայնորեն ներկայացված էին: Բոլոր երկրներում ԵՀԹ-ի անդամները աջակցում կամ վարում էին գնահատման աշխատաժողովները։
Իրականացված գնահատումների հիման վրա, MEASURE Evaluation ծրագիրը մշակել է մանրամասն զեկույցներ՝ յուրաքանչյուր երկրում երեխաների խնամքի և պաշտպանության համակարգի բարեփոխումների վերաբերյալ: Յուրաքանչյուր երկրի հետ գնահատելով երեխաների խնամքի և պաշտպանության իր համակարգը, MEASURE Evaluation ծրագիրն աջակցել է նաև տվյալ երկրում այլընտրանքային խնամքի համակարգի բարեփոխումների համար պատասխանատու նախարարությանը կազմակերպելու աշխատաժողով՝ գնահատման արդյունքների հիման վրա առաջնահերթություններ սահմանելու և գործողությունների ծրագրեր մշակելու համար: Այս զեկույցում ներկայացված են բոլոր չորս երկրների բացահայտումներն, ըստ համակարգի բաղադրիչների և խնամքի ոլորտների և ամփոփված են այլընտրանքային խնամքի համակարգերի զարգացման համար կատարված առաջարկությունները։ |
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Strengthening Côte d’Ivoire's Health Information System to Combat HIV: Validating Data on the Effectiveness of Interventions
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MEASURE Evaluation |
2018 |
English |
COTE D'IVOIRE |
HIS strengthening, validating data, Health Information Systems, triangulation |
MEASURE Evaluation—a project funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief—has, since 2004, supported the efforts of the Government of Côte d’Ivoire to strengthen its health management information system and HIV monitoring and evaluation systems.
To contribute to evidence about what works to strengthen health information systems (HIS), MEASURE Evaluation is assessing HIS investments in Côte d’Ivoire as part of the project’s Learning Agenda. The evaluation is designed to yield evidence of how HIS strengthening investments affect HIS performance and public health outcomes.
The evaluation specifically focused on how HIV investments affected the overall strength of the HIS in Côte d’Ivoire and, vice versa, how HIS investments might improve HIV outcomes.
The evaluation had two components: data triangulation to validate data by cross-referencing multiple data sources and a qualitative study to explore incentives and barriers to using government tools and data systems to improve the analysis and synthesis of data for improved health programs and outcomes. This report highlights the data triangulation component. Because United States Government (USG) investments were the principle source of support for addressing both the HIV epidemic and HIS strengthening, this report focuses on those USG activities. |
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Gender and Groundnut Value Chains in Eastern Province, Zambia
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MEASURE Evaluation |
2018 |
English |
Africa, ZAMBIA |
Women, Zambia, Gender, Impact Evaluation, Evaluation |
The Gender and Groundnut Value Chains impact evaluation, conducted in Eastern Province, Zambia, tested the hypothesis that the gender mainstreaming interventions implemented by two Feed the Future mechanisms—Production, Finance, & Improving Technology Plus (PROFIT+) and Better Life Alliance (BLA)—assisted in maintaining or increasing women’s control over groundnut production, marketing, and proceeds as efforts at commercialization increased.
Evaluation methods were a baseline (2014) and end line (2017) quantitative longitudinal household survey and a qualitative study. The quantitative component employed a quasi-experimental design in which pre- and post-intervention differences in outcomes were compared between project and comparison domains to measure the impact of PROFIT+ and BLA. The analysis involved descriptive frequencies, cross tabulations, and tests of statistical significance for primary outcomes. Impact analyses were conducted for selected primary outcomes using the difference-in-differences model. The qualitative component consisted of in-depth interviews and focus group discussions with beneficiaries to contextualize quantitative findings.
There was a significant increase in the quantity of groundnuts sold/bartered from baseline to end line in both the project and comparison domains among households that grew groundnuts in both seasons. The increase was significantly higher in the project domain. Women’s participation in groundnut production, marketing, and use of proceeds was maintained as efforts to commercialize groundnuts expanded. Qualitative findings indicated that beneficiaries perceived savings and lending communities (SILCs) and gender messages promoted by PROFIT+ and BLA to have impacted women’s empowerment. Evaluation findings suggest that PROFIT+ and BLA contributed both to groundnut commercialization and maintaining women’s participation in production, marketing, and use of proceeds. |
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Suivi des résultats des programmes pour orphelins et enfants vulnérables du PEPFAR en Haïti: Résultats de l'enquête de 2018 du Programme de Zanmi Lasante/Partners in Health
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MEASURE Evaluation |
2018 |
English |
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Orphans and Vulnerable Children, OVC, Haiti, Child health, PEPFAR, Children |
Dans le cadre de ses orientations en matière de suivi, d’évaluation et de rapportage (MER), le Plan d’urgence du Président Américain pour la Lutte contre le SIDA (PEPFAR) a lancé en 2014 un ensemble d’indicateurs de résultats pour suivre les programmes pour orphelins et enfants vulnérables (OEV), communément appelés indicateurs MER. L'enquête sur ces indicateurs consiste à obtenir un aperçu du bien-être des enfants et des ménages desservis par les projets OEV appuyés par PEPFAR. MEASURE Evaluation, financé par l'Agence des États-Unis pour le développement international (USAID) et PEPFAR, a mené cette enquête auprès des bénéficiaires du programme OEV du Programme de Renforcement des services VIH au sein d'un réseau d'institutions de santé publique du Plateau Central et du bas-Artibonite supporté par PEPFAR, mis en oeuvre par Zanmi Lasante/Partners in Health (PIH) et financé par le Centre pour le contrôle et la prévention des maladies des États-Unis. Entre mars et avril 2018, MEASURE Evaluation a recueilli des données auprès de 413 soignants sur eux-mêmes, leur ménage et 1 197 enfants de moins de 18 ans (taux de réponse des ménages de 86%). |
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Suivi des résultats des programmes pour orphelins et enfants vulnérables du PEPFAR en Haïti: Résultats de l'enquête de 2018 du programme Bien Èt ak Santé Timoun (BEST)
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MEASURE Evaluation |
2018 |
English |
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Orphans and Vulnerable Children, Child health, OVC, PEPFAR, Children, Haiti |
Dans le cadre de ses orientations en matièrede suivi, d’évaluation et de rapportage (MER), le Plan d’urgence du Président Américain pour la Lutte contre le SIDA (PEPFAR) a lancé en 2014 un ensemble d’indicateurs de résultats pour les orphelins et les enfants vulnérables (OEV), communément appelés indicateurs MER. L'enquête sur ces indicateurs consiste à obtenir un aperçu du bien-être des enfants et des ménages desservis par les projets OEV appuyés par PEPFAR. MEASURE Evaluation, financée par l'Agence des États-Unis pour le développement international (USAID) et PEPFAR, a mené cette enquête auprès des bénéficiaires du programme OEV du projet Bien Et ak Santé Timoun (BEST), mis en oeuvre par la Fondation CARIS et financé par USAID. Entre mars et avril 2018, MEASURE Evaluation a recueilli des données sur 385 soignants à propos d'eux-mêmes, de leur ménage et de 1 098 enfants de moins de 18 ans (taux de réponse des ménages de 80%). |
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Strengthening Data Demand and Use in Three African Countries: Lessons Learned from the Associate Awards in Kenya, South Africa, and Tanzania
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MEASURE Evaluation |
2018 |
English |
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Data, MEASURE Evaluation Tanzania, HIS, Tanzania, MEval-SIFSA, Data use, Health Information Systems, Kenya, South Africa, DDU, Data Demand and Use, MEASURE Evaluation PIMA |
To address challenges with measuring data use, MEASURE Evaluation developed a conceptual framework to describe the inputs, outcomes, and impact of applying a specific set of activities that address the most proximate technical, organizational, and behavioral barriers to using data (Nutley & Reynolds, 2013). For example, improving data availability has been identified as an important activity area to improve data demand and use (DDU) because decision makers are more likely to use data if they can easily access summarized information most relevant to decision making that is presented in formats that are easily understood. The framework assumes that efforts to improve the use of data will only be successful if implemented as part of larger long-term HIS strengthening activities (e.g., strengthening data infrastructure, building effective data management systems). Eight priority domains or “activity areas” have been identified as the most influential to improve data-informed decision making.
The conceptual framework has been used to guide the design of interventions to improve data-informed decision making. The interventions were implemented as part of larger HIS strengthening projects in Kenya, South Africa, and Tanzania under MEASURE Evaluation’s associate awards. These projects aim to improve the use of data for policy, advocacy, and monitoring of health and social service programs and to strengthen monitoring and evaluation (M&E) systems at national and subnational levels. The projects implemented interventions across the eight domains to strengthen the quality, demand for, and use of routine health information for decision making. The DDU interventions across the three countries were tailored to address different program areas, target audiences, and country objectives.
To understand each associate award’s progress to improve data use, MEASURE Evaluation explored facilitators and barriers contributing to the effectiveness of DDU interventions implemented at the subnational level in Kenya, South Africa, and Tanzania. The project established the following objectives:
To describe the results of DDU intervention activities.
To understand the factors that contribute to successful data use in country health information systems.
This report provides an overview of the learning exercise approach and key findings across the three countries. For more detail about the findings for specific DDU activities implemented in each country, please see the reports for Kenya, South Africa, and Tanzania. |
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Protecting the Sexual Health of Young South Africans: Midline Results from the Impact Evaluation of a Sexuality and HIV Prevention Education Activity
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MEASURE Evaluation |
2018 |
English |
SOUTH AFRICA, Africa |
Impact Evaluation, HIV prevention, Child health, Adolescent health, South Africa |
In 2015, the South Africa Department of Basic Education (DBE), with support from the United States Agency for International Development (USAID), invested in developing and piloting scripted lesson plans (SLPs) to increase the rigor and uniformity of a Life Orientation (LO) curriculum for learners. The Education Development Center began to pilot the SLPs in the 2016 school year. With support from USAID and in partnership with the DBE, MEASURE Evaluation is conducting an impact evaluation of the activity before it is rolled out nationally. The evaluation examines the effect of the SLPs on herpes simplex virus 2 incidence, and the change in prevalence of pregnancy among a cohort of Grade-8 female learners as they progress to Grade 10. The evaluation also examines whether the activity is related to the secondary outcomes of school retention, knowledge, attitudes, and risk behaviors of female and male learners in Grades 8, 9, and 10. The study employs a two-arm, stratified, cluster design with quantitative data collection at baseline, midline, and end line. Quantitative data are being collected from five education districts in Mpumalanga (MP) and KwaZulu-Natal (KZN). The evaluation also had a qualitative component at midline, examining the perceptions and acceptance of and comfort with the curriculum materials and supportive activities by different stakeholders, and identifying barriers and facilitators to implementation of the activity. Data from in-depth interviews and focus group discussions were collected from three education districts in MP and KZN.
This brief presents the quantitative midline results from 4,123 Grade-9 female learners and 3,988 Grade-9 male learners enrolled in 105 study schools in the third quarter of the 2017 school year. It presents qualitative results from 36 Grade-10 female and 36 Grade-10 male learners enrolled in six study schools (one intervention and one matched control school in MP and two intervention and two matched control schools in KZN) in the first quarter of the 2018 school year, plus interviews with five LO teachers and focus group discussions with eleven groups of parents. |
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Impact Evaluation of a School-Based Sexuality and HIV-Prevention Education Activity in South Africa: Midline Results
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MEASURE Evaluation |
2018 |
English |
Africa, Southern Africa |
Impact Evaluation, HIV, South Africa, Evaluation |
Young people in South Africa, especially young women, are at high risk of acquiring HIV. Gaining the knowledge and skills necessary to make healthy choices about sexual behavior as adolescent learners transition to young adulthood is key to controlling the HIV/AIDS epidemic and reducing its potentially devastating effects. The South Africa Department of Basic Education (DBE) has attempted to attenuate the impact of HIV/AIDS on the nation through its Life Orientation (LO) curriculum, which has been in place since 2000. In 2015, the DBE and the Education Development Center (EDC), with support from the United States Agency for International Development (USAID) through the United States President’s Emergency Plan for AIDS Relief (PEPFAR), invested in developing and piloting scripted lesson plans and supportive activities to increase the rigor and uniformity of the LO curriculum. Before rolling it out nationally, the DBE and USAID tasked MEASURE Evaluation with conducting an impact evaluation of the activity in two South African provinces.
Our 2016 baseline findings are reported here. This working paper summarizes the main findings of the midline data collection and analysis. We make some comparisons with the baseline here but will defer most of these until we report on our end line findings from the 2018 data collection. Access a related brief. |
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Facilitators and Barriers to Data Use: Learning from the MEASURE Evaluation Strategic Information for South Africa Associate Award
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MEASURE Evaluation |
2018 |
English |
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Data use, MEval-SIFSA, South Africa, Learning agenda, Data |
MEASURE Evaluation works to strengthen capacity in developing countries to gather, interpret, and use data to improve health. High-quality data are essential for effective and efficient decision making in health, to promote transparency, and to strengthen the accountability of decision makers. MEASURE Evaluation developed an organizing framework that maps how data use intervention inputs and activities influence the outputs and outcome of regular sustained use of data in program review, planning, and policy (Nutley & Reynolds, 2013). This framework provides a comprehensive and practical strategy for developing interventions to strengthen the demand for and use of data in decision making. The interventions cover eight domains of activities that were identified in the literature and by MEASURE Evaluation’s implementation experience as critical to affect the technical, behavioral, and organizational determinants of data-informed decision making. The intervention is tailored to specific country and program contexts, such that all of the interventions may not need to be implemented to improve the demand for and use of data.
This framework has been used to guide the design of interventions to improve data-informed decision making, which were implemented as part of larger health information system and monitoring and evaluation (M&E) strengthening projects in Kenya, South Africa, and Tanzania (the MEASURE Evaluation associate awards). To understand progress made by each associate award in improving data use, MEASURE Evaluation explored the facilitators and barriers contributing to the effectiveness of specific DDU interventions implemented at the subnational level in Kenya, South Africa, and Tanzania. MEASURE Evaluation established the following objectives for this learning exercise:
To describe the results of DDU intervention activities.
To understand the factors that contribute to successful data use in country health information systems.
This report presents the results of the South Africa DDU learning exercise. Findings for Kenya and Tanzania are presented separately. These reports are meant to be shared with country governments, programs, and donors implementing DDU interventions to sustain a culture of decision making in health programs. Access a related report for an overview of the learning exercise approach and key findings across the three countries. |
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Rwanda's Improved Services for Vulnerable Populations Project: Initial Data Collection Report for an Impact Evaluation
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Jessica Fehringer (Team Leader), Lisa Parker, Gustavo Angeles, Aimee Benson, Chris B. Agala, Sabine Musange, Albert Ndagijimana, Vedaste Ndahindwa, and Veronica Caridad Varela |
2018 |
English |
RWANDA |
Vulnerable populations, Orphans and Vulnerable Children, Impact Evaluation, OVC, Vulnerable children |
Although Rwanda has achieved great progress in economic growth, poverty reduction, and HIV prevention over the past decade, significant challenges to health and development remain. Vulnerable populations, such as people living with HIV/AIDS (PLHA), out-of-school youth, very poor or female-headed households, and orphans and vulnerable children (OVC) face challenges with respect to health, education, and economic stability. The Improved Services for Vulnerable Populations (ISVP) project, known locally as Twiyubake, aims to strengthen the capacity of target populations and communities to improve their health, nutrition, and well-being; OVC, PLHA, and economically vulnerable families are a particular program focus. The ISVP project is led by Global Communities, along with local nongovernmental organizations, Rwandan civil society organizations, and the Ministries of Health and Gender and Family Promotion and supported by the United States Agency for International Development (USAID) Rwanda Mission.
The USAID-funded MEASURE Evaluation, led by the University of North Carolina at Chapel Hill, with support from USAID/Rwanda, and in collaboration with the National University of Rwanda, College of Medicine and Health Sciences and School of Public Health, and Incisive Africa is conducting an impact evaluation of the ISVP project. The ISVP impact evaluation seeks to measure the impact of theTwiyubake interventions on the health, education, and economic well-being of vulnerable children and their families. This report shares results from the 2017 survey to establish initial indicators for background characteristics, primary and secondary outcomes, and exposure to project or similar interventions in both the program and control groups. |
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Review and Revise: A Tool for Reviewing and Revising Key Population Size Estimates
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MEASURE Evaluation |
2018 |
English |
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Population, At-Risk Populations, Size Estimation, Key Populations |
Key populations—a term used to reference sex workers, men who have sex with men, transgender people, people who inject drugs, and prisoners—are at greater risk for acquiring HIV and are least likely to access services, including treatment. Understanding the size of key populations is important to ensure that resources are allocated to reach these populations with the services and treatment they require. Unfortunately, estimating the numbers of these often hidden and mobile populations who engage in illegal or stigmatized sexual behavior is difficult, with no gold standard method for providing consistently valid and precise estimates. Countries have invested resources in multiple methods to estimate the size of key populations in subnational areas and extrapolate findings to the country as a whole. Consequently, countries frequently have multiple and conflicting size estimates of key populations for subnational areas and for the entire country. Multiple estimates often cause confusion when program targets are set and resources are allocated based on projected need.
This tool was designed to help those engaged in program planning and target setting to understand why size estimates may differ and to make an informed judgment about which ones are most appropriate for use by their programs.
Specifically, it will help program planners (1) understand what population size estimates are needed, (2) identify currently available estimates, (3) understand the strengths and limitations of those estimates, and (4) reach a consensus on the most appropriate ones for the program to use. If currently available estimates are insufficient, the tool will help stakeholders understand how to revise them using existing data or (5) collect additional data to produce new estimates.
This tool has been tested in Guyana, Haiti, and the Dominican Republic. |
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Facilitators and Barriers to Data Use in Kenya: Learning from the MEASURE Evaluation PIMA Associate Award
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MEASURE Evaluation |
2018 |
English |
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Kenya, DDU, Monitoring, Evaluation, MEASURE Evaluation PIMA, Data Demand and Use, Data, Data use |
MEASURE Evaluation works to strengthen capacity in developing countries to gather, interpret, and use data to improve health. High-quality data are essential for effective and efficient decision making in health, to promote transparency and strengthen the accountability of decision makers. MEASURE Evaluation developed an organizing framework that maps how data use intervention inputs and activities influence the outputs and outcome of regular sustained use of data in program review, planning, and policy (Nutley & Reynolds, 2013). This framework provides a comprehensive and practical strategy for developing interventions to strengthen the demand for and use of data in decision making.
This framework has been used to guide the design of interventions to improve data-informed decision making, which were implemented as part of larger health information system and monitoring and evaluation (M&E) strengthening projects in Kenya, South Africa, and Tanzania (the MEASURE Evaluation associate awards). To understand the progress made by each associate award in improving data use, MEASURE Evaluation explored the facilitators and barriers contributing to the effectiveness of
This report presents the results of the Kenya follow-up investigation. Findings for South Africa and Tanzania are presented separately. These reports are meant to be shared with country governments, programs, and donors implementing DDU interventions to sustain a culture of decision making in health programs. Access a related report for an overview of the learning exercise approach and key findings across the three countries. |
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Decision Support Systems for Linking Routine and Nonroutine Data Sources
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MEASURE Evaluation |
2018 |
English |
|
Data, HIS, Data use, Health information systems, Master facility list |
As countries strengthen their data infrastructures, global health professionals increasingly need data to monitor programs and to diagnose and control epidemics. These data come from “routine” and “nonroutine” sources. Routine sources are health facility and community information systems. Nonroutine sources are household and other population-based surveys, censuses, civil registration and vital statistics systems, disease surveillance systems, health facility surveys, and administrative data systems. These varied sources complement one another, and when data from them are combined, they are more comprehensive and, thus, more useful.
To exploit the possibilities of linking data, countries are establishing data warehouses where data are stored and linked. Data warehouses are connected to a “health observatory” that permits access to in-depth analyses of population health and health services at the national, subnational, and district levels. A health observatory consists of a decision support system (DSS) plus the various dashboards, portals, and web interfaces developed for specific stakeholders. It uses innovative data visualizations—graphs, spatial analysis and maps, health sector reports, and other media—that make health information more readily available and useful.
This brief focuses on MEASURE Evaluation's web-based DDS. Access the related working paper. |
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How Electronic Health Records Strengthen the Health Systems of Low- and Middle-Income Countries: Learning from Eswatini and Mexico
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Eva Silvestre |
2018 |
English |
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Learning agenda, Health Systems Strengthening, Electronic Health Records, LMICs, Health System, EHR |
Managing patient records is a challenge in any country and for all diseases, especially those that require continuity of care (COC). COC helps HIV-positive people stay in treatment, contributing to the 90-90-90 goals described by the Joint United Nations Programme on HIV/AIDS (UNAIDS), and other health areas, such as maternal care and childhood immunizations. One key intervention for COC is electronic health records (EHRs), which have been implemented worldwide to improve patient management and reporting. The EHR (a term used henceforth both for a single record and the system of health records) is a tool for improving the quality, safety, and efficiency of health services. It also provides data and information for assessing health system performance and the health status of the population. According to the 2015 global survey on eHealth of the World Health Organization (WHO), 57 of 125 countries (46%) reported having some sort of national EHR system ((World Health Organization, 2016). But these interventions are part of the much larger health information system (HIS). There is also great variation in the scope and scale of EHR systems used.
Two examples of large-scale EHR rollout that MEASURE Evaluation—funded by the United States Agency for International Development—has studied are the client management information system (CMIS) in Eswatini (previously called Swaziland), in Phase IV of the project, and the Sistema Administrativo del Expediente Clinico de Colima (SAECCOL, or Management of the Electronic Health Record in Colima, Mexico), in Phase III. This report discusses the role of such EHRs as the SAECCOL and the CMIS in overall health system strengthening. More specifically, it views HIS strengthening through the lens of MEASURE Evaluation’s Learning Agenda—the formal approach that the project has been using to document what we are learning about HIS strengthening. This report also highlights key points to consider when developing an EHR for use on a large scale. |
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Applying New Methods to Estimate Viral Suppression: The “Last 90”
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Zadrozny, S., Weir, S., Edwards, J., & Herce, M. |
2018 |
English |
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People Living with HIV, Key Populations, HIV care, AIDS, HIV prevention, HIV |
The goal of HIV prevention, care, and treatment programs is to maximize the time that people living with HIV spend alive, well, and with a suppressed viral load.
The purpose of these guidelines is to describe an operational protocol for applying new methods to estimate viral suppression—the “last 90” of the 90-90-90 cascade—at the clinical, programmatic, regional, or national level. These approaches can be used for any population living with HIV and can be tailored to focus on population subgroups or key populations (KPs).
The last 90 is an “ambitious treatment target to help end the AIDS epidemic,” according to the Joint United Nations Programme on HIV/AIDS (UNAIDS) (UNAIDS, 2017). The United States Agency for International Development (USAID), through the United States President’s Emergency Plan for AIDS Relief (PEPFAR), is working to achieve the 90–90–90 global goals by 2020.
USAID reports that more than 36.7 million people are living with HIV worldwide (USAID, 2018). Its Office of HIV/AIDS provides global leadership to respond to the epidemic and supports country efforts to meet the challenge. MEASURE Evaluation, funded by USAID and PEPFAR, works across the globe to strengthen health information systems, conduct research and evaluation, and develop global guidance and tools to improve the response to the epidemic in low-resource settings. The project works with USAID and countries to ensure cost-effective, sustainable, and integrated HIV and AIDS programming, using evidence-informed approaches and innovations.
Tools such as the Viral Load Calculator described in this document are among the solutions the project supports to improve data, so as to better describe the epidemic in any locale. In this way, enhanced strategies can be developed to achieve local and global goals. MEASURE Evaluation’s activities take a holistic view of health information systems and the complex contexts that attend HIV and AIDS issues, underpinned by our own research and applications of best practices to advance the field. |
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Effective linkage from point of HIV testing to care and treatment in Tanga region, Tanzania
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Kayabu DE, Ngocho JS, Mmbaga BT |
2018 |
English |
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Tanzania, HIV care, MEASURE Evaluation Tanzania, HIV/AIDS, HIV |
This research was funded by MEASURE Evaluation-Tanzania.
Background Linkage to care and treatment is an important part of efforts to accelerate HIV prevention, treatment, care, and support. It offers an opportunity for PLHIV to receive information and services in a timely manner. Clients who present late for HIV care and treatment may miss out on timely initiation of prophylaxis and ART, which may accelerate disease progression and lead to an increased rate of HIV transmission within the community. The objective of this study was to determine the factors influencing effective linkages of newly diagnosed PLHIV from the point of testing to entry in care and treatment centres (CTCs) in Tanga Region, Tanzania.
Methods This cross-sectional study examined five clinics with a high volume of clients in each of the three districts in Tanga Region. All adults ages 18 years and above at the time of CTC enrolment, between 2010 and 2014, were eligible to participate in the study. The study engaged both secondary and primary data. To complement the secondary data, mixed methods were applied in primary data collection. Using a structured questionnaire, interviews with the sampled CTC clients while focus group discussions with healthcare providers and in-depth interviews with CTC clients. The qualitative data were analysed using a thematic analysis framework. The outcome of interest was whether a client enrolled in a CTC within three months of his or her first positive HIV test. A logistic regression model was used to determine factors associated with effective linkage of newly diagnosed HIV clients to CTC.
Results A total of 16,041 adults from the three study districts were enrolled at a CTC from 2010 to 2014. A total of 1,096 clients from the sampled CTCs were recruited into the study for interview. The characteristics of these clients were representative of the larger group (16,041). The majority (72.4%) were female. More than half (52.1%) were married, and almost aquarter (21.2%) were single. The majority (59.6%) of participants completed primary education and almost half (45.1%) were subsistence farmers. The median CD4 count at enrolment was 218 (87–397) cells/mL with more than half (56.3%) having CD4 counts of less than 350 cells per millilitre (mL). Nearly all (91%) of the clients presented at a CTC within three months of receiving a positive HIV test. In a multivariate analysis, factors that remained significantly associated with early entry in CTC were level of education, CD4 count, and point of diagnosis. Participants’ responses were consistent with many of the factors explained by participants to be barriers to effective linkages and referrals repeated in the FGDs and IDIs across the study sites. For instance, FGD respondent expressed that clients were worried about stigma from their relatives, which creates a delay in seeking treatment.
Conclusion Although the rate of early entry in care and treatment services is high, surprisingly was a marked increase in those who waited more than three months to seek treatment. To meet the target, issues such as disclosure and stigma need to be addressed. |
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A Guide for Monitoring and Evaluating Population-Health-Environment Programs: Second Edition
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Scott Moreland, Jen Curran |
2018 |
English |
|
Population, Environment, Sustainability, Health, PHE, Monitoring, Evaluation |
Conservation projects to protect the environment came to realize that improvements in the health and nutrition of people were also necessary to advance conservation agendas. These programs evolved into what are now called population, health, and environment (PHE) projects that deliver family planning, basic health services, environmental management or conservation information, and service interventions to rural communities in a coordinated or integrated fashion.
PHE projects vary, based on local dynamics, human health problems, and pertinent threats to local environmental conditions. But what all PHE projects have in common is the hypothesis that human populations can be a major threat to the environment, that human health is inextricably linked to the environment, and that working across the human health and environment sectors is more effective than pursuing interventions in isolation. Many projects have also experienced the added benefits of integrating across the PHE sectors—including more women in natural resources management activities; engaging men on reproductive health and family planning decisions; and reaching underserved communities in remote, but often biologically diverse, areas.
The effective management and execution of these or any projects depend on the ability to define and measure success at several levels. A well-thought-out and implemented monitoring and evaluation (M&E) system provides the information for measuring success. It is with that in mind that MEASURE Evaluation has published A Guide for Monitoring and Evaluating Population-Health-Environment Programs, 2nd Edition (2018). It is a comprehensive reference for practitioners and provides not only a list of potential indicators but also advice on setting up M&E systems; the addition of livelihoods indicators; and a new section on evaluating complex programs. The guide further includes several new indicators cross-referenced to the United Nations Sustainable Development Goals (SDGs). |
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Routine Health Information System Rapid Assessment Tool: Implementation Guide
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MEASURE Evaluation |
2018 |
English |
|
Data, Tools, RHIS, Routine Health Information Systems |
The World Health Organization (WHO) and MEASURE Evaluation—funded by the United States Agency for International Development (USAID)— have identified and harmonized standards for data management of the routine health information system (RHIS). The standards, which are best practices, promote the production of timely, accurate data for use in program planning and monitoring and evaluation (M&E). The RHIS Rapid Assessment Tool was developed to assist health information system (HIS) managers and evaluators identify gaps and weaknesses—aspects of health facility and community information systems that do not meet the standard—with a view to strengthening the RHIS and improving the data. The RHIS Rapid Assessment Tool compares a country’s RHIS to the global standards and indicates where resources should be invested to improve the system.
Access the tool's Data Entry Module and Analysis and Dashboards Module. |
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Routine Health Information System Rapid Assessment Tool: Analysis and Dashboards Module
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MEASURE Evaluation |
2018 |
English |
|
RHIS, Data, Tools, Routine Health Information Systems |
This Analysis and Dashboards Module is one of two Microsoft Excel workbooks that comprise the Routine Health Information System (RHIS) Rapid Assessment Tool. The tool was designed to identify gaps in the RHIS during the health-sector planning process, so that deficiencies can be addressed during strategic planning.
The Analysis and Dashboards Module contains the responses for each level of the health system involved in the assessment and the cumulative results across all levels. There are standard-specific results—that is, the percentage of respondents selecting a particular response—and dashboards that display results grouped by domain and subdomain.
Results, comments, and priority actions are cut and pasted from the Data Entry Module (one line each) per completed workbook to see the results in the Analysis and Dashboards Module.
Access the tool's Data Entry Module and Implementation Guide. |
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Routine Health Information System Rapid Assessment Tool: Data Entry Module
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MEASURE Evaluation |
2018 |
English |
|
Tools, Data, RHIS, Routine Health Information Systems |
This Data Entry Module is one of two Microsoft Excel workbooks that comprise the Routine Health Information System (RHIS) Rapid Assessment Tool. The tool was designed to identify gaps in the RHIS during the health-sector planning process, so that deficiencies can be addressed during strategic planning.
The Data Entry Module comprises a checklist of standards for health facility and community information systems, grouped by thematic domain and subdomain. This checklist can be used at any level of the health system involved in data collection, aggregation, transmission, and reporting of RHIS data: (1) national level; (2) subnational level– other (that is, region, province, etc.); (3) subnational level–district; and (4) service delivery point.
Responses and comments entered in the checklist are automatically compiled on the “raw data” tab in the worksheet, with one row for responses and one for comments. These data are cut and pasted in the Data Analysis and Dashboards Module to aggregate and view the results across respondents. The Data Entry Module also has a dashboard that depicts the results for responses entered, but only for the responses emanating from the group or respondent completing the workbook (see “dashboard tab” in the Data Entry Module).
Each item on the checklist is scored as either 0 (no answer/not applicable); 1 (not present, needs to be developed); 2 (needs a lot of strengthening); 3 (needs some strengthening); or 4 (already present, no action needed).
Access the tool's Analysis and Dashboards Module and Implementation Guide. |
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Facilitators and Barriers to Data Use: Learning from the MEASURE Evaluation-Tanzania Associate Award
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Michelle Li, Ismael Ddumba-Nyanzi, and Tara Nutley |
2018 |
English |
|
|
MEASURE Evaluation works to strengthen capacity in developing countries to gather, interpret, and use data to improve health. High-quality data are essential for effective and efficient decision making in health, to promote transparency, and to strengthen the accountability of decision makers. MEASURE Evaluation developed an organizing framework that maps how data use intervention inputs and activities influence the outputs and outcome of regular sustained use of data in program review, planning, and policy (Nutley & Reynolds, 2013). This framework provides a comprehensive and practical strategy for developing interventions to strengthen the demand for and use of data in decision making.
The framework has been used to guide the design of interventions to improve data-informed decision making, which were implemented as part of larger health information system and monitoring and evaluation (M&E) strengthening projects in Kenya, South Africa, and Tanzania (the MEASURE Evaluation associate awards). To understand progress made by each associate award in improving data use, MEASURE Evaluation explored the facilitators and barriers contributing to the effectiveness of specific data demand and use (DDU) interventions implemented at the subnational level in Kenya, South Africa, and Tanzania. MEASURE Evaluation established the following objectives for this learning exercise:
To describe the results of DDU intervention activities.
To understand the factors that contribute to successful data use in country health information systems.
This report presents the results of the Tanzania learning exercise on DDU activities targeted at subnational regional and council health management teams (R/CHMTs). Findings for Kenya and South Africa are presented separately. These reports are meant to be shared with country governments, programs, and donors implementing DDU interventions to sustain a culture of decision making in health programs. Access a related report for an overview of the learning exercise approach and key findings across the three countries. |
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Demand and Readiness Tool for Assessing Data Sources in Health Information Systems (HIS DART)
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Fern Greenwell, Sam Wambugu |
2018 |
English |
|
Data, HIS, HIS DART, Health information systems, Health System, DART, Health Systems Strengthening |
The purpose of the Demand and Readiness Tool for Assessing Data Sources in Health Information Systems (HIS DART) is to guide a systematic review of the demand for HIS data sources and the readiness of these sources to generate comparable data to monitor health system performance. The HIS DART provides an objective appraisal of the alignment of each data source with relevant national and international standards. Conducting this kind of review across data sources is important, because countries need objective evidence as a basis for prioritizing HIS-strengthening investments.
The HIS DART consists of a set of 12 HIS data source modules, with each module containing a questionnaire accompanied by detailed instructions, question by question, to help the administrator and respondents to elicit, convey, and record valid information.
Access the companion reference guide and 12 module files. |
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Using census data to measure maternal mortality: A review of recent experience
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Kenneth Hill, Peter Johnson, Kavita Singh, Anthony Amuzu-Pharin, Yagya Kharki |
2018 |
English |
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Data, Census, Maternal Mortality, Data use, Maternal Health |
Background: The Sustainable Development Goals adopted by the United Nations General Assembly in 2015 (United Nations 2015) set national targets for reducing maternal mortality, putting pressure on governments of countries lacking comprehensive statistical systems to find other ways to measure it. One approach tested since the 1990s has been to collect necessary data through national population censuses.
Objective: This paper reviews maternal mortality data from the 2010 round of censuses for several countries to determine whether the census is useful for monitoring maternal mortality.
Methods: Data on births, deaths, and pregnancy-related deaths from two censuses for 10 countries was evaluated using standard methods; adjustments were applied to the reported numbers if so indicated.
Results: In general, the censuses underreported births moderately and underreported deaths by larger amounts; except in one case, proportions of pregnancy-related deaths appeared plausible. Adjusted estimates of the pregnancy-related mortality ratio (PRMR) were generally higher than estimates from Demographic and Health Survey sibling data or estimates of maternal mortality developed by cross-national studies.
Conclusions: Analysis of recent data confirms results of earlier assessments: Census data provides imperfect but still valuable information on maternal mortality. Data requires careful assessment and often adjustment, resulting in estimates with large uncertainty.
Contribution: This paper provides additional evidence as to whether maternal mortality can usefully be measured by population censuses in countries lacking civil registration data. |
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Evaluation of the Partnership for HIV-Free Survival Country Assessment: Mozambique
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MEASURE Evaluation |
2018 |
English |
MOZAMBIQUE |
Child Health, Maternal Health, Breastfeeding, Nutrition, AIDS, Antenatal Care, Maternal and child health |
The Partnership for HIV-Free Survival (PHFS) was a six-country initiative implemented between 2012–2016. It was designed to reduce mother-to-child transmission of HIV and increase child survival. This document focuses on seven components of PHFS in Mozambique highlighted by a legacy evaluation of partnership activities. The findings are based largely on a rapid assessment conducted by MEASURE Evaluation in Mozambique in January 2018. The core components follow:
• Harmonized quality improvement• Patient records• Mother-baby pairs• Breastfeeding practices• Integration of services• Community-patient links• Coaching
The assessment was conducted by MEASURE Evaluation, which is funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan For AIDS Relief (PEPFAR). This brief presents findings from the evaluation of activities related to PHFS in Mozambique. Findings from assessments of PHFS in other participating countries are available here. |
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Characterizing Male Sexual Partners of Adolescent Girls and Young Women in Mozambique: Key Findings
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Jenifer Chapman, Nena do Nascimento, Mahua Mandal, Sarah Treves-Kagan, Ariane Dinis, and Ana Costa |
2018 |
English |
MOZAMBIQUE |
HIV/AIDS, AIDS, DREAMS, Adolescent health, Adolescent Girls |
Adolescent girls and young women (AGYW) ages 15–24 have been identified as a population vulnerable to HIV. Less than half of AGYW living with HIV know their HIV status, and treatment uptake and viral suppression rates among adolescents and young people, especially females, are extremely low globally. AGYW are at risk of acquiring HIV predominantly through sexual transmission from HIV-positive male partners. To stop AGYW from acquiring HIV, one strategy is to prevent HIV among their male sexual partners and reduce the infectiousness of those partners who are HIV-positive. However, little is known globally about the characteristics of AGYW’s sexual partners, which constrains efforts to reach them with HIV services and thus limits efforts to ultimately reduce HIV prevalence among them. The United States President’s Emergency Fund for AIDS Relief (PEPFAR), through the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe Initiative, has called on U.S. Government missions overseas to address this knowledge gap, through studies to characterize male sexual partners.
USAID/Mozambique asked MEASURE Evaluation to undertake a study that would provide insights into the characteristics of men who have recently engaged in sexual activity with AGYW, the relationship dynamics, and factors that influence men’s engagement with HIV and AIDS prevention and care services.
This study had three research questions:
Who are the sexual partners of AGYW?
Is sexual risk-taking behavior (i.e., multiple recent sexual partners and unprotected sex) among AGYW and their male partners associated with certain sexual partner characteristics (e.g., age, education, employment, income, or other factors)?
To what extent are male sexual partners of AGYW using/willing to use different types of HIV and AIDS services?
This report presents results of a two-part study: the first part involved focus groups with five subgroups of AGYW; the second part consisted of a venue-based intercept survey of men. A related brief is also available.
Versão em Português: https://www.measureevaluation.org/resources/publications/tr-18-259%20pt |
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Ferramenta para Avaliar o Impacto de Clubes de Raparigas e Grupos de Poupança para Adolescentes e Mulheres Jovens em Moçambique
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Nena do Nascimento, Susan Settergren |
2018 |
Portuguese |
Africa, MOZAMBIQUE |
AGYW, HIV PREV, Adolescent Girls, Africa, AIDS, HIV, Young Women, Mozambique, HIV prevention, Adolescents, HIV/AIDS |
Plano de Emergência do Presidente dos Estados Unidos para o Alívio da AIDS (PEPFAR) lançou a iniciativa Determinada, Resiliente, Empoderada, Livre de AIDS, Aconselhada e Segura (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe, DREAMS), em 2016, para acelerar a redução de infecções por HIV entre adolescentes e mulheres jovens (AMJ) em 10 países da África Subsaariana.
Os clubes de raparigas e os grupos de poupança para as AMJ são componentes essenciais do pacote global de intervenções de prevenção do HIV, recomendadas com base em evidências do DREAMS. Esta ferramenta foi projetada para ser usada pelos parceiros de implementação do DREAMS para medir mudanças em nível individual que resultam da participação em clubes de raparigas e/ou grupos de poupança para as AMJ. A ferramenta é projetado para ser administrada antes do início da intervenção e, novamente, após a conclusão do período de participação pretendido, que normalmente será um ano. |
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Characterizing Male Sexual Partners of Adolescent Girls and Young Women in Mozambique
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MEASURE Evaluation |
2018 |
English |
MOZAMBIQUE |
Adolescent health, AIDS, HIV prevention, Adolescent Girls |
In countries with generalized HIV epidemics in sub-Saharan Africa, adolescence marks an increase in HIV prevalence and the emergence, and dramatic expansion, of gender disparities in HIV (Idele, et al., 2014). Recent estimates from seven African countries found that the prevalence of HIV among women ages 15–25 is more than twice that of their male counterparts (Brown, et al., 2018).
Despite the epidemiological and human rights imperative to help adolescent girls and young women (AGYW) remain AIDS-free, programming in this area has had limited success.
One strategy is to prevent the HIV-negative male sexual partners of AGYW from acquiring HIV and to reduce the infectiousness of those male partners who are HIV-positive. This strategy requires information about the characteristics of male sexual partners of AGYW.
The United States Agency for International Development (USAID)/Mozambique asked MEASURE Evaluation—which is funded by USAID and the United States President’s Emergency Plan for AIDS Relief—to study the characteristics of men who have recently engaged in sexual activity with AGYW. This work falls in line with MEASURE Evaluation’s efforts to control the HIV epidemic. The resulting study sought answers to the following research questions:
Who are the sexual partners of AGYW?
Is sexual risk-taking behavior among AGYW and their male partners associated with certain sexual partner characteristics?
To what extent are male sexual partners of AGYW using, or willing to use, HIV/AIDS services?
HIV prevention and care programs should use the study’s results to reach male sexual partners of AGYW more effectively.
Versão em Português: https://www.measureevaluation.org/resources/publications/fs-18-286%20pt/ |
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A Tool to Assess the Impact of Girls’ Clubs and Savings Groups on Adolescent Girls and Young Women in Mozambique
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Nena do Nascimento, Susan Settergren |
2018 |
English |
Africa, MOZAMBIQUE |
Mozambique, AIDS, Africa, HIV, AGYW, HIV prevention, HIV/AIDS, Adolescent Girls, Young Women, HIV PREV |
The United States President’s Emergency Plan for AIDS Relief (PEPFAR) launched the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) initiative in 2016 to accelerate reduction of HIV infections among adolescent girls and young women (AGYW) in 10 sub-Saharan African countries.
Girls’ clubs and savings groups for AGYW are core HIV prevention components of the global DREAMS evidence-informed package of recommended interventions. This tool is designed to be used by DREAMS implementing partners to measure individual-level changes that result from participation in girls’ clubs and/or savings groups for AGYW. It is designed to be administered prior to beginning either intervention, and then again following completion of the intended participation period, which will typically be one year.
Access a related report and Portuguese versions of the tool and related brief. |
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A Retenção de Adolescentes e Mulheres Jovens em Programação de Prevenção ao HIV Uma revista de clubes des raparigas e grupos de poupança para adolescentes e mulheres jovens
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|
2018 |
Portuguese |
Africa, MOZAMBIQUE |
Africa, HIV/AIDS, Mozambique, HIV, Young Women, AGYW, Adolescent Girls, HIV prevention |
O Plano de Emergência do Presidente dos Estados Unidos para o Alívio da AIDS (PEPFAR) lançou a iniciativa Determinada, Resiliente, Empoderada, Livre da AIDS, Aconselhada e Segura (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe, DREAMS) em 2016 para acelerar a redução de infecções por HIV entre adolescentes e mulheres jovens (AMJ) em 10 países na África Subsaariana.
Os clubes de raparigas e os grupos de poupança para as AMJ são componentes essenciais na prevenção do HIV do pacote global de intervenções recomendadas com base em evidências da DREAMS. No âmbito da iniciativa DREAMS em Moçambique, na altura em que esta actividade começou, os clubes e grupos estavam sendo implementados como parte de um pacote maior de serviços DREAMS financiados por dois projetos da Agência dos Estados Unidos para o Desenvolvimento Internacional (USAID): Projeto Força à Comunidade e às Crianças (FCC, Child and Community Strengthening [Fortalecimento à Criança e à Comunidade]) de World Education International (WEI) e do projeto Strengthening Communities through Integrated Programming (Fortalecimento das Comunidades através da Programação Integrada, SCIP) de World Vision (Visão Mundial). |
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Attrition from HIV Care and Treatment Services in Tanzania: Magnitude and Reasons
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Werner Maokola, Joseph Nondi, Veryeh Sambu, and Joel Nchaho |
2018 |
English |
TANZANIA |
People Living with HIV, At-Risk Populations, AIDS, ART |
Because sustained participation is necessary for HIV treatment to be effective, understanding factors that govern participation—or lack of it—is vital to the work of MEASURE Evaluation, which is funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief, to improve site-level health services.
This study aimed to determine the magnitude of attrition for people living with HIV (PLHIV) from antiretroviral therapy (ART), determine common types of attrition, and document reasons for poor retention in ART services—all to improve retention of PLHIV in ART. By addressing this knowledge gap, this research contributes to USAID’s goal of controlling the HIV/AIDS epidemic.
This study used retrospective record review and a cross-sectional study design involving PLHIV enrolled in treatment between 2006 and 2014 in two high-volume care and treatment clinics in MnaziMmoja Hospital (Ilala District, Dar es Salaam region) and Mkuranga District Hospital (Pwani Region).
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Estimating sizes of key populations at the national level: considerations for study design and analysis
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Edwards, Jessie K; Hileman, Sarah; Donastorg, Yeycy; Zadrozny, Sabrina; Baral, Stefan; Hargreaves, James R; Fearon, Elizabeth; Zhao, Jinkou; Datta, Abhirup; Weir, Sharon S |
2018 |
English |
|
Key Populations, Dominican Republic, HIV, Size Estimation |
Background: National estimates of the sizes of key populations, including female sex workers, men who have sex with men, and transgender women are critical to inform national and international responses to the human immunodeficiency virus (HIV) pandemic. However, epidemiologic studies typically provide size estimates for only limited high priority geographic areas. This paper illustrates a two-stage approach to obtain a national key population size estimate in the Dominican Republic using available estimates and publicly available contextual information.
Methods: Available estimates of key population size in priority areas were augmented with targeted additional data collection in other areas. To combine information from data collected at each stage, we used statistical methods for handling missing data, including inverse probability weights, multiple imputation, and augmented inverse probability weights.
Results: Using the augmented inverse probability weighting approach, which provides some protection against parametric model misspecification, we estimated that 3.7% (95% CI: 2.9, 4.7) of the total population of women in the Dominican Republic between the ages of 15 and 49 were engaged in sex work, 1.2% (95% CI: 1.1, 1.3) of men ages 15 – 49 had sex with other men, and 0.19% (95% CI: 0.17, 0.21) of people assigned the male sex at birth were transgender.
Conclusions: Viewing the size estimation of key populations as a missing data problem provides a framework for articulating and evaluating the assumptions necessary to obtain a national size estimate. In addition, this paradigm allows use of methods for missing data familiar to epidemiologists. |
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Посилення контролю за туберкульозом в Україні: оцінка впливу стратегії інтеграції ТБ/ВІЛ-послуг на кінцеві результати лікування
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Зульфія Чарієва, Сміша Агарвал, Крістен Бруг, Шан Куртіс, Стефані Маллен |
2018 |
Ukrainian |
|
Coinfection, Ukraine, TB, AIDS, HIV, Tuberculosis |
Будучи однією з 30 країн у світі з найвищим рівнем захворюваності на туберкульоз, зокрема однією з 10 країн із найбільшим рівнем захворюваності на туберкульоз із множинною стійкістю, Україна належить до пріоритетних країн з точки зору боротьби з туберкульозом у регіоні Європейського регіонального бюро Всесвітньої організації охорони здоров'я. За оцінками, близько чверті всіх хворих на туберкульоз пацієнтів в Україні також інфіковані ВІЛ. Лікування коінфекції туберкульозу та ВІЛ є особливо складним, оскільки ТБ стає більш загрозливим за наявності пов'язаної з ВІЛ імуносупресії. Зважаючи на складність лікування коінфікованих пацієнтів, режими діагностики і лікування ВІЛ та ТБ мають бути тісно узгодженими: спеціалізовані послуги для пацієнтів з коінфекцією повинні бути легко доступними в центрах СНІДу та протитуберкульозних диспансерах. Проект "Посилення контролю за туберкульозом в Україні" (STbCU), що фінансується USAID, мав на меті покращити надання послуг в сфері лікування туберкульозу та ВІЛ, зокрема підвищити рівень своєчасності лікування та збільшити тривалість життя пацієнтів із коінфекцією ТБ і ВІЛ. На замовлення місії USAID в Україні в рамках проекту MEASURE Evaluation, що фінансується USAID і Президентським планом невідкладних заходів, спрямованих на подолання СНІДу (PEPFAR), було здійснено оцінку впливу проекту STbCU. |
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Data Demand and Use Curriculum – Facilitator’s Guide
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|
2018 |
English |
Global |
Health Information Systems, M&E, DDU, Data use, Data Demand and Use, HIS, Monitoring, Evaluation |
Significant human and financial resources have been invested worldwide in the collection of data to measurepublic health at various levels, such as within a specific population, facility, or community. However, thisinformation is not always used efficiently to inform policy and programmatic decision making. Health programsand policymakers often fail to link evidence to decisions about how to address public health issues. As a result,they are not able to respond most effectively to priority needs of the populations they serve.
Using data effectively for evidence-based decision making involves the following considerations:
How does information flow up to decision makers, and how do they use it to make their decisions?
In what contexts are data collected and decisions made?
What are the organizational infrastructures and technical capacities of those who generate and use data?
This curriculum and facilitator’s guide was designed to explain the conceptual basis for training on data demand and use (DDU) within an organization or program, or at the national, state, or district levels of government. It provides tools created by MEASURE Evaluation to facilitate the use of data in decision making. The goal is twofold:
Improve the understanding of the role of data in decision making, the context of decision making, the determinants of data use, and the importance of data sharing and feedback.
Build skills for applying DDU tools.
Ideally, this training course should be delivered to teams from the same organization or government level. Each team should include both data users and data producers. Data users are health professionals, policymakers, and other key health decision makers who use data to inform the design, implementation, monitoring, and improvement of health programs. Data producers are professionals who acquire and analyze health data and prepare them for distribution to users. These professionals may be monitoring and evaluation (M&E) specialists, data clerks, and researchers. This team approach to training ensures that all data producers and professionals involved understand their respective roles in DDU and how their roles interact with each other.
When team training is not feasible, this course may be used in separate trainings for data users and data producers from the same organization. To minimize costs, this type of training can be conducted as an add-on to previously scheduled meetings. In such a case trainers should emphasize the links between data users and data producers. |
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Measuring Venue-Based Risk: A Programmatic Mapping Study of Key Populations in Khomas Region, Namibia
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Zahra Reynolds, Ndapewa Hamunime, Steven Y. Hong, Taimi Amaambo, Ntombizodwa Makurira, Risper Kojwang |
2018 |
English |
|
Mapping, Namibia, HIV, HIV/AIDS, PEPFAR, PLACE, Key Populations |
Namibia has a generalized HIV epidemic, but certain populations experience a greater disease burden and risk for infection based on their behaviour. Most notably, female sex workers (FSWs), transgender (TG) women, and men who have sex with men (MSM) have higher prevalence rates compared to the general population. Previous studies have examined these populations through their social networks, but this study used a time-location sampling method to (1) identify places where key populations (KP) socialize and can be reached with outreach services and (2) calculate the size of the populations for FSWs, MSM, and TG women in Windhoek, Namibia. The study was designed to provide results to inform KP programming, both in reach and type. It aligns with the goal of the United States Agency for International Development (USAID) to control the HIV epidemic; the goal of the United States President’s Emergency Plan for AIDS Relief (PEPFAR) to “do the right things in the right places at the right times”; and the global 90-90-90 targets, established by the Joint United Nations Programme on HIV/AIDS. |
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Prevalence of Obstetric Fistula and Pelvic Organ Prolapse in Bangladesh: Summary of the 2016 National Estimates
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MEASURE Evaluation, icddr,b, the Maternal & Child Health Integrated Program, Fistula Care Plus, and Johns Hopkins University |
2018 |
English |
|
Bangladesh, Maternal Mortality, Obstetric care, Maternal Health |
The Bangladesh Maternal Mortality and Health Care Survey (BMMS) in 2016 aimed to measure national levels of obstetric fistula (OF) and pelvic organ prolapse (POP). Validating self-reported cases of OF and POP in the BMMS sample through clinical examination was not feasible for a nationwide sample of women. Therefore, the authors conducted a complementary study—the Maternal Morbidity Validation Study (MMVS)—to gather information on the validity of the self-reported OF and POP that can then be used to adjust the national level estimate from the BMMS data. The study was implemented by a partnership including MEASURE Evaluation, icddr,b, the Maternal & Child Health Integrated Program, Fistula Care Plus, Bangladesh’s National Institute of Population Research and Training, and Johns Hopkins University, with funding from USAID and UKAID. |
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Evaluating the impact of social support services on tuberculosis treatment default in Ukraine
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Martha Priedeman Skiles, Siân L. Curtis, Gustavo Angeles, Stephanie Mullen, Tatyana Senik |
2018 |
English |
|
Impact Evaluation, Tuberculosis, Ukraine, TB, Evaluation |
Ukraine is among the top 20 highest drug-resistant tuberculosis burden countries in the world. Driving the high drug-resistant tuberculosis rates is an unchecked treatment default rate. This evaluation measures the effect of social support provided to tuberculosis patients at risk of defaulting on treatment during outpatient treatment. Five tuberculosis patient cohorts, served in three oblasts from 2011 and 2012, were constructed from medical records to compare risk factors for default, receipt of social services, and treatment outcome. Regression analyses were used to identify risk factors predictive of treatment default and to estimate the impact of the social support program on treatment default, controlling for risk, disease status, and demographics. In 2012, tuberculosis patients receiving social support in Ukraine reduced their probability of defaulting on continuation treatment by 10 percentage points compared to high-risk patients who did not receive social support in 2012 or 2011. Treatment success rates for the high-risk patients receiving social support were comparable to the low-risk cohorts and significantly improved over the high-risk comparison cohorts. Further research is recommended to quantify the costs and benefits for scaling-up social support services, evaluate social support program fidelity, identify which populations respond best to select services, and what barriers might still exist to achieve better adherence. With that information, tailoring programs to most effectively reach and serve clients in a patient-centered approach may reap substantial rewards for Ukraine. |
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A Cost-Effective and Sustainable Approach for Strengthening the Capacity of Routine Health Information System Personnel in Mali
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MEASURE Evaluation |
2018 |
English |
|
Health Information Systems, Mali, RHIS, Routine Health Information Systems, Capacity Building |
Until recently, the Ministry of Health (MOH) in Mali did not have a specific training program to provide staff with cost-effective capacity building to manage and strengthen the country’s routine health information system (RHIS). No formal mechanisms existed for recognizing and engaging the RHIS staff or to provide them a career path. In addition, most training on RHIS were organized in institutions in neighboring countries, and participation in such regional trainings typically cost more than Mali could afford.
The lack of personnel highly skilled in maintaining and managing an RHIS posed a challenge to overall health system performance. The RHIS comprises resources and tools to support data collection, processing, analysis, and interpretation—all of which are essential for producing high-quality data to inform decision making.
With these factors in mind, MEASURE Evaluation approached the University of Bamako School of Medicine’s School of Public Health to discuss how to provide such training in country. Discussions began in early 2017 and led to the creation of a university degree on RHIS in the Department of Teaching, Research in Public Health (le Département d’Enseignment et de Recherche en Santé Publique, or DERSP), using an RHIS curriculum developed jointly by MEASURE Evaluation and global partners, including several universities. |
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Building a Web-Based Decision Support System
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Michael P. Edwards, Theo Lippeveld, Upama Khatri, Derek Kunaka, Michael Mwebaze, and Romain Tohouri |
2018 |
English |
Global |
Data, Interoperability |
As countries strengthen their data infrastructures, global health professionals increasingly need data from multiple sources for monitoring programs and for preventing and controlling the spread of epidemics. These varied sources of data complement one another, and when combined, improve the data’s usefulness.
Before data sources can be linked, they need to be interoperable. To accomplish this, countries are developing health information exchange protocols, also called interoperability layers or health information mediators. Many of the current efforts seek to make patient-level and aggregate data systems interoperable, using health information exchange standards.
To exploit the possibilities of linking multiple data sources, countries are establishing data repositories—also called data warehouses—which bring data sources together and link them through an interoperability layer. Data warehouses are connected to a “health observatory,” which is a gateway to health statistics. Health observatories permit access to in-depth analyses of population health and health services at the national, subnational, and district levels. Health observatories can take the form of dashboards, portals, and web interfaces developed for specific stakeholders.
Another component of a health observatory is a decision support system (DSS)—the focus of this paper. A DSS is a tool that brings data together from multiple sources and presents them in innovative visual formats: graphs, spatial analyses, and maps; health sector reports; and other media. A DSS makes health information more readily available, understandable, and, ultimately, more likely to be used by decision makers.
Access a related brief. |
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The MEASURE Evaluation–Tanzania Small Grants Program: Building Capacity and Informing HIV/AIDS Programs
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Bridgit Adamou |
2018 |
English |
TANZANIA |
Sustainability, self-reliance, HIV/AIDS, Small grants |
Participants attending the 2010 First Global Symposium on Health Systems Research learned that fewer than 10 percent of researchers working in the previous decade in low-income countries on research studies on health systems came from such countries. At the 2012 AIDS Conference, the International AIDS Society issued a call to build on the evidence base and best practices in HIV services and treatment, yet the opportunity to conduct health systems research remained largely unattainable to researchers living in the very countries being studied.
Small grants support health research in low-income countries and give country-based research groups the opportunity to examine local HIV issues and disseminate their findings directly to stakeholders where the research can inform policies and programs. Interventions that work through host-country systems galvanize the knowledge, experience, and support of ministries or local institutions and promote the vision of self-reliance shared by the United States Agency for International Development (USAID) and USAID-funded MEASURE Evaluation.
MEASURE Evaluation–Tanzania, a five-year associate award of USAID that began in 2014, sought to improve the evidence base on health systems by conducting research and building research capacity. To accomplish this, it instituted a small grants program that, through two rounds, provided technical and financial support to a number of local research groups. The researchers focused on research gaps for community health and social service programs addressing HIV/AIDS and the evidence base on linkages and retention in HIV/AIDS care and treatment programs. The program supported local researchers with primary and secondary data analysis, the development of a research manuscript, and assistance with the implementation of data use activities. This paper outlines the goals, processes, and results of implementing the small grants program and draws lessons from the experience. |
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Training a Tech-Savvy Health Workforce
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Sam Wambugu |
2018 |
English |
|
Health data, Technology, Health Workers, Digital Health, ICTs |
Digital technology is billed as an important catalyst in quickening the pace towards the achievement of universal healthcare in low- and middle-income countries (LMICs), where access to quality healthcare remains a pipe dream. Yet, to manage electronic health records, implement remote patient diagnosis and treatment, and manage digital data, health workers need a different set of skills.
For digital technology to be put to efficient use cutting costs, increasing patient safety, and improving overall management of health programs, human resource capacity at all levels is critical—both in skills and numbers.
It is with this realization that Kenyatta University in Kenya, in collaboration with MEASURE Evaluation—funded by the United States Agency for International Development (USAID)—and four other universities, hosted a week-long training program in July on appropriate application of information communication technologies (ICTs) to health programs. This brief provides a summary of the training. |
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Influences of gender norms and gender roles on HIV treatment engagement in Vietnam
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M. Do, H. Le H., H. Ho T., H. Dinh T., T. Truong Q., T. Dang V., D. Nguyen D., K. Andrinopoulos |
2018 |
English |
|
Health Services, Gender Norms, HIV, Gender |
This poster was presented at the 2018 International AIDS Conference.
Background: HIV-positive people who use injection drugs (PWID) face significant challenges that influence their engagement in HIV treatment, particularly in meeting normative expectations related to gender and drug use behavior. In contexts, like Vietnam, where heterosexual transmission of HIV is substantial, PWIDs'' female sexual partners (FSPs) are at risk of drug use and HIV infection. Understanding more about the relationship between gender expectations for PWID and FSPs with drug use and HIV treatment would help inform retention programs.
Methods: We describe how expected gender roles may contribute to HIV treatment engagement among HIV-positive male PWIDs and FSPs. In-depth interviews were conducted with 30 male PWIDs and 21 FSPs in September 2017. The interviews were in Vietnamese, translated into English, and analyzed using NVivo 11 software.
Results: Male PWIDs often presented later to treatment and were less likely to consistently stay in treatment than FSPs for several reasons. The perceived criminalization of drug use led to a higher level of discrimination reported by male PWIDs, compared to FSPs who were often perceived as victims of their partner''s behavior. FSPs who also inject drugs were also highly stigmatized. Perceived norms around the roles of men as the head of the household economically, in maintaining the family lineage and ancestor worship practices may negatively influence PWIDs'' retention, either because they had to travel for work, or had to hide their HIV status and treatment due to family''s expectations. FSPs, on the other hand, were more likely to stay in treatment because of their expected roles in taking care of their family and in-laws, although it could also be challenging as FSPs reported reluctance to seek support from their in-laws or their own family.
Conclusions: While the couple approach is important for HIV treatment retention, specific interventions need to be tailored to assist male PWIDs and FSPs overcome the challenges. The sharp differential treatment of male PWIDs vs. FSPs by families and communities imply that:1) more focused support for FSPs is needed for their long-term treatment and 2) an increasing number of FSPs who inject drugs could remain hidden, posing an additional challenge to HIV programs. |
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Political impunity and HIV vulnerability among Haitian female sex workers in the Dominican Republic
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E. Felker Kantor, Y. Donatstorg, B. Gomez, K. Andrinopoulos |
2018 |
English |
|
AIDS, HIV, Sex Workers, Haiti |
This poster was presented at the 2018 International AIDS Conference.
Background: In the Dominican Republic (DR), Haitian female sex workers (FSWs) are at increased risk for HIV (5.4% HIV prevalence vs. 0.7% national HIV prevalence). Haitian FSWs in the DR exist in a context of political impunity resulting from lack of citizenship and the liminal criminality of sex work. Exploratory research was conducted to understand the vulnerability of Haitian FSWs to HIV in the DR.
Methods: In-depth interviews were conducted with 40 FSWs of Haitian descent (two interviews each) in Puerto Plata (n=20) and Santo Domingo (n=20). Semi-structured guides asked about sex work, family and social networks, HIV risk behavior, gender and ethnic identity following an intersectional framework. Interviews were recorded and transcribed for thematic analysis.
Results: Participants reported high risk for HIV including low HIV knowledge, alcohol use prior to sex, and challenges in negotiating condom use with clients. Relative to Dominicans, participants reported that they were more likely to be street-based (versus venue), charged less per client, and were more often threatened by the client for deportation. While described as not ideal, sex work was noted as one of the few economic opportunities available to Haitian women. Participants described both spiritual and biomedical illness narratives related to HIV. Discrimination in the healthcare setting was reported, but access to HIV testing and care was seen as feasible. Participants reported experience with and fear of violence from male clients.
Conclusions: Haitian FSWs, similar to other stateless populations globally, are doubly at risk for HIV and in need of increased access to HIV education, substance use services, and condom negotiation skills. Street-based sex work combined with the threat of deportation increases their risk of violence and lowers their ability for condom negotiation. Health services targeted to this population should accommodate their belief in both spiritual and biomedical causes of HIV. |
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Changes in HIV and Non-HIV service delivery outcomes at the subnational level associated with PEPFAR funding shifts in Kenya and Uganda
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E.G. Sutherland, C.B. Agala, K. Xiong, S. Watson-Grant |
2018 |
English |
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Service delivery, Uganda, Kenya, HIV, Health Services |
The poster was presented at the 2018 International AIDS Conference.
Background: In 2014, PEPFAR changed its investment strategy within priority countries. This policy shift increased PEPFAR funds and support to some subnational units (SNU), while leaving investment unchanged?or virtually eliminated?in others, according to HIV disease burden. We aimed to identify shifts in HIV and non-HIV service delivery outcomes associated with changes in PEPFAR investment at the SNU level between 2015-2017 in Kenya and Uganda.
Methods: MEASURE Evaluation extracted quantitative data from relevant national HIV health information system databases (e.g., DHIS 2, TiBU [Kenya], iHRIS, etc.) between 2015-2017. Outcomes examined included HIV testing, initiation on ART, and adherence, ANC 4, or 4+ visits, confirmed malaria cases, and TB case detection rate. Qualitative interviews were conducted with SNU health teams to better understand the trends observed. Longitudinal multivariate analyses were conducted to determine the level of statistically significant changes in study outcomes by year, by change in PEPFAR investment, and for an interaction effect between year and PEPFAR investment level.
Results: Preliminary analyses of data between 2015-2016 suggest changes in PEPFAR investment did not immediately affect the direction of trends observed in HIV or non-HIV outcomes at SNU level. However, the magnitude of changes in outcomes observed in the post-PEPFAR prioritization period did significantly vary for some health outcomes by level of PEPFAR investment. For example, the proportion of newly identified HIV-positive individuals initiated on ART in Ugandan districts that lost PEPFAR funding increased significantly less than the same proportion in districts with maintained or increased PEPFAR support.
Conclusions: Because there were some significant differences in the magnitude of changes in health delivery outcomes (both HIV and non-HIV) associated with PEPFAR investment status at the SNU, findings suggests that shifts in PEPFAR investment (and by extension other large shifts in donor investment) may contribute to or worsen pre-existing health outcome disparities among subnational units within countries. However, as this study used aggregate SNU data, there could be a lag time between the implementation of investment shifts within countries, implementation of new interventions, and when changes in service delivery outcomes can be observed. |
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Framework and Toolkit to Strengthen Evaluation Capacity
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Stephanie Watson-Grant and Lauren Hart |
2018 |
English |
Global |
Toolkit, Tools, Capacity Assessment, Capacity Building |
The demand for accountability and rigorous evaluations of health programs has increased substantially. This has increased the pressure on national and regional institutions to conduct high-quality evaluations. This demand can highlight a capacity gap and creates an opportunity for capacity strengthening.
This document includes an evaluation capacity assessment framework and a guidance document for assessing and planning evaluation capacity strengthening. MEASURE Evaluation, which is funded by the United States Agency for International Development, created this toolkit is to help evaluators engage in collaborative implementation. The toolkit provides guidance on a systematic approach to work with research partners to strengthen their research capacity while collaboratively conducting an evaluation. |
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Results of Sample Vital Registration with Verbal Autopsy to Improve Malawi’s Health Programs
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MEASURE Evaluation |
2018 |
English |
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Vital Registration, SAVVY, Verbal Autopsy, Malawi, CRVS |
Vital statistics serve as an important data source for both government and nongovernmental entities to plan health programs. Specifically, measurement of causes of death are essential to understanding the health of a nation and where greater resources are needed to ensure that services prevent avoidable deaths. Measuring trends in cause of death helps countries like Malawi recognize the successes, failures, and opportunities related to health policies and initiatives.
Sample Vital Registration with Verbal Autopsy (SAVVY) can serve as a key source of vital statistics. SAVVY collects data on demographic and health indicators that can be used for planning, implementing, and evaluating policies and programs that are effective, equitable, and beneficial to reduce the burden of disease.
The objective of SAVVY in Malawi is to provide nationally representative estimates of age- and sex-disaggregated cause-specific mortality fractions. It relies on community-based data to capture both hospital- and community-based deaths. SAVVY is designed to collect reliable and timely data that illuminate current mortality issues to inform policies, programs, and monitoring and evaluation of health programs. In the Malawi context, objectives also included creating awareness of vital statistics, contributing to the development of the vital statistics program, and building capacity within the Government of Malawi to implement mortality surveillance. The baseline survey for SAVVY was implemented by the National Statistical Office (NSO) and the Central Monitoring and Evaluation Division (CMED) of the Ministry of Health (MOH), with technical assistance from the United States Census Bureau and the United States Agency for International Development- and United States President’s Emergency Plan for AIDS Relief (PEPFAR)-funded MEASURE Evaluation. Funding for this work came from PEPFAR. |
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How does integrating HIV and TB services affect health outcomes for HIV-TB coinfected patients in Ukraine? Results from an impact evaluation
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S. Agarwal, S. Curtis, S. Mullen, M. Skiles, Z. Charyeva, K. Brugh, C. Suchindran, O. Zaliznyak, T. Senik, P. Brodish, S. Eagan |
2018 |
English |
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Ukraine, Impact Evaluation, HIV care, TB, Tuberculosis, HIV, Integration |
This poster shares findings from an impact evaluation of the Strengthening Tuberculosis Control in Ukraine project, which examined the relationship between the project's TB-HIV integration strategy and TB/HIV service utilization and mortality outcomes. The poster was presented at the 2018 International AIDS Conference. |
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Use of HIV prevention services in the East Africa Cross-Border Integrated Health Study, 2016
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A. Virkud, J. Edwards, M. Markiewicz, G. Mulholland, P. Arimi |
2018 |
English |
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Key Populations, HIV prevention, HIV, HIV care |
East African cross-border sites are visited by mobile populations and others at greater risk of acquiring HIV: young women, female sex workers, fisherfolk, workers at public places, truck drivers, men who have sex with men, and people who inject drugs. These groups may not benefit from HIV treatment and prevention interventions conducted at their place of residence. This poster presents an analysis exploring whether venues that these populations visit in East African cross-border areas receive adequate HIV prevention services.
The poster was presented at the 2018 International AIDS Conference. |
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Improving Care for People in Ukraine Who Have Tuberculosis and HIV: Findings from a Qualitative Analysis of Integrated Services
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Z. Charyeva, S. Curtis, S. Mullen, R. Teal, O. Zaliznyak, T. Senik, S. Eagan |
2018 |
English |
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HIV care, HIV, Ukraine, TB, Tuberculosis, Evaluation |
This poster shares results from qualitative research conducted for an evaluation of the Strengthening Tuberculosis Control in Ukraine project. It was presented at the 2018 International AIDS Conference. |
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Strengthening Tuberculosis Control in Ukraine: Evaluation of the Impact of the TB-HIV Integration Strategy on Treatment Outcomes
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Zulfiya Charyeva, Smisha Agarwal, Kristen Brugh, Siân L. Curtis, Stephanie Mullen |
2018 |
English |
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Social services, Impact Evaluation, TB, Tuberculosis, HIV care, Coinfection, Ukraine, Intervention, HIV |
Ukraine is one of 30 countries with the highest tuberculosis (TB) burdens in the world, and one of 10 countries with the highest incidence of multidrug-resistant TB, making it one of the highest priority countries in the World Health Organization European Region to fight TB. About one quarter of all patients with TB in Ukraine are estimated to also to be HIV-positive. The treatment of TB-HIV coinfections is particularly challenging as TB becomes more virulent in the presence of HIV-associated immunosuppression. Given the complexities of treating coinfected patients, HIV and TB diagnostic and treatment regimens need to be closely aligned: specialized services for patients with coinfections need to be readily available at AIDS centers and TB dispensaries. Strengthening Tuberculosis Control in Ukraine (StbCU)—a project funded by the United States Agency for International Development (USAID)—aimed to strengthen the delivery of TB and HIV services, with the goal of improving timeliness of care and enhancing the life expectancy of patients with TB-HIV coinfections. The USAID mission in Ukraine commissioned MEASURE Evaluation—funded by USAID and the United States President’s Emergency Plan for AIDS Relief—to conduct an impact evaluation of the STbCU project. This report discusses the evaluation and findings.
Access a related workshop report to disseminate the findings. Also available in Ukrainian. |
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Obstetric ultrasound use in low and middle income countries: a narrative review
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Eunsoo Timothy Kim, Kavita Singh, Allisyn Moran, Deborah Armbruster, and Naoko Kozuki |
2018 |
English |
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MCH, Maternal and child health, LMICs, Obstetric care |
IntroductionAlthough growing, evidence on the impact, access, utility, effectiveness, and cost-benefit of obstetric ultrasound in resource-constrained settings is still somewhat limited. Hence, questions around the purpose and the intended benefit as well as potential challenges across various domains must be carefully reviewed prior to implementation and scale-up of obstetric ultrasound technology in low-and middle-income countries (LMICs).
Main BodyThis narrative review discusses these issues for those trying to implement or scale-up ultrasound technology in LMICs. Issues addressed in this review include health personnel capacity, maintenance, cost, overuse and misuse of ultrasound, miscommunication between the providers and patients, patient diagnosis and care management, health outcomes, patient perceptions and concerns about fetal sex determination.
ConclusionAs cost of obstetric ultrasound becomes more affordable in LMICs, it is essential to assess the benefits, trade-offs and potential drawbacks of large-scale implementation. Additionally, there is a need to more clearly identify the capabilities and the limitations of ultrasound, particularly within the context of limited training of providers, to ensure that the purpose for which an ultrasound is intended is actually feasible. We found evidence of obstetric uses of ultrasound improving patient management. However, there was evidence that ultrasound use is not associated with reducing maternal, perinatal or neonatal mortality. Patients in various studies reported to have both positive and negative perceptions and experiences related to ultrasound and lastly, illegal use of ultrasound for determining fetal sex was raised as a concern.
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Impact Evaluation of Malawi's Organized Network of Services for Everyone's (ONSE) Health Project: Baseline Report
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Emily Weaver, Milissa Markiewicz, Bernard Agala, and John Kadzandira |
2018 |
English |
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Maternal Health, Child Mortality, Malawi, Child Health, Child survival, Impact Evaluation |
MEASURE Evaluation is conducting an impact evaluation of the Organized Network of Services for Everyone’s (ONSE) Health project, in Malawi. ONSE aims to reduce maternal, newborn, and child morbidity and mortality.
The primary goal of the impact evaluation is to estimate the extent to which the ONSE project has impacted health outcomes.
The study uses a quasi-experimental approach in three ONSE and three non-ONSE districts. The end line survey will use a difference-in-differences approach to estimate the causal impact of the ONSE project on changes in health and facility outcomes. Baseline data were collected from April to July 2017 from 7,929 households and 139 health facilities.
Skilled antenatal care (ANC) attendance and skilled birth attendance were almost universal. One-half of pregnant women received the recommended four or more ANC visits during their pregnancy. Knowledge of key maternal and newborn danger signs was very low. The availability of services for family planning, ANC, and basic obstetric care was very high. Readiness to provide services was more varied. Obstetrics was the area with the lowest general readiness of all service types. Assisted vaginal delivery and removal of retained products were the two signal functions of basic emergency obstetric and newborn care provided by the lowest percentage of health facilities and hospitals. The end line survey will provide follow-up data on these indicators and will measure change over the project period. |
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Integrating Heath Facility Information in Nigeria: Progress on a Master Facility List and Health Facility Registry
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MEASURE Evaluation |
2018 |
English |
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Data, HIV, Health Information Systems, Nigeria, Health Facilities, Master facility list |
A master facility list (MFL) is a data source for countries or a district within a country that comprises a list of health facilities, by location and type of services delivered; a data system that houses the data on each facility; and the governance structure to support the continued updating and maintenance required to sustain the MFL’s accuracy.
An accurate list of health facilities referenced by their geographic location is a crucial tool for the health sector to be able to offer services that meet local needs, and to ensure HIV services are offered in the areas where there is the greatest potential to achieve control of the HIV epidemic. MEASURE Evaluation—funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—is a global leader in working with countries to build national master facility lists.
Developing an MFL and a health facility registry (HFR) to house data was a priority action in the Nigeria Health Information System Strategic Plan (2014–2018). However, this was yet to be fully achieved in 2016, with a chief shortcoming that processes to facilitate ongoing management did not exist. As part of strengthening the national health information system (HIS) in Nigeria, addressing this gap was prioritized by USAID, which had previously supported the development of a paper-based MFL in the country between 2011 and 2013.
This brief documents the first phase of the process of creating a sustainable MFL/HFR, including the creation of local ownership through strong governance structures and the consolidation and validation of the facility listing. We display the process in a timeline (Figure 1) and in a model (Figure 2) that illustrates improvements made and those desired in three main MFL elements: (1) a facility listing; (2) a facility registry; and (3) governance structures in Nigeria. (The rollout of the MFL/HFR to the states so they may update the outstanding data elements in the HFR and begin maintaining the MFL is the next crucial step.)
The process may serve as a guide for other countries wishing to refine or establish an MFL/HFR. |
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Decision Tree to Assess Capacity for Monitoring and Evaluation and to Manage Health Information Systems
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MEASURE Evaluation |
2018 |
English |
Global |
M&E, Data informed, Monitoring, Evaluation, Data use |
A step-wise guide to tools that can help countries to assess their capacity to monitor and evaluate their health information systems (HIS). This “decision tree” guides readers through relevant questions and describes how to answer them with ready-made tools. MEASURE Evaluation, funded by the United States Agency for International Development (USAID), works globally in low-resource settings to help countries improve their capacity to collect, analyze, and use health data for better health outcomes for people. The first page provides a graphic guide through a set of questions and appropriate tools. The second page gives an overview of each tool mentioned. |
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Botswana's Gender-Based Violence Referral System Project: Operations Research End Line Report
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Abby Cannon, Sarah Treves-Kagan, Meghan Cutherell, Jessica Fehringer, Helen Apps, Peggie Ramaphane, Shelah S. Bloom |
2018 |
English |
Africa, BOTSWANA |
GBV, Gender, Gender-based violence, Botswana |
This operations research study evaluated a pilot mobile phone-based referral system for survivors of gender-based violence in Botswana. Through a quasi-experimental design, researchers sought to improve understanding of the process and results of that counttry’s Gender-Based Violence Referral System Project. This report presents results and recommendations related to community perceptions of gender-based violence (GBV), provider perceptions and processing of GBV cases, and the GBV referral system. |
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Assessing Alternative Care for Children in Armenia
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Zulfiya Charyeva, Hasmik Ghukasyan, Armenia country core team |
2018 |
English |
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Alternative Care, Children, Child Health, Armenia, Care for children |
Armenia’s care reform initiative is based on the United Nations Guidelines for Alternative Care of Children (hereinafter referred to as the UN Guidelines), which outlines specific principles and standards for the appropriate care of children to ensure that they grow up in a protective environment, free from deprivation, exploitation, danger, and insecurity. To support this agenda, the Ministry of Labor and Social Affairs (MOLSA), with funding and technical assistance from the Displaced Children and Orphans Fund (DCOF) of the United States Agency for International Development (USAID) and MEASURE Evaluation, conducted a self-assessment of the care reform system at a participatory stakeholder workshop held January 17–19, 2018, at the Tsakhkadzor Hotel Russia, in Armenia.
The purpose of the assessment workshop was to bring together key stakeholders—decision makers, policy developers, service providers, civil society representatives, and donors—to assess and identify the main care reform areas in which action is needed. The assessment results aim to provide information to improve the implementation of care reform in line with the government’s international commitments and the National Strategy and Action Plan on Child Rights Protection in the Republic of Armenia for 2017‒2021.
The main findings of the assessment workshop are summarized by area of care, following the logic of the discussions. We also summarize findings by system components, followed by a summary of recommendations organized in the same way, to allow for the rapid identification of common issues for all areas of care that require immediate attention. |
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ՀԱՅԱՍՏԱՆՈՒՄ ԵՐԵԽԱՆԵՐԻ ԽՆԱՄՔԻ ԵՎ ՊԱՇՏՊԱՆՈՒԹՅԱՆ ՀԱՄԱԿԱՐԳԻ ԲԱՐԵՓՈԽՈՒՄՆԵՐԻ ՄՇՏԱԴԻՏԱՐԿՈՒՄ, ԳՆԱՀԱՏՈՒՄ ԵՎ ՎԵՐՀԱՆՎԱԾ ԽՆԴԻՐՆԵՐԻՆ ԱՐՁԱԳԱՆՔՈՒՄ․ ՄԱՍՆԱԿՑԱՅԻՆ ԳՆԱՀԱՏՄԱՆ ՀԱՇՎԵՏՎՈՒԹՅՈՒՆ
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Զուլֆիյա Չարիևա, Տեխնիկական խորհրդատու, MEASURE Evaluation/Պալադիում, Հասմիկ Ղուկասյան, ՄԳ հարցերով խորհրդատու, MEASURE Evaluation/Պալադիում Երկրի հիմնական թիմի անդամներ |
2018 |
Armenian |
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Alternative Care, Children, Care for children, Armenia, Child Health |
Հայաստանում երեխաների խնամքի և պաշտպանության համակարգի բարեփոխումների գնահատման նախաձեռնությունը հիմնված է Միավորված ազգերի կազմակերպության «Երեխայի այլընտրանքային խնամքի մասին ուղեցույցի» վրա, որը նկարագրում է երեխաների պատշաճ խնամքին վերաբերող հիմնական սկզբունքներն ու ստանդարտները, որոնք ուղղված են ապահովելու, որ երեխաները մեծանան պաշտպանված միջավայրում՝ զերծ զրկանքներից, շահագործումից, վտանգներից և անապահովությունից։ Այս նպատակներին աջակցելու համար ՀՀ աշխատանքի և սոցիալական հարցերի նախարարությունը (ԱՍՀՆ) Ամերիկայի Միացյալ Նահանգների Միջազգային զարգացման գործակալության (ԱՄՆ ՄԶԳ) «Տեղահանված և ծնողազուրկ երեխաների հիմնադրամի» (DCOF) և “MEASURE Evaluation» ծրագրի ֆինանսավորմամբ և մասնագիտական աջակցությամբ իրականացրեց երեխաների խնամքի և պաշտպանության համակարգի բարեփոխումների մասնակցային ինքնագնահատում՝ հիմնական շահագրգիռ կողմերի հետ աշխատաժողովի միջոցով, որը տեղի ունեցավ Հայաստանում 2018 թվականի հունվարի 17-ից-19-ը, Ծաղկաձորի «Ռոսիա» հյուրանոցում։
Գնահատման աշխատաժողովի նպատակն էր մեկտեղել երեխաների խնամքի և պաշտպանության համակարգի բարեփոխումներում ներգրավված հիմնական դերակատարներին, այդ թվում՝ որոշում կայացնողներին, քաղաքականություն մշակողներին, ծառայություն մատուցողներին, քաղաքացիական հասարակության ներկայացուցիչներին և դոնորներին՝ գնահատելու և հայտնաբերելու երեխաների խնամքի և պաշտպանության համակարգի բարեփոխումների այն ուղղությունները, որոնք պահանջում են հրատապ միջամտություն և գործողություններ։ Գնահատման արդյունքները կնպաստեն բարելավելու երեխաների խնամքի և պաշտպանության համակարգի բարեփոխումների իրականացումը՝ կառավարության ստանձնած միջազգային պարտավորություններին և ՀՀ երեխայի իրավունքների պաշտպանության 2017-2021թթ․ ազգային ռազմավարության ու միջոցառումների ծրագրին համահունչ։
Գնահատման աշխատաժողովի հիմնական արդյունքներն ամփոփվել են ըստ խնամքի ոլորտների, հետևելով քննարկումների տրամաբանությանը, իսկ առաջարկությունների ցանկը տրամադրվել է ըստ համակարգի բաղադրիչների, ինչը թույլ կտա արագ հայտնաբերել խնամքի բոլոր ոլորտների համար անհապաղ ուշադրություն պահանջող ընդհանուր հարցերը։ |
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Bangladesh's Electronic Management Information Systems: Using Digital Technology to Link Community Data with Facility Data: Case Study
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Dawne Walker, Tariq Azim |
2018 |
English |
BANGLADESH |
Community, HIS, Information systems, MHealth, Health Information Systems, Bangladesh, CHIS |
Strengthening community health information systems (CHIS) entails improving the case management data collection tools used by community health workers and the performance monitoring tools used by their supervisors. By strengthening these tools, the quality of information flowing into the CHIS will improve and be more likely to be used for decision making by wider stakeholder groups. This case study sought to answer the following question:
Is there a use case where a country has strengthened its CHIS and linked it to a facility information system using mHealth solutions?
To answer this question, MEASURE Evaluation used the mHealth for monitoring and evaluation (M&E) and case management landscape analysis developed for Scaling Mobile Community-Based Health Information Systems to select an example for the case study. We looked for examples in which the national government was involved in developing mobile case management tools and integrating the mobile tools with the larger electronic health management information system (MIS).
In Bangladesh, the Ministry of Health and Family Welfare (MOHFW) and its partners—the United States Agency for International Development (USAID), the USAID-funded MEASURE Evaluation, the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), the MaMoni Health Systems Strengthening (HSS) Project, and the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Project—have implemented an electronic MIS (eMIS) in two districts and are scaling it up nationally. This eMIS created an integrated electronic data system in which data collected at the community level are shared across primary healthcare providers and flow up to the national level. This case study looks at how Bangladesh established the eMIS and the initial changes in data management as well as service delivery that have resulted from implementing the system. |
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Impact Evaluation of the Western Highlands Integrated Program in Guatemala: Midline Report
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Gustavo Angeles, PhD (team lead); Aimee Benson, MA; Paul Brodish, PhD; Kristen Brugh, PhD; Roberto Molina, MSc; Martin Romero, PhD; Tory M. Taylor, MPH; Emily Weaver, PhD; Jose Urquieta, PhD |
2018 |
English |
GUATEMALA |
Nutrition, Evaluation, Impact Evaluation, Guatemala |
The main objectives of the Western Highlands Integrated Program (WHIP), which was funded by the United States Agency for International Development (USAID)/Guatemala, were to reduce poverty and chronic malnutrition among children in 30 priority municipalities. The program combined the Rural Value Chains Project (RVCP) with a health and nutrition program. The primary evaluation question focused on the effects of the WHIP on key indicators at the population level in the program’s zone of influence (ZOI). The secondary evaluation questions focused on understanding the impacts of the integrated (RVCP plus health/nutrition) program and the health/nutrition program by itself; the relative effectiveness of the integrated program compared to the health intervention alone; and the presence of spillover effects from RVCP direct beneficiaries to nonassociation members’ households in RVCP areas (known as RVCP indirect beneficiaries). The evaluation used a prospective, quasi-experimental study design with a matched comparison group, and implemented a difference-in-differences analysis controlling for household-level fixed effects using pooled baseline and midline data from a panel of households. Results of the midline impact evaluation indicated that although there was no statistically significant program impact on household consumption, poverty, or hunger, these indicators were moving in the expected direction consistent with the program’s theory of change. Mixed results in the time trends for infant and young child feeding practices, nutritional status, and the decreasing use of reproductive and maternal health services suggest that the cessation of the health and nutrition program in 2013/2014 may have had detrimental effects on these indicators in the ZOI areas. |
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Assessment of the 2017 National Campaign for the Promotion of Family Planning in Mali
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MEASURE Evaluation |
2018 |
English |
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Family Planning, Mali, Contraception, Evaluation |
The Republic of Mali has one of the world’s lowest modern contraceptive prevalence rates (9.9%). This low rate contributes not only to high fertility and rapid population growth, but also to high rates of infant and maternal mortality. The government of Mali has made strides to improve these conditions by repositioning family planning (FP) as an essential public health and development intervention. Mali is also actively participating in global FP initiatives, such as the Ouagadougou Partnership and FP2020. Mali’s National Strategic Plan for 2014–2018 identifies four priority areas—demand, supply, enabling environment, and the reliability of the monitoring and coordination system—to reach the goal of increasing the contraceptive prevalence rate to 15 percent by 2018 (Ministère de la Santé et de l’Hygiène Publique, 2014).
As part of the National Strategic Plan, the Malian government organizes an annual FP campaign. In 2017, MEASURE Evaluation was hired by USAID/Mali to conduct an evaluation of the 2016 national campaign. The objective of the evaluation was to assess how well the campaign’s activities were implemented and to highlight required adjustments that should be made to improve future FP campaigns and interventions. The assessment focused on the five target intervention districts of Diéma, Bougouni, San, Koro, and Nara. The findings were presented to local stakeholders in a written report and at a dissemination workshop. The final version of the evaluation report on the 2016 national campaign to promote FP identified many strengths and weaknesses in the campaign.
In 2017, Mali launched its thirteenth national FP campaign on August 24, 2017, with a theme of “A responsible and engaged youth committed to FP in Mali, a way to reach the demographic dividend.” Due to a variety of factors, the campaign was postponed from its typical April launch to an August launch and was implemented over a period of approximately nine weeks, ending on October 22, 2017 (extended from the initial end date of September 23). Importantly, one reason for the delay was to consider some of the findings from the 2016 evaluation; namely, to strengthen contraceptive supply and logistics management in order to avoid stockouts and to add indicators to the health information system in order to monitor the campaign activities. This assessment of the 2017 campaign activities and outcomes aims to provide the opportunity to determine whether improvements were made, to assess whether the campaign achieved its intended outcomes, and to formulate other recommendations. |
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Evaluation de la Campagne nationale de 2017 pour la promotion de la planification familiale au Mali
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MEASURE Evaluation |
2018 |
French |
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Evaluation, Mali, Family Planning |
Le taux de prévalence contraceptive au Mali est l’un des plus faibles au monde (9,9%). Ce faible taux contribue non seulement à un niveau de fécondité élevé et à une croissance démographique rapide mais également à des taux élevés de mortalité maternelle et infantile. Le Gouvernement du Mali a réalisé des progrès considérables pour remédier à la situation, notamment en repositionnant la planification familiale en tant qu’intervention essentielle en matière de santé publique et de développement. Par ailleurs, le Mali participe activement à des initiatives globales dans le domaine de la PF, telles que le Partenariat de Ouagadougou et FP2020. Le Plan stratégique national pour la période s’étalant de 2014 à 2018 définit quatre domaines prioritaires, à savoir l’offre, la demande, la présence d’un environnement habilitant et la fiabilité du dispositif de suivi et de coordination, pour atteindre l’objectif d’améliorer le taux de prévalence contraceptive à 15 pour cent d’ici 2018 (Ministère de la Santé et de l’Hygiène Publique, 2014).
Dans le cadre du Plan Stratégique National, le gouvernement du Mali organise chaque année une campagne nationale de PF. L’année dernière, MEASURE Evaluation a été engagé par l’USAID/Mali pour évaluer la campagne nationale de 2016. L’objectif de cette évaluation était de déterminer dans quelle mesure les activités de la campagne ont été mises en œuvre et faire ressortir les ajustements nécessaires qui devraient être faits pour améliorer les futures campagnes et interventions de PF. L’évaluation s’est focalisée sur les cinq districts d’intervention intensive de Diéma, Bougouni, San, Koro, et Nara. Les résultats ont été présentés aux parties prenantes locales par le biais du rapport d’évaluation et l’atelier de dissémination. Le rapport d'évaluation final de la campagne nationale de 2016 pour la promotion de la PF a mis en lumière un certain nombre de points forts et de points faibles durant la campagne.
En 2017, la 13ème édition de la campagne nationale PF au Mali a été lancée le 24 août 2017 avec pour thème « Une jeunesse impliquée et responsable qui s’engage à utiliser la PF au Mali comme moyen d’atteindre le dividende démographique ». Compte tenu de certains facteurs, la campagne prévue en avril (sa date de lancement habituelle) a été repoussée en août pour une durée de mise en œuvre d’environ 9 semaines et a pris fin le 22 octobre 2017 (après une extension par rapport à son échéance initiale du 23 septembre 2017). Il est important de noter qu’une des raisons du report était liée à la prise en compte de certains résultats de l’évaluation de 2016, à savoir renforcer la gestion logistique et l’approvisionnement en contraceptifs pour éviter les ruptures de stock et pour ajouter des indicateurs au système de données sanitaires afin de suivre les activités de la campagne. Une évaluation des activités et des résultats de la campagne de 2017 fournira l’opportunité de déterminer si des améliorations ont été faites, si les objectifs prévus ont été atteints et de formuler d’autres recommandations. |
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Western Highlands Integrated Program Evaluation Addendum to the Baseline Report: Sampling Considerations
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Roberto Molina-Cruz, Tory M. Taylor, Gustavo Angeles |
2018 |
English |
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Monitoring, Guatemala, Sampling, Monitoring, Evaluation, Evaluation |
This document is an addendum to the Monitoring and Evaluation Survey for the Western Highlands Integrated Program: Baseline 2013 report released in 2014 (Angeles, Hidalgo, Molina-Cruz, Taylor, Urquieta-Salomón, Calderón…Romero, 2014). It contains detailed additional technical information on the sampling procedures used in the baseline household survey, including the development of the sampling frame for domains specific to the Rural Value Chains Project (RVCP); the initial selection procedures for primary and secondary sampling units (census tracts and households, respectively); and procedures for sampling unit replacements.
The content is organized in three sections: 1) unit identification and selection processes for sample domains 1 and 2, which relied heavily on beneficiary lists obtained from program partners and subsequent household mapping and verification activities; 2) the necessary deviations from probability-based approaches in census tract selection and possible analytic implications; and 3) the replacement of households in the sample and likelihood of affiliated bias in the baseline results. |
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National Social Service Systems for Orphans and Vulnerable Children: Tool for Data Management, Analysis, and Use
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MEASURE Evaluation |
2018 |
English |
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OVC, Social services, Data use, Orphans and Vulnerable Children |
System strengthening is recognized globally as a logical and effective step to improving the efficiency, quality, and sustainability of service delivery. The USAID- and PEPFAR-funded MEASURE Evaluation developed a framework for planning, monitoring, and evaluation to fill part of the gap that exists in demonstrating the impact that system strengthening has on child outcomes, by providing indicators and guidance for measuring system performance. These indicators measure the outcome of system-strengthening interventions in five core areas, defined by PEPFAR as the components of social service system strengthening: (1) leadership and governance structures; (2) the social service workforce; (3) financing; (4) information management and accountability systems; and (5) coordination and networking mechanisms. MEASURE Evaluation published a full guidance document that defines these indicators and offers guidance to apply them in a country or program.
This is an Excel-based tool to support data management, analysis, and use upon implementing the indicators. This tool should be used to collect and store information for all the indicators. It should also be used to support interpretation and application of results to strengthen the system.
French language version: Système national des services sociaux pour les orphelins et les enfants vulnérables: Outil pour la gestion, l'analyse et l'utilisation des données
National Social Service Systems for Orphans and Vulnerable Children – Framework for Planning and Monitoring and Evaluation |
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Characterizing Male Sexual Partners of Adolescent Girls and Young Women in Mozambique: Quantitative Results from Beira, Quelimane, and Xai-Xai Districts
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Jenifer Chapman, Sarah Treves-Kagan, Mahua Mandal, Ariane Dinis |
2018 |
English |
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AGYW, Young Women, Mozambique, Adolescent Girls, HIV, HIV prevention |
Globally, adolescent girls and young women (AGYW), ages 15–24 years, are disproportionately affected by HIV/AIDS. In 2016, approximately 400,000 of this group were newly HIV-positive. Despite the epidemiological and human rights imperative to support AGYW in remaining AIDS-free, programming to date has had limited success.
One strategy for preventing HIV infection among AGYW is to prevent their HIV-negative male sexual partners from acquiring HIV and to reduce the infectiousness (the ability to transmit the virus) of those male partners who are HIV-positive. That strategy would be easier to implement if programs had more information about the characteristics of AGYW’s male sexual partners.
This is the first study meant to characterize the male sexual partners of AGYW in Mozambique—a country where HIV prevalence among youth ages 15–24 years is more than three times higher among females than males: 9.8 percent versus 3.2 percent. Results of this study illuminate sexual risk behaviors in the context of different types of relationships, the characteristics of male sexual partners of AGYW, and their health-seeking behavior and HIV service preferences. This information should be used by programs to better reach male sexual partners of AGYW with HIV prevention and care programming.
Access the related Characterizing Male Sexual Partners of Adolescent Girls and Young Women in Mozambique: Findings from Focus Group Discussions in Xai-Xai, Beira, and Quelimane Districts resource. |
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Improving Family Planning Service Delivery in Ghana
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Erasmus E.A. Agongo, Kofi Issah, John E. Williams, Francis Ayaba, Beatrice Kunfah, and Windfred Kombla Ofosu |
2018 |
English |
GHANA |
Monitoring, Evaluation, Ghana, Family Planning, Service access and availability |
Family planning (FP) is one of the most cost-effective interventions for improving the health of children and women, and the achievement of Millennium Development Goal (MDG) 4 (reducing under-five child mortality by two-thirds) and MDG 5 (reducing maternal mortality by three-fourths) from the 1990 figures by 2015. Despite several national and global initiatives to improve health outcomes, challenges remain in low- and middle-income countries to achieve national and global targets.
Ghana has a long history of population policies and FP programs that have contributed to increased use of contraceptive services and improved maternal and child health. However, the country has not achieved MDGs 4 and 5, particularly in the three northern regions, which are the poorest and most deprived. This study focuses on one of those areas―the Upper East Region (UER). Although the UER has made great strides in improving access to FP services, there is still a huge unmet need.
The objectives of this study were to map out the distribution of all FP service providers in the region and document how the community-based FP information system is linked to the national system as a means to recommend strategies for supporting program planning and implementation and improving FP services. |
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Development of a Centralized Collection of Community-Based Indicators for HIV Programs
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Jackie Hellen and Dawne Walker |
2018 |
English |
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CBIS, HIV/AIDS, Community-based, Community, HIV, Community-based health information systems |
Information from community-based health programs is important for understanding what HIV programs are doing to test, treat, and retain in care people who are living with HIV. However, until now there has been no centralized registry of community-based indicators that would allow programs to inform HIV programming at the community level.
To address the need for standard measures of performance, MEASURE Evaluation developed an online collection, Community-Based Indicators for HIV Programs. The collection includes detailed indicator definitions, data use cases for selected indicators, additional resources, and a means to submit an indicator or make recommendations. This brief provides an overview of the collection. |
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Male Engagement in Family Planning Indicator Brief
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MEASURE Evaluation |
2018 |
English |
Global |
M&E, Male engagement, Monitoring, Evaluation, Family Planning, Indicators |
Constructive male engagement in family planning (FP) entails a thoughtful, gender-sensitive approach that places gender equality and women’s empowerment on equal footing with other desired outcomes (Gilles, 2015). When men are engaged in FP, gender equity improves, leading to better health outcomes for men, women, and children.
Rigorous monitoring and evaluation (M&E) is essential to the success of FP programs, and establishing consistent and effective indicators is part of the work of MEASURE Evaluation, which is funded by the United States Agency for International Development, to improve health information systems globally. This brief outlines 15 key indicators that ministries of health and organizations can use to inform the M&E of programs that encourage male engagement in FP.
Each indicator featured here contains its definition, suggested disaggregations, and, if applicable, calculation. Full indicator reference sheets for all indicators in this brief may be accessed online at the MEASURE Evaluation Family Planning and Reproductive Health Indicators Database, here: https://www.measureevaluation.org/prh/rh_indicators |
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Guinea's Readiness Response to Ebola: Strengthening Data Availability and Use
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MEASURE Evaluation |
2018 |
English |
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Routine Health Information Systems, RHIS, Data use, Guinea, HIS, Health Information Systems, Ebola, Data |
A serious outbreak of Ebola virus disease in Guinea in 2014 resulted in 3,801 recorded Ebola cases and 2,533 recorded deaths—the highest mortality rate (66%) from Ebola in West Africa. Disruptions caused by the outbreak were inevitably felt throughout the healthcare system, leading the international community to call for investment to strengthen a weakened healthcare infrastructure. The urgency of the Ebola response challenge led to a heightened awareness of shortcomings in the nation’s health information system (HIS) and accelerated the search for appropriate digital data platforms, including electronic and mobile data systems. It also led to consideration of the potential of digital technology to contribute to the restoration and long-term resilience of the health system. In September 2015, MEASURE Evaluation, funded by the United States Agency for International Development (USAID), embedded two senior advisors in the Ministry of Health (MOH) to begin developing an environment that would support creation of a health information strategy, work to strengthen health data collection in the routine health information system (RHIS), and support efforts to strengthen the organizational infrastructure within the MOH.
By December 2017, Guinea’s RHIS environment had these fundamental elements in place:
A DHIS 2 platform established and functional nationwide down to districts and prefectural hospital levels (100%)
A national five-year HIS strategic plan and a costed operational plan developed and updated RHIS guidance documents developed for national use (IPs then collaborated to disseminate them for use at lower levels throughout the country); MEASURE Evaluation led the technical assistance (TA) and paid for piloting and rollout of DHIS 2 (training, equipment, supervision visits, maintenance, Internet fees, etc.) in more than half of the country (three regions: Conakry, Kindia, and Labé) and provided TA when possible to other regions that requested it.
Data review meetings conducted at regional, district, and health facility levels; data dashboards and data visualizations developed at the district level; and national RHIS quarterly bulletins published
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Workshop to Disseminate Findings and Facilitate Data Use: Impact Evaluation of Strengthening Tuberculosis Control in Ukraine (STbCU) Project Workshop Report
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Nicole Judice, Zulfiya Charyeva |
2018 |
English |
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HIV, Tuberculosis, HIV/AIDS, TB, Ukraine |
The United States Agency for International Development (USAID) mission in Ukraine is testing strategies to combat the problems posed by multidrug-resistant tuberculosis (MDR-TB) and HIV. One strategic mechanism was the Strengthening Tuberculosis Control in Ukraine (STbCU) project. The project’s goal was to decrease the country’s tuberculosis (TB) burden and to improve the quality of TB services, including detection and treatment of TB, MDR-TB, and extensively drug-resistant TB. The project also aimed to provide prevention and treatment support to counter the rapid growth of TB and HIV coinfection
USAID Ukraine commissioned MEASURE Evaluation to conduct an impact evaluation of the STbCU project. This report focuses on a workshop conducted to disseminate the findings of the STbCU project impact evaluation and to facilitate their use. MEASURE Evaluation convened the workshop on March 14–16, 2018, in Kyiv, Ukraine. The report presents the content of each day of the workshop along with recommendations generated by participants. The report concludes with a brief description of next steps. |
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Strengthening Routine Health Information Systems through Electronic Management Systems in Bangladesh
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MEAUSURE Evaluation |
2018 |
English |
BANGLADESH |
Routine data, Bangladesh, Routine Health Information Systems, MIS |
The aims of the Electronic Management Information System(s) are large: nothing less than to change the way public sector community health workers (CHWs) do their jobs. CHWs provide outreach, information, and referral for health services in culturally and socially appropriate ways. They are a link between communities and health facilities and collect vital demographic and health service-related data on people living within their catchment areas. Prior to the initiative, these frontline healthworkers used paper-based forms and huge register books to gather data on health complaints of presenting clients, health services delivered, and medicines used. All those data were to inform policy making and resource allocations to improve health for the population.
This technical document gives an overview of the tools developed under the eMIS initiative. |
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Retaining Adolescent Girls and Young Women in HIV Prevention Programming: A Review of Girls' Clubs and Savings Groups in Mozambique
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Nena do Nascimento, Susan Settergren, Thandie Harris-Sapp |
2018 |
English |
MOZAMBIQUE, Africa |
AGYW, HIV, Young Women, HIV/AIDS, Adolescent Girls, Mozambique, HIV prevention |
To strengthen adolescent girls and young women (AGYW) programming in Mozambique and inform the design, implementation, and monitoring of PEPFAR girls’ clubs and savings groups globally, USAID asked MEASURE Evaluation to implement an activity with the following objectives:
1. Gather information from the literature and the two projects in Mozambique implementing girls’ clubs and savings groups for AGYW regarding the following:
The dosage (i.e., length of participation and number of sessions attended) to achieve intended program outcomes
Approaches used to promote consistent participation (or “retention”) in these groups, and methods used to measure retention
2. Summarize findings and provide data collection guidance (e.g., interview topics and suggested methods) for programs to use in improving retention in girls’ clubs and savings groups for AGYW.
This report presents a description of the girls’ clubs and savings groups implemented by Project Força à Comunidade e Às Crianças (FCC; Child and Community Strengthening) of World Education International (WEI) and World Vision’s Strengthening Communities through Integrated Programming (SCIP) project. The report also synthesizes information obtained from the projects and the literature on dosage and approaches used to measure and promote consistent participation and retention.
Related Publications
A Tool to Assess the Impact of Girls’ Clubs and Savings Groups on Adolescent Girls and Young Women in Mozambique
Ferramenta para Avaliar o Impacto de Clubes de Raparigas e Grupos de Poupança para Adolescentes e Mulheres Jovens em Moçambique
A Retenção de Adolescentes e Mulheres Jovens em Programação de Prevenção ao HIV Uma revista de clubes des raparigas e grupos de poupança para adolescentes e mulheres jovens
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L’importance du genre dans les données sur le paludisme
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MEASURE Evaluation |
2018 |
French |
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Malaria, Gender |
L’examen des disparités entre les genres lors du suivi et de l’évaluation des projets de lutte contre le paludisme permet de garantir l’équité en termes d’accès et d’avantages pour les hommes et les femmes. Cette publication analyse l’importance de la dimension de genre dans les activités de suivi et d’évaluation et suggère des indicateurs pour mettre en lumière et expliquer les disparités observées dans ce domaine, s’agissant des résultats obtenus en matière de lutte contre le paludisme. |
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Assessment of the Effectiveness of the MomConnect Helpdesk in Handling and Resolving Complaints
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MEASURE Evaluation SIFSA |
2018 |
English |
Africa, SOUTH AFRICA |
MomConnect, MEval-SIFSA |
MomConnect is a national-scale ministerial mHealth initiative that employs cell phone technology to register pregnant women in South Africa and deliver to them stage-based maternal messages during pregnancy and after delivery. The effort aligns with the global health goal of the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief to prevent child and maternal deaths. USAID supported early implementation and rollout of the initiative through the MEASURE Evaluation-Strategic Information for South Africa (MEval-SIFSA) project.
MomConnect has a helpdesk feature that allows mothers to ask maternal and child health-related questions and to provide feedback on services they receive at antenatal care (ANC) clinics. The MomConnect helpdesk has responded to almost 250,000 messages since the initiative’s launch, in August 2014. According to quantitative analysis conducted on helpdesk messages received through March 2017, feedback on health services comprised about 4 percent of all helpdesk messages. Approximately 8,100 messages were compliments and 1,800 were complaints about services received at ANC clinics.
Compliments and complaints received through the helpdesk at the national office are forwarded to a MomConnect focal person at the relevant province or district department of health (DOH) office for follow-up action. Standard operating procedures (SOPs) were developed to outline steps for communicating and investigating complaints at national, provincial, district, and facility levels. The SOP document also includes requirements for documentation, monitoring, and reporting at each level to track the progress of complaints. |
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MEASURE Evaluation PIMA – Final Project Report (2012–2017)
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Amin A, Lairumbi G, Watson-Grant S |
2018 |
English |
Africa, KENYA |
BEmONC, civil registration and vital statistics, HIS, MEASURE Evaluation PIMA, M&E, DHIS 2, Data Demand and Use, MEASURE Evaluation Tanzania |
MEASURE Evaluation PIMA (MEval–PIMA) was a five-year project awarded in October 2012 by the United States Agency for International Development (USAID), with the University of North Carolina at Chapel Hill (UNC) as prime with five partners: ICF; John Snow, Inc.; Management Sciences for Health; Palladium; and Tulane University. The project was an associate award of MEASURE Evaluation Phase III and was designed to “build sustainable M&E capacity for Kenyan health workers and officials to collect and use high-quality data that help inform evidence-based decisions that improve the effectiveness of the Kenyan health system.” The project received funding for malaria, population, and maternal and child health. However, funding from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID accounted for the majority received and spent.MEval–PIMA contributed to the USAID mission in Kenya’s implementation framework (2010–2015) and its successor, the Country Development Cooperation Strategy, Objective 2: “health and human capacity improved.” It also aligned with the strategic mission of USAID in Kenya to strengthen health systems for the sustainable delivery of quality services. |
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Conceptualizing and Measuring Data Use: A Review of Assessments and Tools
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Tara Nutley, Michelle Li |
2018 |
English |
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HISS, Health Information Systems, Data use, HISSM, Health Systems Strengthening, HIS, Data |
MEASURE Evaluation is at the forefront of developing guidance for the monitoring and measurement of data use―a key output of health information systems strengthening. This paper has the following purposes:
Expand on the Health Information System Strengthening Model (HISSM) definition and conceptualization of the use of data, especially for acting on and implementing decisions related to health system performance.
Describe activity areas to strengthen the demand for and use of data for decision making.
Summarize indicators to measure the process and outputs of data use.
Review tools to measure the dimensions of data use.
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Conceptual Framework for Community-Based HIV Program Data Demand and Use
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Jackie Hellen and Dawne Walker |
2018 |
English |
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HIV, Data Demand and Use |
This framework outlines a strategy for instilling a culture of data demand and use into community-based programs globally, in line with user needs. This framework for data demand and use demonstrates the clear linkages between the use of data, the quality of data, and information needs—consistent with national health and social service system targets and goals for controlling the HIV epidemic.
When community-based decision makers have positive experiences accessing needed information and interpreting results, and increased ownership and involvement through the systems design and maintenance process, they will be more committed to using data to make decisions for improved accountability. They will plan, implement activities, and allocate resources for community-based HIV programs based on sound evidence, leading to improved health system performance and patient outcomes. Therefore, development of this framework advances MEASURE Evaluation's efforts to address health information systems holistically. |
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Assessing Alternative Care for Children in Ghana
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Mari Hickman, Bashiru Adams, Ghana country core team |
2018 |
English |
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Child Health, Ghana, Care for children, Alternative Care, Children |
Ghana’s care reform initiative is based on the United Nations Guidelines for the Alternative Care of Children (hereinafter called “UN guidelines”; United Nations, 2012), which outlines specific principles and standards for the appropriate care of children, to ensure that they grow in a protective environment, free from deprivation, exploitation, danger, and insecurity. In November 2017, the DSW, under the MOGCSP, with funding and technical assistance from USAID’s DCOF and MEASURE Evaluation, conducted a self-assessment of the care reform system through a participatory stakeholder’s workshop that took place from November 14–17, 2017, at the Sunset Hotel in Kumasi, Ghana.
The assessment workshop aimed to strengthen the capacity of government partners to accomplish the following specific objectives:
Provide leadership in implementing a structured assessment of national care reform systems and strategies using a standardized framework/tool.
Identify gaps and continuing needs in care reform.
Develop plans to address priority needs in care reform.
The report presented here provides detailed findings from the assessment, based on analysis, and specific recommendations and actions to be taken by the government and partners based on the findings. |
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Decision Tree for Assessing Health Information System Status
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MEASURE Evaluation |
2018 |
English |
Global |
HISS, M&E, Health information systems, HIS |
A step-wise guide to tools that can help countries improve their health information systems (HIS), this “decision tree” guides readers through relevant questions and describes how to answer them with ready-made tools. MEASURE Evaluation, funded by the United States Agency for International Development (USAID), works globally in low-resource settings to take a holistic look at HIS and help countries improve their capacity to collect, analyze, and use health data for better health outcomes for people. The first page provides a graphic guide through a set of questions and appropriate tools. The second page gives an overview of each tool mentioned. |
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Evaluarea Îngrijirii Alternative a Copilului în Moldova: Raport de Evaluare (Volumul 2)
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Molly Cannon, Camelia Gheorghe, Echipa-Nucleu de Țară Moldova |
2018 |
Romanian |
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Child Health, Moldova, Care for children, Alternative Care, Children |
În anul 2017, Fondul pentru Copii Separați de Familie și Copii Orfani (DCOF) al Agenției Statelor Unite pentru Dezvoltare Internațională (USAID) a angajat echipa proiectului MEASURE Evaluation, finanțat de USAID, pentru a sprijini eforturile naționale de abordare a problematicii copiilor lipsiți de îngrijire părintească în Moldova. Cu sprijinul MEASURE Evaluation, Ministerul Sănătății, Muncii și Protecției Sociale (MSMPSP) a desfășurat o auto-evaluare participativă a sistemului național de îngrijire alternativă a copilului. Mai exact, evaluarea a examinat stadiul în care se află Moldova în ce privește implementarea Liniilor Directoare ONU pentru Îngrijirea Alternativă a Copiilor. Scopul atelierului de evaluare a fost să informeze procesul de planificare a acțiunilor necesare pentru abordarea nevoilor din domeniul îngrijirii alternative a copiilor.
Acest raport de evaluare conține două volume. Volumul 1 prezintă o vedere de ansamblu asupra instrumentului de evaluare și metodelor utilizate, precum și constatările principale ale evaluării pe domenii de îngrijire și componente de sistem. De asemenea, acest volum include și un rezumat al recomandărilor rezultate din evaluare. Volumul 2 prezintă instrumentul de evaluare, glosarul termenilor utilizați, recomandări detaliate și referințe bibliografice. În plus, volumul include o prezentare a componenței Echipei-Nucleu de Țară (ENȚ) și lista participanților la atelierul de evaluare. |
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Assessing Alternative Care for Children in Moldova: Appendixes (Volume 2)
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Molly Cannon, Camelia Gheorghe, Moldova country core team |
2018 |
English |
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Care for children, Moldova, Children, Child Health, Alternative Care |
In 2017, the Displaced Children and Orphans Fund (DCOF) of the United States Agency for International Development (USAID) engaged the USAID-funded MEASURE Evaluation to build on and reinforce progress in advancing national efforts on behalf of children who lack adequate family-based care in Moldova. With the support of MEASURE Evaluation, the Ministry of Health, Labour and Social Protection (MOHLSP) conducted a participatory self-assessment of the national alternative care system. Specifically, the assessment measured Moldova’s status on implementation of the United Nations’ Guidelines for Alternative Care of Children. The purpose of the assessment workshop was to inform action planning to address priority needs identified in alternative care for children.
This Volume 2 of the report presents the assessment tool and responses, a glossary of key terms, detailed recommendations, and a list of references. It also presents the country core team (CCT) membership and the assessment workshop participants. Volume 1, available here, provides an overview of the assessment tool and methods used for conducting the assessment and presents the key findings of the assessment, by alternative care areas and system components. It also includes a summary of recommendations. |
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Evaluarea Îngrijirii Alternative a Copilului în Moldova: Raport de Evaluare (Volumul 1)
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Molly Cannon, Camelia Gheorghe, Echipa Nucleu de Țară Moldova |
2018 |
Romanian |
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Care for children, Moldova, Children, Child Health, Alternative Care |
În anul 2017, Fondul pentru Copii Separați de Familie și Copii Orfani (DCOF) al Agenției Statelor Unite pentru Dezvoltare Internațională (USAID) a angajat echipa proiectului MEASURE Evaluation, finanțat de USAID, pentru a sprijini eforturile naționale de abordare a problematicii copiilor lipsiți de îngrijire părintească în Moldova. Cu sprijinul MEASURE Evaluation, Ministerul Sănătății, Muncii și Protecției Sociale (MSMPSP) a desfășurat o auto-evaluare participativă a sistemului național de îngrijire alternativă a copilului. Mai exact, evaluarea a examinat stadiul în care se află Moldova în ce privește implementarea Liniilor Directoare ONU pentru Îngrijirea Alternativă a Copiilor. Scopul atelierului de evaluare a fost să informeze procesul de planificare a acțiunilor necesare pentru abordarea nevoilor din domeniul îngrijirii alternative a copiilor.
Acest raport de evaluare conține două volume. Volumul 1 prezintă o vedere de ansamblu asupra instrumentului de evaluare și metodelor utilizate, precum și constatările principale ale evaluării pe domenii de îngrijire și componente de sistem. De asemenea, acest volum include și un rezumat al recomandărilor rezultate din evaluare. Volumul 2 prezintă instrumentul de evaluare, glosarul termenilor utilizați, recomandări detaliate și referințe bibliografice. În plus, volumul include o prezentare a componenței Echipei-Nucleu de Țară (ENȚ) și lista participanților la atelierul de evaluare. |
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Assessing Alternative Care for Children in Moldova: Assessment Report (Volume 1)
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Molly Cannon, Camelia Gheorghe, Moldova country core team |
2018 |
English |
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Child Health, Moldova, Care for children, Alternative Care, Children |
In 2017, the Displaced Children and Orphans Fund (DCOF) of the United States Agency for International Development (USAID) engaged the USAID-funded MEASURE Evaluation to build on and reinforce progress in advancing national efforts on behalf of children who lack adequate family-based care in Moldova. With the support of MEASURE Evaluation, the Ministry of Health, Labour and Social Protection (MOHLSP) conducted a participatory self-assessment of the national alternative care system. Specifically, the assessment measured Moldova’s status on implementation of the United Nations’ Guidelines for Alternative Care of Children. The purpose of the assessment workshop was to inform action planning to address priority needs identified in alternative care for children.
This Volume 1 of the report provides an overview of the assessment tool and methods used for conducting the assessment and presents the key findings of the assessment, by alternative care areas and system components. It also includes a summary of recommendations. Volume 2, available here, presents the assessment tool and responses, a glossary of key terms, detailed recommendations, and a list of references. It also presents the country core team (CCT) membership and the assessment workshop participants. |
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Assessing Alternative Care for Children in Uganda
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Ismael Ddumba-Nyanzi, Michelle Li, Uganda country core team |
2018 |
English |
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Alternative Care, Care for children, Child Health, Children |
Uganda’s alternative care system for children is based on the United Nations Guidelines for Alternative Care of Children, which outline principles and standards for appropriate care of children, to ensure that they grow in a protective environment, free from deprivation, exploitation, danger, and insecurity. To support this agenda, Uganda's Ministry of Gender, Labor and Social Development, with funding and technical assistance from USAID’s Displaced Children and Orphans Fund and MEASURE Evaluation, conducted a self-assessment of the alternative care system for children through a participatory stakeholder workshop, held November 27–30, 2017, at the Imperial Royale Hotel in Kampala, Uganda.
The assessment workshop aimed to strengthen the capacities of government partners to accomplish the following objectives:
Provide leadership in implementing a structured assessment of the national alternative care system for children and strategies using a standardized framework and tool
Identify gaps and continuing needs in alternative care for children
Develop plans to address high-priority needs in alternative care for children
This report provides detailed findings from the assessment, based on analysis, as well as specific recommendations and actions taken by government and partners based on the findings. |
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Data Science in Global Health: Programming Library/Resource List
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MEASURE Evaluation |
2018 |
English |
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Data, Data Science, Global health |
Getting started with data science can be a daunting task. Identifying and understanding the appropriate methods and techniques presents one challenge, while producing the code necessary to implement those methods and techniques presents another challenge.
MEASURE Evaluation’s Programming Library/Resource list seeks to address those twin challenges by providing links to existing resources that present an overview of data science techniques and example code for applying those techniques. The links in this resource list are intended for global health professionals with basic to moderate programming skills and who are interested in strengthening their knowledge and experience in data science methods and techniques.
Links with R code
UCLA ResourcesThis site provides multiple links to R resources including links for downloading software: https://stats.idre.ucla.edu/r/
The site includes links to free online modules introducing fundamentals of R including importing data, variable construction, and data visual representation: https://stats.idre.ucla.edu/r/modules/
Additional links provide code for data visual representation and various statistical methods including descriptive statistics, logistic regression, and multilevel models: https://stats.idre.ucla.edu/r/codefragments/introduction/ and https://stats.idre.ucla.edu/other/dae/
UNC ResourcesOpen course materials presented as separate lectures for various statistical methods, including multiple negative binomial regression. The site also includes lectures introducing Bayesian methods for regression analysis, and graphical representations in R. Each lecture page provides sample R code for each method presented: https://www.unc.edu/courses/2010fall/ecol/563/001/docs/lectures/lecture1.htm
RspatialThis site provides code and descriptions for spatial data analysis in R, as well as links to download various spatial analysis packages. The site also includes an introduction to manipulating spatial data in R: http://www.rspatial.org/
Code IndexCollection of code snippets for specific tasks: https://source.opennews.org/code/
Starting data analysis/wrangling with R: Things I wish I had been toldDescriptions of data wrangling techniques and associated R code: http://reganmian.net/blog/2014/10/14/starting-data-analysiswrangling-with-r-things-i-wish-id-been-told/
R Reference Card for Data MiningList of R packages and functions that can assist with data mining: http://www.rdatamining.com/docs/r-reference-card-for-data-mining
Causal Impact: Estimating causal effects in time seriesOpen-source R package developed by Google that makes causal analyses simple and fast. based on Bayesian structural time-series models. We use these models to construct a synthetic control—what would have happened to our outcome metric in the absence of the intervention. This approach makes it possible to estimate the causal effect that can be attributed to the intervention, as well as its evolution over time: https://opensource.googleblog.com/2014/09/causalimpact-new-open-source-package.html
RAPPORR and Python open source project from Google to facilitate analysis of data while preserving privacy of individuals: https://github.com/google/rappor and https://ai.googleblog.com/2014/10/learning-statistics-with-privacy-aided.html
Mapping with ggplot: Create a nice choropleth map in RBasic tutorial on how to produce choropleth maps in R: http://rforpublichealth.blogspot.com/2015/10/mapping-with-ggplot-create-nice.html
Introduction to R Markdown (R Notebooks)R Markdown is the R version of Jupyter notebooks. Code can be written and executed in a document that makes it possible to present findings and the output of analysis but also include the code used to conduct analysis in a way that makes reproducible results possible: https://rmarkdown.rstudio.com/r_notebooks.html
Flexdashboard: Easy interactive dashboards for RInteractive dashboards produced using R Markdown. Can be linked with Shiny to make visualizations dynamic: https://rmarkdown.rstudio.com/flexdashboard/
Implementation of a reproducible data analysis workflowOverview of best practice for creating a workflow in R that can be replicated. Replicable workflows make it possible to execute analysis of data by launching one R script and can facilitate collaboration: http://blog.jom.link/implementation_basic_reproductible_workflow.html
Access WHO Global Health Observatory Data from RGithub repository of code to access data from the WHO Global Health Observatory within R: https://github.com/pierucci/rgho and https://cran.r-project.org/web/packages/WHO/vignettes/who_vignette.html
Obtaining DHS Data via APICode snippets for access to DHS data via an API: https://api.dhsprogram.com/#/samples-python.cfm and http://api.dhsprogram.com/#/samples-r.cfm
Apps to visualize or map data: http://api.dhsprogram.com/#/sample-apps.cfm
DHS.rates R package: https://cran.r-project.org/web/packages/DHS.rates/vignettes/DHS.rates.html
Links with Python code
Python for data scienceThis short primer on Python is designed to provide a rapid “on-ramp” to enable computer programmers who are already familiar with concepts and constructs in other programming languages learn enough about Python to facilitate the effective to use of open-source and proprietary Python-based machine learning and data science tools: http://nbviewer.jupyter.org/github/gumption/Python_for_Data_Science/blob/master/Python_for_Data_Science_all.ipynb
Python basics for data scienceTutorial on using Python and Jupyter notebooks. Provides an overview of key Python libraries and techniques and an introduction to Jupyter notebooks: https://data36.com/python-for-data-science-python-basics-1/
Bayesian First Aid: Pearson Correlation TestUnderstanding the degree of correlation between two variables is a key step in effective use of data for decisions. Bayesian analysis offers the opportunity to assess correlation in data that doesn’t have a normal distribution: http://www.sumsar.net/blog/2014/03/bayesian-first-aid-pearson-correlation-test/
General Data Science Links
The Data Science Toolbox is a virtual environment based on Ubuntu Linux that is specifically suited for doing data science. Its purpose is to get you started in a matter of minutes. You can run the Data Science Toolbox either locally (using VirtualBox and Vagrant) or in the cloud: http://datasciencetoolbox.org/
Cross Validated is a question and answer site for people interested in statistics, machine learning, data analysis, data mining, and data visualization: https://stats.stackexchange.com/ |
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Pilot-Testing a Gender-Integrated Routine Data Quality Assessment Tool in Zambia: Summary of the Results
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MEASURE Evaluation |
2018 |
English |
ZAMBIA |
HIV, Gender, Age-Disaggregated Data, Tools, Routine data |
The prevalence of HIV remains high in Zambia relative to that in other low- and middle- income countries. Vulnerable populations, such as orphans and vulnerable children and people experiencing gender-based violence, are at greater risk of contracting HIV. Gender- and age-disaggregated data and gender-sensitive indicators are key to assessing the needs and experiences of different at-risk, vulnerable populations.
In recent years, the United States President’s Emergency Plan for AIDS Relief has increased requirements for the disaggregation of sex and age data, but it is unclear how researchers understand and address these requirements in practice. MEASURE Evaluation, in collaboration with the United States Agency for International Development and implementing partners, piloted a new tool to collect and analyze information from a gender perspective: the Routine Data Quality Assessment, Plus Gender (RDQA+G) https://www.measureevaluation.org/our-work/gender/gender-integrated-routine-data-quality-assessment-rdqa-g-tool/gender-integrated-routine-data-quality-assessment-rdqa-g-tool
This brief summarizes the results of the RDQA+G pilot test, conducted as part of a larger initiative to assess gender and HIV data quality, build capacity, and identify best practices for improving data quality in Zambia. Gender-specific results are emphasized in this brief to illustrate the capacity and utility of the modified assessment tool. |
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Family Planning Method Choice: Key Indicators
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MEASURE Evaluation |
2018 |
English |
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Community-based health information systems, Indicators, Family Planning |
The United States Agency for International Development (USAID) Office of Population and Reproductive Health (PRH) is working to provide contraceptive method choice to women, men, and adolescents in priority countries who wish to prevent pregnancy. The aim is to enable people in these priority countries to use their preferred method of family planning (FP) (USAID, n.d.). By seeking to provide FP method choice, PRH acknowledges that appropriate methods for couples and individuals vary according to their age, parity, family-size preference, and other factors. PRH also ensures that women, men, and youth have information and access to the widest range of safe and effective FP methods to enable them to exercise free and informed choice (United Nations Population Fund, 1996). This work is in line with the goal of the USAID-funded MEASURE Evaluation to improve site-level health service.
Because rigorous monitoring and evaluation (M&E) is essential to the success of FP programs, PRH identifies it as a priority area. This resource outlines 10 key indicators intended for use by USAID partner organizations, to inform their M&E of programs to enhance method choice.
No program or project should ever attempt to use all indicators presented here. For routine monitoring, program managers and evaluators should select a few relevant indicators that both are important to program objectives and easy to collect and interpret. The indicators may be supplemented or tailored to reflect a program’s unique context and objectives. |
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Family Planning Workforce: Key Indicators
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MEASURE Evaluation |
2018 |
English |
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Indicators, Community-based health information systems, Family Planning |
The United States Agency for International Development (USAID) Office of Population and Reproductive Health (PRH) strives to increase access to and use of family planning (FP) products and services. PRH works with countries to strengthen the FP workforce so that it can support and implement priority interventions that expand access to these products and services (USAID, n.d.). Robust human resource systems that enable strong human resource management will reinforce sustainability of the FP workforce.
Rigorous monitoring and evaluation is essential to the success of FP programs. This resource outlines eleven key indicators that USAID partner organizations can use to inform the monitoring and evaluation of programs strengthening the FP workforce, which PRH identified as a priority area. Though some of these indicators address higher-level FP workforce issues, the information they yield is nonetheless critical to programmatic decision making. Each indicator featured in this resource contains its definition and calculation as well as any suggested disaggregations or reference periods.
No program or project should use all indicators presented here. For routine monitoring, program managers and evaluators should select a few relevant indicators that both are important to program objectives and easy to collect and interpret. The indicators may be supplemented or tailored to reflect a program’s unique context and objectives. |
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Family Planning Supply Chain: Key Indicators
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MEASURE Evaluation |
2018 |
English |
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Family Planning, Supply chain and logistics, Community-Based Surveillance, Indicators |
The United States Agency for International Development (USAID) Office of Population and Reproductive Health (PRH) strives to build the capacity of countries to “design, implement, and sustain high-performing supply chain systems for family planning (FP) and reproductive health (RH) services,” which contributes to the long-term availability of FP/RH commodities that clients can afford and trust (USAID, n.d.).
Rigorous monitoring and evaluation is essential to the success of FP programs. This resource outlines eight key supply chain indicators that USAID implementing partners can use to inform the M&E of FP programs supporting activities in the supply chain PRH priority area. Each indicator featured in this resource contains a definition as well as any calculations, suggested disaggregations, or reference periods.
No program or project should use all indicators presented here. For routine monitoring, program managers and evaluators should select a few relevant indicators that both are important to program objectives and easy to collect and interpret. The indicators may be supplemented or tailored to reflect a program’s unique context and objectives. |
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Family Planning Social and Behavioral Change Communication: Key Indicators
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MEASURE Evaluation |
2018 |
English |
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Indicators, Community-based health information systems, Family Planning |
The United States Agency for International Development (USAID) Office of Population and Reproductive Health (PRH) is working to improve access to and quality of family planning (FP) products and services, to contribute to increased contraceptive use among priority populations. This increase in contraceptive use requires that health-seeking behaviors of individuals and communities, as well as the norms that underpin those behaviors, change. Interventions that seek to change behaviors by addressing knowledge, attitudes, and practices are known collectively as social and behavior change interventions. Because these interventions complement and enhance the role played by other FP interventions they are a priority area for PRH. Social and behavior change communication (SBCC) activities can raise awareness, dispel myths, and address barriers that prevent people from accepting and using FP.
Rigorous monitoring and evaluation (M&E) is essential to the success of FP programs, and establishing consistent and effective indicators is part of USAID-funded MEASURE Evaluation’s work to improve health information systems globally. This resource outlines seven key SBCC indicators that are intended to inform USAID and implementing partners on the M&E of FP programs supporting SBCC activities. Each indicator featured in this resource contains a definition as well as any calculations, suggested disaggregations, or reference periods.
For routine monitoring purposes, program managers and evaluators should select a few relevant indicators that both are important to program objectives and easy to collect and interpret. The indicators may be supplemented or tailored to reflect a program’s unique context and objectives. |
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Total Market Approach to Family Planning: Key Indicators
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MEASURE Evaluation |
2018 |
English |
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Community-based health information systems, Indicators, Family Planning, Total market approach |
The United States Agency for International Development (USAID) Office of Population and Reproductive Health is pursuing a total market approach (TMA) to family planning (FP) programs. The agency is working to help countries build their capacity to “design, implement, and sustain high-performing FP programs” to provide “information, product, and service delivery in a rational, efficient, and equitable way” (USAID, n.d.). This approach calls for programs to include all sectors, and it is embraced by USAID-funded MEASURE Evaluation, which also operates holistically.
The objective of TMA is to engage all sectors of the FP market, in order to increase overall use of FP products and services, by better targeting free or subsidized products, reducing inefficiencies and overlaps, and creating space for the private sector to increase provision of FP commodities (Global Health eLearning Center, 2014).
Rigorous monitoring and evaluation (M&E) is essential to the success of FP programs. This resource outlines nine key indicators that USAID implementing partners can use to inform the M&E of FP programs supporting activities in the TMA priority area. Each indicator featured in this resource contains a definition as well as any calculations, suggested disaggregations, or reference periods.
For routine monitoring, program managers and evaluators should select a few relevant indicators that both are important to program objectives and easy to collect and interpret. The indicators may be supplemented or tailored to reflect a program’s unique context and objectives. |
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La Surveillance de Base Communautaire au Sénégal: Programme de formation
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2018 |
French |
SENEGAL, Africa |
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Face aux maladies émergentes et pandémiques, la surveillance à base communautaire (SBC) est devenue une priorité pour les gouvernements et les agences et les donateurs dans les pays en développement. Au cours de la récente épidémie d’Ebola en Afrique de l’Ouest, le Sénégal a eu un cas et a été en mesure d’en prévenir d’autres grâce à la réponse rigoureuse des autorités sanitaires. Avec l’augmentation de la couverture du réseau mobile au Sénégal, les communautés peuvent davantage s’impliquer dans le système de surveillance si elles sont formées à l’utilisation des téléphones mobiles pour alerter les cas potentiels de maladie. Le Ministère de la Sante et de l’Action Sociale (MSAS) à lancé à travers la Direction de la Prévention (DP) et le Centre des Opérations d’Urgence sanitaire (COUS) la surveillance à base communautaire en 2017 avec le soutien de l’Agence des Etats-Unis pour le développement international (USAID). MEASURE Evaluation a fourni un appui technique à la mise en œuvre du projet pilote SBC dans quatre districts des régions de SaintLouis et de Tambacounda. Ensemble, nous avons développé ce guide de formation pour les infirmiers et les agents de santé communautaires, mis en place une plateforme mHealth pour les notifications par SMS (Short Message Service), développé des procédures opérationnelles normalisées pour l’analyse des données et développé des grilles pour la supervision formative.
Les objectifs de formation pour les infirmiers, contenus dans ce document, sont de les préparer à faciliter des ateliers de formation de deux jours pour les groupes de santé communautaire qu’ils supervisent. Cette formation comprend tous les sujets qui seront abordés avec les groupes de santé communautaires et d’autres sujets spécifiques au rôle des infirmiers dans la surveillance communautaire.
Les objectifs de cette formation pour les agents de santé communautaires—également contenus dans ce document—sont de leur permettre de détecter les symptômes des maladies prioritaires au niveau du village, d’assurer une prise en charge précoce des cas et de permettre aux équipes cadres de district (ECD) de faire des investigations pour le contrôle des maladies. L’objectif global de cette initiative est de réduire le délai entre l’apparition des symptômes et la riposte du système de santé, dans le but de prévenir les épidémies de maladies infectieuses.
La formation pour les infirmiers se déroulera sur trois jours et peut accueillir de 15 à 25 infirmiers par session. Des PowerPoints sont inclus pour la formation et des notes de facilitateurs pour l’ECD. La formation de deux jours destinée aux agents de santé communautaires sera facilitée par les infirmiers des postes de santé et peut accueillir de 15 à 25 personnes par session. Des PowerPoints sont inclus pour la formation et des notes de facilitateurs pour les infirmiers.
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On the Lookout for Infectious Diseases: Experiences from a Community-Based Surveillance Pilot Activity in Senegal
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MEASURE Evaluation |
2018 |
English |
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Infectious disease, Community-Based Surveillance, Ebola |
The Health Emergencies Operations Center (COUS) of the Ministry of Health and Social Action (MSAS) of Senegal launched community-based surveillance (CBS) in 2016, with support from the United States Agency for International Development (USAID) and the World Health Organization (WHO). Using funds from Pillar IV of the Global Health Security Agenda of USAID to support Senegal’s post-Ebola response, MEASURE Evaluation provided technical support to implement the pilot stage of CBS in four districts in the regions of Saint Louis and Tambacounda. These regions border countries also affected by the 2013 Ebola outbreak (see map). This initiative aimed to prevent infectious disease epidemics, by reducing the lag between the onset of symptoms and the health system’s response.
This brief shares an overview of the pilot and findings. A full report on our findings is available in English, here: www.measureevaluation.org/resources/publications/tr-18-247/. And the French version is here: www.measureevaluation.org/resources/publications/tr-18-247-fr/. |
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Feasibility of Scaling Up Home-Based HIV Counselling and Testing among Women Delivering at Home: A Geita District Council Case, Tanzania
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Juma Adinan, Caroline Amour, Paulo L. Kidayi, Levina Msuya |
2018 |
English |
TANZANIA, Africa |
Antenatal Care, Sub-Saharan Africa, ART, household-based HIV counselling and testing, PMTCT, Antenatal care |
Background: Major progress has been made in implementing prevention of mother-to-child transmission of HIV (PMTCT) interventions in sub-Saharan Africa (SSA) over the past 10 years. However, new pediatric infections remain unacceptably high, contributing to over 90 percent of the estimated 390,000 infections globally in 2010 (United States Agency for International Development [USAID], 2010). About half (49%) of women in Tanzania do not deliver at health facilities, where those who are HIV-positive can be enrolled for PMTCT services (Tanzania Demographic Health Survey, 2012). Data on prevalence of HIV infection among women delivering at home (WDH) are scant. Studies have reported seroconversion among pregnant women who initially had negative HIV test results at an antenatal care (ANC) visit (Gay, et al., 2010; Oladeinde, et al., 2011; Mbena, et al., 2014; De Schacht, et al., 2014). A similar situation can happen to other women who deliver at home. Delivering at home is not only a missed opportunity for knowing one’s HIV status, but it also increases the chances of mother-to-child HIV transmission.
Objective: The study objective was to determine the feasibility of home-based HIV testing and linking to care for HIV services among WDH in Geita District Council, Tanzania.
Methods: A longitudinal household survey was conducted in Geita District Council in Geita Region, Tanzania. We used embedded mixed-methods to answer study objective. The study involved all mentally-able women who delivered within two years (WDTY) preceding the survey and their children under the age of two.
Results: Of the 993 women who participated in the study, a total of 879 (88.5%) had ever been tested for HIV and 791 (79.7%) tested during an ANC visit. Nearly all (981; 98.8%) accepted household-based HIV counselling and testing (HBHCT) from the research team. Of the 565 WDH participants, 486 (86.0%) had ever tested for HIV. Among these, 433 (76.6%) tested during an ANC visit and 562 (99.4%) accepted HBHCT.
Of the 981 participants who accepted HBHCT, 52 (5.3%) [95%CI: 2.1–12.8%] tested HIV-positive. More than half (28; 53.8%) of the HIV-positive women were in the 25- to 35-years age category and half were newly identified during HBHCT. Among these women, 21 (40.4%) were enrolled in PMTCT services. Of the 32 HIV-positive participants who delivered at home, eight (25.8%) were enrolled in the PMTCT.
Also, HBHCT identified 19 new HIV infections among 393 community members who were not eligible to participate in the study but requested HIV testing.
Conclusion: HBHCT was acceptable and uptake was high. HBHCT detected new HIV infection among WDH as well as seroconversion among women with previously negative HIV tests. HBHCT can be used as an intervention to improve PMTCT services among WDH, because it was acceptable for detecting new HIV infection among WDH as well as seroconversion among women with a negative HIV test in their previous PMTCT HIV testing. |
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Enhancing HIV Retention and Clinical Outcomes in Tanzania through Pediatric- and Adolescent-Friendly Services
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Redempta Mbatia, Samwel Kikaro, Edward Mgelea, Francis Nyabukene, Christopher Henjewele, Lydia Temba, Sisty Moshi, Agnes Rubare, and Benedicta Masanja |
2018 |
English |
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ART, Care for children, Adolescents, AIDS, Health Facilities, HIV counseling and testing, Pediatric care |
Background: Despite global reductions in AIDS-related deaths among adults, the rate for children increased by 50 percent. This increase points to inadequate testing, counselling, and treatment coverage and poor retention in services for these children. Pediatric- and adolescent-friendly health services have the potential to improve retention and clinical outcomes among children living with HIV. This study was conducted to provide evidence of the effectiveness of pediatric- and adolescent-friendly clinics in Kigoma, Tanzania.
Methods: We conducted a mixed-methods study using a retrospective cohort analysis of secondary data from the national CTC2 database that routinely collects patient-level information from all HIV clients receiving care and treatment. Outcomes were compared between those enrolled before (Group I) and after (Group II) the establishment of pediatric- and adolescent-friendly HIV care and treatment services. Qualitative data were collected through focus group discussions and in-depth interviews to assess the perceptions of adolescents, health providers, and parents or guardians of pediatric and adolescent HIV clients.
Results: Late initiation of antiretroviral therapy (ART) in clinical stage IV was more common before the establishment of pediatric- and adolescent-friendly services. Three-quarters of children and adolescents initiated on ART had an immunological assessment at baseline in Group II compared to less than half in Group I. Retention rates for children and adolescents at three, six, nine, and 12 months was better after the establishment of the friendly clinic. The probability of attrition from HIV care after 12 months was higher in Group I. Qualitative analysis revealed that pediatric- and adolescent-friendly services provided support for disclosure of HIV status and strategies for coping with the disease.
Conclusion: This study showed that pediatric- and adolescent-friendly services for HIV care and treatment improve retention in HIV care. |
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Community-based surveillance of priority diseases in Senegal: Lessons learned in pilot districts
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Alioune Badara Ly, Jenny Mwanza, Doudou Diop, Judith Nguimfack Tsague |
2018 |
English |
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Senegal, CBHIS, Community-based health information systems, Community-Based Surveillance |
The Health Emergencies Operations Center (COUS) of the Ministry of Health and Social Action (MSAS) of Senegal launched community-based surveillance (CBS) in 2016 with support from the United States Agency for International Development (USAID) and the World Health Organization (WHO).
The USAID-funded MEASURE Evaluation provided technical support to implement the pilot stage of CBS in four districts in the regions of Saint Louis and Tambacounda. The overall goal of this initiative was to reduce the time lapse between the onset of symptoms and the health system’s response to prevent infectious disease epidemics.
Together, we created a CBS teaching manual, tailored the mHealth platform to send notifications via SMS (Short Message Service) and data management, and developed standard operating procedures (SOPs) for data analysis and checklists for supportive supervision. Overall, 16 district medical team (ECD) members, 106 nurses and health-post head nurses (ICPs), and 2,094 community health workers (CHWs) were trained to implement CBS.
As of 13 March 2018, 360 priority disease alerts were sent via SMS by community watch and alert committees (CVACs), including 72 percent that were investigated by ICPs. Of the investigated alerts, 112 were classified by ICPs as corresponding to the clinical symptoms of priority diseases under surveillance that should be reported to the district as suspected cases. In this report, we describe the pilot project to implement CBS, preliminary results, and recommendations for supporting a surveillance system for priority diseases at the community level.
Access a related overview. |
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Посилення контролю за туберкульозом в Україні: оцінка впливу стратегії соціальної підтримки на результати лікування
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Zulfiya Charyeva, Sian Curtis, Stephanie Mullen |
2018 |
Ukrainian |
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HIV, Ukraine, HIV/AIDS, Tuberculosis, TB |
Місія Агентства США з міжнародного розвитку (USAID) в Україні здійснює тестування стратегій вирішення проблем, спричинених туберкульозом з множинною лікарською стійкістю (МЛС-ТБ) та ВІЛ-інфекцією. Одним з таких стратегічних механізмів був проект "Посилення контролю за туберкульозом в Україні" (STbCU), впровадження якого здійснювалося у партнерстві з урядом України та зацікавленими сторонами на національному й міжнародному рівні, а також за додаткової фінансової підтримки у рамках Президентського плану невідкладних заходів, спрямованих на подолання СНІДу (PEPFAR). Цей проект мав на меті полегшити тягар туберкульозу в країні та покращити якість послуг у зв'язку з туберкульозом, у тому числі послуг щодо виявлення та лікування туберкульозу, МЛС-ТБ, а також у ширшому контексті – туберкульозу з лікарською стійкістю. Він також спрямований на надання підтримки у галузі профілактики та лікування для зупинення стрімкого зростання кількості випадків коінфекції ТБ/ВІЛ. Впровадження проекту почалося у березні 2012 року, а закінчилося у квітні 2017 року. Проект спирався на більш ніж 10-річній досвід USAID з надання допомоги хворим на туберкульоз у 10 пріоритетних регіонах країни.
Місія USAID в Україні залучила проект MEASURE Evaluation до проведення оцінки впливу проекту STbCU. У рамках цієї оцінки було проаналізовано зв'язок між певними стратегіями впровадження заходів, які було застосовано, та змінами, які відбулися у досягненні основних результатів. Дві стратегії, які представляли інтерес для дослідження, – це цільове спрямування послуг соціальної підтримки (СП) для покращення дотримання режиму лікування серед осіб з високим ризиком (ВР) переривання лікування, а також інтеграція послуг та заходів з направлення пацієнтів на рівні протитуберкульозних закладів й закладів у галузі профілактики та лікування ВІЛ-інфекції для надання більш своєчасної медичної допомоги та покращення результатів лікування пацієнтів з коінфекцією. Результати оцінки впливу стратегії СП представлено у цьому звіті. Окремий звіт було підготовлено за результатами оцінки стратегії інтеграції послуг у зв'язку з туберкульозом та ВІЛ-інфекцією. |
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Strengthening Tuberculosis Control in Ukraine: Evaluation of the Impact of a Social Support Strategy on Treatment Outcomes
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Zulfiya Charyeva, Sian Curtis, Stephanie Mullen |
2018 |
English |
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Tuberculosis, TB, HIV, Ukraine |
The United States Agency for International Development (USAID) mission in Ukraine is testing strategies to combat the problems posed by multidrug-resistant tuberculosis (MDR-TB) and HIV. One strategic mechanism was the Strengthening Tuberculosis Control in Ukraine (STbCU) project, which was implemented in partnership with the Government of Ukraine and national and international stakeholders, with additional funding from the United States President’s Emergency Plan for AIDS Relief (PEPFAR). The project’s goal was to decrease the country’s TB burden and to improve the quality of TB services, including detection and treatment of TB, MDR-TB, and extensively drug-resistant TB. It also aimed to provide prevention and treatment support to counter the rapid growth of TB and HIV coinfection. The project started in March 2012 and ended in April 2017. It built on more than 10 years of USAID’s TB assistance in 10 priority geographic areas of the country.
USAID/Ukraine commissioned MEASURE Evaluation to conduct an impact evaluation of the STbCU project. The impact evaluation examined the relationship between select intervention strategies that were implemented and changes in key outcomes. The two strategies of interest were targeting social support (SS) services to improve treatment adherence among those at high-risk (HR) of treatment default; and integrating services and referrals between TB facilities and HIV facilities to improve the timeliness of care and the treatment outcomes for coinfected patients. This report presents findings from the impact evaluation of the SS strategy. A separate brief has been prepared on the findings from the evaluation of the TB and HIV services integration strategy. |
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Strengthening Multisectoral Community Event-Based Surveillance of Zoonotic Diseases in Senegal – Rapid Assessment of a Global Health Security Agenda Project
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2018 |
English |
Africa, West Africa, SENEGAL |
Global health, Senegal, Community-Based Surveillance, Africa, Global health security, Global Influenza Surveillance and Response System, Community-based health information systems, Integrated Disease Surveillance and Response |
Senegal is committed to the Global Health Security Agenda (GHSA) and International Health Regulations 2005. The government has undertaken several initiatives in this direction, and promoting the One Health initiative is part of that approach. Recently, after approval by the Prime Minister, Senegal established a legal structure for the One Health platform. The national One Health platform is taking several steps to advance the One Health agenda in the country. Government ministries involved in advancing the agenda are Health, Livestock, Environment, Interior, Education, and Gender.
The first phase of MEASURE Evaluation’s GHSA One Health surveillance program is focused on strengthening multisectoral collaboration in community surveillance of six prioritized zoonotic diseases in two regions, Tambacounda (comprising Tambacounda and Koumpentoum districts) and Saint Louis (comprising Pété and Podor districts). The surveillance activity will be implemented in two additional regions during the next phase; these regions will be selected after consulting with the stakeholders. The activities in the One Health program extend the current work of MEASURE Evaluation in these four districts in the community surveillance of eight priority human diseases. This rapid assessment assessed the preparedness of the participating sectors, i.e., health, livestock, and environment in the four project districts. We also expect that a review of similar activities by other partners in the country could help MEASURE Evaluation find opportunities that complement the current project and avoid any duplication.
Our rapid assessment of the health sector revealed that it is well prepared for the implementation of the activity, in terms of the physical infrastructure, staffing distribution, and presence of organized community health volunteer groups in the four project districts. Community groups have recently undergone training in the surveillance of priority human diseases. Additionally, Senegal has the laboratory capacity for the diagnosis of the six prioritized zoonotic diseases.
The livestock sector is prepared in terms of their service delivery points and staff distribution. In addition to the government veterinarians and para-veterinarians, private veterinarians play a significant role in the delivery of services in certain regions, and therefore, must be included in the One Health activities. The private veterinarians work closely with auxiliary livestock agents from the community. These agents could potentially be included in the community health volunteer groups for detecting outbreaks of zoonotic diseases in animals. The central laboratory (LNERV) of Senegal is equipped to diagnose all the six zoonotic diseases; although, the laboratory capacity needs to be strengthened at the regional levels.
Part of the National Park Niokolo-Koba that is managed by the Ministry of Environment extends to one of the project districts, Tambacounda. The Eco-guides and Eco-guards working in these regions represent the community for surveillance activities, and therefore, could be potential members of the community health volunteer groups. The National Park personnel work closely with the Ministry of Livestock for the diagnosis of diseases. When an outbreak or an unusual health event is reported in the National Park, park personnel report the event to the nearest veterinarian, who then follows the routine surveillance pathway Livestock Sector.
Several partners working in community-based surveillance and One Health complement our project activities, including Food and Agriculture Organization (FAO), World Bank, Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), Catholic Relief Services, PATH, EcoHealth Alliance, and One Health East and Central Africa (OHCEA). It would, therefore, be worthwhile to form a Partners’ Forum and schedule regular meetings to exchange information. FAO and OHCEA were identified as two active partners that complement specific activities in the One Health project. |
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Capacity Building Interventions in Health Information Systems: Action for Stronger Health Systems
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MEASURE Evaluation |
2018 |
English |
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Health Systems Strengthening, HIS, Health Information Systems, Learning agenda, Capacity Building, HISS |
MEASURE Evaluation works with global, national, and local partners to strengthen health information systems (HIS) in scores of countries. We have a set of prescribed results to achieve, many of which depend on successful capacity building—such as to strengthen the collection and use of routine health data, improve country-level capacity to manage HIS and conduct rigorous evaluations, and address health information gaps and challenges. We work to build country capacity to generate, manage, and use health information at national and subnational levels; foster country ownership and accountability for HIS; and promote the use of data for decision making.
This synthesis—one of a series produced by MEASURE Evaluation—explores the importance of individual capacity building for people working with HIS and, in turn, how capacity building may help to strengthen HIS and health outcomes, thereby strengthening the health system overall. |
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Interactions among poverty, gender, and health systems affect women’s participation in services to prevent HIV transmission from mother to child: A causal loop analysis
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Jennifer Yourkavitch, Kristen Hassmiller Lich, Valerie L. Flax, Elialilia S. Okello, John Kadzandira, Anne Ruhweza Katahoire, Alister C. Munthali, James C. Thomas |
2018 |
English |
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Health Services, ART, HIV, PMTCT, HIV/AIDS |
Retention in care remains an important issue for prevention of mother-to-child transmission (PMTCT) programs according to WHO guidelines, formerly called the “Option B+” approach. The objective of this study was to examine how poverty, gender, and health system factors interact to influence women’s participation in PMTCT services. We used qualitative research, literature, and hypothesized variable connections to diagram causes and effects in causal loop models. We found that many factors, including antiretroviral therapy (ART) use, service design and quality, stigma, disclosure, spouse/partner influence, decision-making autonomy, and knowledge about PMTCT, influence psychosocial health, which in turn affects women’s participation in PMTCT services. Thus, interventions to improve psychosocial health need to address many factors to be successful. We also found that the design of PMTCT services, a modifiable factor, is important because it affects several other factors. We identified 66 feedback loops that may contribute to policy resistance—that is, a policy’s failure to have its intended effect. Our findings point to the need for a multipronged intervention to encourage women’s continued participation in PMTCT services and for longitudinal research to quantify and test our causal loop model. |
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Assessing Barriers to Data Demand and Use in the Health Sector: A Toolkit
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2018 |
English |
Global |
Data use, Data Demand and Use, M&E, Health Information Systems, HIS, DDU, Monitoring, Evaluation |
Evidence-informed decision making is essential for ensuring efficient and high-quality health services, supportive policies, and improved outcomes. Global commitments to improve health systems and outcomes have led to better monitoring and evaluation (M&E) and health information systems (HIS), thus providing improved data to use for decision making.
Overall, the relationship of improved information, increased demand for data, and continued use of data constitutes a cycle that leads to improved health programs and policies. Improving data demand and use (DDU) is necessary to improve the effectiveness and sustainability of a health system.
Data use goes beyond completing data reporting forms at the various levels of a national HIS and the passive dissemination of reports and information products. The best decisions are made when data are used and considered to answer a question that is linked to a specific program, policy, or client care action.
Despite the increased commitment to base decisions on data, many organizations struggle to institutionalize and sustain a culture of data use. MEASURE Evaluation (MEval) developed this suite of tools to help data users, producers, and policy makers understand the barriers that impede widespread data use in the health sector and develop action plans to address them. |
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Methodology and Baseline Results From the Evaluation of a Sexuality Education Activity in Mpumalanga and KwaZulu-Natal, South Africa
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Ilene S. Speizer, Mahua Mandal, Khou Xiong, Aiko Hattori, Ndinda Makina-Zimalirana, Faith Kumalo, Stephen Taylor, Muzi S. Ndlovu, Mathata Madibane, Andy Beke, |
2018 |
English |
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HIV, South Africa, Evaluation, Sexually Transmitted Infections (STIs) |
In South Africa, adolescents and young adults (ages 15–24) are at risk of HIV, sexually transmitted infections, and unintended pregnancies. Recently, the Department of Basic Education has revised its sexuality education content and teaching strategies (using scripted lessons plans) as part of its life orientation curriculum. This paper presents the methodology and baseline results from the evaluation of the scripted lesson plans and supporting activities. A rigorous cluster-level randomized design with random assignment of schools as clusters is used for the evaluation. Baseline results from grade 8 female and male learners and grade 10 female learners demonstrate that learners are at risk of HIV and early and unintended pregnancies. Multivariable analyses demonstrate that household-level food insecurity and living with an HIV-positive person are associated with sexual experience and pregnancy experience. Implications are discussed for strengthening the current life orientation program for future scale-up by the government of South Africa. |
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Tool for Using Demographic and Health Survey Data to Estimate the Size of Orphans-and- Vulnerable-Children Groups at the National and Subnational Levels
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MEASURE Evaluation |
2018 |
English |
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Data, OVC, Orphans and Vulnerable Children |
This workbook is designed to assist PEPFAR orphans and vulnerable children (OVC) country programs to estimate the size of four groups of potentially vulnerable children:
Children ages 0-17 years of age living in a household with at least one HIV-positive adult member age 18 or older
Orphans (includes children whose guardian does not know if biological parents are alive) and children ages 0-17 living with orphans in a household with at least one HIV-positive adult member age 18 or older
Children ages 0-17 years of age who are orphans (biological mother and/or biological father deceased), irrespective of reason for parent's death
Orphans and children ages 0-17 years of age living with an orphan (coresident children), irrespective of reason for parent's death or presence of an HIV-positive adult in the household
Each PEPFAR country has its own worksheet (tab). The percentages of potentially vulnerable children are derived from Demographic and Health Survey (DHS) data sets.
Access the related Estimating Numbers of Orphans and Vulnerable Children – A Test of Regression Modeling resource. |
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La surveillance à base communautaire des maladies prioritaires au Sénégal: Leçons apprises dans les districts pilotes
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Alioune Badara Ly, Jenny Mwanza, Doudou Diop, Judith Nguimfack Tsague |
2018 |
French |
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Information systems, Surveillance, Community-based health information systems, Senegal, Infectious disease |
Le Centre des Opérations d’Urgence Sanitaire (COUS) du Ministère de la Santé et de l'Action Sociale (MSAS) du Sénégal a lancé la surveillance à base communautaire (SBC) en 2016 avec le soutien de l'Agence des États-Unis pour le développement international (USAID), et l’Organisation Mondiale de la Santé (OMS).
MEASURE Evaluation a fourni un appui technique pour la mise en oeuvre de la phase pilote de la SBC dans quatre districts dans les régions de Saint-Louis et de Tambacounda. L'objectif global de cette initiative était de réduire le délai entre l'apparition des symptômes et la réponse du système sanitaire, dans le but de prévenir des épidémies de maladies infectieuses.
Ensemble, nous avons créé du matériel didactique pour la SBC, personnalisé la plateforme mHealth pour les notifications par SMS (Short Message Service) et la gestion des données, développé des procédures opérationnelles normalisées (PON) pour l’analyse des données et des checklists pour la supervision formative. Au total, 16 membres des équipes cadres du district (ECD), 106 infirmiers et infirmières chef de poste de santé (ICP) et 2 094 acteurs de santé communautaire (ACS) ont été formés pour mettre en oeuvre la SBC.
À la date du 13 mars 2018, 360 alertes sur les maladies prioritaires ont été envoyées par SMS par les Comités de Veille et d'Alerte Communautaire (CVAC), dont 72% ont fait l'objet d'une investigation par les ICP. Parmi les alertes investiguées, 43% ont été classées par les ICP comme correspondant aux symptômes cliniques des maladies prioritaires sous surveillance et devant être rapportées au district en tant que cas suspects. Dans ce rapport, nous décrivons le projet pilote de la mise en oeuvre de la SBC, les résultats préliminaires ainsi que des recommandations pour soutenir un système de surveillance des maladies prioritaires au niveau communautaire.
Access a related overview. |
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Geographic Information Systems (GIS) Tools Matrix
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MEASURE Evaluation |
2018 |
English |
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Geospatial analysis, GIS, Spatial data, Geography, Geographic Information Systems |
This document presents the major tools available from MEASURE Evaluation to support the use of spatial data. The matrix lists and describes the tools available and gives examples of situations for which the tool would be appropriate. These tools can help beginners and experts to gather, handle, assess, analyze, and display geographic data. |
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Barriers to Use of Health Data in Low- and Middle-Income Countries — A Review of the Literature
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2018 |
English |
Global |
ICT, Data Demand and Use, Monitoring, Evaluation, health management information system, HIS, M&E, DQA, Data Quality Review, HMIS, Data Quality Audit |
Health information is one of the essential functions of a strong health system. Global commitments to improving health systems and outcomes have led to improved monitoring and evaluation (M&E) and health management information systems (HMIS). HMIS produce data about health service provision and population health status to be used for decision making and program planning at all levels of the health system. Quality and timely data from a health information system should be used to guide decision making across all the other health system functions (service delivery, health workforce, access to essential medicines, financing, leadership, and governance). These decision-making processes include priority setting, annual health planning and budgeting, health resource allocation and utilization, and introducing and improving service delivery and policymaking to promote greater utilization of health services and improve health outcomes. Data-informed decision making contributes to a culture of transparency and accountability, as available information is used to ensure that resources such as workforce, finances, and commodities are being used effectively and appropriately.
Despite improvements in technological solutions facilitating the collection of data and improving data analytics and visualization, actual use of data remains limited in many settings, especially at lower levels such as the district or community. Data-informed decision making entails that potential courses of action are given full and unbiased consideration and the option most likely to be successful is chosen, based on a full assessment of relevant, available data that meet quality criteria. However, decision making is complex and influenced by several factors such that data are not always the basis for decisions. There are multiple facilitators that strongly influence the ability of individuals and organizations to use data effectively, as well as barriers that prevent this from happening. Despite the global recognition for the need to strengthen data-informed decision making, little is known on how to best accomplish this goal. We conducted a literature review to examine the barriers to data use and have highlighted interventions that sought to overcome those barriers. |
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The Children Left Behind: Barriers to Testing and Enrolling Children in HIV Care and Treatment in Njombe Region, Tanzania
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Jackson Mbogela, MPH; Alfred I. Kyando, MS; Riziki Mahenge, LLB |
2018 |
English |
TANZANIA |
HIV/AIDS, At-Risk Populations, Service access and availability, HIV, OVC, Referral Systems, People Living with HIV, ART, Orphans and Vulnerable Children, HIV counseling and testing, Service delivery |
Though they live in an area with one of the highest rates of HIV prevalence in the world, nearly 60 percent of HIV-exposed infants in Njombe region Tanzania did not receive an HIV test in 2013 or 2014. As a result, a much lower proportion of infants and children in the region have initiated anitretroviral therapy, compared to adults. The purpose of this study was to explore why these infants and children with HIV are not enrolled in HIV/AIDS care and treatment programs and make recommendations to correct barriers that researchers discovered.
This was an exploratory, descriptive, and retrospective qualitative study. Data were collected through in-depth face-to-face interviews, using an interview guide with open-ended questions. The study population consisted of 132 parents and guardians of HIV-exposed or HIV-positive children and 50 healthcare workers at relevant facilities.
Researchers discovered that the main barriers to enrolling children in HIV care and treatment programs were lack of understanding of how the HIV care and treatment system works and negligence. Other factors included self-denial, fear, embarrassment, feeling too shy to go to a treatment centre, and self-stigma. Healthcare workers said that parents and guardians declined to get their children tested, because of low levels of awareness among adults on the importance of testing, along with barriers related to transportation. A barrier for orphans is not having a parent or guardian to care for their health.
Recommendations include the following: Health facilities, in cooperation with the community health service providers, should establish an escort system to the treatment facilities. The government should improve provision of medication for opportunistic infections in pediatric HIV treatment units. Strategies should prioritize collaborations with nongovernmental organizations and community-based organizations in identifying and linking HIV-positive infants and children to care and treatment. The government should provide equipment, supplies, and training to regional hospitals on processing dried blood spot tests to facilitate results and initiation of treatment.
The study team concluded that there is no system to identify HIV-positive infants and children outside of health facilities, and a policy requiring that children under 15 years old be tested with their parents/guardians’ consent limits HIV-exposed children from accessing HIV testing and counselling services. Health workers agreed that this requirement creates a significant barrier discouraging children from getting an HIV test. Parents and guardians suggested that a knowledge gap and inadequate awareness on the importance of testing their HIV-exposed children was a key barrier to testing children. |
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Alternative Care for Children Newsletter (April 2018)
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MEASURE Evaluation |
2018 |
English |
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Alternative Care, Child Health, Children |
The April 2018 edition of the Alternative Care for Children newsletter provides updates since the 2017 workshop in London to foster communication and knowledge sharing across Armenia, Ghana, Moldova, and Uganda.
MEASURE Evaluation conducted workshop assessments in these four countries, yielding concrete suggestions for improving areas of alternative care systems meant to provide family-based care for children. The workshop assessments provided information to enhance future assessments, aid in developing action plans for each country, and help guide MEASURE Evaluation work with country core teams and other stakeholders on activities related to monitoring and evaluation. These updates are discussed in depth in the newsletter.
Learn more about MEASURE Evaluation’s alternative care work at www.measureevaluation.org/our-work/youth-and-adolescents/alternative-care. |
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Population Size Estimation Tool for Programs Serving Orphans and Vulnerable Children
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MEASURE Evaluation |
2018 |
English |
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OVC, Orphans and Vulnerable Children, Children, Child Health, HIV, PEPFAR |
Intended user: Managers of PEPFAR OVC programs in Botswana, Nigeria, South Africa, and South Sudan
What: A workbook calculator to help in estimating the population size of children ages 0–17 years living in a household with at least one adult who is HIV-positive or orphans and children ages 0–17 years living in such a household. The calculator is for use in countries that do not have a recent AIDS indicator survey or DHS survey with biomarker/HIV testing.
Investment: Time to complete a form and availability of the number of children ages 0–17 years in the country and an estimate of HIV prevalence among people ages 15 years and older
Tool output: The tool provides only national-level estimates, based on adult HIV prevalence. It estimates the proportion of all children and the number of children in each group, with lower and upper range estimates with a 99 percent confidence level.
Access the related Tool for Using Demographic and Health Survey Data to Estimate the Size of Orphans-and- Vulnerable-Children Groups at the National and Subnational Levels resource. |
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The MomConnect helpdesk: how an interactive mobile messaging programme is used by mothers in South Africa
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Khou Xiong, Joy Kamunyori, Jane Sebidi |
2018 |
English |
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South Africa, Antenatal Care, MomConnect, MCH, Maternal Health |
South Africa’s MomConnect mobile messaging programme, which aims to promote safe motherhood and improve pregnancy outcomes for South African women, includes a helpdesk feature which allows women registered on the system to ask maternal and child health (MCH)-related questions and to provide feedback on health services received at public health clinics. Messages sent to the helpdesk are answered by staff located at the National Department of Health. We examined event data from the MomConnect helpdesk database to identify any patterns in messages received, such as correlation of frequency or types of messages with location. We also explored what these data could tell us about the helpdesk’s effectiveness in improving health service delivery at public health clinics. We found that approximately 8% of registered MomConnect users used the helpdesk, and that usage was generally proportional to the use of antenatal care (ANC) services in provinces (as indicated by number of ANC first visits and number of MomConnect registrations), except in two provinces. Language, category and key topics of helpdesk messages were correlated with provinces. Most users accessed the helpdesk to seek maternal information, and where feedback about health services was provided, there were significantly more compliments than complaints. The MomConnect helpdesk is an important resource providing expectant mothers and mothers of infants with an interactive option for accessing MCH-related information—above that included in the standard MomConnect messages—and advances achievement of the health goals of the MomConnect programme. |
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The Routine Health Information System in Punjab Province, Pakistan – Exploring the Potential for Integrating Health Information Systems for Family Planning Data
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Mustafa M |
2018 |
English |
PAKISTAN |
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Background: Globally, a health management information system (HMIS) includes both routine and non-routine health data. A routine health information system (RHIS) generates data at regular intervals (no longer than a year) that have been collected at the public and private health facilities and institutions, as well as at community-level healthcare posts and clinics (MEASURE Evaluation, 2017). In developed countries, the RHIS exists in its true essence having both a facility-based and a community-based health information system (CHIS), yet the situation is different in developing countries, such as Pakistan. In Punjab, Pakistan, the HMIS is fragmented as there are more than 20 different HMISs, which use dedicated vertical channels. Among these, three systems gather and transmit information related to family planning (FP)/reproductive health: the District Health Information System (DHIS), the Lady Health Workers-Management Information System (LHW–MIS), and the Contraceptive Logistic Management Information System (cLMIS) which is combined with the Population Welfare Management Program-Management Information System (PWMP–MIS). In addition, nongovernmental organizations (NGOs) have their own HMIS, and there are separate HMISs for countless private hospitals and clinics. Gaps exist in the current RHIS, specifically about reproductive health data from different sources, whether public, private, community or facility-based. These data are not integrated and consolidated into the national HMIS and therefore are not used for decision making.
Objectives: The objective of the study was to review the RHIS in Punjab province of Pakistan and explore the potential for integrating community-level data into the national HMIS, particularly FP data, collected by public or private, for-profit, and not-for-profit organizations.
Methods: The study used both primary and secondary data. Primary data were collected through key informant interviews (KIIs), identified purposively and through snowball sampling technique. Secondary data were gathered through document review including reports, articles, and statistical data.
Findings: Community-based FP data are not fully integrated with RHIS. Some effort has been made to integrate FP data through Contraceptive Performance Report by the Pakistan Bureau of Statistics and the cLMIS, which is an integrated system where data from the DHIS, LHW–MIS, Population Welfare Department (PWD), and influential NGOs are presented and compiled in one form. There is potential for organizing CHIS with RHIS, yet structural barriers exist. For example, there is potential for integration between LHW–MIS and DHIS as they come under the province’s Department of Health (DoH), but it is difficult to integrate data between the DoH and PWD, as PWD has a separate administration and ministry. Nevertheless, though the cLMIS has provided a platform for including data from all public and private entities, several NGOs and public departments do not regularly report their data. In addition, there are several data quality issues in the RHIS which should be addressed before integration occurs, such as: fake entries; incomplete information; dissatisfaction about numbers and types of FP indicators; inaccurate data; duplication of data and services; overreporting; poor feedback mechanisms; and the way reports are consolidated. These issues must be tackled along with integration of CHIS into the RHIS.
Recommendations: To facilitate integration of CHIS with RHIS, the study suggests several recommendations. These include shifting the paradigm from an individual-level healthcare approach to a family-centered approach; promoting a culture and system of inter-organizational information sharing; sensitizing decision-makers about the benefits of interlinking the community-level data streams with RHIS; strengthening the computerized national identity card (CNIC)-based data entry; developing a single dashboard with core FP indicators; and expanding FP indicators beyond commodity-based indicators to psychosocial and behavioral indicators to understand the uptake, switching, and dropping of modern FP methods. |
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Monitoring, Evaluating, and Reporting PEPFAR's Essential Survey Indicators for Orphans and Vulnerable Children Programs: Supervisor Manual Template
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MEASURE Evaluation |
2018 |
English |
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MER, PEPFAR, OVC, Children, Child health, Orphans and Vulnerable Children |
MEASURE Evaluation developed this supervisor manual template for organizations collecting Monitoring, Evaluation, and Reporting (MER) Orphans and Vulnerable Children (OVC) Essential Survey Indicators (ESI) of the United States President’s Emergency Plan for AIDS Relief (PEPFAR). This supervisor manual includes sections on the data collection team, organizing and supervising interviews, data management, and other procedures for data collection of the nine MER OVC ESI.
Supervisors overseeing enumerators who are implementing the PEPFAR OVC MER ESI questionnaire must follow the highest standards during oversite of data collection. This supervisor manual focuses on documenting the fieldwork procedures for data collection of the nine MER OVC ESI. Groups wanting to implement the OVC MER ESI questionnaire may need to adapt this manual and materials to reflect the aims and design of the specific study. However, the structure of the manual for supervisors should be similar, regardless of study objectives or design. This supervisor manual aims to provide as much guidance as possible for prospective supervisors to provide oversite to enumerators who are implementing the questionnaire.
Access the related protocal template and enumerator manual template. |
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Monitoring, Evaluating, and Reporting PEPFAR's Essential Survey Indicators for Orphans and Vulnerable Children Programs: Enumerator Manual Template
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MEASURE Evaluation |
2018 |
English |
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PEPFAR, Child Health, OVC, Children, Orphans and Vulnerable Children, MER |
MEASURE Evaluation developed this enumerator manual template for organizations collecting Monitoring, Evaluation, and Reporting (MER) Orphans and Vulnerable Children (OVC) Essential Survey Indicators (ESI) of the United States President’s Emergency Plan for AIDS Relief (PEPFAR). This enumerator manual focuses on documenting the fieldwork procedures for data collection of the nine MER OVC ESI.
Enumerators implementing the PEPFAR OVC MER ESI questionnaire must follow the highest standards during data collection. Groups wanting to implement the OVC MER ESI questionnaire may need to adapt this manual and materials to reflect the aims and design of the specific study. However, the structure of this manual for enumerators should be similar, regardless of study objectives or design. This enumerator manual aims to provide as much guidance as possible for prospective enumerators to implement the questionnaire.
Access the related protocal template and supervisor manual template. |
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SQUAD: A Tool for Spatial Quality and Anomalies Diagnosis – Documentation and Tutorial (QGIS version)
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Spencer J, Wilkes B |
2018 |
English |
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GIS, Data Quality, Geographic Information Systems, Spatial data |
When working with datasets, ensuring the quality of data is always a challenge. The challenge increases with large datasets that contain hundreds or thousands of geographic coordinates. Validating spatial data can quickly become overwhelming since it is necessary to check the accuracy of both the spatial information (the accuracy and precision of the recorded coordinates) and the attribute information (data associated with that location, such as a location name, address, or associated administrative unit). Both of these domains must be accurate, and they must be in agreement.
When working with large spatial data sets, manually reviewing each record to validate both location and attribute information can be prohibitively time-consuming. A more effective approach would be to look for anomalies in the data that may indicate data quality issues. MEASURE Evaluation’s Spatial Quality Anomalies Diagnosis (SQUAD) Tool can rapidly identify the presence of any of these anomalies, which can then be investigated further to determine if there is a data quality issue. Narrowing the focus to records most likely to have an error will greatly reduce the time and effort necessary to identify and resolve errors in a database. This tool may not identify every record that has incorrect information, but it will systematically identify records that should be investigated further to resolve anomalies.
The tool produces a list of which records need to be corrected, and it also gives specific feedback on what may be wrong with the data. If these errors are identified early on, the dataset can be corrected and made stronger, more useful, and more trusted.
This tool is available as a plug-in from the QGIS website. The method for doing this is detailed in the main documentation and also in the QGIS Tool Quick Start Guide, which includes a tutorial that uses the sample data file also available below. You will need to extract the contents of this file, which should be used with the documentation and tutorial above or with the Quick Start Guide below.
NOTE: This tool requires the use of QGIS 2.18 or 3.0. QGIS is available as a free download from www.qgis.org.
Overview: Spatial Quality Anomalies Diagnosis (SQUAD) Tool for QGISThis brief provides an overview of the SQUAD tool for QGIS, including an introduction, information on prerequisites, instructions on using the tool, and information on reviewing results.
Spatial Quality and Anomalies Diagnosis (SQUAD) Tool for QGIS Quick Start Guide (requires sample data file)QGIS is a free and open-source geographic information system (GIS) software. The SQUAD tool is a QGIS plug-in that will assess data quality of large spatial data sets. This short guide will show you how to install the plug-in and use the provided sample data to generate your first coded anomalies file.
Access main SQUAD tool information page |
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Landscape Survey: Understanding the Monitoring of Nutrition Assessment, Counseling, and Support
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MEASURE Evaluation |
2018 |
English |
Southern Africa |
Nutrition, HIV/AIDS, PHFS, HIS |
The Nutrition Assessment, Counseling, and Support (NACS) framework is a systems approach for integrating nutrition in routine health service delivery at the facility and community levels, and it has three primary components: nutrition assessment and classification, nutrition counseling, and nutrition support within a health care continuum.
In 2013, the Partnership for HIV-Free Survival (PHFS) launched an initiative—integrating NACS—in six countries: Kenya, Lesotho, Mozambique, South Africa, Tanzania, and Uganda. The initiative was designed to assist with existing national efforts to improve antenatal and postnatal HIV care and to increase maternal, infant, and child nutrition through the optimal uptake of World Health Organization guidelines on breastfeeding and HIV using quality-improvement methods.
A set of harmonized nutrition and HIV indicators was developed in 2012 to assist in the monitoring and evaluation of NACS. To better understand how these harmonized indicators are collected, used, and reported within the NACS framework, MEASURE Evaluation—funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief—conducted a landscape assessment in 2014 of NACS implementation in 12 of 16 priority NACS countries. This research aligns with USAID’s goals to prevent child and maternal deaths and to control the HIV epidemic, and also with the global 90-90-90 targets.
This report contains findings from the landscape assessment, which have also helped shape ongoing discussions and activities related to the overlap between nutrition and HIV, including a multipronged independent evaluation of the PHFS program.
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Evaluation of the Partnership for HIV-Free Survival Country Assessment: South Africa
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MEASURE Evaluation |
2018 |
English |
SOUTH AFRICA |
PMTCT, Nutrition, PHFS, Newborn health |
The Partnership for HIV-Free Survival (PHFS) was a six-country initiative implemented between 2012–2016. It was designed to reduce mother-to-child transmission of HIV and increase child survival.
This document focuses on seven components of PHFS in South Africa highlighted by a legacy evaluation of partnership activities. The findings are based largely on a rapid assessment conducted by MEASURE Evaluation in South Africa in January 2018. The core components follow:
• Government engagement• Continuous quality improvement• Mentoring• Knowledge exchange• Integration of services• Mother-baby pairs• Nutrition
The assessment was conducted by MEASURE Evaluation, which is funded by the United States Agency for International Development (USAID) and PEPFAR. Findings from assessments of PHFS in other participating countries are available on MEASURE Evaluation’s website, here: https://www.measureevaluation.org/our-work/hiv-aids/evaluations-of-the-who-pepfar-partnership-for-hiv-free-survival-1 |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Tanzania 2017: Survey Findings from Kizazi Kipya
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MEASURE Evaluation |
2018 |
English |
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Orphans and Vulnerable Children, PEPFAR, MER, Child health, Children, OVC |
As part of its monitoring, evaluation, and reporting (MER) guidance, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) launched a set of outcome indicators for orphans and vulnerable children (OVC) programs in 2014. The purpose of collecting these MER OVC Essential Survey Indicators is to obtain a snapshot of program outcomes at one point in time (Round 1–August 2017) and to assess changes in outcomes among OVC program beneficiaries over time (Round 2—planned for mid-2019). MEASURE Evaluation, funded by the United States Agency for International Development and PEPFAR, conducted this Round 1 survey in the councils in which Kizazi Kipya was working mid-2017. MEASURE Evaluation collected data from 680 caregivers and 2,309 children (a 91% response rate).
Kizazi Kipya is a five-year (2016-2021) project funded by PEPFAR through USAID. The project will achieve the following results: (1) parents and caregivers have the financial resources to meet the needs of vulnerable children and adolescents; (2) parents and caregivers have the skills to meet the needs of HIV-positive and vulnerable children and adolescents; (3) high-quality services are available to HIV-positive and vulnerable children and adolescents; and (4) high-quality services are available to “hard-to-reach” HIV-positive and vulnerable children and adolescents.
Access the related report at www.measureevaluation.org/resources/publications/tr-18-296/. |
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Overview: Spatial Quality Anomalies Diagnosis (SQUAD) Tool for ArcGIS
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MEASURE Evaluation |
2018 |
English |
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Data Quality, Spatial data, Data, Geography, GIS, Geographic Information Systems |
Knowledge about health facility locations is important in addressing HIV, maternal and child mortality, and other issues. As a result, there has been a rapid growth in large geospatial data sets, such as master facility lists (MFLs). An MFL and other similar lists typically contain locations of health facilities as well as attributes of the facilities—including name, address, or which administrative unit the facility is located in.
Assessing the quality of these data sets can be challenging, because there are two types of possible errors: spatial errors and attribute errors. Assessing spatial errors involves looking at such things as the presence of a coordinate, whether it is properly recorded, and the accuracy of its location. Assessing attribute errors involves determining whether attributes such as site name or site ID are correct.
When you work with large spatial data sets, manually reviewing each record to validate both location and attribute information can be prohibitively time-consuming. A more effective approach would be to look for anomalies in the data that may indicate data quality issues. MEASURE Evaluation’s Spatial Quality Anomalies Diagnosis (SQUAD) tool identifies six types of anomalies in spatial data. This fact sheet provides an overview of how to use the SQUAD tool with ArcGIS v10.5 with an advanced license. The tool can also be used with QGIS. |
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Overview: Spatial Quality Anomalies Diagnosis (SQUAD) Tool for QGIS
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MEASURE Evaluation |
2018 |
English |
|
Geographic Information Systems, GIS, Data Quality, Geography, Spatial data, Data |
Knowledge about health facility locations is important in addressing HIV, maternal and child mortality, and other issues. As a result, there has been a rapid growth in large geospatial data sets, such as master facility lists (MFLs). An MFL and other similar lists typically contain locations of health facilities as well as attributes of the facilities—including name, address, or which administrative unit the facility is located in.
Assessing the quality of these data sets can be challenging, because there are two types of possible errors: spatial errors and attribute errors. Assessing spatial errors involves looking at such things as the presence of a coordinate, whether it is properly recorded, and the accuracy of its location. Assessing attribute errors involves determining whether attributes such as site name or site ID are correct.
When you work with large spatial data sets, manually reviewing each record to validate both location and attribute information can be prohibitively time-consuming. A more effective approach would be to look for anomalies in the data that may indicate data quality issues. MEASURE Evaluation’s Spatial Quality Anomalies Diagnosis (SQUAD) tool identifies six types of anomalies in spatial data. This fact sheet provides an overview of how to use the SQUAD tool with QGIS2.18 or QGIS 3.0. The tool can also be used with ArcGIS. |
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Model of a Community-Based Information System: Essential Components and Functions
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Dawne Walker |
2018 |
English |
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Data use, Health information systems, CBHIS, Health System, Community-based health information systems, HMIS, Data |
A community-based information system (CBIS) is a dynamic system that includes information on how data are collected, how they flow, how to assess and improve data quality, and how the information is used. A CBIS involves data collection, management, and analysis of health and related services provided to communities outside of facilities (de la Torre, 2014).
To support the goals of the United States Agency for International Development (USAID) to combat infectious disease threats, the USAID-funded MEASURE Evaluation seeks to learn what works to improve health information systems and to address these systems holistically. MEASURE Evaluation’s work on CBIS aligns with these goals, because these systems operate at the community level, where health services are closest to the people who need them.
The CBIS model presented here is a starting point for framing what is currently known from the literature and from MEASURE Evaluation’s experience with community health and social service information systems in low- and middle-income countries. The model describes how a CBIS should function to help countries assess and strengthen their CBIS, by providing them with a reference for what should be included in a CBIS. The CBIS model has eight components that should be in place for a system that produces high-quality information for decision making. The components are leadership and governance; system design; system management; data sources; data management; information products and dissemination; data quality; and data use. The model also details the stakeholder groups who have a vested interest in the information generated by the CBIS and their roles in relation to the system. |
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Reproductive Health Cost Reporting System
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MEASURE Evaluation |
2018 |
English |
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Cost-effectiveness, Cost, Reproductive Health |
Program managers, finance directors, and funders often want to know the cost of delivering services. To answer this, programs often undertake or commission cost studies. Such studies take time, can be expensive, and provide snapshot information of a point in time. Organizations frequently collect service delivery data and track expenditures on human resources and labor and medical supplies, including pharmaceuticals and other regularly incurred office and equipment expenses. Yet these data are rarely assessed together. A better way may be to harness the basic information already available to an organization in real time—housed in its tracking systems and service delivery records. That is where the Reproductive Health Cost Reporting System (RHCRS) can assist.
This resource provides an overview of the RHCRS. A user guide is also available. |
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Integrating Family Planning Data from Public and Private Health Facilities in Malawi: How Current Approaches Align with FP2020 Goals
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Evelyn Evah Mwaungulu, MPH; Zione Dembo, MSc; Peter Mtema, MScs |
2018 |
English |
MALAWI |
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Introduction: Family planning (FP) data from public and private health providers in Malawi is not integrated. The country’s 2016 costed implementation plan review of progress indicated a modern methods contraceptive prevalence rate of 45 percent, far below the 60 percent goal. However, this figure excludes data from private facilities, which provide up to 40 percent of the health care in Malawi.
Objectives: The objective of this study was to find approaches to improve the national health information system by integrating FP data from private-sector service delivery points and government facilities. This research aligns with MEASURE Evaluation’s approach of addressing health information systems holistically
Methods: A qualitative approach brought both primary and secondary data sources into the analysis. Primary data were collected through key informant interviews and field observations. The study targeted three main actors from the private sector: Christian Health Association of Malawi (CHAM) facilities; Banja La Mtsogolo (BLM) clinics, a Marie Stopes International (MSI) franchise; and Population Services International (PSI) and its franchising clinics and pharmacies.
Findings: Both private and public institutions make a significant contribution toward provision of FP services, even though they do not always provide the same FP methods. A system is in place for dataflow from private facilities to the nearest government facility for consolidation in monthly reports to be included in DHIS 2. However, this system faces multiple challenges.
Recommendations: To integrate FP data generated by private facilities in the government system, we recommend conducting periodic meetings between the DHOs and private hospitals to share data, instituting proper systems for consolidating shared data, and harmonizing the private health facilities’ data management systems with the government system. Furthermore, the DHOs must take responsibility for encouraging private service providers to share their data for a minimum set of indicators.
Conclusion: Because both public and private facilities provide FP services, FP data integration is an important step toward improving site-level health services, a goal shared by the Government of Malawi and MEASURE Evaluation.
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Spatial Quality and Anomalies Diagnosis (SQUAD) Tool for QGIS Quick Start Guide
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MEASURE Evaluation |
2018 |
English |
|
GIS, Geographic Information Systems, Data, Spatial data |
QGIS is a free and open-source geographic information system (GIS) software. The Spatial Quality and Anomalies Diagnosis (SQUAD) tool is a QGIS plug-in that will assess data quality of large spatial data sets. Because it can be difficult to perform data quality checks on large data sets, the SQUAD tool rapidly and automatically looks for anomalies in the data that may indicate data quality issues.The tool requires two data sets (in the form of shapefiles): one consisting of point locations and the other consisting of polygons that represent administrative units. The tool will review the point locations and identify one of six anomalies:
Missing coordinates
Truncated coordinates (lack of adequate precision)
Duplicate coordinates for distinct records
Duplicate key attributes (two identical names, but plotting in different locations)
Coordinate not located exactly where it would be expected (but falling within two kilometers of a border)
Coordinate not located anywhere near where expected
The quick start guide provides a general overview of the use of the tool with the sample data available for the tool. A more detailed overview is available on the MEASURE Evaluation web site, here: www.measureevaluation.org/resources/tools/geographic-information-systems/squad-tool/.
Requires sample data file. |
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MEASURE Evaluation Modelo de Fortalecimiento del Sistema de Información en Salud: Un Resumen
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MEASURE Evaluation |
2018 |
Spanish |
|
Health Systems Strengthening, HIS, HISS, HISSM, Health Information Systems |
MEASURE Evaluation ha elaborado un modelo para fortalecer los sistemas de información en salud (SIS) en países de ingresos bajos y medianos. El modelo de fortalecimiento de los sistemas de información en salud es un punto de partida para contextualizar lo que sabemos ahora y las oportunidades que tenemos para aprender más sobre el fortalecimiento del SIS. Este modelo explica la comprensión actual de MEASURE Evaluation y nos guía a medida que continuamos aprendiendo cómo los SIS en los países de ingresos bajos y medianos recursos se diseñan, desarrollan e implementan a lo largo del tiempo para apoyar los sistemas de salud y mejorar sus resultados. Un SIS se define ampliamente para abarcar todas las fuentes de datos de salud, incluidos los datos de las instalaciones de salud y de la comunidad recopilados como parte de los SIS de rutina o los sistemas de información de gestión de salud; registros electrónicos de salud para la atención del paciente; datos basados en la población; información de recursos humanos; información financiera; información de la cadena de suministro; e información de vigilancia. Nuestro modelo incluye todo tipo de información que puede usarse para la toma de decisiones en el sector de la salud. Este modelo fue elaborado en colaboración con expertos de todo el mundo, utilizando el Marco de la Red de Métricas de Salud (HMN—por sus siglas en inglés) como base (HMN, 2008) para abordar cuatro objetivos clave: (1) promover los SIS como una función esencial de un sistema de salud, (2) definir el fortalecimiento, (3) medir el desempeño, y (4) monitorear y evaluar las intervenciones del sistema de información en salud.
MEASURE Evaluation agradece los comentarios acerca del modelo de fortalecimiento de los sistemas de información en salud y compartirá actualizaciones a través de MEASURE Evaluation HIS Strengthening Resource Center: https://www.measureevaluation.org/his-strengthening-resource-center/. |
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Uganda’s Resources to Finance Family Planning Commodities: Implications for a Total Market Approach
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Albert Kalangwa, Ventrine Marion Chelimo, Rose Nakandh |
2018 |
English |
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Contraception, Total market approach, Family Planning, Uganda |
Background: Uganda is in the initial stages of adopting a total market approach (TMA) as a sustainable way to finance national needs for family planning (FP) commodities. We assessed how in-country resources could mitigate financing shortages for FP commodities.
Method: Import data for FP commodities available at the National Drug Authority (NDA) of Uganda were analyzed to establish the financing trends for FP commodities in different sectors of the country for a three-year period (July–June 2013–2014, 2014–2015, and 2015–2016).
The need for FP commodities, the quantity of FP commodities distributed, and the proportion of FP commodities financed by the government, the private sector, and global financing mechanisms in Uganda per year were determined through a quantitative analysis of secondary data. The commercial value of FP commodities used in Uganda per year was computed using data obtained from the NDA, and market prices were obtained through retail audits. The TMA indicators that could be routinely reported in Uganda’s routine health information system (RHIS) were determined through key informant interviews (KIIs) targeting national-level stakeholders.
Findings: The universe of need (UON) increased from 2014 to 2016. The extent to which the UON was met by supplies available in-country was below one percent for all commodities, on average. The total quantity of male condoms and implants distributed in-country during the period 2014 to 2016 decreased and the quantity of intrauterine devices (IUDs), injectables, female condoms, emergency contraceptive pills (ECPs), and combined oral pills increased. The commercial value of all FP commodities distributed in Uganda per year declined from United States dollar (US$)89,175,917 in 2013–2014 to US$81,112,086 in 2014–2015 and decreased further in 2015–2016 to US$21,128,815. |
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PEPFAR Orphans and Vulnerable Children Monitoring, Evaluating, and Reporting Essential Survey Indicators: Protocol Template
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Lisa Marie Albert, Lisa Parker |
2018 |
English |
|
OVC, MER, Monitoring, Evaluation, Children, Orphans and Vulnerable Children, PEPFAR |
MEASURE Evaluation developed this protocol template for organizations collecting the Monitoring, Evaluation, and Reporting (MER) Orphans and Vulnerable Children (OVC) Essential Survey Indicators (ESI) of the United States President’s Emergency Plan for AIDS Relief (PEPFAR). This protocol template includes sections on background, study design, human subjects research, and fieldwork procedures for data collection of the nine MER OVC ESI.
If you are unable to use the Word version of the template, download the PDF.
Access the related enumerator manual template and supervisor manual template. |
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Characterizing Male Sexual Partners of Adolescent Girls and Young Women in Mozambique: Findings from Focus Group Discussions in Xai-Xai, Beira, and Quelimane Districts
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Nena do Nascimento, Ana Costa, Jenifer Chapman |
2018 |
English |
|
Adolescent Girls, Sexual Behavior, Young Women, HIV, AGYW |
While a considerable amount of information is available on the factors that contribute to HIV risk for adolescent girls and young women (AGYW) in Mozambique, little is known about the characteristics of boys and men with whom AGYW engage in sexual activity and how AGYW form sexual partnerships. This knowledge is critical for targeting HIV services to this group of boys and men, and ultimately to reduce the spread of HIV and AIDS among AGYW. To address this knowledge gap, we undertook a study to answer the following research questions:
Who are the sexual partners of AGYW?
Is sexual risk-taking behavior (namely partner concurrency and unprotected sex) among AGYW and their male partners associated with certain sexual partner characteristics (such as age, education, employment, and income)?
We conducted a total of 15 focus group discussions (FGDs) with 102 AGWY ages 15–24 years in three Mozambique locations: Quelimane, Beira, and Xai-Xai Districts. Each FGD averages six to eight participants; one had only four.
We sampled AGYW with diverse demographic characteristics (such as in-school/out-of-school, married/single, and mother/childless). Our study team convened a committee in each district to devise a recruitment strategy in each location. Local PEPFAR implementing partner organizations recruited study participants from health clinics, schools, and other locations in the community.
This report shares findings from the FGDs. Access the related Characterizing Male Sexual Partners of Adolescent Girls and Young Women in Mozambique: Quantitative Results from Beira, Quelimane, and Xai-Xai Districts resource. |
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Improving Outbreak Detection through Strengthened Health Information Systems
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MEASURE Evaluation |
2018 |
English |
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Health Systems Strengthening, LMICs, Health information systems, Infectious disease, HISS, HIS |
The purpose of this synthesis—which is one of a series—is to understand how strengthened health information systems (HIS) can improve outbreak detection in low- and middle-income countries (LMICs). To investigate the ways that outbreak detection can be improved through strengthened HIS, we were interested in programs that explored connections between HIS strengthening interventions and outbreak detection of two infectious diseases: malaria and Ebola. We searched a wide range of possible interventions and examined a few that met our criteria—those discussed here in some depth. |
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Selecting Key Indicators for Male Engagement in Family Planning: Forum Report
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Brittany Iskarpatyoti, Bridgit Adamou |
2018 |
English |
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Male engagement, Family Planning, Gender |
Although male engagement is becoming more common in family planning strategies and interventions, effective monitoring and evaluation (M&E) of this approach lags. MEASURE Evaluation—funded by the United States Agency for International Development (USAID)—conducted a review: “Male Engagement in Family Planning: Gaps in Monitoring and Evaluation” (Adamou, Iskarpatyoti, Agala, & Mejia, 2017). The report identifies gaps in the M&E of male engagement in FP (MEFP) and makes recommendations to address them. One recommendation was to identify strong, high-quality indicators to monitor and evaluate MEFP interventions.
To achieve consensus on key indicators for MEFP, MEASURE Evaluation conducted an online forum to discuss a set of proposed indicators with experts in the field. Forty-two people joined the online forum, hosted by Google Groups, over a period of four weeks. We asked forum participants to share their experiences with and reactions to the proposed indicators, explore potential missing key indicators and share solutions to reach consensus on key indicators for measuring MEFP.
This report summarizes those discussions and the recommendations that emerged. |
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Phylogenetic Analysis of HIV in East Africa Cross-Border Areas: Final Report
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Jessie K. Edwards, PhD; Arti Virkud, MPH; Milissa Markiewicz, MPH; and Grace Mulholland, MSPH |
2018 |
English |
East Africa |
Key Populations, AIDS, ART |
In 2015, 50–80% of roughly 8 million individuals living with HIV in East Africa received antiretroviral therapy (ART) to achieve HIV suppression and reduce transmission. These individuals are at risk of acquired drug resistance. Resistance mutations are projected to increase in prevalence, as ART is prescribed earlier and more frequently.
MEASURE Evaluation, funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief, conducted the East Africa Cross-Border Integrated Health Study in 2016 with the aim of describing the health status and behaviors of mobile and vulnerable populations at 14 cross-border sites in Kenya, Rwanda, Tanzania, and Uganda. The study interviewed 11,567 participants and had the following objectives:
Identify possible HIV transmission clusters
Characterize drug resistance mutations in mobile and vulnerable populations
Examine the relationship between the presence of drug resistance mutations and characteristics of the sample
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Diagnóstico de la capacidad de monitoreo y evaluación del VIH (Guatemala)
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MEASURE Evaluation |
2018 |
Spanish |
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Guatemala, MECAT, Monitoring, Evaluation, HIV, HIV/AIDS, Capacity Building |
Con la presencia de participantes de diversos sectores, el Ministerio de Salud Pública y Asistencia Social de Guatemala a través del Programa Nacional de VIH y MEASURE Evaluation, llevó a cabo el 26 y 27 de Febrero 2018, un taller para valorar las capacidades en monitoreo y evaluación (MyE) con que cuentan los actores claves de la respuesta nacional de Guatemala en el marco de las recomendaciones de lineamientos internacionales para controlar la epidemia de VIH como problema de salud pública.
Durante el taller se aplicó la Herramienta para evaluar la capacidad de Monitoreo y Evaluación MECAT (Monitoring and Evaluation Capacity Assessment Toolkit), la cual utiliza los 12 Áreas de Capacidad para un Sistema Nacional Funcional de MyE de VIH. |
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Le programme de renforcement du leadership pour la demande et l’utilisation des données en Guinée
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MEASURE Evaluation |
2018 |
French |
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HIS, Ebola, Health Systems Strengthening, Health Information Systems, HISS, Guinea |
L’équipe de MEASURE Evaluation a été contractée par l’Agence des Etats-Unis pour le développement international (USAID) dans le but de renforcer les efforts déjà entrepris par le gouvernement Guinéen pour réorganiser le système d’information sanitaire (SIS) au lendemain de l’épidémie de l’Ebola. Au bout de six mois, un nouveau système national d’information sanitaire (SNIS) était mis en place dans le pays au niveau de 38 districts sanitaires, soutenu par le logiciel DHIS 2. Parmi les nombreuses instances d’assistance technique fournies au cours de cette période d’implémentation figurait le programme de leadership pour la demande et l’utilisation des données (DUD). Ce programme visait à transmettre une approche d’apprentissage expérientielle pour développer les compétences nationales en matière de leadership, de gestion et d’utilisation des données. Ce, dans le but de traduire les données de routine en informations qui peuvent facilement être utilisées dans les prises de décision pour améliorer les prestations de services.
The MEASURE Evaluation team was contracted by the United States Agency for International Development (USAID) to strengthen the efforts already made by the Guinean government to reorganize the health information system (HIS) following the Ebola epidemic. At the end of six months, a new National Health Information System (NHIS) was established in the country at 38 health districts, supported by the DHIS 2 software. The implementation period included the Leadership for Data Demand and Use (DDU) program as part of the technical assistance provided. This program aimed to convey an experiential learning approach to develop national skills in leadership, management, and use of data in order to translate routine data into information that can easily be used in decision making to improve service delivery. |
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Engagement de la communauté dans la revue et l’amélioration des services de santé en utilisant les données du système national d’information sanitaire (SNIS)
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MEASURE Evaluation |
2018 |
French |
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Data, Community, Health information systems, Guinea, Health Workers, HIS |
Les activités de revue des données du SNIS pour les niveaux communautaires ont pour but de mettre en place un cadre de concertation et une synergie d’action entre les acteurs sanitaires au niveau local et communautaire. Il s’agit d’un projet pilote centré sur le renforcement des capacités et sur la promotion de l’utilisation des données qui vise l’implication et l’engagement des agents de santé communautaire, des comités de santé et d’hygiène (COSAH), et des centres de santé dans la gestion des programmes et services de santé. Ce projet pilote se déroule au travers des réunions de revue de données pour la prise de décision basée sur des données de qualité.
National health information system data review activities at the community level aim to put in place a framework for consultation and coordinated action between health actors at the local and community level in Guinea. This pilot project focuses on capacity building and promoting data use and aims for the implication and the commitment of community health workers, health and hygiene committees (COSAH), and health centers in the management of health programs and services. This pilot project takes place through data review meetings for data-driven decision-making. |
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Renforcement organisationnel pour un Système d’Information Sanitaire durable
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MEASURE Evaluation |
2018 |
French |
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Health Information Systems, Guinea, HIS, HISS, Health System |
Au regard des insuffisances identifiées à la suite de l’évaluation du Système National d’Information Sanitaire (SNIS) en 2014, il est apparu primordial d’organiser le SNIS autour d’une vision stratégique. Cette vision stratégique est partagée dans une perspective systémique pour offrir aux usagers et intervenants du secteur de la santé une base de travail et un référentiel unifié. Le Bureau de Stratégie et de Développement (BSD) du Ministère de la Santé de Guinée, en collaboration avec ses partenaires techniques et financiers, a produit un plan stratégique 2016–2020 pour renforcer le SNIS. A la fin de l'année 2017, le BSD, en collaboration avec les partenaires et les représentants de tous les niveaux du système sanitaire, a passé en revue le progrès réalisé à la mi-parcours du plan stratégique. Les groupes ont produit un rapport des solutions, interventions et recommandations selon les axes stratégiques pour le plan opérationnel de 2018.
In view of the shortcomings identified following the evaluation of Guinea’s National Health Information System (NHIS) in 2014, it seemed essential to organize the NHIS around a strategic vision. This strategic vision is shared in a systemic perspective to provide users and stakeholders in the health sector with a unified frame of reference. The Bureau of Strategy and Development (BSD) of the Ministry of Health of Guinea, in collaboration with its technical and financial partners, has produced a strategic plan for 2016-2020 to strengthen the NHIS. At the end of 2017, the BSD, in collaboration with partners and representatives from all levels of the health system, reviewed the progress made at the mid-point of the strategic plan. The groups produced a report of the solutions, interventions, and recommendations along the strategic lines for the 2018 operational plan. |
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La DCS de Kaloum, Championne en DUD, contribute à l’amélioration de la couverture vaccinale: Le taux d’abandon entre les antigènes BCG/VAR a été réduit
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MEASURE Evaluation |
2018 |
English |
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Immunization, Health Services, Disease prevention, Child survival, Child Health |
Une intervention essentielle pour la survie de l’enfant est la prévention de la maladie grâce à l’adhésion au calendrier vaccinal. C’est la mission que la Direction Communale de la Santé (DCS) de Kaloum s’est fixée en vue de renforcer les capacités des centres de santé (CS) à fournir ce service important pour la survie de l’enfant. L’équipe de la DCS de Kaloum a identifié que le niveau de mise en œuvre du service de vaccination était trop faible pour atteindre la couverture suffisante afin de protéger les enfants de la commune de Kaloum.
An essential intervention for child survival is disease prevention related to adherence to the vaccination calendar. The Communal Health Authority (DCS) in Kaloum, Guinea, has set itself the goal of strengthening health centers to provide this important service for child survival. The Kaloum DCS team identified that the implementation level of the immunization service was too low to achieve sufficient coverage to protect Kaloum’s children. |
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Succès de l’utilisation des données : La région de Kindia renforce les capacités des agents de santé communautaire dans la lutte contre le paludisme
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MEASURE Evaluation |
2018 |
French |
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Malaria, Capacity Building, Health information, Guinea, DHIS 2 |
L’équipe régionale de Kindia a utilisé les données du District Health Information Software–version 2 (DHIS 2) pour identifier le besoin de renforcer les capacités des agents de santé communautaire (ACS) dans la lutte contre le paludisme. Les membres de l’équipe ont réussi à engager les parties prenantes de leur région pour comprendre les problèmes et élaborer un plan d’action avec un large soutien. Leurs efforts collectifs ont abouti à l’expansion des services de paludisme pour les habitants de Kindia.
The regional team in Kindia, Guinea, used data from the District Health Information Software version 2 (DHIS 2) to identify the need for capacity building of community health workers (CHWs) in the fight against malaria. Team members successfully engaged stakeholders in their region to understand the issues and develop an action plan with broad support. Their collective efforts have resulted in the expansion of malaria services for the inhabitants of Kindia. |
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La promotion de la demande et de l’utilisation des données du SNIS en Guinée contribue à l’amélioration de la performance dans les établissements sanitaires
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MEASURE Evaluation |
2018 |
French |
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Health data, Data, HIS, Guinea, DHIS 2 |
La situation : Une évaluation approfondie du système national d’information sanitaire (SNIS) en 2014 a révélé un vrai manque des éléments essentiels à l’utilisation régulière des données— la disponibilité des rapports, la référence aux rapports dans la gestion des services, le suivi des décisions prises, et le signalement au niveau supérieur de problèmes rencontrés pour recevoir un appui externe (MEASURE Evaluation ; PRISM).
Les défis : Avec la mise en place et le déploiement du DHIS 2 pour gérer les données sanitaires de routine et y accéder depuis les quatre coins du pays, les équipes au niveau sous-national ont besoin d’identifier le SNIS comme un outil essentiel pour leur travail. Ces équipes devaient être capables d’analyser, d’interpréter, et de relier les données aux services rendus pour renforcer leurs connaissances et améliorer leurs performances.
The situation: An in-depth evaluation of Guinea’s National Health Information System (NHIS) in 2014 revealed a lack of some essential elements for the regular use of data, namely the availability of reports, references to reports in service management, following-up of decisions made, and reporting to the next level problems encountered in receiving external support (MEASURE Evaluation ; PRISM).
Challenges: With the implementation and deployment of DHIS 2 to manage and access routine health data from across the country, subnational teams need to identify the NHIS as an essential tool for their work. These teams should be able to analyze, interpret, and link the data to the services provided to enhance their knowledge and improve their performance.
The 2018 version of the PRISM Series, updated and with new modules (Toolkit, User’s Kit, and Training Kit) is available here: https://www.measureevaluation.org/prism |
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Une approche standardisée au renforcement du Système National d’Information Sanitaire (SNIS) est la clef d’une mise en œuvre réussie
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MEASURE Evaluation |
2018 |
French |
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Guinea, Health Information Systems, Digital Health, HIS |
Cette affiche partage les neuf principes du développement numérique au renforcement du système national d'information sanitaire de la Guinée.
This poster shares the nine principles of digital development for the reinforcement of Guinea's national health information system. |
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Approches techniques de renforcement de la gestion du système d’information sanitaire de routine (SISR) de Guinée
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MEASURE Evaluation |
2018 |
French |
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Health information, Health Information Systems, RHIS, HIS, Guinea, Routine Health Information Systems |
Un système d’information sanitaire robuste favorise des prises de décision éclairées. Quelles stratégies ont été utilisées pour le renforcement du SISR ? Les stratégies reposaient sur l’engagement des partenaires (cartographie et matrices des responsabilités), le renforcement du savoir-faire des acteurs nationaux et la mise en place d’un mécanisme de coordination des interventions. Qu’est ce qui a changé ? Les composantes du système d’information sanitaire sont en place pour la coordination des interventions. Tous les acteurs du SISR savent comment réaliser et maintenir le fonctionnement du SISR, tout en assurant que le SISR est à même de répondre aux questions de santé qui se posent. Les outils appropriés ont été développés et mis à la disposition des acteurs.
A robust health information system promotes enlightened decision-making. What strategies have been used to strengthen Guinea’s routine health information system (RHIS)? The strategies were based on the commitment of partners, strengthening the know-how of national actors, and setting up a mechanism for coordinating interventions. What has changed? The components of the health information system are in place for the coordination of interventions. All actors in the RHIS know how to achieve and maintain system functions, while ensuring that the RHIS is able to respond to health issues that arise. Appropriate tools have been developed and made available to stakeholders. |
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Renforcement des systèmes d’information sanitaire en Guinée
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MEASURE Evaluation |
2018 |
French |
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Health information, Health information systems, HISSM, HIS, Guinea, HISS |
MEASURE Evaluation, une initiative financée par l’Agence des États-Unis pour le développement international, collabore avec le Bureau de Stratégie et de Développement (BSD) en Guinée sous l’égide du Ministère de la Santé et de l’Hygiène Publique (MSHP) pour actualiser sa collecte de données, autrefois cloisonnée et facilitée par les bailleurs de fonds, en la transférant vers un système simplifié recourant à la plateforme électronique DHIS 2. La plupart de ces efforts visent à renforcer les éléments du système d’information sanitaire (SIS) définis dans le Modèle de renforcement des systèmes d’information sanitaire (MRSIS) de MEASURE Evaluation.
The MEASURE Evaluation project, funded by the United States Agency for International Development (USAID), collaborates with Guineas’s Office of Strategy and Development (BSD) within the Ministry of Health and Public Hygiene (MSHP) to update its data collection system, formerly divided and facilitated by donors, by transferring it to a simplified system using the electronic platform DHIS 2. Most of these efforts aim to strengthen the elements of the health information system (HIS). |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Namibia: 2017 Survey Findings from Project HOPE
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MEASURE Evaluation |
2018 |
English |
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PEPFAR, Monitoring, Namibia, OVC, Orphans and Vulnerable Children |
This poster shares findings from a survey of Project HOPE in Namibia. |
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Scaling Mobile Community-Based Health Information Systems: Two Case Studies: Medic Mobile and Living Goods, Dimagi and mothers2mothers
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Dawne Walker, Liz Nerad |
2018 |
English |
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Community-based health information systems, CBHIS, Health Workers, MHealth |
Focusing on practical and replicable mHealth implementations, the USAID-funded MEASURE Evaluation conducted case studies of two mHealth projects that have moved beyond the pilot phase. These studies aim to provide insight into how two implementing partners worked with technology companies to implement mHealth solutions in order to improve case management and care coordination, and thus monitoring and evaluation (M&E) of their programs. Through these studies, MEASURE Evaluation shares lessons learned and best practices that others can draw upon when developing their own mHealth solutions.
The first case study highlights the partnership between Living Goods and Medic Mobile. The second case study features Dimagi and mothers2mothers.
Access a related resource. |
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Use of Community Health Data for Shared Accountability
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MEASURE Evaluation |
2018 |
English |
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Health data, Community, Health Workers |
MEASURE Evaluation, funded by the United States Agency for International Development (USAID), developed guidance for use by country ministries of health (MOHs), local government, nongovernmental organizations (NGOs), civil society, and community leaders to foster community engagement and shared accountability for monitoring and responding to significant health events and concerns (e.g., pregnancies,bmaternal and neonatal deaths, and epidemics). It is available here: https://www.measureevaluation.org/our-work/data-demand-and-use/useofcommunityhealthdata. That document takes a community-centric approach, whereby the community determines its own higher-priority health concerns and actions, in line with the principles of achieving the United Nations Sustainable Development Goals for health (United Nations, 2015). It draws from a variety of experiences and examples of community-level data collection, presentation, and use for taking action. This brief provides an overview of the guidance. |
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Use of Community Health Data for Shared Accountability: Guidance
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Tariq Azim, Binyam Tilahun, Stephanie Mullen |
2018 |
English |
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Health data, Accountability, Community, Health Workers |
This is a guidance for practice document on how to use health data to be more responsible and accountable to communities for their health status. This document is designed for community leaders (informal and formal, including religious leaders, ethnic group leaders, civic leaders, and civil administration leaders in the community), community activists, and community residents, in general. This document will guide them through the process of using health data for shared accountability for improving their own health. The guidelines may also be used by ministries of health to provide support to communities in developing tools, procedures, and processes to foster community engagement and shared accountability between the health system and the community for the monitoring of and responsiveness to significant health events (e.g., pregnancies, child health, maternal and neonatal deaths, chronic diseases, epidemics). By using these guidelines, health ministries, district health authorities, and nongovernmental organizations can promote a culture of health information use at the community level.
Access a related brief and PowerPoint presentation. |
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Measurements to Capture the Quality of HIV Services for Men Who Have Sex with Men and for Transgender People
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Leslie Craig, Katherine Andrinopoulos |
2018 |
English |
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HIV, PLHIV, MSM, HIV/AIDS, Key Populations, TG, Transgender, Service delivery, Men who have sex with men |
The goal of achieving quality in service provision is common in HIV programming, but progress in the field has stalled, because of a lack of clarity about how to operationalize quality and measure end roads to success. A previous report used findings from a systematicliterature review to develop a definition of quality and an analytical framework for the quality of HIV services geared to men who have sex with men (MSM) and for transgender people.
This new report presents existing measures of quality proposed in our previous framework, highlights the current gaps, and suggests future directions. Produced by MEASURE Evaluation, a project funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—the report is directed to policymakers, program managers, and researchers who collect and use data about quality to design, implement, and evaluate programs along the HIV care continuum for MSM and transgender people. |
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Reproductive Health Cost Reporting System: A User Guide
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Scott Moreland, Shaylen Foley, Stacie Gobin |
2018 |
English |
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Reproductive Health, Data, Reporting, TEST, Cost |
The Reproductive Health Cost Reporting System (RHCRS) is a management tool that can help reproductive health (RH) service delivery organizations to capture and analyze existing financial data on a regular basis. As such, it is designed to treat financial, commodity, labor, and other cost data as inputs to a system that allows service delivery organizations to estimate what it costs to deliver specific services, what the cost drivers are, and how these costs may differ across service delivery points (SDPs), across regions and over time.
Organizations frequently collect service delivery counts and track expenditures on human resources and labor, medical supplies and procurement, and other regularly incurred office and equipment expenses. Yet, these data are rarely assessed together, let alone annually. The RHCRS allows organizations to use these records to calculate the average cost of their services. These unit costs can then be compared across sites and regions of the organization and broken down by various cost elements. Annual data enable programs to assess trends in service costs. Reports and graphics are available to illustrate and summarize these comparisons.
The purpose of this guide is to provide organizations using the Reproductive Health Cost Reporting System with information about how the system works and who it is intended for, and a detailed tutorial on how to use it. The downloadable file above is A4 size. Download the letter-sized version.
Access the RHCRS at https://rhcrs.measureevaluation.org.
Watch a related webinar and view the slides. |
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Map of Data Flow in Health Information Systems (A series of four)
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J. C. Thomas |
2018 |
English |
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Health Information Systems, Data, HIS, Health System, Health outcomes |
This set of illustrations poses four basic questions about health system performance and illustrates how the data generated by functioning health information systems (HIS) contribute to that performance. The questions move from policy to use of resources and health outcomes:
What are our population health priorities?
What resources do we have to address our priorities?
Are we using our resources efficiently?
Are we making progress on our priorities?
The graphics also outline the data sources that generate the information to answer those questions. Data sources considered are government health entities from districts or national levels; medical stores; laboratories; community organizations; health facilities, both public and private; and household data from population surveys. The four flow charts illustrate which entities generate data that are contributing to the overall picture of health trends, disease prevalence, available medical commodities, and population trends. The understanding of these aspects of health are an aid to decision makers who must make judgments about how to allocate resources, where more staff are needed, what programs are working, and what health policies might need to change.
Access additional health information systems infographics and models. |
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Prevention Needs and Priorities among Vulnerable Female Populations Living with HIV
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Ida M. Swai, MPAFF; Dino Wosio; and Mwanaisha Mnaro |
2018 |
English |
TANZANIA |
People Living with HIV, HIV counseling and testing, HIV/AIDS, Temeke, Vulnerable populations, PLHIV |
Historically, HIV prevention efforts have focused on reducing risk among those who have tested negative for the virus and those with unknown serostatus. However, these efforts overlook the specific role that people living with HIV can play in prevention. These HIV-positive populations should be engaged in prevention efforts to help them live healthy lives and to minimize the risk of spreading HIV to others. This study’s purpose was to establish the prevention needs and priorities for vulnerable female populations living with HIV: pregnant women, adolescent girls, female sex workers, and female elders.
The study employed a mixed-methods approach relying on survey data collected from 246 females living with HIV who were attending four care and treatment centers across Temeke municipality, in the Dar es Salaam region. Focus group discussions were conducted with 50 selected respondents and eight policy-related questionnaires were completed by program administrators.
This report outlines background and methods, reports results, and provides recommendations to address the unmet prevention needs in Temeke Municipality, Tanzania. |
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Strengthening Health Information Systems in Botswana
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MEASURE Evaluation |
2018 |
English |
BOTSWANA |
Health Systems Strengthening, HISSM, Health Information Systems, HISS, health information system strengthening, HIS |
MEASURE Evaluation, funded by the United States Agency for International Development, has been working with Botswana’s Gender Affairs Department—housed within the Ministry of Nationality, Immigration, and Gender Affairs—to put in place a mobile-based referral system to better connect survivors of gender-based violence (GBV) to available services. Before this pilot, a system for capturing or transferring GBV data did not exist. In the absence of such a system, collecting GBV data for planning purposes was difficult, and when GBV survivors sought help, they were forced to provide their information multiples times at different legal, health, and other service points. MEASURE Evaluation’s collaborative effort to create and implement the GBV referral system strengthens elements of the health information system (HIS) identified in our Health Information System Strengthening Model.
This brief features a graphic that depicts MEASURE Evaluation activities in the model’s “enabling environment” and “information generation” domains to support the referral system. By displaying interventions across the model, we see their strategic interaction, and how this combination of interventions strengthens data quality and use at all levels of the health system. A table lists additional MEASURE Evaluation activities that support HIS strengthening in Botswana, by the year in which they began. Because of these interventions, we expect to the quality of the data collected to improve and the use of GBV data to generate health indicators, statistics, and trends for data-informed decision making to increase. |
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Standard Operating Procedure for Integrating Gender in Monitoring, Evaluation, and Research
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MEASURE Evaluation |
2018 |
English |
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Gender |
Gender-related issues permeate culture and its institutions, often leading to health inequities for everyone. Gender inequalities affect health outcomes and program implementation, and ultimately the success of programs. Public health information systems must identify sex-specific trends and provide information needed to eliminate inequities, but gender integration in monitoring, evaluation, and research goes beyond just sex-disaggregated data. The purpose of this standard operating procedure (SOP) is to clearly identify ways to account for gender equality as part of monitoring, evaluation and research activities from planning and budgeting to implementation and dissemination. |
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Integrating Family Planning Data in Uganda's Health Management Information System
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Stephen Ojiambo Wandera, PhD; Betty Kwagala, PhD; Olivia Nankinga, MSc; Patricia Ndugga, MSc; Allen Kabagenyi, PhD |
2018 |
English |
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Health information systems, Health Systems Strengthening, Family Planning |
Uganda’s health management information system (HMIS) was established in 1985 to collect and analyze national data on morbidity from communicable and noncommunicable diseases, reproductive health, family planning (FP), and immunization. The routine health data reporting system has evolved to the current platform, DHIS 2, use of which began in 2011 in a few districts and was rolled out to all districts in Uganda in 2012.
Few studies have explored the mechanisms for integrating FP data from the public and private health sectors in Uganda’s national HMIS. This study aimed to investigate the barriers, facilitators, and best practices of integrating these FP data in the district and national HMIS in Uganda. |
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Assessing Capacity for Evaluation: A Pilot in Kenya
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MEASURE Evaluation |
2018 |
English |
KENYA |
Capacity Assessment, Evaluation, APHRC, Pilot, Capacity Building |
Funders want to know if the programs they support in low-resource countries are succeeding and look to evaluations for the answer. However, if outside experts conduct the evaluations, these countries miss the chance to build their capacity to do this work themselves. Strengthening the capacity of local institutions to implement evaluations is a critical need.
The capacity-building approach embraced by MEASURE Evaluation, funded by the United States Agency for International Development, is “learning by doing.” While an evaluation is implemented, a concurrent process develops the knowledge, skills, and competencies of a local organization.
In 2016, with the goal of systematizing this learning-by-doing approach, MEASURE Evaluation prepared a toolkit for capacity building in evaluation.
That same year, MEASURE Evaluation piloted this guidance with a local research partner in Kenya: the African Population and Health Research Center (APHRC), which is a pan-African research institution headquartered in Nairobi. Our goals were to conduct an evaluation and to improve APHRC’s evaluation capacity. This experience in Kenya, outlined in this brief, was a valuable test of the toolkit, yielding insights for future applications. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Mozambique: 2017 Baseline Evaluation of Project Força à Comunidade e às Crianças
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Jenifer Chapman, Alicia Calane, Carlos Lauchande, Arsenia Amelia Paulo, Zulfiya Charyeva |
2018 |
English |
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Mozambique, Monitoring, Orphans and Vulnerable Children, OVC, Monitoring, Evaluation |
In 2014, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) introduced a set of outcome indicators for programs serving orphans and vulnerable children (OVC)—referred to as monitoring, evaluation, and reporting (MER) essential survey indicators (ESI)—with the requirement that these indicators be collected every two years by a research organization not providing services to OVC households. These outcome indicators reflect internationally accepted developmental milestones and collectively measure holistic well-being of children over time. A standard survey method and tools have been developed to collect these data in countries where PEPFAR is supporting OVC programs. The purpose of this study is to collect the MER essential survey indicators at two points in time (2017 and 2019) from active beneficiaries of Project Força à Comunidade e às Crianças (Project FCC).
This report describes the methods used to conduct the Project FCC MER OVC ESI survey and presents results for the ESI in accordance with MER guidance. This information is intended to help Project FCC better understand the strengths and weaknesses of its beneficiary population at this time. It also is intended to support the project, the PEPFAR OVC team, and other program decision makers and stakeholders, including those from the Government of Mozambique, to take evidence-informed actions to improve OVC program strategy, resource allocation, and implementation, to improve the well-being of the children and households they serve. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Kenya: Timiza 90 2016 Survey Findings
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Susan K. Settergren, Cheikh M. Faye, Donatien Beguy |
2018 |
English |
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Monitoring, Evaluation, Orphans and Vulnerable Children, Monitoring, Kenya, MER, OVC |
In 2014, PEPFAR introduced a new global reporting requirement for monitoring the outcomes of its orphans and vulnerable children (OVC) programs, referred to as the monitoring, evaluation, and reporting (MER) OVC Essential Survey Indicators (ESIs). The ESIs are intended to measure and track child and household well-being using standardized indicators and methodology across projects and countries.
In 2016, The PEPFAR Kenya OVC team requested the assistance of the USAID project, MEASURE Evaluation, to collect data for the MER ESI. This report describes the methods used to conduct the Timiza 90 MER OVC ESI survey and presents results for the ESIs in accordance with MER guidance. A brief discussion of the findings is also provided. This information is intended to help the Timiza 90 project better understand the well-being of its beneficiaries and to support the project, the PEPFAR OVC team, and other program decision makers and stakeholders, including those from the Government of Kenya, to take evidence-informed actions to improve OVC program strategy, resource allocation, and implementation, with the ultimate goal of improving the well-being of the children and households they serve. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Kenya: APHIAplus Western Kenya 2016 Survey Findings
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Susan K. Settergren, Cheikh M. Faye, Donatien Beguy |
2018 |
English |
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|
In 2014, PEPFAR introduced a new global reporting requirement for monitoring the outcomes of its orphans and vulnerable children (OVC) programs, referred to as the monitoring, evaluation, and reporting (MER) OVC Essential Survey Indicators (ESIs). The ESIs are intended to measure and track child and household well-being using standardized indicators and methodology across projects and countries.
In 2016, The PEPFAR Kenya OVC team requested the assistance of the USAID project, MEASURE Evaluation, to collect data for the MER ESI. This report describes the methods used to conduct the APHIAplus Western Kenya (APHIAplus) MER OVC ESI survey and presents results for the ESIs in accordance with MER guidance. A brief discussion of the findings is also provided. This information is intended to help the APHIAplus project better understand the well-being of its beneficiaries at this point in time and to support the project, the PEPFAR OVC team, and other program decision makers and stakeholders, including those from the Government of Kenya, to take evidence-informed actions to improve OVC program strategy, resource allocation, and implementation, with the ultimate goal of improving the well-being of the children and households they serve. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Kenya: 2016 Survey Findings from APHIAplus Western Kenya
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MEASURE Evaluation |
2018 |
English |
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Monitoring, OVC, Kenya, Orphans and Vulnerable Children |
This poster shares findings from a survey among beneficiaries of the APHIAplus Western Kenya project in late 2016. MEASURE Evaluation collected data from 426 caregivers about themselves, their households, and 1,458 children under age 18 who were under their care (an 89 percent household response rate). |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Kenya: 2016 Survey Findings from Timiza 90
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MEASURE Evaluation |
2018 |
English |
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OVC, Monitoring, Orphans and Vulnerable Children, Kenya |
This poster shares findings from a survey among beneficiaries of the Timiza 90 project in Kenya in late 2016. MEASURE Evaluation collected data from 209 caregivers about themselves, their households, and 718 children under age 18 who were under their care (an 87 percent household response rate). |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Kenya: 2016 Survey Findings from the Walter Reed Program/Henry M. Jackson Foundation Medical Research International Project
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MEASURE Evaluation |
2018 |
English |
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OVC, Monitoring, Orphans and Vulnerable Children, Kenya |
This poster shares findings from a survey among beneficiaries of the Walter Reed Program/Henry M. Jackson Foundation Medical Research International (WRP/HJFMRI) project in Kenya in late 2016. MEASURE Evaluation collected data from 353 caregivers about themselves, their households, and 1,136 children under age 18 who were under their care (a 74 percent household response rate). |
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Assessing the Capacity of Monitoring and Evaluation and Health Information Systems: Tools for Assessing Capacity
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MEASURE Evaluation |
2018 |
English |
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Monitoring, Evaluation, Health Information Systems, HIS |
This spreadsheet is a categorized matrix of capacity-building assessment tools, for use in work to improve capacity for general monitoring and evaluation activities or health information systems, or to strengthen capacity to conduct rigorous evaluation. It is a companion to Assessing and Improving the Capacity of Monitoring and Evaluation and Health Information Systems: Guidance. |
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Assessing the Capacity of Monitoring and Evaluation and Health Information Systems: Guidance
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MEASURE Evaluation |
2018 |
English |
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Evaluation, HIS, Monitoring, Health Information Systems, Monitoring, Evaluation, Capacity Building |
The purpose of this document is to present best practices for assessing capacity systematically and using the assessment results to develop a capacity building plan (CBP) to strengthen HIS and M&E systems. The document provides information that:
Helps you decide whether a formal capacity assessment is appropriate for your activity
Offers strategies if you are struggling with stakeholder buy‐in
Identifies options and alternatives for assessing capacity if you have stakeholder buy‐in but constrained resources
Presents considerations for how the formal capacity assessment results or other documented information about capacity may be used for planning your capacity building interventions and for monitoring and tracking progress
Offers options for adapting or hybridizing tools if no existing tool fits your needs
Outlines ways that assessing and documenting M&E‐related capacity may be used to inform project planning, to provide feedback to donors and other stakeholders, and to report, including through the development of a CBP
Access associated tools. |
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Evaluation of the Partnership for HIV-Free Survival: Uganda
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MEASURE Evalution |
2018 |
English |
UGANDA |
HIV care, Uganda, Partnership for HIV-Free Survival, HIV, PHFS, Program evaluation |
The Partnership for HIV-Free Survival (PHFS) was implemented in six countries in eastern and southern Africa between 2012 and 2016. PHFS was a collaboration among the United States President's Emergency Plan for AIDS Relief (PEPFAR), UNICEF, and the World Health Organization (WHO) to accelerate the uptake of the WHO 2010 guidelines on HIV and infant feeding.
In Uganda, PHFS was implemented in 22 demonstration sites and 56 scale-up sites in six districts (Jinga, Manafwa, Namutumba, and Tororo in the Eastern Region; Kisoro and Ntungamo in the Western Region). Key partners included ASSIST (University Research Company, LLC), Food and Nutrition Technical Assistance Project (FANTA) (FHI 360), Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) (JSI), The AIDS Support Organization (TASO), the Uganda Ministry of Health, and USAID.
Findings from assessments of PHFS in other participating countries are available on MEASURE Evaluation’s website, here. |
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Evaluation of the Partnership for HIV-Free Survival Four-Country Overview: Kenya, Lesotho, Tanzania, and Uganda
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MEASURE Evaluation |
2018 |
English |
TANZANIA, UGANDA, KENYA, LESOTHO |
Evaluation, PMTCT, AIDS, partnership for HIV-free survival, PHFS |
This brief presents findings from the evaluation of activities related to the Partnership for HIV-Free Survival (PHFS). It focuses on eight components that contributed to the partnership’s success in Kenya, Lesotho, Tanzania, and Uganda:• Mother-baby pairs• Mother-baby clinics• Integration of services• Community engagement• Partnership• Quality improvement• Coaching• Knowledge exchangeThe findings are drawn largely from rapid, qualitative assessments conducted in these countries between June and December 2017 by MEASURE Evaluation, which is funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief.
Findings from assessments of PHFS in other participating countries are available here. |
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Health Information System Strengthening: Standards and Best Practices for Data Sources
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Fern Greenwell, PhD, MPH; Shannon Salentine, MPH |
2018 |
English |
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Health Systems Strengthening, best practices, Health Information Systems, data sources, Standards, HISS |
The purpose of this guide is to help health authorities and health information officers align health information system (HIS) data sources with standards and best practices. This alignment will maximize the likelihood that information on health conditions, services, and resources are recorded in a consistent way and ensure that reliable data produce comparable statistics at all levels of the health system. National standards are important especially for types of data for which global standards do not exist. The same principles apply to national and international standards; they should generate data that are exhaustive and mutually exclusive, in a format that can be analyzed statistically.
Although standards and best practices are continuously evolving, countries’ ongoing efforts to align data sources will increase the HIS efficiency to monitor population health status and health service delivery, identify health inequalities, and allocate health finances to achieve universal health care.
This guide is primarily directed to national health authorities and health information officers in ministries of health. It may also be informative for a wider range of technical and policy-oriented professionals. Each HIS data source module covers an HIS data source, summarizes best practices and standards for data from that source, and offers additional references to tools and resources.
This is the complete tool. Modules can be downloaded individually here.
Access the related Demand and Readiness Tool for Assessing Data Sources in Health Information Systems (HIS DART) resource. |
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mHealth Data Security, Privacy, and Confidentiality Guidelines: Companion Checklist
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Lauren Spigel, Samuel Wambugu, Christina Villella |
2018 |
English |
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Privacy, MHealth, Data, Confidentiality |
The mHealth Data Security, Privacy, and Confidentiality Checklist will help mHealth project managers and health information systems (HIS) officials from ministries of health assess security, privacy and confidentiality concerns of mHealth programs.
This checklist is designed to be used hand in hand with the mHealth Data Security, Privacy, and Confidentiality Guidelines. It is organized to follow the same order as the sections in the guidelines.
The checklist has two main goals:
Self-assessment: This checklist is to be used by mHealth managers and ministry of health HIS officials to assess the ability of mHealth programs to ensure the security, privacy, and confidentiality of sensitive health data. Although there is no built-in scoring system, items in the checklist are considered best practices.
Plan: This checklist will help implementers and policy managers identify security, privacy, and confidentiality considerations for mHealth programs. This checklist is not comprehensive, but it lays out critical elements of a robust security system within mHealth programs.
This checklist contains action-oriented steps that organizations and policymakers can take to bolster protections of sensitive data stored in mHealth ecosystems. |
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mHealth Data Security, Privacy, and Confidentiality: Guidelines for Program Implementers and Policymakers
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Lauren Spigel, Samuel Wambugu, Christina Villella |
2018 |
English |
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Data, Confidentiality, Privacy, MHealth |
These guidelines are intended to strengthen national health information systems (HIS), by providing a tool to guide decisions on security, privacy, and confidentiality of personal health information collected and managed using mobile devices.
mHealth technology comprises many layers that can affect data security, privacy, and confidentiality throughout the data life cycle. These layers include national and organizational policy; technology used in data collection, management, storage, and use; as well as user behavior. Each layer requires careful analysis to identify and protect potential vulnerabilities. The sensitivity of health data requires that the developers of mobile apps for health should build systems that have a secure back-end database; keep minimal or no personal health information data on the device; and ensure that the hardware, software, and communication channels between the device and other systems are secure.
These guidelines are meant to help mHealth program managers and ministry of health officials systematically address mHealth data privacy and security issues. For each of the layers of technology, these guidelines explore common vulnerabilities and propose ways to proactively address them to reduce possibilities of data breaches.
The guidelines also address overarching topics, such as national data leadership and governance, user behavior, and training. Other topics are technology-specific, such as mobile devices (hardware), operating systems, applications, networks, and data storage.
Access an accompanying checklist. |
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Evaluation of the Partnership for HIV-Free Survival Country Assessment: Tanzania
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MEASURE Evaluation |
2018 |
English |
TANZANIA |
Evaluation, PMTCT |
This brief presents findings from the evaluation of activities related to the Partnership for HIV-Free Survival (PHFS) in Tanzania. It focuses on six components: partnership, mother-baby pairs, integration of services, quality improvement, knowledge exchange, and community engagement. The findings are drawn largely from a rapid assessment conducted in Tanzania in June 2017 by MEASURE Evaluation, which is funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR).
The Partnership for HIV-Free Survival was implemented in six countries in eastern and southern Africa between 2012 and 2016. PHFS was a collaboration among the United States President's Emergency Plan for AIDS Relief, UNICEF, and the World Health Organization (WHO) to accelerate the uptake of the WHO 2010 guidelines on HIV and infant feeding in participating countries: Kenya, Lesotho, Mozambique, South Africa, Tanzania, and Uganda. Although specific aims differed slightly by country, the initiative was designed to reduce mother-to-child transmission of HIV and increase child survival, through improvements in breastfeeding practices, antiretroviral uptake and coverage among HIV-positive pregnant women and mothers, and overall mother-baby care.
Rapid assessments that MEASURE Evaluation conducted in participating PHFS countries used a qualitative lens to examine key PHFS activities and accomplishments.
In Tanzania, PHFS was implemented in a total of 90 sites located in three districts in each of three regions (Mbeya, Mufindi, and Nzega). Each district had 10 demonstration sites; 20 scale-up sites were added after one year. Partners at the national level were USAID, the Reproductive and Child Health Section/Prevention of Mother-to-Child Transmission of HIV Unit of Tanzania’s MOHCDGEC, University University Research Co. LLC (URC)-Applying Science to Strengthen and Improve Systems (ASSIST), Food and Nutrition Technical Assistance (FANTA), Tanzania Food and Nutrition Centre, and Jhpiego.
Findings from assessments of PHFS in other participating countries are available here. |
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Evaluation of the Partnership For HIV-Free Survival Country Assessment: Lesotho
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MEASURE Evaluation |
2018 |
English |
LESOTHO |
PMTCT, Evaluation |
The Partnership for HIV-Free Survival (PHFS) was implemented in six countries in eastern and southern Africa between 2012 and 2016. PHFS was a collaboration among United States President's Emergency Plan for AIDS Relief, UNICEF, and the World Health Organization (WHO) to accelerate the uptake of the WHO 2010 guidelines on HIV and infant feeding in participating countries: Kenya, Lesotho, Mozambique, South Africa, Tanzania, and Uganda. Although specific aims differed slightly by country, the initiative was designed to reduce mother-to-child transmission of HIV and increase child survival through improvements in breastfeeding practices, antiretroviral therapy uptake and coverage among HIV-positive pregnant women and mothers, and overall mother-baby care.
In Lesotho, health facilities are managed either by the government or by the Christian Health Association of Lesotho, and all are considered part of the national system.
This brief presents findings from the evaluation of activities related to PHFS in Lesotho. Findings from assessments of PHFS in other participating countries are available here. |
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Evaluation of the Partnership For HIV-Free Survival Country Assessment: Kenya
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MEASURE Evaluation |
2018 |
English |
KENYA |
PMTCT, Evaluation |
The Partnership for HIV-Free Survival (PHFS) was implemented in six countries in eastern and southern Africa between 2012 and 2016. PHFS was a collaboration among United States President' Emergency Plan for AIDS Relief, UNICEF, and the World Health Organization (WHO) to accelerate the uptake of the WHO 2010 guidelines on HIV and infant feeding in participating countries: Kenya, Lesotho, Mozambique, South Africa, Tanzania, and Uganda. Although specific aims differed slightly by country, the initiative was designed to reduce mother-to-child transmission of HIV and increase child survival through improvements in breastfeeding practices, antitretroviral uptake and coverage among HIV-positive pregnant women and mothers, and overall mother-baby care.
In Kenya, PHFS was implemented in 28 sites (16 original sites and 12 scale-up sites) in Kwale County, on the country’s south coast. National-level partners were USAID, the Kenya Ministry of Health, and University Research Co. LLC (URC)-Applying Science to Strengthen and Improve Systems (ASSIST).
This brief presents findings from the evaluation of activities related to PHFS in Kenya. Findings from assessments of PHFS in other participating countries are available here. |
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Improving the Quality of Zambia’s Clinical Care Data – Findings from Expedited Audits of Data Quality in 93 Health Facilities in October 2017
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MEASURE Evaluation |
2018 |
English |
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Data Quality, Health Facilities, Zambia, Data, Data Quality Audit |
Data from Zambia’s health facilities must be of high quality for U.S. government funders and for the country’s policymakers to make sound decisions on health policy, health programs, and the allocation of scarce resources. The goal of investments in data quality there is to improve the health of the Zambian people.
At the request of the United States Agency for International Development (USAID)/Zambia, and with the benefit of expert guidance from the Mission, the USAID-funded MEASURE Evaluation and USAID/Zambia developed and implemented an intensive and rapid set of activities and assessments focused on data quality. Two data quality assessments (DQAs) at USAID-supported health facilities in Zambia—one in July 2017 and the other in October 2017—were complemented by a focused and comprehensive data quality intervention undertaken by the Mission and the implementing partner in August and September. This report provides a brief narrative on the findings and some special features of the DQA activity and its findings. |
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How MEASURE Evaluation Contributes to the Health Data Collaborative
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MEASURE Evaluation |
2018 |
English |
KENYA, Africa, Global |
Health, Health data |
MEASURE Evaluation brings field and technical expertise in improving health data and building capacity to a number of Health Data Collaborative (HDC) subgroups. In addition to MEASURE Evaluation’s foundational working in health information system (HIS) strengthening, MEASURE Evaluation is engaged in collaborative work with the HDC’s facility-based, community-based, and digital health and interoperability working groups. All tools and resources listed in this document (and more) can be found on MEASURE Evaluation’s website. Please see the Health Information System Strengthening Resource Center for additional resources on HIS. |
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How Geographic Information Systems Can Sharpen HIV Program Planning
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MEASURE Evaluation |
2018 |
English |
Global |
HIV/AIDS, HIV, Geographic Information Systems, GIS |
Data are essential to a well-functioning health system. At present, an explosion in the quantity of data has prompted an increasing emphasis on how this information can advance global health. Over the past decade, low- and medium-income countries have made great strides in developing strong data infrastructures, and global health professionals have been working to expand human capacity for analysis and use of data.
Within this burgeoning data “tsunami,” as some have termed it, are rich streams of data on the populations at risk and in need of HIV treatment, the services being provided, and the context in which these both exist. Many of these data streams have a geographic component. Geographic information systems (GIS) can make use of the geographic data to produce analysis that can better locate services and ensure they reach populations in need.
GIS synthesizes data from many sources, such as health surveys, routine health information systems (RHIS), or census data, and links them using a common geography. It offers the opportunity to combine data sources that previously may not have been used together, resulting in a richer picture of the context in which HIV programs operate.
MEASURE Evaluation believes GIS has a big role to play in strengthening health information systems (HIS) and improving monitoring and evaluation (M&E). We are breaking new ground with research on the uses of GIS in these areas to guide decision making on health policy, resource allocation, priorities, and programs. A high priority is research focused on benefiting PEPFAR-supported HIV country programs. |
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How the Priorities for Local AIDS Control Efforts (PLACE) Method Helps Prevent HIV Transmission and Reach the 90-90-90 Targets
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|
2018 |
English |
|
HIV/AIDS, HIV, PLACE |
The HIV pandemic is global, but the epidemic differs widely by country, and within a country HIV prevalence differs by region, district, and even community. In fact, no two local HIV epidemics are the same. Local epidemics are driven by sexual and injecting-drug use networks in unique local contexts — whether urban, rural, along a major highway, within a fishing village, or along drug trafficking routes. Therefore, all transmission is also local. To be effective, responses to HIV should be tailored to the local context and drivers of transmission.
To help countries tailor HIV responses, MEASURE Evaluation—funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—developed the PLACE method. An important part of MEASURE Evaluation’s overall effort to strengthen health information systems (HIS), PLACE addresses the challenge of how to identify local epidemics and tailor prevention programs to them. Not only are many HIV-positive people asymptomatic, which contributes to a hidden epidemic, but also people occupying central positions in HIV transmission networks are often members of mobile, stigmatized, and hard-to-reach populations. Many people do not know their HIV status and, because many of those who do are hidden, methods are needed that are based on sound epidemiological science and that use technology appropriate to the setting to uncover local transmission networks in a way that leads to effective, ethical, and evidence-based prevention.
The PLACE method increases the understanding of the local HIV epidemic among service delivery providers, community leaders, and other stakeholders, so they can tailor local responses to the epidemic. Such understanding is crucial for those who manage HIS and service delivery programs, to enable them to allocate resources where they are most needed, to design effective programs, and to scale up programs that work. The heart of the PLACE method is to identify where to reach those most likely to acquire and transmit infection, measure gaps in services to these people, and develop action plans to address the gaps.
Access the PLACE manual and other resources. |
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How Geographic Information Systems Help Countries Develop and Maintain Master Facility Lists
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MEASURE Evaluation |
2018 |
English |
Global |
GIS, capability statement |
An accurate, geo-referenced facility list is a crucial tool for the health sector to be able to offer effective services in the areas where there is the greatest potential to achieve control of the HIV epidemic. MEASURE Evaluation has provided global leadership on this issue and has on-the-ground experience working with countries to build national master facility lists (MFLs). An MFL is the keystone for integrating health information from different actors, programs, and monitoring systems. It is crucial that there be a clear plan for governance issues such as updating and sharing data. Through technical assistance, MEASURE Evaluation addresses both technical issues related to data schemas and governance issues that control updates and use of such lists. |
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SQUAD: A Tool for Spatial Quality and Anomalies Diagnosis – Documentation and Tutorial (ArcGIS)
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Spencer J, Wilkes B |
2017 (Updated May 2018) |
English |
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Data Quality, GIS, Spatial data |
When working with datasets, ensuring the quality of data is always a challenge. The challenge increases with large datasets that contain hundreds or thousands of geographic coordinates. Validating spatial data can quickly become overwhelming since it is necessary to check the accuracy of both the spatial information (the accuracy and precision of the recorded coordinates) and the attribute information (data associated with that location, such as a location name, address, or associated administrative unit). Both of these domains must be accurate, and they must be in agreement.
When working with large spatial data sets, manually reviewing each record to validate both location and attribute information can be prohibitively time-consuming. A more effective approach would be to look for anomalies in the data that may indicate data quality issues. MEASURE Evaluation’s Spatial Quality Anomalies Diagnosis (SQUAD) Tool can rapidly identify the presence of any of these anomalies, which can then be investigated further to determine if there is a data quality issue. Narrowing the focus to records most likely to have an error will greatly reduce the time and effort necessary to identify and resolve errors in a database. This tool may not identify every record that has incorrect information, but it will systematically identify records that should be investigated further to resolve anomalies.
The tool produces a list of which records need to be corrected, and it also gives specific feedback on what may be wrong with the data. If these errors are identified early on, the dataset can be corrected and made stronger, more useful, and more trusted.
The SQUAD Tool downloadable package for ArcGIS contains a ZIP file with an ArcGIS Toolbox, a sample geodatabase, and a sample map file. You will need to extract the contents of this file, which should be used with the documentation and tutorial above. It also comes with a brief overview of the tool, a slide show about the tool, and a full manual complete with tutorial information, which helps you explore the sample map file and geodatabase and practice running the tool. NOTE: This tool requires the use of ArcGIS 10.3 or newer with an Advanced License.
Overview: Spatial Quality Anomalies Diagnosis (SQUAD) Tool for ArcGISThis brief provides an overview of the SQUAD tool for ArcGIS, including an introduction, information on prerequisites, instructions on using the tool, and information on reviewing results.
SQUAD Tool package for ArcGISThe SQUAD tool downloadable package for ArcGIS contains a ZIP file with the ArcGIS Toolbox, a sample geodatabase, and a sample map file.
Access main SQUAD tool information page |
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Spatial Quality and Anomalies Diagnosis (SQUAD) Tool (ArcGIS and QGIS)
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Spencer J, Wilkes B |
2017 (Updated 2018) |
English |
|
|
MEASURE Evaluation’s Spatial Quality Anomalies Diagnosis (SQUAD) Tool can rapidly identify the presence of certain anomalies, which can then be investigated further to determine if there is a data quality issue.
When working with datasets, ensuring the quality of data is always a challenge. The challenge increases with large datasets that contain hundreds or thousands of geographic coordinates. Validating spatial data can quickly become overwhelming since it is necessary to check the accuracy of both the spatial information (the accuracy and precision of the recorded coordinates) and the attribute information (data associated with that location, such as a location name, address, or associated administrative unit). Both of these domains must be accurate, and they must be in agreement.
When working with large spatial data sets, manually reviewing each record to validate both location and attribute information can be prohibitively time-consuming. A more effective approach would be to look for anomalies in the data that may indicate data quality issues. MEASURE Evaluation’s Spatial Quality Anomalies Diagnosis (SQUAD) Tool can rapidly identify the presence of any of these anomalies, which can then be investigated further to determine if there is a data quality issue. Narrowing the focus to records most likely to have an error will greatly reduce the time and effort necessary to identify and resolve errors in a database. This tool may not identify every record that has incorrect information, but it will systematically identify records that should be investigated further to resolve anomalies.
The tool produces a list of which records need to be corrected, and it also gives specific feedback on what may be wrong with the data. If these errors are identified early on, the dataset can be corrected and made stronger, more useful, and more trusted.
The SQUAD tool comes in two versions: One requires the use of ArcGIS 10.3 or newer with an advanced license. The other requires the use of QGIS and works in version 2.18 or 3.0. (QGIS is a fully open-sourced GIS, which available as a free download from http://qgis.org.)
Go to the ArcGIS version
Go to the QGIS version |
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Measuring the Strength of National Social Service Systems for Orphans and Vulnerable Children
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MEASURE Evaluation |
2017 (Revised in 2018) |
English |
|
OVC programs, Social services, Orphans and Vulnerable Children, PEPFAR, OVC |
The U.S. government and other stakeholders investing in strengthening social service systems for orphans and vulnerable children can assess and monitor the difference they are making in sustaining government systems.
Globally, strengthening a social service system is recognized as a logical and effective step to improve the efficiency, quality, and sustainability of the services the system delivers. Investments in system strengthening by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) ensure the effectiveness and sustainability of PEFPAR’s efforts to prevent HIV and link HIV-positive children and their caregivers to testing, care, and treatment.
MEASURE Evaluation—funded by the U.S. Agency for International Development (USAID) and PEPFAR—developed the framework presented here to fill part of the gap that exists in demonstrating the impact that system strengthening has on children’s outcomes, by providing indicators and guidance for measuring system performance. The framework is intended to support governments as well as PEPFAR implementing partners and other stakeholders in monitoring and evaluating system-strengthening efforts. These indicators measure the outcomes of system-strengthening interventions in five core areas, defined by PEPFAR as the components of social-service system strengthening: (1) leadership and governance structures; (2) the social service workforce; (3) financing; (4) information management and accountability systems; and (5) coordination and networking mechanisms. This document defines these indicators and offers guidance to apply them in a country or program.
Resources
Guidance DocumentThe National Social Service Systems for Orphans and Vulnerable Children: Framework for Planning and Monitoring and Evaluation describes indicators, indicator definitions, and a process for applying the indicators to assess, monitor, or evaluate social-service system strengthening efforts. Included in this document are useful processes and tools to adapt the indicators for country-specific context and a process and checklist for applying the indicators and using the results for decision making.
Data Management ToolAs data are collected by means of a workshop, key informant interviews, or analysis of other data, they will need to be stored in a management tool. The purpose of a data management tool is to consolidate all data for easy access, verify them, and maintain them in a secure location. We developed an Excel-based data management tool for the storage and use of data related to this framework.
Indicator Fact SheetThis fact sheet gives an overview of the 33 indicators for measuring the strength of national social service systems including background, what they measure, why they are needed, and how they were developed.
National Social Service Systems for Orphans and Vulnerable Children: Framework for Planning, Monitoring, and Evaluation (Webinar)
Access the online collection at https://www.measureevaluation.org/our-work/ovc/measuring-the-strength-of-national-social-service-systems |
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Strengthening Health Information Systems in Eswatini
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MEASURE Evaluation |
2017 (Revised in 2018) |
English |
SWAZILAND |
Swaziland, Health Systems Strengthening, HISS, HIS, Health Information Systems |
Since 2011, MEASURE Evaluation, funded by the United States Agency for International Development (USAID), has been working with the Strategic Information Department of Eswatini’s Ministry of Health (MOH) to streamline and integrate the parallel health information systems (HIS) for HIV/AIDS, tuberculosis, noncommunicable diseases, sexual and reproductive health, and child health. MEASURE Evaluation has been providing technical assistance to the MOH’s HIS management unit—through the local, USAID-funded implementing partner, Institute for Health Management—to implement a national electronic health record: the Client Management Information System (CMIS). The new CMIS will streamline data management processes, improve the availability of high-quality data, and increase the ability of providers and policymakers to address emerging health issues in the country. In addition, MEASURE Evaluation has supported the MOH’s monitoring and evaluation unit through the Institute for Health Management to increase the capacity of key stakeholders to analyze, synthesize, communicate, and use data for decision making.
Much of this work with the MOH strengthens elements of the HIS identified in MEASURE Evaluation’s Health Information System Strengthening Model. |
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National Social Service Systems for Orphans and Vulnerable Children – Framework for Planning and Monitoring and Evaluation
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MEASURE Evaluation |
2017 (Revised in 2018) |
English |
Global |
MIS, Monitoring, Evaluation, Social services, Management Information System, HIV, Orphans and Vulnerable Children |
Since 2003, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) has provided more than $2 billion USD for initiatives to mitigate the impact of HIV and AIDS on orphans and vulnerable children (OVC). Over the past several years, to ensure the sustainability and ownership of these initiatives, PEPFAR has increased funding for initiatives intended to strengthen the social service system in HIV-affected countries to improve the protection and care of children. Rather than focus exclusively on initiatives to address specific child protection concerns in isolation (such as HIV and AIDS, child labor, household income generation, or education), system-strengthening initiatives aim to create a system with the capacity to address multiple interconnected vulnerabilities. Although PEPFAR’s OVC programs will continue to be concerned primarily with the welfare and protection of HIV-affected children, PEPFAR’s investments in countries’ social service system will sustainably improve those systems’ capacity to benefit children and households facing a diversity of vulnerabilities, including HIV, as well as circumstances that are proven to increase the risk of acquiring HIV, such as lack of education, child abuse, and poverty.
PEPFAR’s investments in social service system strengthening cover the following areas: supporting governments to formulate national plans of action for vulnerable children; providing targeted organizational capacity building for governments to increase sustainable financing and improve service delivery; supporting training programs for staff (e.g., the social service workforce) who work with households and children; and supporting the development of national information management systems for child welfare and protection programs. PEPFAR also invests significant resources to help families and communities engaged in care for children. For example, PEPFAR provides support aimed at improving positive parenting practices, such as nonviolent discipline and child development activities. Educating parents about topics such as maternal and child health issues and services also increases the capacity of families to care for their children, including preventing and responding to HIV.
Such investments support what is known as the formal, or government-led, social service system, as well as the informal, or family- and community-based, social service system.
This guidance is intended for anyone with a stake in a country’s social service system. That includes stakeholders involved in planning, managing, or developing strategy related to social service systems and stakeholders that support the strengthening of social service systems and the delivery of services. Although we developed this guide with USAID’s and PEPFAR’s support, its audience is not limited to these agencies’ partners. Other donors and organizations providing technical assistance to social service systems may also find this guide useful for generating information for programs and policy. Similarly, government ministries, such as a ministry of social services, can use this guide to assess the status of their social service systems, inform planning, and make program and policy decisions.
French language version: Système national des services sociaux pour les orphelins et les enfants vulnérables: Cadre de planification et de suivi et évaluation
Download a related data management tool. |
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Workshop Materials: Impact Evaluation of Population, Health, and Nutrition Programs
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MEASURE Evaluation |
2017 |
English |
|
Impact Evaluation, Workshop |
Many governments and international organizations have established improving people’s health as a key objective of their actions. To that end, it is important to know whether these programs are having the intended impact they were designed for. Good evaluations play an important role by providing evidence of the impact of program actions on target populations. Does a program have an impact? By how much? Does the program have a different impact on different groups of people? Do different program components have different impacts? Why and how does the program have an impact?
Those are important questions that can be answered by rigorous impact evaluations.
In this workshop we will review concepts and methods for providing answers to some of those questions. But, how credible are the answers? We will also review the limitations of the methodologies and the conditions under which they provide valid and credible answers.
Most of the material presented here comes from the 2016 impact evaluation workshop held in Accra, Ghana in collaboration with the University of Ghana and GEMNet-Health institutions. The material built on the experience of numerous workshops conducted over the years with the National Institute of Public Health of Mexico, the Public Health Foundation of India, Addis Continental Institute of Public Health, and University of Pretoria. We have collected all workshop materials to be used as a resource to review the main methods for evaluating program impact and to increase participants' ability to design and conduct impact evaluations of health programs. The main workshop objectives are as follows:
to understand the basic concepts of program evaluation
to define the impact evaluation questions and to examine the main issues to consider for answering those questions in a valid way
to review the main evaluation designs and estimation techniques used for evaluating program impact
to develop criteria for choosing the appropriate estimation strategy given different scenarios of program characteristics and data availability
to interpret results appropriately and to examine their programmatic implications to gain practical experience applying the estimation strategies and tools.
The workshop materials in the zip file are listed in order by workshop day. Some files require STATA software to run. The collection is also available online at https://www.measureevaluation.org/resources/training/capacity-building-resources/workshop-on-impact-evaluation-of-population-health-and-nutrition-programs |
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Monitoring and Evaluation Capacity Assessment Toolkit (MECAT)
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MEASURE Evaluation PIMA |
2017 |
English |
|
MEASURE Evaluation PIMA, MECAT, Monitoring, Monitoring, Evaluation, Data, Capacity Assessment |
Worldwide, the use of health system data to guide decisions on how resources are allocated is rising rapidly, and 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 under scrutiny, and efforts to strengthen health information systems (HIS) must focus on improved health program monitoring and evaluation (M&E), beginning with standardized baseline capacity and performance assessments. To help meet this need, MEASURE Evaluation, the flagship M&E and HIS strengthening project of the United States Agency for International Development, and its Kenya associate award, MEASURE Evaluation PIMA, developed a process and toolkit to conduct a standard baseline assessment of M&E capacity: the Monitoring and Evaluation Capacity Assessment (MECAT) Toolkit. Some MECAT resources are available in English, French, or Spanish.
The full collection is also available online at https://www.measureevaluation.org/pima/m-e-capacity/me-capacity |
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Data Quality Assurance: Data quality auditing and routine data quality assessment tools
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MEASURE Evaluation |
2017 |
English |
|
RDQA, Data Quality Audit, Tool, Tools, DQA, Data Quality, Routine data |
The MEASURE Evaluation data quality assurance suite of tools and methods include both data quality auditing (DQA) tools designed for use by external audit teams and routine data quality assessment (RDQA) tools designed for capacity building and self-assessment.
Access these resources and more online at https://www.measureevaluation.org/resources/tools/data-quality |
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Building Leadership for Data Demand and Use: A Facilitator's Guide
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MEASURE Evaluation |
2017 |
English |
|
DDU, Data Demand and Use, Data, Data use |
This guide aims to provide the conceptual basis for leading data use within an organization or program, or at the national, state, or district level of government. It includes a variety of leadership, management, and data demand and use (DDU) tools created by MEASURE Evaluation partners to facilitate the sustainable use of data in decision making. The specific learning objectives are to:
raise awareness of the importance of data in decision making
define the role of leadership in promoting sustainable data use
build individual and team capacity to apply DDU concepts, approaches, and tools
promote and sustain them through strong leadership
develop and implement specific plans to overcome barriers to data use
The guide is for both experienced and novice workshop facilitators to use and learn from. It presents them with the foundations of a workshop, explains how to conduct all the necessary activities, and is designed to be easy to use and adaptable to suit the specific needs of various audiences.
The full collection is also available at https://www.measureevaluation.org/resources/training/capacity-building-resources/building-leadership-in-data-demand-and-use-a-facilitators-guide |
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Toolkit for Integrating Gender in the Monitoring and Evaluation of Health Programs
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Jessica Fehringer, Brittany Iskarpatyoti, Bridgit Adamou, and Jessica Levy |
2017 |
English |
|
Gender, M&E, Monitoring, Evaluation, Toolkit, Health programs |
This toolkit aims to help international health programs integrate a gender perspective in their monitoring and evaluation (M&E) activities, measures, and reporting.
It is designed for use by health program staff working in various health sectors (such as HIV; malaria; reproductive, maternal, newborn, and child health; and tuberculosis), and for various health agencies and initiatives. The toolkit will support health program staff to integrate gender in their programs, projects, and M&E activities.
Its objectives are to provide the following:
Processes and tools for integrating gender in a health program’s M&E activities
Guidance on facilitating communication with primary stakeholders on the importance of gender and M&E
Additional resources on gender-integrated programming and M&E
The full collection is available online at https://www.measureevaluation.org/resources/tools/gender/toolkit-for-integrating-gender-in-the-monitoring-and-evaluation-of-health-programs
Access resources from a related webinar. |
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Gender In Series
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MEASURE Evaluation |
2017 |
English |
|
Gender Norms, Gender |
Gender is in family planning, infectious diseases, malaria, HIV/AIDS and other health issues. That means it’s always important to include gender sensitivity in planning or measuring any health program.
The demand for specific data and indicators incorporating a gender perspective has moved beyond advocates of the rights of women and key populations to include decision makers at every level and in every area of social and economic development. And while there is greater general awareness of the need for a gender perspective in health policy and programming, not all health areas have considered gender implications equally.
Gender constructs have a significant impact on a person’s health outcomes. Gender expectations shape behaviors and beliefs related to risk and vulnerability. They also affect such health-seeking behavior as testing and treatment adherence. Gender even shapes the way in which health services are structured and provided. These social expectations lead to important differences in risk and service use for men, women, and key populations. For example:
Unequal power relationships increase women’s vulnerability to HIV by limiting their ability to negotiate sexual relationships and condom use.
Tuberculosis progresses more quickly in women of reproductive age than men of the same age group.
Women may be more willing than men to invest in malaria-prevention measures—such as insecticide-treated bed nets (ITN)—but may lack the financial power to do so.
Men are often excluded from family planning and reproductive health(FP/RH) services or FP/RH information systems that are tailored for women.
Most caregivers of orphaned and vulnerable children (OVC) are female; boys may not be acquainted with positive role models whom they can emulate.
Efforts to contain and respond to emerging infectious diseases often divert resources away from routine health services, disproportionately impacting women who seek contraceptives, or maternal health and postnatal care.
Addressing gender when monitoring and evaluating health projects helps ensure equity in access and benefits for men and women. MEASURE Evaluation’s Gender In Series explores the implications of gender on various technical area data and suggest indicators to reveal and explain gender gaps in health outcomes.
Access the online collection at https://www.measureevaluation.org/our-work/gender/gender-in-series |
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National Social Service Systems for Orphans and Vulnerable Children: Tool for Data Management, Analysis, and Use
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MEASURE Evaluation |
2017 |
English |
|
Orphans and Vulnerable Children, Tools, Social services, OVC |
System strengthening is recognized globally as a logical and effective step to improving the efficiency, quality, and sustainability of service delivery. The USAID- and PEPFAR-funded MEASURE Evaluation developed a framework for planning, monitoring, and evaluation to fill part of the gap that exists in demonstrating the impact that system strengthening has on child outcomes, by providing indicators and guidance for measuring system performance. These indicators measure the outcome of system-strengthening interventions in five core areas, defined by PEPFAR as the components of social service system strengthening: (1) leadership and governance structures; (2) the social service workforce; (3) financing; (4) information management and accountability systems; and (5) coordination and networking mechanisms. MEASURE Evaluation published a full guidance document that defines these indicators and offers guidance to apply them in a country or program.
This is an Excel-based tool to support data management, analysis, and use upon implementing the indicators. This tool should be used to collect and store information for all the indicators. It should also be used to support interpretation and application of results to strengthen the system. |
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Participatory Monitoring & Evaluation in Tanzania’s Health and Social Service Programmes: Field Manual
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MEASURE Evaluation Tanzania |
2017 |
English |
|
Tanzania, Monitoring, Evaluation, PM&E, M&E, MEASURE Evaluation Tanzania, Curriculum |
This field manual was developed as part of an effort to build a participatory monitoring and evaluation (PM&E) programme for health and social services at the community level in the United Republic of Tanzania. It serves as a toolkit of useful PM&E techniques for improving the performance and impact of community-based interventions, such as those involving the most vulnerable children (MVC), home-based care (HBC), and gender-based violence (GBV).
This manual is designed to help facilitators of PM&E apply PM&E techniques in the field. The manual includes a five-step PM&E programme path and six community group tools. The facilitators undergo a four-day training, which focuses on PM&E concepts, methods, and tools to be used with beneficiaries and providers at the community level. The PM&E programme will enhance the relationship among all stakeholders in the value chain in health-related services and other social service providers.
Access a related training manual and slide presentation. |
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Participatory Monitoring & Evaluation in Tanzania’s Health and Social Service Programs: Training Manual
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MEASURE Evaluation Tanzania |
2017 |
English |
|
Tanzania, MEASURE Evaluation Tanzania, PM&E, M&E, Curriculum, Monitoring, Evaluation |
This training manual was developed as part of an effort to build a participatory monitoring and evaluation (PM&E) programme for health and social services at the community level in the United Republic of Tanzania. It serves as a toolkit of useful PM&E techniques for improving the performance and impact of community-based interventions, such as those involving the most vulnerable children (MVC), home-based care (HBC), and gender-based violence (GBV).
This training manual contains session guides and reference notes for use in the PM&E training and in the application of this approach by PM&E facilitators in the field. (A slide presentation accompanies the manual.) The training sessions focus on PM&E concepts, methods, and tools to be used with beneficiaries and providers at the community level. The manual is based on MEASURE Evaluation Tanzania’s experience in building PM&E skills at NGOs working in health and social service programmes.
Access a related field manual and slide presentation. |
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DHIS 2 Functions and Data Use for Health Information System Strengthening Training Manual: Participants’ Guide
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Tanzania Ministry of Health, Community Development, Gender, Elderly and Children |
2017 |
English |
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Health Information Systems, HIS, Tanzania, Data Quality, Data, DHIS 2, Training |
This manual was developed to augment the capacity and skills of Council Health Management Teams (CHMTs) and Regional Health Management Teams (RHMTs) in Tanzania to use the advanced functions and features of DHIS 2.
The training manual addresses competencies that will enable users to improve the quality, analysis, and use of routinely collected health management information system data for effective health program monitoring, planning, and decision making. The participants' guide is downloadable on this page, and a related facilitators' guide is available here. |
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DHIS 2 Functions and Data Use for Health Information System Strengthening Training Manual: Facilitators’ Guide
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Tanzania Ministry of Health, Community Development, Gender, Elderly and Children |
2017 |
English |
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Health information systems, Data use, HIS, Tanzania, Data Quality, Data, Health data, DHIS 2, Training |
This manual was developed to augment the capacity and skills of Council Health Management Teams (CHMTs) and Regional Health Management Teams (RHMTs) in Tanzania to use the advanced functions and features of DHIS 2.
The training manual addresses competencies that will enable users to improve the quality, analysis, and use of routinely collected health management information system data for effective health program monitoring, planning, and decision making. The facilitators' guide is downloadable on this page, and a related participants' guide is available here. |
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Towards a Framework for Realising the Benefits of eHealth in South Africa
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|
2017 |
English |
Africa, SOUTH AFRICA |
EHealth, MEval-SIFSA |
The South African national eHealth strategy (2012/2013–2016/2017) includes a strategic priority focused on realisation of benefits. The strategy states that “[s]pecific actions are required to ensure that eHealth implementations deliver on their promise and that anticipated benefits are realised for all stakeholders.”
The specific activity highlighted within this priority was the development of “…a benefits realisation plan which specifies health outcome benefits expected at local level for all eHealth interventions.” Although this was never completed, it would be an effective starting place to understand the benefits of eHealth. Once benefits have been shown clearly, generating business cases and obtaining appropriate funding and support for projects become easier.
This document summarises an eHealth benefits realisation framework toolkit, which consists of technical briefs and a set of examples. |
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Uganda’s SCORE Program for Vulnerable Children and Their Families: Mixed-Methods Performance Evaluation
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Molly Cannon, Zulfiya Charyeva, Nena do Nascimento, Eve Namisango, Ismael Ddumba-Nyanzi |
2017 |
English |
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OVC, Evaluation, Vulnerable children, Children, Child Health, Orphans and Vulnerable Children |
Background: USAID’s Sustainable, Comprehensive Responses (SCORE) project operates in 35 Ugandan districts to build economic resilience, enhance food security, improve child protection, and increase access to education and critical services. USAID/Uganda asked MEASURE Evaluation to evaluate the performance of the SCORE program based on select outcome indicators (food failure, school enrolment, child abuse/neglect, and child labour); intervention effects on those outcomes; and program strengths and challenges.
Methods: We conducted secondary data analysis of select outcome indicators, which SCORE collected annually for four years, and routine data for 21 interventions. We merged the two data sets using unique identification numbers and analysed these data using multilevel modelling. We also collected qualitative data from 157 regional and national program beneficiaries, program staff, and community and government workers.
Key findings: We found improvements in all four indicators: a 7-percent increase in school enrolment, a 50-percent decrease in food failure, a 23-percent decrease in child abuse, and a 32-percent decrease in child labour. Participation in farmer field schools and financial market literacy trainings were associated with improvements in food security; participation in horticulture sessions, community dialogues, and home visits with school enrolment; and parenting skills training with reduced child abuse. Qualitatively, we found improved finances, household relations, and health and nutrition and learned that a combination of interventions led to pathways of changes in outcomes. Beneficiaries said the SCORE program had positive effects on their lives. Areas of concern were males’ resistance to female economic empowerment interventions and inadequate local government involvement for sustainability. |
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Plan Stratégique de Renforcement du Système d’Information Sanitaire 2018–2022 de Madagascar
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MEASURE Evaluation |
2017 |
French |
|
Health System, HIS, Health Information Systems, Madagascar |
Dans beaucoup de pays, les gouvernements ont mis en œuvre des Plans de Développement du Secteur Santé (PDSS) pour l’amélioration de la santé des populations. Le suivi de ces plans nécessite un système d’information performant, capable de mettre à la disposition des décideurs, des responsables de santé, des partenaires au développement et des citoyens, des informations fiables et valides pour l’allocation des ressources, la mesure des progrès accomplis et l’appréciation de la situation sanitaire du pays.
Pour s’assurer de la disponibilité de l’information contribuant à la gestion efficace des interventions des acteurs du système de santé il est nécessaires d’élaborer un plan stratégique du système d’information sanitaire et des outils permanents qui permettent de faire le suivi des activités du SIS. En effet, la disponibilité et l’accessibilité en temps réel de données de qualité constituent la garantie des meilleures prises de décision et planifications des ressources et interventions du système de santé.
C’est dans ce contexte que le Ministère de la santé de Madagascar avec l’appui technique et financier de MEASURE Evaluation et en collaboration avec ses partenaires techniques et financiers s’est engagé dans le processus de la mise à jour du présent plan national stratégique de renforcement du système d’information sanitaire (PRSIS) qui couvre la période 2018-2022.
Le PSRSIS 2018-2022 a pour objectifs de : renforcer la disponibilité des données exhaustives et de qualité, accroître l’accès aux informations sanitaires à tous les utilisateurs ; améliorer le plateau technique et les capacités des institutions chargées de la gestion des données ; renforcer les capacités du personnel des institutions chargées de la gestion des données à collecter, à vérifier, à analyser et à générer des données de qualité, ainsi qu’à utiliser les informations sanitaires dans la prise de décision et l’action.
Le PSRSIS 2018–2022 constitue, d’une part, un outil de travail indispensable pour les responsables de santé de tous les niveaux appelés à gérer des programmes de santé et, d’autre part, représente le document de référence par excellence et la base programmatique pour toutes planifications, toutes allocations de ressources et tous plaidoyers dans le domaine du Système d’Information Sanitaire à Madagascar. |
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Manuel des Normes et Procedures du Système National d’Information Sanitaire à Madagascar
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MEASURE Evaluation |
2017 |
French |
|
|
Les résultats de l’évaluation du Système d’Information Sanitaire (SIS) de Madagascar réalisée en 2016 ont fait état d’une faible performance du SIS, d’un manque de coordination des activités et interventions du SIS, de l’existence de systèmes d’information parallèles au niveau des programmes de santé, d’absence de document normatif sur le SIS qui définit les rôles et responsabilités à tous les niveaux de la pyramide sanitaire Malgache entre autres.
Dans le cadre de la mise en œuvre des recommandations de ladite évaluation du SIS, un sous-comité de renforcement du SIS a été créé et une feuille de route de ce sous-comité a été élaborée. L’une des activités émanant des recommandations de l’évaluation du SIS et de la feuille de route du sous-comité SIS consistait à élaborer des documents de normes et procédures du SIS ; l’objectif de ce document est de définir les éléments de références et de cadrage en matière de SIS. Plus spécifiquement, il a pour objectifs de : définir tous les outils ainsi que les mécanismes pour la production des informations sanitaires à Madagascar ; établir les normes pour toutes les étapes de gestion des données et informations sanitaires ; décrire les procédures à respecter à tous les niveaux et par tous les intervenants pour toutes les étapes de gestion des informations.
Ainsi, pour coordonner la mise en œuvre des activités du SIS, le sous-comité SIS avec l’appui technique et financier de MEASURE Evaluation a procédé à l’élaboration du présent manuel de normes et de procédures pour la gestion des informations sanitaires. Le présent manuel permettra de : mieux préciser le fonctionnement du SIS à tous les niveaux ; définir le circuit de l’information ; préciser la liste des indicateurs pertinents et leur mode de calcul ; et de donner des orientations sur les techniques d’analyse de données en vue de leur utilisation. |
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A Stronger Health Information System Means a Healthier Country
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JC Thomas |
2017 |
English |
|
Health data, Health System, Data, HISS, Health information systems, Health Systems Strengthening |
This poster illustrates how the quality and availability of health data can improve health outcomes. The illustration depicts a health system with only limited data function and what kinds of capabilities that health system would possess. It then shows what additional functions might be possible for a health system that had additional data at hand; and, finally, what kinds of health questions and trends could be identified with still more available and robust data. |
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Decision Support Tools for Malaria Prevention and Treatment
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Massoud Moussavi, PhD; Kent W. Lewis, MA; Vilas Mandlekar, MBA, MS; Aminata Y. Sallah, MBChB; Tajrina Hai, MHS; and Yazoumé Yé, PhD |
2017 |
English |
|
Malaria, Tools, Malaria control |
Malaria-endemic countries have experienced a significant decline in malaria burden in recent years, and they are relying on strong health management information systems to provide good-quality data to track progress and measure program achievements. The DHIS 2 software platform has been rolled out in several countries to collect, validate, report, analyze, and present aggregated statistical data using a dashboard for the health system’s operations. However, DHIS 2 falls short in providing guidance to program managers on high-priority actions and the potential impact of those actions. MEASURE Evaluation conducted a literature review to identify decision support tools, synthesize their strengths and weaknesses, and assess gaps.
The research team searched databases of peer-reviewed and gray literature for decision support tools for malaria control. The reference databases and digital libraries included MEDLINE (via PubMed), Google Scholar, and SCOPUS. In addition, the team performed online searches of websites and online publications to identify decision support tools developed by specific organizations.
The research team found 11 decision support tools related to malaria prevention and treatment. Each of these tools focuses on different interventions and outcomes, with some tools focusing on multiple interventions and others focusing on a single intervention. This review covers the 11 tools for malaria prevention and provides recommendations for developing a new tool to address operational and implementation challenges facing subnational decision makers. |
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Monitoring the Outcomes of Orphans and Vulnerable Children Programs in Namibia: Project Hope Namibia 2016 Survey Findings
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Robert Mswia, Lizl Stoman |
2017 |
English |
|
OVC, Monitoring, Evaluation, MER, PEPFAR, Namibia, Orphans and Vulnerable Children, Monitoring |
In 2014, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) introduced a set of outcome indicators for programs serving orphans and vulnerable children (OVC), referred to as the Monitoring, Evaluation, and Reporting (MER) Essential Survey Indicators. PEPFAR requires these indicators to be collected every two years by a research organization external to the OVC program. These outcome indicators reflect internationally accepted developmental milestones; together, they measure the holistic well-being of children over time. A standard survey method and tools have been developed to collect these data in countries where PEPFAR is supporting OVC programs. PEPFAR/Namibia asked MEASURE Evaluation—funded by the United States Agency for International Development (USAID) and PEPFAR—to conduct a survey to collect these indicators for Project HOPE Namibia (PHN).
MEASURE Evaluation, in partnership with Survey Warehouse, a market research firm in Namibia, conducted a household survey using a two-stage cluster sampling approach from among currently enrolled beneficiaries PHN. This report shares the survey findings. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Nigeria: Institute of Human Virology 2016 Survey Findings
|
MEASURE Evaluation |
2017 |
English |
|
OVC, Monitoring, Evaluation, Nigeria, Monitoring, MER, Orphans and Vulnerable Children |
This poster shares findings from a survey of the Institute of Human Virology in Nigeria's Federal Capital Territory and the states of Benue and Nasarawa. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Nigeria: Association for Reproductive and Family Health 2016 Survey Findings
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MEASURE Evaluation |
2017 |
English |
|
OVC, Monitoring, Evaluation, Nigeria, Monitoring, MER, Orphans and Vulnerable Children |
This poster shares findings from a survey of the Association for Reproductive and Family Health (ARFH) project in Nigeria conducted in 12 scale-up local government areas in Akwa-Ibom, Lagos, and Rivers States that were registered as beneficiaries of the ARFH project. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Nigeria: 2016 Survey Findings from the APIN Public Health Initiatives in Lagos State
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MEASURE Evaluation |
2017 |
English |
|
Nigeria, Orphans and Vulnerable Children, OVC, Monitoring, Evaluation, Monitoring |
This poster shares findings from a survey of the APIN Public Health Initiatives project in Lagos State, Nigeria, in four scale-up local government areas: Ikeja, Mushin, Ifako-Ijaiye, and Alimosho. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Nigeria: Widows and Orphans Empowerment Organizations (WEWE) 2016 Survey Findings
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MEASURE Evaluation |
2017 |
English |
|
OVC, MER, Nigeria, Monitoring, Monitoring, Evaluation, Orphans and Vulnerable Children |
This poster shares findings from a survey of the Widows and Orphans Empowerment Organizations (WEWE) organization in Nigeria. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Nigeria: Sustainable Mechanism for Improving Livelihood & Household Empowerment (SMILE) Program 2016 Survey Findings
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MEASURE Evaluation |
2017 |
English |
|
Nigeria, Orphans and Vulnerable Children, OVC, MER, Monitoring, Evaluation, Monitoring |
This poster shares findings from a survey of the Sustainable Mechanism for Improving Livelihood & Household Empowerment (SMILE) Program in Nigeria. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Nigeria: APIN Program 2016 Survey Findings in Lagos State
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Walter Obiero, Elizabeth Omoluabi, Akanni Akinyemi, Adesegun Fatusi |
2017 |
English |
|
Mozambique, OVC, Monitoring, Evaluation, Nigeria, MER, Monitoring, Orphans and Vulnerable Children |
Investment programs to improve the well-being of approximately 17.5 million orphans and vulnerable children (OVC) and their households in Nigeria have been substantial, and yet the impact of this investment is uncertain (PEPFAR, 2012). To address this, in 2014, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) introduced a set of outcome indicators for OVC programs, referred to as Monitoring, Evaluation, and Reporting (MER) Essential Survey Indicators (ESIs), with the requirement that these indicators be collected every two years by a research organization external to the OVC program. These outcome indicators reflect internationally accepted developmental milestones and collectively measure holistic well-being of children over time. This survey used a standard method developed for application across multiple countries to provide measurable indicators on PEPFAR-supported projects that aim to improve the well-being of OVC in Nigeria.
The objective of this survey was to collect the first round of the nine essential outcome indicators for registered active beneficiaries of APIN Public Health Initiatives Lte/Gte. This survey provided the first estimates of the essential outcome indicators and will be repeated at two-year intervals to monitor changes in the well-being of OVC and their caregivers over time. This report shares the findings of the APIN study. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Nigeria: Association for Reproductive and Family Health 2016 Survey Findings
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Walter Obiero, Elizabeth Omoluabi, Akanni Akinyemi, Adesegun Fatusi |
2017 |
English |
|
Monitoring, Evaluation, Nigeria, Orphans and Vulnerable Children, Monitoring, Mozambique, MER, OVC |
Investment programs to improve the well-being of approximately 17.5 million orphans and vulnerable children (OVC) and their households in Nigeria have been substantial, and yet the impact of this investment is uncertain (United States President’s Emergency Plan for AIDS Relief [PEPFAR], 2012). To address this, in 2014, PEPFAR introduced a set of outcome indicators for OVC programs, referred to as Monitoring, Evaluation, and Reporting (MER) Essential Survey Indicators, with the requirement that these indicators be collected every two years by a research organization external to the OVC program. These outcome indicators reflect internationally accepted developmental milestones and collectively measure holistic well-being of children over time. This survey is designed to use standardized methodology developed for application across multiple countries to provide measurable indicators on PEPFAR-supported projects that aim to improve the well-being of OVC in Nigeria.
The objective of this survey was to collect the first round of the nine essential outcome indicators for registered active beneficiaries of Association for Reproductive and Family Health (ARFH). This survey provided the first estimates of the essential outcome indicators and will be repeated at a two-year interval to monitor changes in the well-being of OVC and their caregivers over time. This report shares the findings of the ARFH survey. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Nigeria: Widows and Orphans Empowerment Organization (WEWE) 2016 Survey Findings
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Walter Obiero, Elizabeth Omoluabi, Akanni Akinyemi, Adesegun Fatusi |
2017 |
English |
|
Mozambique, OVC, Monitoring, Evaluation, MER, Monitoring, Orphans and Vulnerable Children |
Investment programs to improve the well-being of approximately 17.5 million orphans and vulnerable children (OVC) and their households in Nigeria have been substantial, yet their impact is uncertain (United States President’s Emergency Plan for AIDS Relief [PEPFAR], 2012). To address this uncertainty, in 2014, PEPFAR introduced a set of outcome indicators for OVC programs, referred to as the Monitoring, Evaluation, and Reporting (MER) Essential Survey Indicators, with the requirement that they be collected every two years by a research organization external to the OVC program. These outcome indicators reflect internationally accepted developmental milestones and collectively measure the holistic well-being of children over time. This survey was designed to use a standard method developed to apply across multiple countries to provide measurable indicators on PEPFAR-supported projects that aim to improve the well-being of OVC in Nigeria.
The objective of this survey was to collect the first round of the nine essential outcome indicators for enrolled active beneficiaries of the Widows and Orphans Empowerment Organization (WEWE). This survey provided the first estimates of these indicators and will be repeated at two-year intervals to monitor changes in the well-being of OVC and their caregivers over time. This report shares findings of the WEWE survey. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Nigeria: Sustainable Mechanism for Improving Livelihoods and Household Empowerment (SMILE) Program 2016 Survey Findings
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Walter Obiero, Elizabeth Omoluabi, Akanni Akinyemi, Adesegun Fatusi |
2017 |
English |
|
Mozambique, Monitoring, Orphans and Vulnerable Children, OVC, Monitoring, Evaluation, MER |
Nigeria has an estimated 17.5 million orphans and vulnerable children (OVC), and AIDS, maternal mortality, ethnic violence, and poverty have an impact on their lives. The United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the Government of Nigeria have made substantial investments designed to improve the well-being of OVC in Nigeria (PEPFAR, 2012). To measure the impact of this support, PEPFAR introduced in 2014 a set of outcome indicators for OVC programs, referred to as monitoring, evaluation, and reporting (MER) essential survey indicators. PEPFAR required that the indicators be collected every two years by a research organization external to the OVC program. These outcome indicators reflect internationally-accepted developmental milestones and collectively measure holistic well-being of children over time. Our survey is designed to use standardized methods developed for application across multiple countries to provide measurable indicators on PEPFAR-supported projects that aim to improve the well-being of OVC in Nigeria.
The objective of this survey was to collect the first round of the nine essential outcome indicators for enrolled active beneficiaries of the Catholic Relief Services/Sustainable Mechanism for Improving Livelihoods and Household Empowerment (CRS/SMILE) project. This survey provided the first estimates of the essential outcome indicators and will be repeated at a two-year interval to monitor changes in the well-being of OVC and their caregivers over time. This report shares the findings of the CRS/SMILE survey. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Nigeria: Institute of Human Virology 2016 Survey Findings
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Walter Obiero, Elizabeth Omoluabi, Akanni Akinyemi, Adesegun Fatusi |
2017 |
English |
|
OVC, Monitoring, Evaluation, Nigeria, MER, Monitoring, Orphans and Vulnerable Children |
Nigeria has an estimated 17.5 million orphans and vulnerable children (OVC), and AIDS, maternal mortality, ethnic violence, and poverty have an impact on their lives. The United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the Government of Nigeria have made substantial investments designed to improve the well-being of OVC in Nigeria (PEPFAR, 2012). To measure the impact of this support, PEPFAR introduced in 2014 a set of outcome indicators for OVC programs, referred to as monitoring, evaluation, and reporting (MER) essential survey indicators. PEPFAR required that the indicators be collected every two years by a research organization external to the OVC program. These outcome indicators reflect internationally-accepted developmental milestones and collectively measure holistic well-being of children over time. Our survey is designed to use standardized methods developed for application across multiple countries to provide measurable indicators on PEPFAR-supported projects that aim to improve the well-being of OVC in Nigeria.
The objective of this survey was to collect the first round of the nine essential survey indicators for registered active OVC beneficiaries of the Institute of Human Virology, Nigeria (IHVN), a nongovernmental organization focusing on research, health services, and capacity building. This survey provided the first estimates of the essential outcome indicators and will be repeated at two-year intervals to monitor changes in the well-being of OVC and their caregivers over time. This report shares the findings of the IHVN survey. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Mozambique: 2017 Survey Findings from Project Força à Comunidade e às Crianças (FCC)
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MEASURE Evaluation |
2017 |
English |
|
Orphans and Vulnerable Children, OVC, Mozambique, MER, Monitoring, Evaluation, Monitoring |
This poster shares findings from a survey in Mozambique districts in which Project Força à Comunidade e às Crianças worked in mid-2017. MEASURE Evaluation collected data from 658 caregivers and 2,349 children (a 97% response rate). |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Kenya: Walter Reed Program/Henry Jackson Foundation Medical Research International 2016 Survey Findings
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Susan K. Settergren, Cheikh M. Faye, Donatien Beguy |
2017 |
English |
|
OVC, Monitoring, Evaluation, MER, Kenya, Orphans and Vulnerable Children, Monitoring |
In 2014, PEPFAR introduced a new global reporting requirement for monitoring the outcomes of its orphans and vulnerable children (OVC) programs, referred to as the monitoring, evaluation, and reporting (MER) OVC Essential Survey Indicators (ESIs). The ESIs are intended to measure and track child and household well-being using standardized indicators and methodology across projects and countries.
In 2016, The PEPFAR Kenya OVC team requested the assistance of the USAID project, MEASURE Evaluation, to collect data for the MER ESI. This report describes the methods used to conduct the Walter Reed Program/Henry Jackson Foundation Medical Research International (WRP/HJFMRI) project MER OVC ESI survey and presents results for the ESIs in accordance with MER guidance. A brief discussion of the findings is also provided. This information is intended to help the WRP/HJFMRI project better understand the well-being of its beneficiaries and to support the project, the PEPFAR OVC team, and other program decision makers and stakeholders, including those from the Government of Kenya, to take evidence-informed actions to improve OVC program strategy, resource allocation, and implementation, with the goal of improving the well-being of the children and households they serve. |
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Health Information System Stages of Continuous Improvement Toolkit: Stages Measurement Scale
|
MEASURE Evaluation |
2017 |
English |
|
HIS, Health Systems Strengthening, Health Information Systems |
This tool was updated in 2019. Access the updated version at www.measureevaluation.org/resources/publications/tl-19-27
Access the full toolkit. |
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Directives des réunions de revue des données: pour évaluer et améliorer la performance
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Eric Geers, Jonas Sagno, and Albert Camara |
2017 |
French |
GUINEA |
Data Quality Review, Data Quality, Data, Data Science, Data Demand and Use |
A l’échelle mondiale, de nombreux systèmes de soins de santé gouvernementaux sont en transition, passant du format papier vers des logiciels basés sur l'Internet, tels que la plateforme DHIS 2, pour la gestion régulière des données collectées. Ces plateformes électroniques facilitent l'intégration et la comparaison des données provenant de plusieurs sources, notamment celles portant sur la performance de la prestation des services de santé, la surveillance des maladies, le suivi des produits médicaux, les ressources humaines, ainsi que les budgets et les finances. Ces outils offrent des avantages supplémentaires, tels que l'amélioration de l'accès en ligne à davantage de données, l’automatisation du processus d’assurance-qualité des données et la mise en place d’applications analytiques.
La valeur de ces systèmes nationaux d'information sanitaire (SNIS) repose sur la capacité du personnel de santé à comprendre, traiter et utiliser les données pour prendre des décisions éclairées du niveau national jusqu'à la prestation des services. Le but d'un SNIS est non seulement de concevoir un meilleur système d'information de soins de santé, mais aussi de devenir un moteur d'action et d'amélioration constant de la prestation des services de santé. Ces directives visent à aider le personnel de santé à organiser collectivement et à mettre en œuvre régulièrement des analyses de données pour évaluer la performance, et à renforcer la prise de décisions fondées sur des données probantes pour améliorer cette performance. Elles permettent de structurer les réunions pour que les prestataires de soins puissent: (1) identifier et prioriser les questions programmatiques, (2) relier les questions vers des sources de données disponibles et des indicateurs pertinents, (3) effectuer une analyse pour répondre à des questions d'intérêt, (4) communiquer et interpréter les résultats, (5) développer les plans d'action fondés sur les informations, et (6) suivre ces actions pour documenter et mettre en évidence une amélioration des performances. |
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Postnatal care for newborns in Bangladesh: The importance of health-related factors and location
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Kavita Singh, Paul Brodish, Mahbub Elahi Chowdhury, Taposh Kumar Biswas, Eunsoo Timothy Kim, Christine Godwin, and Allisyn Moran |
2017 |
English |
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Bangladesh, Newborn health, Postnatal care |
BackgroundBangladesh achieved Millennium Development Goal 4, a two thirds reduction in under-five mortality from 1990 to 2015. However neonatal mortality remains high, and neonatal deaths now account for 62% of under-five deaths in Bangladesh. The objective of this paper is to understand which newborns in Bangladesh are receiving postnatal care (PNC), a set of interventions with the potential to reduce neonatal mortality.
MethodsUsing data from the Bangladesh Maternal Mortality Survey (BMMS) 2010 we conducted logistic regression analysis to understand what socio-economic and health-related factors were associated with early postnatal care (PNC) by day 2 and PNC by day 7. Key variables studied were maternal complications (during pregnancy, delivery or after delivery) and contact with the health care system (receipt of any antenatal care, place of delivery and type of delivery attendant). Using data from the BMMS 2010 and an Emergency Obstetric and Neonatal Care (EmONC) 2012 needs assessment, we also presented descriptive maps of PNC coverage overlaid with neonatal mortality rates.
ResultsThere were several significant findings from the regression analysis. Newborns of mothers having a skilled delivery were significantly more likely to receive PNC (Day 7: OR = 2.16, 95% confidence interval (CI) 1.81, 2.58; Day 2: OR = 2.11, 95% 95% CI 1.76). Newborns of mothers who reported a complication were also significantly more likely to receive PNC with odds ratios varying between 1.3 and 1.6 for complications at the different points along the continuum of care. Urban residence and greater wealth were also significantly associated with PNC. The maps provided visual images of wide variation in PNC coverage and indicated that districts with the highest PNC coverage, did not necessarily have the lowest neonatal mortality rates.
ConclusionNewborns of mothers who had a skilled delivery or who experienced a complication were more likely to receive PNC than newborns of mothers with a home delivery or who did not report a complication. Given that the majority of women in Bangladesh have a home delivery, strategies are needed to reach their newborns with PNC. Greater focus is also needed to reach poor women in rural areas. Engaging community health workers to conduct home PNC visits may be an interim strategy as Bangladesh strives to increase skilled delivery coverage.
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Does postnatal care have a role in improving newborn feeding? A study in 15 sub-Saharan African countries
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Shane M Khan, Ilene S Speizer, Kavita Singh, Gustavo Angeles, Nana AY Twum–Danso, and Pierre Barker |
2017 |
English |
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Breastfeeding, Postnatal care, Newborn health |
BackgroundBreastfeeding is known as a key intervention to improve newborn health and survival while prelacteal feeds (liquids other than breastmilk within 3 days of birth) represents a departure from optimal feeding practices. Recent programmatic guidelines from the WHO and UNICEF outline the need to improve newborn feeding and points to postnatal care (PNC) as a potential mechanism to do so. This study examines if PNC and type of PNC provider are associated with key newborn feeding practices: breastfeeding within 1 day and prelacteal feeds.
MethodsWe use data from the Demographic and Health Surveys for 15 sub-Saharan African countries to estimate 4 separate pooled, multilevel, logistic regression models to predict the newborn feeding outcomes.
FindingsPNC is significantly associated with increased breastfeeding within 1day (OR = 1.35, P < 0.001) but is not associated with PLFs (OR = 1.04, P = 0.195). PNC provided by nurses, midwives and untrained health workers is also associated with higher odds of breastfeeding within 1 day of birth (OR = 1.39, P < 0.001, (OR = 1.95, P < 0.001) while PNC provided by untrained health workers is associated with increased odds of PLFs (OR = 1.20, P = 0.017).
ConclusionsPNC delivered through customary care may be an effective strategy to improve the breastfeeding within 1 day but not to discourage PLFs. Further analysis should be done to examine how these variables operate at the country level to produce finer programmatic insight.
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The importance of skin-to-skin contact for early initiation of breastfeeding in Nigeria and Bangladesh
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Kavita Singh, Shane M Khan, Liliana Carvajal-Aguirre, Paul Brodish, Agbessi Amouzou, and Allisyn Moran |
2017 |
English |
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Breastfeeding, Bangladesh, Nigeria, Newborn health |
BackgroundSkin-to-skin contact (SSC) between mother and newborn offers numerous protective effects, however it is an intervention that has been underutilized. Our objectives are to understand which newborns in Bangladesh and Nigeria receive SSC and whether SSC is associated with the early initiation of breastfeeding.
MethodsDemographic and Health Survey (DHS) data were used to study the characteristics of newborns receiving SSC for non-facility births in Nigeria (DHS 2013) and for both facility and non-facility births in Bangladesh (DHS 2014). Multivariable logistic regression was used to study the association between SSC and early initiation of breastfeeding after controlling for key socio-demographic, maternal and newborn-related factors.
ResultsOnly 10% of newborns in Nigeria and 26% of newborns in Bangladesh received SSC. In the regression models, SSC was significantly associated with the early initiation of breastfeeding in both countries (OR = 1.42, 95% CI 1.15–1.76 for Nigeria; OR = 1.27, 95% CI 1.04–1.55, for Bangladesh). Findings from the regression analysis for Bangladesh revealed that newborns born by Cesarean section had a 67% lower odds of early initiation of breastfeeding than those born by normal delivery (OR = 0.33, 95% CI 0.26–0.43). Also in Bangladesh newborns born in a health facility had a 30% lower odds of early initiation of breastfeeding than those born in non-facility environments (OR = 0.70, 95% CI 0.53–0.92). Early initiation of breastfeeding was significantly associated with parity, urban residence and wealth in Nigeria. Geographic area was significant in the regression analyses for both Bangladesh and Nigeria.
ConclusionsCoverage of SSC is very low in the two countries, despite its benefits for newborns without complications. SSC has the potential to save newborn lives. There is a need to prioritize training of health providers on the implementation of essential newborn care including SSC. Community engagement is also needed to ensure that all women and their families regardless of residence, socio-economic status, place or type of delivery, understand the benefits of SSC and early initiation of breastfeeding. |
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Measuring coverage of essential maternal and newborn care interventions: An unfinished agenda
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Liliana Carvajal–Aguirre, Lara ME Vaz, Kavita Singh, Deborah Sitrin, Allisyn C Moran, Shane M Khan, and Agbessi Amouzou |
2017 |
English |
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Maternal Health, Newborn health, Intervention |
This article introduces the Journal of Global Health's "Measuring coverage of essential maternal and newborn care interventions: An unfinished agenda" collection.
With the increasing focus on the need for data on newborns, and availability of new data, it is time to understand these data and take stock of the findings but also of gaps. In the current context in which newborn survival is central to the global health agenda, there is an urgent need to strengthen the collection of data on newborn care, particularly on aspects related to quality of care and to identify remaining gaps as well as ensure the data are aligned with global and national monitoring needs. Attuned to this context, the series of papers in this collection provide program and policy findings on measurement of maternal and newborn care and outcomes, with implications for future measurement implementation and research. |
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Evaluations of Structural Interventions for HIV Prevention: A Review of Approaches and Methods
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Brittany S. Iskarpatyoti, Jill Lebov, Lauren Hart, Jim Thomas, Mahua Mandal |
2017 |
English |
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HIV, HIV/AIDS, Intervention |
Structural interventions alter the social, economic, legal, political, and built environments that underlie processes affecting population health. We conducted a systematic review of evaluations of structural interventions for HIV prevention in low- and middle-income countries (LMICs) to better understand methodological and other challenges and identify effective evaluation strategies. We included 27 peer-reviewed articles on interventions related to economic empowerment, education, and substance abuse in LMICs. Twenty-one evaluations included clearly articulated theories of change (TOCs); 14 of these assessed the TOC by measuring intermediary variables in the causal pathway between the intervention and HIV outcomes. Although structural interventions address complex interactions, no evaluation included methods designed to evaluate complex systems. To strengthen evaluations of structural interventions, we recommend clearly articulating a TOC and measuring intermediate variables between the predictor and outcome. We additionally recommend adapting study designs and analytic methods outside traditional epidemiology to better capture complex results, influences external to the intervention, and unintended consequences. |
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Допомагаючи людям з туберкульозом в Україні продовжувати лікування Результати якісного аналізу в рамках оцінки програми соціальної підтримки
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MEASURE Evaluation |
2017 |
Ukrainian |
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Tuberculosis, Ukraine, HIV, HIV care |
У 2014 році місія Агентства США з міжнародного розвитку (USAID) в Україні звернулася до групи MEASURE Evaluation з проханням здійснити оцінку впливу двох ініціатив, реалізованих в рамках проекту «Посилення контролю за туберкульозом в Україні» (STbCU): (1) надання послуг соціальної підтримки для кращого дотримання режиму лікування туберкульозу (ТБ); (2) поліпшення інтеграції ТБ/ВІЛ-послуг та зниження смертності завдяки ранньому діагностуванню та лікуванню пацієнтів з ко-інфекцією ТБ/ВІЛ. Група MEASURE Evaluation розробила два незалежних, але взаємодоповнюючих дослідження для оцінки впливу цих ініціатив в рамках проекту STbCU: дослідження соціальної підтримки та дослідження інтеграції ТБ/ВІЛ-послуг. В обох дослідженнях були застосовані змішані методи: квазіекспериментальна кількісна оцінка і якісний опис результатів. У даному резюме підсумовуються результати якісного дослідження, проведеного з метою оцінки програми соціальної підтримки |
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Поліпшення догляду за пацієнтами з туберкульозом та ВІЛ в Україні Результати якісного аналізу в рамках оцінки інтеграції ТБ/ВІЛ-послуг
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MEASURE Evaluation |
2017 |
Ukrainian |
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Tuberculosis, Ukraine, HIV, HIV care |
У 2014 році місія Агентства США з міжнародного розвитку (USAID) в Україні звернулася до групи MEASURE Evaluation з проханням здійснити оцінку впливу двох ініціатив, реалізованих в рамках проекту «Посилення контролю за туберкульозом в Україні» (STbCU): (1) надання послуг соціальної підтримки для кращого дотримання режиму лікування туберкульозу (ТБ); (2) поліпшення інтеграції ТБ/ВІЛ-послуг та зниження смертності завдяки ранньому діагностуванню та лікуванню пацієнтів з ко-інфекцією ТБ/ВІЛ. Група MEASURE Evaluation розробила два незалежних, але взаємодоповнюючих дослідження для оцінки впливу цих ініціатив в рамках проекту STbCU: дослідження соціальної підтримки та дослідження інтеграції ТБ/ВІЛ-послуг. В обох дослідженнях були застосовані змішані методи: квазіекспериментальна кількісна оцінка і якісний опис результатів. У даному резюме підсумовуються результати якісного дослідження, проведеного з метою оцінки програми інтеграції ТБ/ВІЛ-послуг. |
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MomConnect Security Findings and Recommendations
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Annah Ngaruro |
2017 |
English |
SOUTH AFRICA |
MomConnect, mHealth, Mobile technology |
The U.S. Agency for International Development-funded MEASURE Evaluation—Strategic Information for South Africa (MEval-SIFSA) project and other partners have provided support to the South African National Department of Health in the implementation and rollout of the MomConnect mobile health intervention since its launch in August 2014. As part of this support, in 2016 MEval-SIFSA conducted a system and data assessment to assess the MomConnect system’s compliance with the existing legal requirements for data privacy and security best practices, identify any vulnerabilities, and assist with identifying and addressing vulnerabilities. This security assessment was conducted by a Certified Information Systems Security Professional using a step-by-step process that included extensive questionnaires, in-person assessment and examination, and the use of automated security testing tools.
This report discusses the assessment purpose, process, and results, and it presents the implementation recommendations identified. These recommendations, regardless of priority level, have been categorised as short-, medium-, and long-term action items to help guide the implementation process. |
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Guide to a Team Approach to Building Capacity for Health Information Management
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MEASURE Evaluation |
2017 |
English |
Global |
Health Information Systems, HIS, Capacity Building |
There is a widespread problem of staff shortages for health information systems (HIS) at subnational levels in developing countries. Although health ministries are aware of these shortcomings, they lack the financial and technical resources to create enough positions for specific HIS development and operations. A feasible approach to addressing gaps in HIS functions is to build the HIS capacity of existing staff and mobilize them to take on HIS responsibilities, either solely or as a component of other services.
MEASURE Evaluation, which is funded by the United States Agency for International Development, designed this guide to help health managers and administrators at subnational levels identify staff with potential; build their capacity in the production, management, and use of information for effective action planning and other decision making; and mobilize them to take on HIS responsibilities.
The guide begins with a discussion of the purpose of an HIS, the desired attributes of a fully functional HIS, and how this compares with the HIS of a typical developing country. It then describes how a facility or a health office can effectively manage and use an HIS. Tools and references with illustrative examples are provided in the appendixes. |
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The Strongest Motivators for Using Routine Health Information in Family Planning: A Prospective Study in Lagos, Nigeria
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Abayomi Joseph Afe, Adeola Olatoun, Timothy Akinmurele, Oduola Abimbola, and Ganiyu Agboola |
2017 |
English |
NIGERIA |
Family Planning, Routine Health Information Systems, Routine data |
Health system performance depends on the collection, collation, and use of quality health data and information. One of the primary roles of a routine health information system is generating data within the health system for decision making, policy formulation, and implementation. When data are generated and analyzed, they can provide relevant information to support planning and management of high-quality healthcare services at the facility, ward, local government, state, and federal levels.
MEASURE Evaluation, funded by the United States Agency for International Development, supported this study to bridge the knowledge gap concerning the motivators behind using routine health information in family planning (FP) to improve the use of FP services.
The study design was a prospective, cross-sectional study conducted over a period of 12 months in three local government areas of Lagos State, in southwest Nigeria. Twelve key informant interviews were conducted and 425 questionnaires were administered to 105 men and 320 women working in the health sector.
This working paper outlines the study and results and provides a series of recommendations based on these findings. |
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Implementing Swaziland's Client Management Information System: Stakeholders' Views of the Process and Recommendations to Improve It
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Eva Silvestre |
2017 |
English |
SWAZILAND |
CMIS, Client Management Information System, Electronic Health Records |
Swaziland policymakers and health administrators decided to change from the current paper-based health records system to an electronic health records (EHR) system. This change is being undertaken to harmonize healthcare data and improve patient care. The country’s client management information system (CMIS) is an EHR system that improves patient care by improving data quality and access, reducing duplicated cases within the system, and improving patient flow and wait times within the clinic.
MEASURE Evaluation is conducting an evaluation of the CMIS implementation process through health facility assessments and key stakeholder interviews (conducted from July 2017 through August 2017). The interviewers collected the opinions and experiences of key stakeholders of the CMIS to discover the challenges of implementation and recommend ways to improve the process, especially for the primary users of the system. The results of those interviews and our recommendations based on them are presented in this report.
The CMIS is being implemented in Swaziland by the Ministry of Health’s Health Management Information Systems, with support from the Institute for Health Measurement. It is being financed by the Swaziland Ministry of Health, with help from the Global Fund to Fight AIDS, Tuberculosis and Malaria and United States Agency for International Development. |
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Innovations in Geographic Information Systems Mapping Technology: GIS Working Group Meeting, October 2017
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Sky Barlow, John Spencer, Becky Wilkes |
2017 |
English |
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GIS, Geospatial analysis, Geographic Information Systems, Mapping, Geography |
To promote and improve the use of geospatial data by the implementing partners of the United States President’s Emergency Plan for AIDS Relief (PEFPAR), MEASURE Evaluation—funded by the United States Agency for International Development (USAID) and PEPFAR—convened a meeting of the Geographic Information Systems (GIS) Working Group in Washington, DC, on October 23, 2017. The group has been meeting at least annually since 2000, giving GIS specialists and users a regular opportunity to share their experiences with spatial data and platforms, and to keep up to date on recent developments in GIS technology and its uses for global public health. Over the years, several springboard discussions from these meetings have resulted in publications and have led to further collaborative work within the project.
This report shares the insights, innovations, and research that engaged the working group at this meeting. Presentations covered a wide array of topics but can be distilled to two overarching ones: “innovations” and “research and discoveries.” The Innovations section of this report describes presentations related to new tools, technologies, and other offerings of some of our guest experts. The Research and Discoveries section showcases some of the work that our presenters have done on upcoming tools, techniques, and data analysis.
Meeting Presentations
GIS Working Group meeting welcome
GIS Apps to Support Health Information Systems
Accelerating map making with artificial intelligence and web GIS
NavigateHealth—a ‘Yelp’–like app to support community health workers in finding the best service delivery point for their clients, based on GIS and crowd-sourced data
Google Earth Engine: Health Applications of Google’s Cloud Platform for Big Earth Data
Open mapping for health and humanitarian action using OpenStreetMap
How the polio eradication effort in Nigeria led to a quest for global geospatial reference data |
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Data Use in the Democratic Republic of the Congo's Malaria Program: Results from Seven Provinces
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MEASURE Evaluation |
2017 |
English |
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Data, Democratic Republic of Congo, DDU, Malaria, Data Demand and Use |
Evidence-informed decision making is essential for the success of health systems, programs, and services. Global commitments to improving health systems and outcomes have led to improved monitoring and evaluation (M&E) and health information systems, thus providing an opportunity to use data for decision making and not simply for reporting.
Overall, the relationships among improved information, demand for data, and continued data use constitute a cycle that leads to improved health programs and policies. Improving data demand and use (DDU) is necessary to improve the effectiveness and sustainability of a health system.
MEASURE Evaluation, which is funded by the United States Agency for International Development and the United States President’s Malaria Initiative, undertook an assessment to understand the data use context for those working in the Democratic Republic of the Congo (DRC) in the National Malaria Control Program (NMCP) at the provincial and health zone levels in seven provinces (Bukavu, Haut Lomami, Kasai Central, Kasai Oriental, Lomami, Sankuru, and Tanganyika), as well as implementing partners working with the NMCP at the provincial level. The purpose of this assessment was to identify how data are currently being used for decision making and how future interventions can be designed to promote the demand for and use of data in decision making. |
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Stages of Health Information System Improvement: Strengthening the Health Information System for Improved Performance
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Manish Kumar, Liz Millar |
2017 |
English |
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Data, Health Systems Strengthening, Health Information Systems, HIS, Health information, Data Quality |
This brief describes a suite of tools under development by MEASURE Evaluation to provide systematic guidance on how to assess the existing status of a health information system (HIS) and identify specific improvements that take an HIS through a defined progression toward optimum functioning. The goal of this suite of tools is to answer the question: “What are the stages of HIS development?” |
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Bangladesh Maternal Mortality and Health Care Survey 2016: Summary (Bengali Version)
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United States Agency for International Development, MEASURE Evaluation |
2017 |
Bengali |
BANGLADESH |
Bangladesh, Maternal Mortality, Maternal Health, Bangladesh Maternal Mortality and Health Care Survey |
In Bangladesh, the fourth Health, Population, and Nutrition Sector Programme (4th HPNSP) for 2017-2022 aims at a maternal mortality ratio (MMR) target of 121 per 100,000 live births by 2022. The 2016 Bangladesh Maternal Mortality and Health Care Survey (BMMS 2016) assesses the recent progress in maternal health and establishes the baseline for HPNSP and Sustainable Development Goals (SDGs).
MEASURE Evaluation, funded by the United States Agency for International Development, produced this fact sheet to summarize the preliminary results of the BMMS 2016. See the full preliminary report here.
Follow the link below for a version in English:
FS-17-245-en |
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Bangladesh Maternal Mortality and Health Care Survey 2016: Summary
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United States Agency for International Development, MEASURE Evaluation |
2017 |
English |
BANGLADESH |
Bangladesh Maternal Mortality and Health Care Survey, Maternal Health, Maternal Mortality |
Working to build on recent progress, Bangladesh's, fourth Health, Population, and Nutrition Sector Programme (4th HPNSP) for 2017–2022 aims to reach a maternal mortality ratio of 121 per 100,000 live births by 2022. The 2016 Bangladesh Maternal Mortality and Health Care Survey (BMMS 2016) assesses the recent progress in maternal health and establishes the baseline for HPNSP and Sustainable Development Goals.
MEASURE Evaluation, funded by the United States Agency for International Development, produced this fact sheet to summarize the preliminary results of the BMMS 2016. See the full preliminary report here.
Follow the link below for a version in Bengali. বাংলা সংস্করণ:
FS-17-245-ba
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Health Information Systems Interoperability Maturity Toolkit: Users' Guide
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MEASURE Evaluation |
2017 |
English |
Global |
Interoperability, Toolkit, Health Information Systems, HIS |
The Health Information Systems (HIS) Interoperability Maturity Toolkit addresses challenges in low- and middle-income countries (LMICs), where information systems are largely fragmented. The siloed information systems collect data to support specific health programs or services. These systems include program-specific information systems; health management information systems; laboratory and imaging information systems; and disease surveillance information systems. Because of their fragmented nature, these systems cannot effectively exchange data or be harnessed to realize the benefits for which the data were collected. In these conditions, decision makers inside and outside of government are unable to efficiently and effectively access the data they need to make decisions. Without timely, complete, and accurate data, decision makers lack important information on which to base their decisions.
The purpose of the HIS Interoperability Maturity Toolkit is for ministries of health, their implementing partners, and other stakeholders to identify the key domains for interoperability and the required levels of maturity to achieve HIS interoperability goals.
The toolkit consists of an HIS interoperability maturity model, a maturity assessment tool, a complete list of references from the literature review that was conducted as part of the toolkit’s development, and this guide for users of the model and the tool.
Access the full toolkit. |
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Health Information Systems Interoperability Maturity Toolkit: Assessment Tool
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MEASURE Evaluation |
2017 |
English |
Global |
HIS, Interoperability, Health Information Systems |
The Health Information Systems (HIS) Interoperability Maturity Toolkit addresses challenges in low- and middle-income countries (LMICs), where information systems are largely fragmented. The purpose of the HIS Interoperability Maturity Toolkit is for ministries of health, their implementing partners, and other stakeholders to identify the key domains for interoperability and the required levels of maturity to achieve HIS interoperability goals.
The toolkit consists of a users' guide, interoperability maturity model, a complete list of references from the literature review that was conducted as part of the toolkit’s development, and this maturity assessment tool. The objective of this assessment tool is to measure the stage of development of each domain and subdomain for a resilient HIS that serves a country’s data needs. Countries can use results from this assessment to plan for the implementation of HIS activities to achieve a strong and interoperable national HIS.
Access the full toolkit. |
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Health Information Systems Interoperability Maturity Toolkit: Model
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MEASURE Evaluation |
2017 |
English |
Global |
HIS, Interoperability, Toolkit, Health Information Systems |
The Health Information Systems (HIS) Interoperability Maturity Toolkit addresses challenges in low- and middle-income countries (LMICs), where information systems are largely fragmented. The purpose of the HIS Interoperability Maturity Toolkit is for ministries of health, their implementing partners, and other stakeholders to identify the key domains for interoperability and the required levels of maturity to achieve HIS interoperability goals.
The toolkit consists of a users' guide, a maturity assessment tool, a complete list of references from the literature review that was conducted as part of the toolkit’s development, and this interoperability maturity model. The HIS interoperability maturity model is a matrix, with domains, their respective subdomains, and maturity levels. The model’s three domains are leadership and governance; human resources; and technology. Each domain is divided into subdomains, for a total of 18 subdomains.
Access the full toolkit. |
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Health Information Systems Interoperability Maturity Toolkit: Complete References from the Literature Review
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MEASURE Evaluation |
2017 |
English |
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Health Information Systems, Interoperability, HIS |
The Health Information Systems (HIS) Interoperability Maturity Toolkit addresses challenges in low- and middle-income countries (LMICs), where information systems are largely fragmented. The purpose of the HIS Interoperability Maturity Toolkit is for ministries of health, their implementing partners, and other stakeholders to identify the key domains for interoperability and the required levels of maturity to achieve HIS interoperability goals.
The toolkit consists of a users' guide, interoperability maturity model, a maturity assessment tool, and this complete list of references from the literature review that was conducted as part of the toolkit’s development.
Access the full toolkit. |
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How Social Networks Can Improve the Use of Data
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Michelle Li |
2017 |
English |
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Data, Technology, Social networks, Data use, Data Quality |
A social network (SN) may be defined as an electronic platform that allows participants to create personal profiles and build a network of connections with other users, enabling multidirectional communication and collaboration on the platform (Capurro, Cole, Echavarria, Joe, Neogi, et al., 2014). SNs enable users to generate and share content with others. As a mechanism for collaborative discussion and problem solving, SNs are a low-cost way to communicate rapidly and to promote social support and social influence.
Recent literature reviews have examined the use of SN platforms for public health practice and research, primarily in high- and middle-income country settings. Cappurro, et al. (2014) found that SN sites were mainly used to reach hard-to-reach populations; promote healthy behaviors; and for disease surveillance and communications during natural disasters. However, there is the potential for SN platforms to be used as “persuasive technology,” helping to change user attitudes or behaviors through persuasion and social influence (Halko & Kientz, 2010). Connecting groups of people can be a means to provide social and emotional support, advice, and education, which can promote healthy behaviors. Literature reviews conducted in 2014 and 2015 on the use and effectiveness of SN sites for health behavior change found that SN interventions positively affect health behaviors (Maher, Lewis, Ferrar, Marshall, De Bourdeaudhuij, et al., 2014; Laranjo, Arguel, Neves, Gallagher, Kaplan, et al., 2015). In these cases, most interventions conducted were information sharing and advice, with only one involving data sharing to promote accountability and friendly social competition (Foster, Linehan, Kirman, Lawson & James, 2010).
Significant human and financial resources have been invested in information systems, with the goal of producing high-quality data that are used to meet decision-making needs at all levels of a health system. For data to be used for decision making, they must be of high quality (i.e., available, timely, and complete), and then analyzed, synthesized, interpreted, and reviewed (Nutley & Reynolds, 2013). These are the key elements of the data use process. The data use process is impacted by the confluence of technical, organizational, and behavioral factors that facilitate or constrain the use of data. For example, data interpretation and review may be impeded because mechanisms for review (e.g., meetings) occur infrequently and require resources (e.g., time and funding). Moreover, data analysis and interpretation skills may be limited. Organizations may prioritize data quality and reporting while if they lead to the use of information.
Social network platforms can help to overcome barriers to data use, by providing a mechanism for diverse types of users to interact, share information and feedback, and review and discuss data. MEASURE Evaluation explored how SN platforms are being used to improve data collection, data quality, and data review and interpretation, and how their potential can be harnessed to facilitate data-informed decision making.
Access resources from a related webinar. |
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Civil Registration and Vital Statistics System – End-of-Project Assessment Report
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MEASURE Evaluation PIMA |
2017 |
English |
East Africa, Africa, KENYA |
civil registration office, Child health, CRVS, civil registration and vital statistics, Maternal Health, Monitoring, Evaluation, Kenya Vital Statistics Report, Kenya National Bureau of Statistics |
The MEASURE Evaluation PIMA project’s goal was to assist the Government of Kenya to strengthen monitoring and evaluation systems, including the civil registration system which is the basis of all vital statistics in Kenya. The project targeted four main areas: (1) increasing the monitoring and evaluation capacity of the Department of Civil Registration Services, (2) expanding birth and death registration coverage, (3) improving data quality, and (4) enhancing use of quality vital statistics for evidence-based decision making at national and county levels. This scope was informed by the project’s 2013 baseline civil registration and vital statistics system assessment and a separate assessment of the capacity of the department to undertake monitoring and evaluation functions. The recommendations from these assessments, coupled with objectives prioritized in the Department of Civil Registration Services Strategic Plan 2013–2017, guided development of the project’s interventions. In the project’s last year of implementation, MEASURE Evaluation PIMA sought to assess the status of the civil registration system. This end-of-project assessment aims to determine the level for which support for the system has improved availability and use of quality vital statistics among stakeholders at different levels while also recognizing the broader legal and administrative challenges inherent in ensuring a functioning system.
The assessment involved a desk review of available documents and onsite analysis of civil registration processes and the electronic system at select civil registration offices. Structured interviews with key informants—including staff from the Department of Civil Registration Services, registrars at the county level, personnel in select county departments of health, and implementing partners—were conducted. A focus group discussion was held with select local registration agents in Kakamega County. Quantitative data were extracted from vital statistics reports, routine monitoring reports, and the health information system. These data were analyzed using Microsoft Excel, and the analysis involved computation of basic descriptive indicators defined in the project’s performance monitoring plan.
This report outlines findings from the assessment and provides recommendations on how gaps in specified aspects of the system can be bridged. Specifically, the assessment reveals commendable efforts to strengthen the civil registration and vital statistics system, which have resulted in improvements in the quality of statistics produced. Vital statistics are readily available, and reporting by government agencies has been harmonized. Guidelines implemented for certifying and coding causes of death have resulted in the availability of higher quality cause-of-death information from health facilities. Data quality assurance procedures need to be improved, however, to increase reporting and enable use of mortality statistics at the international level. The report provides documentation on project achievements and lessons learned. |
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Bangladesh Maternal Mortality and Health Care Survey 2016: Preliminary Report
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National Institute of Population Research and Training; International Centre for Diarrhoeal Disease Research, Bangladesh; and MEASURE Evaluation |
2017 |
English |
BANGLADESH |
Maternal health, Monitoring, Maternal Mortality |
The Government of Bangladesh is committed to reducing the maternal mortality ratio (MMR) to 143 deaths per 100,000 live births by 2015 and increasing skilled attendance at birth to 50 percent by 2015. The decline in MMR between 2001 and 2010 indicates remarkable progress. The 4th Health, Population and Nutrition Sector Program 2017–2022 has set the target of reaching an MMR of 105 per 100,000 live births in 2022. Within this context, the 2016 Bangladesh Maternal Mortality and Health Care Survey (BMMS 2016) sought to assess how well the country is progressing toward these targets. The survey was funded by the Government of People’s Republic of Bangladesh, the United States Agency for International Development, and the Department for International Development.
The BMMS 2016 sample size was designed to estimate the MMR with a similar level of relative precision to the estimate obtained in the 2010 BMMS, assuming that the MDG target of 143 per 100,000 live births had been met. The BMMS 2016 used a multistage sampling procedure, using sampling frames derived from the 2011 census.
This report—supported by the United States Agency for International Development-funded MEASURE Evaluation—covers a preliminary outline of the results of the BMMS 2016.
Follow the links below for a brief summary of the preliminary report in English and Bengali:
FS-17-245-en
বাংলা ভাষায় সংস্করণ
FS-17-245-ba
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Getting to an Evaluation Plan: A Six-Step Process from Engagement to Evidence
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Brittany S. Iskarpatyoti, Beth Sutherland, Heidi W. Reynolds |
2017 |
English |
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Evaluation, HIV, Data |
MEASURE Evaluation has just published a workbook—Getting to an Evaluation Plan: A Six-Step Process from Engagement to Evidence—developed to help HIV program implementers plan evaluation of their work. The collection, analysis, and use of evaluation data to measure performance—especially when different stakeholders own the data—should be intentionally planned so the effort yields evidence of how and why programs are or are not working. An evaluation plan is a means to organize evaluation activities as they are connected to outputs, outcomes, and impact.
The purpose of this workbook is to provide practical advice and activities to facilitate the preparation of a written evaluation plan that is in line with best evaluation planning practices, as outlined by the Joint United Nations Programme on HIV/AIDS (UNAIDS) HIV Monitoring and Evaluation Reference Group, United States President's Emergency Plan for AIDS Relief (PEPFAR), and the United States Agency for International Development (USAID) (USAID, 2011; UNAIDS, 2010b; PEPFAR, 2015).
The workbook will help implementers identify existing and planned data sources; prioritize evaluation research questions; and determine the roles, responsibilities, and timelines for answering the research questions. The process of developing an evaluation plan in cooperation with a group of stakeholders will foster collaboration, shared purpose, and transparency, thereby ensuring that stakeholders agree on the purpose and use of the evaluation’s findings. A plan also deflects wasted effort and ensures that information is available to answer the agreed-upon questions.
This workbook describes a six-step process for developing a written evaluation plan: (1) engage stakeholders; (2) know your program; (3) know your evaluation needs; (4) select the evaluation design; (5) draft the evaluation plan; and (6) ensure use. Extensive field testing of this process assures that that users will successfully produce a complete evaluation plan that is wholly owned by the stakeholders who participate in the process.
Although this workbook was developed in the context of evaluation planning for HIV programs, many stakeholders involved in the pilot and field applications come from other sectors. The variety of users suggests that this process can be applied successfully in other health areas and sectors. |
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Care Reform Workshop Report
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MEASURE Evaluation |
2017 |
English |
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Children, Child health, Alternative Care, Care for children |
The United States Agency for International Development (USAID) Displaced Children and Orphans Fund (DCOF) works in countries around the world to improve the safety, well-being, and development of vulnerable children, with particular attention to preserving and facilitating their access to appropriate, protective, and permanent family care. USAID/DCOF has engaged USAID-funded MEASURE Evaluation (MEval) to build on and reinforce current U.S. government programming on child care and protection in four countries: Armenia, Ghana, Moldova, and Uganda. MEval works globally to strengthen country capacity to gather, analyze, and use data for decision making to improve sector outcomes.
The overall goal of this USAID/DCOF-funded activity is to intensify country leadership in advancing national efforts on behalf of children who lack adequate family care: that is, national care reform. Throughout the activity, MEval will promote learning across the four collaborating countries. As a part of this learning and collaboration, MEval held a five-day workshop in London with representatives from each of the four countries.
The workshop provided participants with an opportunity to share experiences in national care reform strategies; learn from leading international experts in care reform from Lumos, Better Care Network, Child’s i Foundation, Hope and Homes for Children, and Family for Every Child; review and begin adaptation of the self-assessment tool; and participate in M&E capacity building sessions in the areas of data demand and use, M&E basics and indicator development, and M&E system strengthening. |
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A review of measures of women’s empowerment and related gender constructs in family planning and maternal health program evaluations in low- and middle-income countries
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Mandal M, Muralidharan A, Pappa S |
2017 |
English |
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Maternal health, Women, Family Planning, Empowerment, Evaluation |
Background: Evidence suggests that gender-integrated interventions, which actively seek to identify and integrate activities that address the role of gender norms and dynamics, improve family planning (FP) and maternal health (MH). To understand the link between the gender components of interventions and FP and MH outcomes, it is critical to examine the gender measures used in evaluations.
Methods: We conducted a systematic review of evaluations of gender-integrated FP and MH interventions in low- and middle-income countries. We examine characteristics of the interventions and their evaluations, and summarize women’s empowerment and related gender measures.
Results: Out of 16 evaluation articles, five reported the theoretical or conceptual model that guided the intervention. Twelve described how gender was quantitatively measured and identified 13 women’s empowerment and related gender constructs. Gender scales or indexes were used in five evaluations, three of which noted that their scales had been validated. Less than one third of articles reported examining the effect of gender on FP or MH.
Conclusions: Evaluations of gender-integrated FP and MH interventions do not consistently describe how gender influences FP and MH outcomes or include validated gender measures within their studies. As a result, examining the pathways through which interventions empower women and the manner in which women’s empowerment leads to changes in FP and MH outcomes remains a challenge. Valid measures of commonly reported women’s empowerment and gender constructs, such as gender-equitable attitudes and women’s decision-making power, must be adapted and used within evaluations to examine how empowerment and improvements in gender-related factors can produce positive FP and MH outcomes.
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Impact Evaluation of the Marketing Innovation for Health Project in Bangladesh
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MEASURE Evaluation |
2017 |
English |
Asia, BANGLADESH |
Bangladesh Demographic and Health Survey, Reproductive Health, Maternal Health, Bangladesh Maternal Mortality and Health Care Survey, Antenatal Care, behavior change communication, Child Health, Bangladesh |
The United States Agency for International Development (USAID)/Bangladesh awarded the Marketing Innovation for Health (MIH) project to Social Marketing Company (SMC), Bangladesh in July 2012 for a period of four years. SMC implemented the project in close collaboration with four partner nongovernmental organizations—BRAC, CWFD, PSTC, and Shimantik. (We use the CPS abbreviation to collectively refer to the latter three organizations, because they had similar intervention strategies that differed from those of BRAC.) The project aimed to contribute to sustained improvements in the health status of women and children, by increasing access to and demand for essential health products and services through a private-sector approach in 19 priority districts, with a total population of about 20 million.A difference-in-differences analysis of data collected through baseline and end line surveys from randomly selected intervention and comparison clusters shows that there was a significant increase in client-worker contacts and in women’s knowledge and use of health products and services, as the project intended. There were differences in the performance of BRAC and CPS in some of the indicators considered, which is possibly because of organizational, policy, and fieldworker differences among the implementing organizations. For example, our findings of significant positive impacts of CPS on current use of modern contraceptives and of BRAC on receiving four or more antenatal care visits can be partially explained by these differences. The programmatic implications of the findings are discussed and recommendations are made. |
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How Gender Affects Adherence to Antiretroviral Therapy in Tanzania
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Kahamba JS, Massawe FA, Nombo CI, Jeckoniah JN |
2017 |
English |
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HIV care, Tanzania, Gender, HIV, ART |
Background: AIDS was first diagnosed in 1983. We know that HIV and AIDS have been in Tanzania for more than three decades. Although efforts to find a cure for AIDS have not yet been fruitful, the Government of Tanzania initiated the rollout of free antiretroviral therapy (ART) in 2004. This intervention has dramatically reduced rates of mortality and morbidity and improved the quality of life for people living with HIV (PLHIV). However, the availability of ART does not guarantee that all PLHIV have equal access to it. Gender can increase a person’s vulnerability to HIV and influence his or her ability to access information about preventive measures, care, support, and treatment. The purpose of this study was to investigate how gender-related factors affect access to and follow-through of this important treatment for HIV and AIDS.
Methods: We conducted our study in Njombe District of Njombe Region, Tanzania, from October to November 2015. The region has the highest HIV prevalence rate in the country. We used a cross-sectional design to collect data using a structured questionnaire administered at one public permanent care-and-treatment clinic (CTC) and one mobile CTC. The study population consisted of male and female PLHIV who were more than 18 years of age, were registered in an ART program in Njombe District for at least three months, and had consented to participate in the study. A combination of convenience and snowball sampling techniques was used to capture respondents with the desired characteristics. A total of 132 respondents (97 females and 35 males) completed the questionnaire. Five key informant interviews (KIIs) were conducted with health workers, nongovernmental organization (NGO) staff, and caretakers at the family level. Two focus group discussions (FGDs) were also conducted; one consisted of eight females, the other had seven males. In addition, secondary data from Njombe District health facilities were collected.
Results: Our study found that heterosexual intercourse with a spouse was the leading cause of HIV transmission for more than two-thirds of the women (64.9%), and casual sex outside of marriage was the major cause for more than half of men (54.3%). The main reasons respondents gave for getting tested for HIV were compulsory HIV screening during prenatal visits, HIV awareness campaigns (especially for men), and unhealthy symptoms such as weight loss and frequent diseases. Most PLHIV (86% of men and 80% of women) started on ART within the same year they were diagnosed. Partners did not usually get tested for HIV together; men were typically more reluctant, and they denied the problem, usually asserting their wives were the source of the virus. Women were less likely than men to consult their spouse/partners before getting tested and less likely to get support from their partners after they were tested. Women (especially married women) were more likely to face social problems, including stigma, when disclosing their HIV status to their partners. Some women feared family quarrels and harsh consequences, such as being physically abused and/or divorced. Communication barriers during the early stages of deciding to get tested, and the poor responses women received from their partners when the women consulted them, affected women’s next phase of living with HIV and had a negative impact on ART access and adherence to services. Respondents had a working knowledge of how to adhere to ART and practice safe sex, but they rarely followed safe-sex practices. While nearly all the women (96.9%) took all their medicine, they were less likely than the men to follow the clinic schedule precisely. Women in the FGD said that heavy household workloads made it more difficult for them to take their medications on time.
Conclusion: Gender inequity adversely affects adherence to ART in different ways for women and men living with HIV. This study has improved understanding of gender differences in ART access and adherence. We hope this will contribute to the development of more effective gender-based interventions that can potentially enhance ART access and follow-through. |
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Global Evaluation and Monitoring Network for Health (GEMNet-Health)
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MEASURE Evaluation |
2017 |
English |
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GEMNet-Health, Capacity Building, Monitoring, Evaluation |
GEMNet-Health fosters organizational growth, collaboration, and peer-to-peer support for monitoring and evaluation (M&E) of health programs globally through ongoing institutional linkages among members. As a network with a diverse set of skills and experiences and with members located across the world, GEMNet-Health is a global resource for technical assistance and capacity building in a range of M&E topics.
This brief provides an overview of GEMNet-Health. |
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A systematic review and synthesis of the strengths and limitations of measuring malaria mortality through verbal autopsy
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Herrera S, Enuameh Y, Adjei G, Ae-Ngibise KA, Asante KP, Sankoh O, Owusu-Agyei S, Yé Y |
2017 |
English |
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BackgroundLack of valid and reliable data on malaria deaths continues to be a problem that plagues the global health community. To address this gap, the verbal autopsy (VA) method was developed to ascertain cause of death at the population level. Despite the adoption and wide use of VA, there are many recognized limitations of VA tools and methods, especially for measuring malaria mortality. This study synthesizes the strengths and limitations of existing VA tools and methods for measuring malaria mortality (MM) in low- and middle-income countries through a systematic literature review.
MethodsThe authors searched PubMed, Cochrane Library, Popline, WHOLIS, Google Scholar, and INDEPTH Network Health and Demographic Surveillance System sites’ websites from 1 January 1990 to 15 January 2016 for articles and reports on MM measurement through VA. Inclusion criteria: article presented results from a VA study where malaria was a cause of death; article discussed limitations/challenges related to measurement of MM through VA. Two authors independently searched the databases and websites and conducted a synthesis of articles using a standard matrix.
ResultsThe authors identified 828 publications; 88 were included in the final review. Most publications were VA studies; others were systematic reviews discussing VA tools or methods; editorials or commentaries; and studies using VA data to develop MM estimates. The main limitation were low sensitivity and specificity of VA tools for measuring MM. Other limitations included lack of standardized VA tools and methods, lack of a ‘true’ gold standard to assess accuracy of VA malaria mortality.
ConclusionsExisting VA tools and methods for measuring MM have limitations. Given the need for data to measure progress toward the World Health Organization’s Global Technical Strategy for Malaria 2016–2030 goals, the malaria community should define strategies for improving MM estimates, including exploring whether VA tools and methods could be further improved. Longer term strategies should focus on improving countries’ vital registration systems for more robust and timely cause of death data.
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A Notch Above: Streamlining Capacity Building for M&E in Kenya
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MEASURE Evaluation PIMA |
2017 |
English |
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MEASURE Evaluation PIMA, Data, Kenya, Capacity Building, Monitoring, Evaluation |
MEASURE Evaluation PIMA (MEval-PIMA) was funded in 2012 by the United States Agency for International Development (USAID) in Kenya to support the Ministry of Health (MOH) to strengthen the capacity of health officials at the national and county levels for the monitoring and evaluation (M&E) of health programs and for making better use of health data for decision making. The project’s strategic approach stressed integration and a systemwide perspective to reduce duplication of effort and to reach all levels of data collectors and users. A baseline assessment provided a powerful and effective platform for preliminary engagement and joint planning with partners. The project used the findings to design stakeholder engagement plans and to prioritize interventions to create more efficient use of resources and a faster-paced implementation process.
MEval-PIMA established a common language and standard definitions, reliable and scientific measures of capacity at baseline and end line, and capacity-building work plans. This foundation helped the project address ownership of M&E improvements, build stakeholder buy-in, and demonstrate that important gains can be made with a sustained and rational approach to capacity building. |
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Baked into Our Work: Approaches for Sustainable Capacity Building in Kenya
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MEASURE Evaluation PIMA |
2017 |
English |
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Kenya, HIS, MEASURE Evaluation PIMA, Capacity Building, Sustainability, Health Information Systems |
In Kenya, the government and stakeholders agreed on the importance of stronger monitoring and evaluation (M&E) and health information systems (HIS) in the health sector. To achieve that aim, the United States Agency for International Development (USAID) created MEASURE Evaluation PIMA (MEval-PIMA), a research, evaluation, and capacity-building project, for a five-year period that began in 2012.
The expectation was that a more efficient and unified HIS, with effective M&E, would contribute to a systematic and rational use of data for managing programs and informing policies. To successfully take on this role, health teams required support and capacity building for organizational strengthening and dissemination and use of information at all levels. MEval-PIMA took an approach that capacity building was not separate from—but integral to—strengthening health systems for improved health outcomes.
The overarching strategic objective at the project’s inception was, therefore, to build sustainable M&E capacity for Kenyan health workers to use evidence-informed decision making to improve the effectiveness of the Kenyan health system. Capacity was to be built at the national and subnational levels and within each of the eight regions, covering stakeholders in counties, districts, facilities, and communities. |
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At the Click of a Button: Information System Strengthening in Kenya
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MEASURE Evaluation PIMA |
2017 |
English |
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HIS, MEASURE Evaluation PIMA, Kenya, Information systems, Health Information Systems |
The Government of Kenya wanted a robust, stable health information system (HIS) to inform health decisions and health management. It also needed a support system to train users to take full advantage of health data. MEASURE Evaluation PIMA (MEval-PIMA) was created in 2012 by the United States Agency for International Development (USAID) to help Kenya achieve these goals and make health data available to improve health services.
The USAID Mission in Kenya focused on core priorities for HIV programming funded by the United States President’s Plan for Emergency AIDS Relief (PEPFAR): referral system strengthening (RSS), strengthening of the civil registration and vital statistics (CRVS) system, child protection information and an ongoing orphans and vulnerable children (OVC) longitudinal management information system (OLMIS), and community health information system (CHIS).
In these four important sectors of the HIS, MEval-PIMA has created a legacy of routinized approaches to collect and use health data to improve lives—informed in each case by assessments to understand existing system strengths and weaknesses and existing capacity among the health workers who run the system. The project, always engaging with stakeholders, developed a purposeful mix of solutions—software, hardware, infrastructure, mentoring, training, and monitoring—to upgrade and institutionalize methods that leave Kenya better positioned to know its health issues, to devise strategies to address them, and to manage the work required to improve the health of its citizens. |
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Report of the Kenya Health Data Collaborative: Resource Mapping for Health Information and Monitoring and Evaluation Systems
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Republic of Kenya Ministry of Health |
2017 |
English |
KENYA |
Data, Health information systems, Monitoring, Evaluation |
Global stakeholders interested in collaborating on health data investments joined together to form the Health Data Collaborative (HDC). The main purpose of HDC is to enhance country statistical capacity and stewardship, and for partners to align their technical and financial commitments around strong, nationally owned health information systems (HIS) and a common monitoring and evaluation (M&E) plan.
For Kenya’s health sector to achieve the goals and objectives that are set out in the country health policy and strategic and operational documents, there is a need to establish and implement an accompanying robust and efficient HIS/M&E system. Recognizing this fact, the health sector, through the stewardship of the Ministry of Health (MOH), sought to bring all stakeholders in health together to set a common course for M&E, by holding the first Kenya Health Data Collaborative (KHDC) conference. To organise this conference, Kenya worked closely with the global HDC.
More than 150 participants drawn from different groups, including national and county governments, civil society, the private sector, and development partners, each representing their different constituencies, attended the first KHDC conference. The main purpose of the KHDC is to enhance country statistical capacity and stewardship, and for partners to align their technical and financial commitments around strong, nationally owned HIS and a common M&E plan.
To support KHDC objectives, a partner resource mapping activity was initiated in August 2016 to estimate existing resources for Kenya’s HIS from all sector stakeholders. This information would allow for more informed and efficient investments in HIS in the future and help identify resource gaps and potential duplicative investments at the national and county level. The activity was implemented using a detailed Excel mapping tool, which was designed to help identify details of all investments in HIS/M&E. Each organization (e.g., donors, implementers, and government agencies) contributing to the development of Kenya’s HIS was expected to complete the tool.
The mapping tool addressed the following aspects of partner investments in HIS/M&E activities in Kenya:
Who: All government agencies, funders, and implementing partners contributing to HIS
What: Type of investment activities (e.g., district health information system rollout, HIS strategy, analytic training)
How: Cost categories included within the focus area (e.g., training, equipment)
Where: Investments by county and national levels
When: Current budget year as well as a few future years, if information is available
How much: Budget (or best estimate) for the activity by geographic area
This report presents the results of the application of the mapping tool for the 40 counties in Kenya (out of a total of 47) that received some level of budgetary support for HIS/M&E activities in FY2016–2017 and the focus areas of those investments. |
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Assisted vaginal delivery in low and middle income countries: An overview
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Bailey PE, van Roosmalen J, Mola G, Evans C, de Bernis L, and Dao B |
2017 |
English |
Asia, Latin America and the Caribbean, Africa |
LMICs, Maternal Health |
ObjectiveTo assess the use of assisted vaginal delivery (AVD) in low- and middle-income countries (LMICs), highlighting what level of care procedures were performed and identifying systemic barriers to its use.
DesignCross-sectional health facility assessments.
SettingUp to 40 countries in Latin America, sub-Saharan Africa and Asia.
PopulationAssessments tended to be national in scope and included all hospitals and samples of midlevel facilities in public and private sectors.
MethodsDescriptive secondary data analysis.
Main outcome measuresPercentage of facilities where health workers performed AVD in the 3 months prior to the assessment, instrument preference, which health workers performed the procedure, and reasons AVD was not practiced.
ResultsFewer than 20% of facilities in Latin America reported performing AVD in the last 3 months. In sub-Saharan Africa, 53% of 1728 hospitals had performed AVD but only 6% of nearly 10 000 health centres had done so. It was not uncommon to find <1% of institutional births delivered by AVD. Vacuum extraction appears preferred over forceps. Lack of equipment and trained health workers were the most frequent reasons for non-performance.
ConclusionsThe low use of AVD in LMICs is in contrast with many high-income countries, where high caesarean rates are also associated with significant rates of AVD. In many LMICs, rising caesarean rates have not been associated with maintenance of skills and practice of AVD. AVD is underused precisely in countries where pregnant women continue to face hardships accessing emergency obstetric care and where caesarean delivery can be relatively unsafe.
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Scaling mHealth for Community-Based Health Information Systems – Lessons and Best Practices
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MEASURE Evaluation |
2017 |
English |
Global |
MHealth, HMIS |
Increasingly, community-based health programs are asked to collect client data that then are reported to national health information systems (HIS) and health programs so that projects and governments can use them to inform decision making. To meet this request, community-based programs are working to develop mobile health (mHealth) solutions to help community health workers (CHWs) collect data, receive timely feedback to improve data quality, use data, and, ultimately, ease the transfer of community data into the health management information system (HMIS).
Low-cost technology and improved Internet access have expanded the availability of mHealth solutions for community-based programs. However, despite almost two decades since the introduction of mHealth, few programs have managed to successfully scale and sustain mHealth solutions.
Many documented small-scale digital health interventions exist but, despite a high degree of market penetration, informatics companies say that digital devices are not as widely used for health services as might be expected. Possible reasons for the lack of sustainable mHealth interventions are a general lack of resources, training, and support for long-term sustainability.
To address this need, MEASURE Evaluation, funded by the United States Agency for International Development (USAID), scanned the Internet and spoke with community health and mHealth stakeholders to develop a matrix of mHealth solutions that support monitoring and evaluation (M&E) of HIV; reproductive, maternal, and child health (RMCH); and Ebola. Next, we narrowed our list to mHealth organizations that appeared to have a wide breadth of experience and had gone beyond pilot. Then we reached out to them again, to confirm the scope of their mHealth projects and their willingness to participate in the case study.
This document considers several aspects of these two programs, including what aspects of scaling up were considered, how they trained staff, what HIS systems they connect to, what costs savings (if any) were realized in scaling, and what best practices and recommendations they discovered. |
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Surveillance Data Review Meetings in Malaria-Endemic Counties in Kenya
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MEASURE Evaluation PIMA |
2017 |
English |
KENYA |
Capacity Building, Malaria Surveillance, Data Demand and Use, Data Quality Audit, DQA, Data Quality, Malaria, Malaria control |
MEASURE Evaluation PIMA, funded by the United States Agency for International Development and the U.S. President's Malaria Initiative, supported the rollout of training to the malaria high-burden, high-priority counties of Kisumu, Siaya, Migori, Homa Bay, Kakamega, Busia, Vihiga, and Bungoma. To date, a total of 4,669 health workers have been trained on malaria surveillance nationally. In the malaria lake endemic region of west Kenya, a total of 1,152 health workers were trained. To ensure that the skills and competencies gained by the health workers during the training are used, MEASURE Evaluation PIMA conducted a number of post-training activities in the targeted counties. The aim of these activities was to instill high demand for data and good data use practices among health workers, thereby developing a culture of data use for decision making. These post-training activities included stakeholder mapping, data/performance review, malaria technical working groups, mentorship visits, continuing medical education, and data quality audits. This report provides a summary of the data/performance review meetings that took place within the PIMA-targeted counties. |
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Trousse à outils de suivi et d’évaluation pour un bilan de capacités (MECAT)
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MEASURE Evaluation PIMA |
2017 |
French |
KENYA |
Health Systems Strengthening, MECAT, Monitoring, Evaluation, Trousse à outils, Health Information Systems, HISS, Capacity Assessment, HIS |
À l’échelle mondiale, l’utilisation de données de systèmes de santé pour orienter des décisions sur l’attribution de ressources a tendance à augmenter rapidement, tandis que les ministères de la santé et les programmes nationaux de santé vont dans le sens d’une recherche de garanties de fiabilité en ce qui concerne ces données de systèmes de santé. Par conséquent, la collecte, la communication, et l’utilisation de données font l’objet d’un contrôle de plus en plus strict et les efforts pour renforcer les systèmes d’information sanitaire (SIS) doivent porter sur l’amélioration du suivi et de l’évaluation (S&E) des programmes de santé, en commençant par des bilans de capacités et de performances de base standardisés.
Afin de permettre de répondre à ce besoin, MEASURE Evaluation, le projet phare de renforcement S&E et SIS de l’Agence des États-Unis pour le développement international, ainsi que MEASURE Evaluation PIMA au Kenya, ont développé un processus et une trousse à outils pour dresser un bilan standard de base des capacités S&E.
Click here for the English version.
Version française |
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Integrating Gender in the Monitoring and Evaluation of Health Programs: A Toolkit
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Jessica Fehringer, Brittany Iskarpatyoti, Bridgit Adamou, and Jessica Levy |
2017 |
English |
Global |
Gender, Integration, Monitoring, Evaluation |
Gender expectations have a significant impact on a person’s health, by shaping behaviors and beliefs related to risk and vulnerability, and on health-seeking behavior.
The assessment of whether programs achieve intermediate and long-term objectives related to gender norms and health status requires gender-relevant information. The integration of gender in the monitoring and evaluation (M&E) activities of health programs is important for the collection of the required information; for understanding the effectiveness of gender-integrated programming in changing gender norms; reducing gender inequalities; and improving service delivery, access to services, and health outcomes.
This toolkit, developed by MEASURE Evaluation (which is funded by the United States Agency for International Development), aims to help international health programs integrate a gender perspective in their M&E activities, measures, and reporting. It is designed for use by health program staff (such as project directors, gender focal persons, program officers, and M&E officers), working in various health sectors (such as HIV; malaria; reproductive, maternal, newborn, and child health; and tuberculosis), and for various health agencies and initiatives (such as the United States President’s Emergency Plan for AIDS Relief, the President’s Malaria Initiative, Feed the Future, and Family Planning 2020).
Access the full toolkit. |
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How Kenya Monitors Health Information System Performance: A Case Study
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MEASURE Evaluation |
2017 |
English |
KENYA |
HIS, Community-based health information systems |
A properly functioning health information system (HIS) gets the right information into the right hands at the right time, enabling policymakers, managers, and individual service providers to make informed choices on decisions ranging from patient care to national budgets. Monitoring HIS performance can help produce timely and high-quality data that can be used for evidence-informed decision making to plan, implement, and improve health programs and allocate resources effectively.
As part of MEASURE Evaluation’s Phase IV Learning Agenda to strengthen HIS, MEASURE Evaluation, which is funded by the United States Agency for International Development, conducted a case study in Kenya to provide greater in-depth understanding of how different countries measure the performance of their HIS.
This case study describes how HIS performance is currently monitored in Kenya based on interviews with the government and partners, review of documents, and review of HIS indicators. The goal of the case study is to inform a guidance document that will provide technical assistance in monitoring HIS performance in-country by stakeholders, HIS managers, and HIS implementers. |
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MomConnect Operational Research: Capacity Building to Increase Registration Rates at Clinics
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Khou Xiong and Brittany Iskarpatyoti |
2017 |
English |
SOUTH AFRICA |
MomConnect, Maternal health, Antenatal Care, Capacity Building, EHealth |
The accomplishments of MomConnect, though substantial, fell short of the target to register 1 million pregnant women. To improve registration rates, MEASURE Evaluation–Strategic Information for South Africa (MEval–SIFSA)—funded by the United States President’s Emergency Plan for AIDS Relief through the United States Agency for International Development—and the NDOH provided retraining and additional support to enhance the capacity of district- and facility-level supervisors who oversee MomConnect implementation at facilities.
The objectives of the study in this report were to (1) assess whether capacity building efforts improved MomConnect registrations, (2) identify high-volume antenatal care (ANC) facilities that are consistently underperforming after capacity-building (CB) efforts, and (3) determine the persisting barriers that contribute to low registration rates.
During trainings, checklists, pretests, and posttests were used to assess information shared and gained by participants. During supportive site visits, the research team performed a standardized assessment to determine the persisting barriers that contribute to low registration rates. MomConnect registration and ANC visit data in the district health information system 2 (DHIS 2) were tracked monthly to monitor the registration rates of ANC facilities.
MomConnect CB efforts were found to have made substantial strides in increasing registrations among pregnant women, and MEval–SIFSA makes a series of recommendations to achieve further improvement. |
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Opening the Black Box of Maternal and Newborn Deaths in Kenya: A Report on Technical Support for Implementation of Maternal and Perinatal Death Surveillance and Response
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MEASURE Evaluation PIMA |
2017 |
English |
KENYA |
Maternal Health, Health information systems, Capacity Building, Child Mortality, Kenya, Child Health, Maternal Mortality |
Kenya aims to reduce its high maternal mortality rate from 362 deaths per 100,000 live births to 200 deaths per 100,000 live births by 2030. Maternal and perinatal death surveillance and response (MPDSR) is an essential, high‑impact element of obstetric and newborn care and a game-changing approach to attaining this goal. In 2008, the Kenya Ministry of Health (MOH) adopted the World Health Organization’s technical guidelines on maternal death reviews and incorporated a perinatal component. A 2014 audit of the implementation of maternal death reviews showed weaknesses, such as a lack of knowledge of classification of causes of death in accord with the International Classification of Diseases, low levels of reporting of maternal deaths, and a lack of reporting forms. These issues show that health workers in maternal and neonatal health programs face challenges in providing specific services to eliminate the deaths of women and newborns. WHO has described these kinds of data gaps—in Kenya and elsewhere—as the “black box of maternal mortality.” The missing data are necessary for Kenya to track preventable maternal and newborn deaths precisely and in real time and to respond effectively.
MEASURE Evaluation PIMA, funded by the United States Agency for International Development, helped with the audit, the development of maternal and perinatal death surveillance and response guidelines, tools for implementing the guidelines, and efforts to strengthen maternal and perinatal death surveillance and response. This report outlines those efforts and lessons.
In Kenya, knowledge of MPDSR as a high-impact intervention has increased, especially among health workers, despite varying degrees of implementation by county MPDSR committees. With global and national commitments to eliminate preventable maternal, child, and newborn deaths, and Kenya’s efforts toward these goals, there is promise that the vision for a functional MPDSR system will be achieved. Experience from efforts to institutionalize MPDSR in the five focus counties shows that although reporting is still low, information on the extent and characteristics of maternal and perinatal deaths is becoming more available and accessible. Specific maternal and perinatal mortality data from the “black box” are increasingly accessed, analyzed, and used for policy and service delivery. |
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Kakamega County: End Line Assessment of Monitoring and Evaluation Capacity
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MEASURE Evaluation PIMA |
2017 |
English |
KENYA |
Monitoring, Evaluation, Capacity Assessment, Kakamega, Kenya |
This report is a brief synthesis of an end line assessment undertaken to discern and document the capacity of the county health management teams to perform monitoring and evaluation (M&E) functions in Kakamega County, Kenya, as a means to understand the impact of MEASURE Evaluation PIMA (MEval‑PIMA) in improving M&E systems at the county level.
The MEval-PIMA project was implemented between December 2012 and June 2017. As part of project closeout, MEval-PIMA conducted an end-of-project assessment to document achievements and provide lessons learned toward strengthening the capacity of the Ministry of Health at the national and subnational levels to produce and use high-quality data for decision making and to communicate project results with stakeholders and beneficiaries. Specifically, the end line assessment aimed to accomplish the following:
Document changes in M&E capacity since the baseline assessments were conducted.
Document the key drivers of changes in M&E capacity.
Document MEval-PIMA’s contribution to the changes in M&E capacity.
Document lessons learned in terms of strengthening M&E capacity at individual and organizational levels.
The end line assessment was conducted in a workshop setting using three participatory data collection tools and a self-administered individual capacity tool. Respondents for this assessment were program managers and program officers, including M&E officers and data managers from Kakamega County.
Despite progress over the four years in developing a conducive environment that supports planning and prioritization of resources for M&E at the county level, we found that several threats to the sustainability of these gains remain. This report also contains recommendations to address these threats. |
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Narok County: End Line Assessment of Monitoring and Evaluation Capacity
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MEASURE Evaluation PIMA |
2017 |
English |
KENYA |
Monitoring, Evaluation, Capacity Assessment, Kenya, Narok |
This report is a brief synthesis of an end line assessment undertaken to discern and document the capacity of the county health management team to perform monitoring and evaluation (M&E) functions in Narok County, as a means to understand the impact of MEASURE Evaluation PIMA (MEval-PIMA) in improving M&E systems at the county level and the changes in M&E capacity since the start of the project.
The MEval-PIMA project was implemented between December 2012 and June 2015. As part of the project closeout, MEval-PIMA conducted an end-of-project assessment to document achievements and provide lessons learned toward strengthening capacity of the Ministry of Health (MOH) at the national and subnational levels to produce and use high-quality data for decision making and to communicate project results with stakeholders and beneficiaries. Specifically, the end line assessment aimed to achieve the following:
Document changes in M&E capacity since the baseline assessments were conducted.
Document the key drivers of changes in M&E capacity.
Document MEval-PIMA’s contribution to the changes in M&E capacity.
Document lessons learned in terms of strengthening M&E capacity at individual and organizational levels.
The decision to include Narok County as part of the end line assessment was aimed at delineating the differences in M&E capacity between counties that benefited from financial and technical assistance from MEval-PIMA and those counties that did not benefit, for the period of the project.
The end line assessment was conducted in a five-day workshop setting using three participatory data collection tools. Respondents for this exercise were program managers and program officers, including M&E officers and data managers from Narok County.
Narok showed some improvement, compared to performance at baseline. The biggest threat to the sustainability of these gains is the lack of financial autonomy to undertake M&E activities, which is linked to poor prioritization of M&E in county budgets. Respondents made a series of recommendations to address these, and other, threats. |
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Siaya County: End Line Assessment of Monitoring and Evaluation Capacity
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MEASURE Evaluation PIMA |
2017 |
English |
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Monitoring, Evaluation, Siaya, Capacity Assessment, Kenya |
This report is a brief synthesis of an end line assessment undertaken to discern and document the capacity of the county health management teams to perform monitoring and evaluation (M&E) functions in Siaya County, Kenya, in order to understand the impact of MEASURE Evaluation PIMA (MEval-PIMA) in improving M&E systems at the county level.
The MEval-PIMA project, funded by the United States Agency for International Development, was implemented between December 2012 and June 2016. As part of the project closeout, MEval-PIMA conducted an end-of-project assessment to document achievements and provide lessons learned toward strengthening capacity of the Ministry of Health at the national and subnational levels to produce and use high-quality data for decision making and to communicate project results with stakeholders and beneficiaries. Specifically, the end line assessment aimed to accomplish the following:
Document changes in M&E capacity since the baseline assessments were conducted.
Document the key drivers of changes in M&E capacity.
Document MEval-PIMA’s contribution to the changes in M&E capacity.
Document lessons learned in terms of strengthening M&E capacity at individual and organizational levels.
The end line assessment was conducted in a five-day workshop setting using three participatory data collection tools. Respondents for this exercise were program managers and program officers, including M&E officers and data managers from Narok County.
We found that, although Siaya made remarkable progress between the baseline and end line assessments, the biggest threat to the sustainability of these gains is low prioritization of M&E in the county budgeting process and inadequate funding for M&E activities, such as printing data collection and reporting tools. Participants offered a series of recommendations to address these and other threats. |
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National Malaria Control Programme Monitoring and Evaluation Capacity: End Line Assessment Report
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MEASURE Evaluation PIMA |
2017 |
English |
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MECAT |
The MEASURE Evaluation PIMA (MEval-PIMA) project has been implemented in Kenya over the last five years, and key achievements have been made across the various results areas.
As part of the project closeout, MEval-PIMA conducted an end-of-project assessment to document achievements and impact and provide lessons learned toward strengthening monitoring and evaluation (M&E) capacity of the Ministry of Health (MOH) at the national and subnational levels, to provide data demand and use information for decision making, and to communicate and share the project legacy and closure with stakeholders and beneficiaries. As part of this assessment, the systematic documentation of the project legacy had two areas of focus: (1) capturing the experiences of the beneficiaries of key project support toward M&E capacity building, and (2) sharing end of project communications, culminating in a project closeout event in Nairobi.
The main purpose of the end line assessment is to evaluate the changes in M&E capacity against the baseline and measure progress toward achievement of the Intermediate Result “Improved capacity of the MOH to identify and respond to M&E information needs.” Specifically, the end line aimed to:
Determine the change in M&E capacity in the programs by using the quantitative Monitoring and Evaluation Capacity Assessment Toolkit (MECAT) group assessment.
Document the key drivers to the changes in M&E capacity using participatory approaches.
Document MEval-PIMA contributions to the changes in M&E capacity.
Document lessons learned in terms of strengthening M&E capacity at individual and program levels.
An end line assessment was conducted in a workshop setting using three participatory methods and an individual capacity assessment. Respondents for this exercise were program managers and program officers, including M&E officers and data managers from the NMCP.
End line assessments are also available for Siaya, Narok, and Kakamega counties. |
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How Access to Smartphones Affects HIV Risk among Students in Tanzania: A Case Study of Selected High Schools in the Dar es Salaam Region
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Anna Meleiya Mbise and Gwao Omari Gwao |
2017 |
English |
TANZANIA |
What's New, HIV/AIDS, Tanzania, Adolescent health, Mobile technology, Smartphones, Child Health |
Studies show that smartphone adoption by teenagers in Tanzania has increased substantially, and mobile access to the Internet is pervasive. This study investigated whether the use of smartphones by high-school students in Tanzania raises their awareness of HIV or makes them more vulnerable to its acquisition.
Twelve private and government high schools in Ilala and Kinondoni Municipalities, both day and boarding schools, participated in this study. Data collection entailed qualitative and quantitative methods. Questionnaires were administered to 240 students, ages 17–22 years, and two focus group discussions were facilitated with 28 students. In-depth interviews were conducted with 40 stakeholders, including district education officials, teachers, and education and health officials from nongovernmental organizations and parents of high schoolers. In addition, secondary data were collected through a document review.
Although respondents mentioned that a smartphone could be used to improve academic performance and health, many students in fact used their smartphones for purposes other than education or health.
Respondents recommended that the Tanzania Communications Regulatory Authority, and other arms of the Government of Tanzania, educate the public on the proper use of smartphones. Those surveyed thought that parents and guardians should monitor their children’s smartphone use; parents, teachers, and community members should restrict the use of smartphones among students under 18 years of age; and youth should be taught the proper use of technologies, including smartphones. |
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Enhancing Use of Routine Health Information for Family Planning to Influence Decision Making in Tanzania
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Peter Bujari |
2017 |
English |
TANZANIA |
Family Planning, Data Demand and Use, Tanzania |
Family planning (FP) is a priority in Tanzania’s health sector and in strategies for reducing poverty. Family planning makes a critical contribution to reducing both maternal and child deaths. However, implementation of Tanzania’s FP policy has faced challenges for many years because of inadequate allocation of funds. As a result, Tanzania has low rates of FP use, a high fertility rate, and high maternal mortality.
This study examined the sources of FP data in Tanzania and how the data are collected, analysed, and used to inform planning and budgeting. The study investigated five research questions:
What kind of routine health information is collected for FP and how often does this process happen?
Who is involved in the information chain at every level of data consumption?
How adequate is the FP health management information system (HMIS), particularly to inform decisions for FP?
How and at what level are the data analysed?
What can be done to address existing information gaps to influence decisions for FP services?
This was a cross-sectional descriptive study with convenience sampling. The study compared the best-performing and worst-performing regions in relation to key FP indicators.
At the national level, the study involved the Reproductive and Child Health Section of the Ministry of Health, Community Development, Gender, Elderly, and Children. Key informant interviews were conducted with 31 members of the study population, and data were analysed using the Statistical Package for Social Scientists version 23.0 and a qualitative pattern-matching approach.
We found that a system for FP data collection has been established at all health facilities, but has limited inclusion of the private sector and of outreach or community-based information. This is coupled with inadequate analysis and use of information to inform planning and budgeting. The paper-based HMIS needs to be harmonised with the new, electronic district health information system, DHIS 2. |
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Male Engagement in Family Planning: Gaps in Monitoring and Evaluation
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Bridgit Adamou, Brittany S. Iskarpatyoti, Chris B. O. Agala, and Carolina Mejia |
2017 |
English |
Global |
What's New, Men's Health, Contraception, Family Planning, Fertility, Families, and Children, Monitoring, Evaluation, Male Involvement |
Organized family planning (FP) programs have traditionally focused primarily on women. With gender equity gaining recognition as a prerequisite for better health, more attention is being placed on deliberately engaging men, in learning about, supporting, and using FP services and products. Efforts to expand constructive male engagement are evolving from encouraging men to be supportive partners of women’s reproductive health (RH), to focusing on meeting men’s own RH needs and engaging them as contraceptive users and agents of change in families and communities.
Although male engagement is becoming more common in FP strategies and interventions, effective monitoring and evaluation (M&E) of this approach lags. This review contributes to the understanding of how male engagement in FP is defined, monitored, and evaluated. Specifically, we sought to identify gaps in M&E of male engagement and to make recommendations to address the gaps.
We obtained information on the successes and challenges of M&E of male engagement in FP interventions through a desk review of peer-reviewed articles and gray literature, including national FP strategies and policies. To supplement information from the desk review, the study team conducted key informant interviews (KIIs) with staff from organizations that are currently implementing or have recently implemented activities involving male engagement in FP.
This review makes several recommendations on how to improve the M&E of male engagement in FP programs: using a standardized definition of male engagement in FP; including male engagement in national FP and RH strategies; using strong, high-quality indicators; and making better use of existing data collection approaches and methods. |
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Integrated Community Case Management of Childhood Illnesses: Assessment of Nigeria’s Program
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Samson B. Adebayo, Gbenga Ishola, and Adedayo Adeyemi |
2017 |
English |
NIGERIA |
Child Mortality, Nigeria, Infectious disease, Integration, ICCM, Integrated Community Case Management |
Integrated community case management (ICCM) is a strategy that enables the assessment, classification, treatment, and referral of cases of the main causes of mortality among children under the age of five years (CU5) in Nigeria: pneumonia, diarrhea, and malaria. Following Nigeria’s creation of national guidelines for ICCM in 2013, rollout of the strategy commenced in several states. This study sought to assess trends in childhood illnesses and identify sociodemographic barriers and enabling factors affecting the seeking of treatment for CU5.
The aim of the study was to assess the effect of the ICCM intervention on the treatment coverage of diarrhea, malaria, and pneumonia, to inform policy and implementation. The study accomplished this goal through the following tasks:
Examining the trends and patterns of community-based treatment of childhood illnesses in Nigeria
Assessing the effects of implementing ICCM on treatment coverage in Nigeria
Identifying barriers and enablers of uptake of ICCM services by caregivers
The study analyzed the 2008 and 2013 Nigeria Demographic and Health Survey (NDHS) data. Ten key informant interviews and 32 focus group discussions were conducted with community members and leaders, health facility staff, and government stakeholders in Benue and Sokoto states. The occurrence of childhood illness was found to have decreased between 2008 and 2013.
Although full implementation of ICCM will help caregivers to assess care for childhood illnesses with more precision, their awareness of the symptoms of sickness must be increased to better prevent and treat childhood illnesses. Demand for community-led healthcare delivery is high, and Nigerians’ acceptance of the implementation of the ICCM is likely to be high, as well, especially in rural communities. |
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Health Systems Strengthening – Monitoring, Evaluation, and Learning Guide
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Aqil A, Silvestre E, Hotchkiss D, Maniscalco L |
2017 |
English |
Global |
electronic health management information system, DHIS 2, MEL, Antenatal Care, HIS, Community-based health information systems, Monitoring, Evaluation, and Learning, Health System, HMIS, DQA, Health Systems Strengthening, Antenatal care, GIS, Electronic Health Records, Monitoring, Evaluation |
As the number of health systems strengthening (HSS) projects funded by the United States Agency for International Development (USAID) increases, so, too, does the need to build the capacities of staff at the missions and at headquarters to plan, manage, and conduct monitoring and evaluation (M&E) of HSS projects. Evidence on how HSS interventions strengthen the performance of health systems (HS) and contribute to sustainable improvements in health status are scarce and scattered, with limited dissemination.
Health systems are multifaceted and multilayered. The interactions among people, institutions, processes, and outputs makes these systems complex. The complexity arises not only from whether the interventions are simple or complex, practical, and economically feasible, but also from a lack of clarity on causal linkages between HS interventions and the system’s performance. HSS monitoring, evaluation, and learning (MEL) is different from the MEL of other types of projects because of its systemic nature, interactions among HS components, and the need to generate evidence on causal pathways and linkages. The guide is complemented by a comprehensive list of HS indicators (Health Systems Strengthening: A Compendium of Indicators) and an HSS MEL needs assessment (Health Systems Strengthening: A Literature Review).
This guide fulfills USAID’s staff capacity-building HSS MEL needs, by providing step-by-step instructions on planning, implementing, and evaluating an HSS project. It has the following purposes:
Provide operational guidance on planning, implementing, and evaluating HS MEL activities
Address the complexity of HS in MEL activities
Describe methods/techniques to generate evidence on the effectiveness of HSS interventions in
improving HS
Apply evidence from HSS MEL to learning, adaptive management, and designing HS projects
This guide’s overarching intent is to encourage the design and implementation of the project MEL component using existing resources such that the project’s capacity to generate evidence around achievements, systemwide changes, and learning is enhanced. |
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Health Systems Strengthening – A Compendium of Indicators
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Diana M, Yeager V, Hotchkiss D |
2017 |
English |
Global |
antiretrovirals, AIDS-free generation, AIDS, Sexually Transmitted Infections (STIs), Demographic and Health Survey, ART, health systems strengthening |
Health Systems Strengthening: Monitoring, Evaluation, and Learning Guide (Aqil, Silvestre, & Hotchkiss, 2017)—part of a package of health systems strengthening [HSS] resources, along with this compendium and one other document—provides advice and direction on how to set up monitoring, evaluation, and learning (MEL) processes. These processes track progress in HSS, generate evidence of the effectiveness of HSS interventions, and use that evidence for continuous learning and better programming. Indicators are an important part of MEL processes, and this compendium presents the wide array of indicators that can be used to monitor progress and generate evidence for HSS. They support USAID’s goals of ending preventable child and maternal deaths (EPCMD) and an AIDS-free generation (AFG goals). The indicators come from many diverse sources and were collected in conjunction with a literature review of M&E frameworks for HSS: Health Systems Strengthening: A Literature Review (Diana, Yeager, & Hotchkiss, 2017): the third document in this package of resources.
The compendium is organized in three sections. First, it provides introduction to indicators, grouping based on health system functions, selection considerations, and data sources. Second, an overview HSS indicators is provided. Lastly, tables of indicators based on core health system functions are presented. |
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Health Systems Strengthening – A Literature Review
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Diana M, Yeager V, Hotchkiss D |
2017 |
English |
Global |
Health Systems Strengthening |
Health systems strengthening (HSS) has become part of a strategy of the United States government (USG) to help developing countries improve population health outcomes. A key premise of this core principle is that weak health systems have limited the effectiveness of governments and their international partners to scale up the availability and use of priority health services. By helping countries to strengthen the components of their health systems—health financing, human resources for health, health information, service delivery, the medicine supply chain, and leadership and governance—the USG hopes that cost-effective technologies for combating disease and other health problems will be more effectively delivered and sustained.
Measuring progress in HSS requires careful planning and sound metrics to assess changes in how health systems function and perform. Health systems frameworks are being used to inform HSS efforts. These frameworks cover a variety of perspectives and scopes, and focus on such diverse topics as performance, supply and demand, health reforms, building blocks, “control knobs” (explained later in this review), and funds and payments. Many health policy analysts argue that health systems are complex adaptive systems with both intended and unintended effects . Each of these frameworks has its own approach to monitoring and evaluation, with different metrics and indicators of health systems functioning. In addition, manuals and other publications provide guidance on assessing health systems functioning, including those developed by the World Health Organization (WHO) and by the Health Systems 20/20 project of the United States Agency for International Development (USAID).
The purpose of this review is to assess the availability of guidance on monitoring and evaluating HSS, and to list and summarize these resources for others in this field. This review is part of a suite of documents that MEASURE Evaluation is releasing that also includes Health Systems Strengthening: A Compendium of Indicators (Diana, Yeager, & Hotchkiss, 2017) and Health Systems Strengthening: Monitoring, Evaluation, and Learning Guide (Aqil, Silvestre, & Hotchkiss, 2017).
This is not an exhaustive review of the resources providing guidance on monitoring and evaluation or on HSS, but we believe it captures the most relevant ones that contribute to work in these realms. We hope this review will offer field staff and project partners guidance to fit their needs. |
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How Kenya Monitors Health Information System Performance – Findings from a Case Study
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MEASURE Evaluation |
2017 |
English |
Africa, KENYA, East Africa |
Kenya, Health Information Systems, Health Services, Africa, Health System, HIS |
A high-functioning health information system (HIS) provides high-quality data to be used for decision making at all levels of the health system. Governments in low- and middle-income countries and international donors agree that HIS strengthening activities increase the use of high-quality health data, leading to improved health service delivery and outcomes. However, few guidelines and tools exist to help these countries assess whether HIS strengthening activities improve HIS performance, specifically regarding data quality and data use. The Health Information Systems Strengthening Model (HISSM) of MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID)—describes data quality and data use as two areas of HIS performance.
In 2015, a team from MEASURE Evaluation conducted a case study in Kenya to understand how the Ministry of Health (MOH) and select national health programs are planning, implementing, and measuring processes to improve HIS data quality and data use. Although Kenya receives support to strengthen its HIS, few documents are publicly available that describe how the country monitors HIS performance. The purpose of the case study was to understand and document the policies and practices being undertaken in Kenya to measure the performance of the HIS. This case study focuses on the monitoring of HIS performance measurement—specifically, data quality and data use—in Kenya. Lessons learned were used to identify needs and develop tools to support HIS managers in assessing and monitoring HIS performance.
Access the case study report. |
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Improving Continuity of Care by Strengthening Health Information Systems
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MEASURE Evaluation |
2017 |
English |
Global |
Health Systems Strengthening, Health Information Systems, Learning agenda, Continuity of Care |
Health information systems (HIS) represent a significant investment for groups that require evidence for accountability and informed decision making. Despite a compelling need for robust evidence of HIS function, these systems have not traditionally been a subject for rigorous study and evaluation. That lack limits learning, sharing, and cultivating best practices that can be shared more widely.
MEASURE Evaluation, funded by the United States Agency for International Development, developed an HIS Learning Agenda, to justify and build an evidence base for which investments in HIS are effective and useful and explore what works to strengthen HIS. For the Learning Agenda, we seek to answer questions such as these: What are the factors and stages of progress in HIS performance and how are they measured? And what are the characteristics of a strong HIS? The project is also implementing activities to build the evidence base on HIS strengthening. We hope our efforts will contribute to evidence-informed global work to strengthen HIS and health outcomes.
One of the many questions that arise in linking improvements to HIS to improved health outcomes is the aspect of coherent client care, or “continuity of care (COC).” COC is the process of providing good-quality healthcare, over time, to a client.
One activity in MEASURE Evaluation’s Learning Agenda is to synthesize what we know so far about how to strengthen HIS and the effects of those efforts. The focus of this synthesis report—which is one of a series—is to document what we are learning about how stronger HIS may improve COC for clients. Here we review what we know now about the effects of HIS strengthening on COC and what areas need research. |
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Easing the Data Collection Burden on Healthcare Providers by Strengthening Health Information Systems
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MEASURE Evaluation |
2017 |
English |
Global |
Learning agenda, EHealth, Health information systems |
Health information systems (HIS) represent a significant investment for groups that require evidence for accountability and informed decision making. Despite a compelling need for robust evidence of HIS function, these systems have not traditionally been a subject for rigorous study and evaluation. That lack limits learning, sharing, and cultivating best practices that can be shared more widely.
MEASURE Evaluation, funded by the United States Agency for International Development, developed an HIS Learning Agenda, to justify and build an evidence base for which investments in HIS are effective and useful and explore what works to strengthen HIS. For the Learning Agenda, we seek to answer questions such as these: What are the factors and stages of progress in HIS performance and how are they measured? And what are the characteristics of a strong HIS? The project is also implementing activities to build the evidence base on HIS strengthening. We hope our efforts will contribute to evidence-informed global work to strengthen HIS and health outcomes.
This paper—one of a series developed by MEASURE Evaluation—explores how to improve HIS to address the burden of data collection that falls to healthcare providers. The aim is to discover ways to help providers collect good-quality data without compromising the care they give to their clients. This paper reviews what we can discern thus far, through a review of literature and our own experience, and it provides a series of recommendations for data collection and HIS. |
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Gauging the Impact of MomConnect on Maternal Health Service Utilisation by Women and Their Infants in Johannesburg, South Africa
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Coleman J, Xiong K |
2017 |
English |
Africa, Southern Africa, SOUTH AFRICA |
What's New, expanded programme on immunization, Antenatal Care, Maternal health, Reproductive Health, reproductive health, MomConnect, ART, Antenatal care, Mobile technology, Neonatal care, Mobile Alliance for Maternal Action, Maternal Health |
South Africa faces several systemic access barriers to sustainable and comprehensive maternal and neonatal child health (MNCH) care (National Committee for Confidential Enquiries into Maternal Deaths, 2013). A United Nations Children’s Fund (UNICEF) report highlighted these barriers in South Africa, such as insufficient health-care infrastructure, staff, counselling, information, and communication within the health system and between health service providers and patients.
South Africa did not achieve Millennium Development Goals #4 and #5 aiming to reduce child mortality and improve maternal health by 2015. Improved retention in maternal health services is essential to meet these goals. This requires innovative retention solutions, such as increasing patient health knowledge and rights, to improve maternal health and related health systems strengthening indicators within the country.
Globally, health systems are expected to provide high-quality services to diverse populations (rural, peri-urban, and urban). Scalable services that are cost effective, reliable, and sustainable are in great demand.
Recognizing the need and potential for broader mHealth applications, South Africa’s National Department of Health (NDOH) initiated MomConnect, the world’s first nationwide mHealth intervention, in August 2014. The aim was to register all pregnant women into a national system to receive preventative health messages and ultimately improve MNCH services and outcomes.
Our hypothesis was that using MomConnect to send pregnant women bi-weekly, informative, and supportive direct SMS(s) timed to the month of pregnancy is a feasible and cost-effective strategy for increasing maternal health service utilisation by pregnant women and their infants attending public health facilities in Johannesburg, South Africa. |
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Methodological Considerations for Use of Routine Health Information System Data to Evaluate Malaria Program Impact in an Era of Declining Malaria Transmission
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Ashton RA, Bennett A, Yukich J, Bhattarai A, Keating J, Eisele TP |
2017 |
English |
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Coverage of malaria control interventions is increasing dramatically across endemic countries. Evaluating the impact of malaria control programs and specific interventions on health indicators is essential to enable countries to select the most effective and appropriate combination of tools to accelerate progress or proceed toward malaria elimination. When key malaria interventions have been proven effective under controlled settings, further evaluations of the impact of the intervention using randomized approaches may not be appropriate or ethical. Alternatives to randomized controlled trials are therefore required for rigorous evaluation under conditions of routine program delivery. Routine health management information system (HMIS) data are a potentially rich source of data for impact evaluation, but have been underused in impact evaluation due to concerns over internal validity, completeness, and potential bias in estimates of program or intervention impact. A range of methodologies were identified that have been used for impact evaluations with malaria outcome indicators generated from HMIS data. Methods used to maximize internal validity of HMIS data are presented, together with recommendations on reducing bias in impact estimates. Interrupted time series and dose-response analyses are proposed as the strongest quasi-experimental impact evaluation designs for analysis of malaria outcome indicators from routine HMIS data. Interrupted time series analysis compares the outcome trend and level before and after the introduction of an intervention, set of interventions or program. The dose-response national platform approach explores associations between intervention coverage or program intensity and the outcome at a subnational (district or health facility catchment) level. |
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Impact of Insecticide-Treated Net Ownership on All-Cause Under-Five Mortality in Malawi, 2006–2010
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Florey LS, Bennett A, Hershey C, Bhattarai A, Nielsen CF, Ali D, Luhanga M, Taylor C, Eisele T, Yé Y |
2017 |
English |
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Malaria, ITN, Malaria control, Malawi, Child Mortality, Child Health |
Insecticide-treated nets (ITNs) have been shown to be highly effective at reducing malaria morbidity and mortality in children. However, there are limited studies that assess the association between increasing ITN coverage and child mortality over time, at the national level, and under programmatic conditions. Two analytic approaches were used to examine this association: a retrospective cohort analysis of individual children and a district-level ecologic analysis.
To evaluate the association between household ITN ownership and all-cause child mortality (ACCM) at the individual level, data from the 2010 Demographic and Health Survey (DHS) were modeled in a Cox proportional hazards framework while controlling for numerous environmental, household, and individual confounders through the use of exact matching. To evaluate population-level association between ITN ownership and ACCM between 2006 and 2010, program ITN distribution data and mortality data from the 2006 Multiple Indicator Cluster Survey and the 2010 DHS were aggregated at the district level and modeled using negative binomial regression. In the Cox model controlling for household, child and maternal health factors, children between 1 and 59 months in households owning an ITN had significantly lower mortality compared with those without an ITN (hazard ratio = 0.75, 95% confidence interval [CI] = 0.62–90). In the district-level model, higher ITN ownership was significantly associated with lower ACCM (incidence rate ratio = 0.77; 95% CI = 0.60–0.98). These findings suggest that increasing ITN ownership may have contributed to the decline in ACCM during 2006–2010 in Malawi and represent a novel use of district-level data from nationally representative surveys. |
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Declines in malaria burden and all cause child mortality following scale up of control interventions in Senegal 2005-2010
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Thwing J, Eckert E, Dione D, Tine R, Faye A, Yé Y, Ndiop M, Cisse M, Ndione JA, Diouf BM, Ba M |
2017 |
English |
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Mortality, Child Mortality, Morbidity, Malaria control, Child Health, Senegal, Malaria |
Malaria is endemic in Senegal. The national malaria control strategy focuses on achieving universal coverage for major interventions, with a goal of reaching preelimination status by 2018. Senegal began distribution of insecticide-treated nets (ITNs) and introduced artemisinin-based combination therapy in 2006, then introduced rapid diagnostic tests in 2007. We evaluated the impact of these efforts using a plausibility design based on malaria’s contribution to all-cause under-five mortality (ACCM) and considering other contextual factors which may influence ACCM.
Between 2005 and 2010, household ownership of ITNs increased from 20% to 63%, and the proportion of people sleeping under an ITN the night prior to the survey increased from 6% to 29%. Malaria parasite prevalence declined from 6% to 3% from 2008 to 2010 among children under five. Some nonmalaria indicators of child health improved, for example, increase of complete vaccination coverage from 58% to 64%; however, nutritional indicators deteriorated, with an increase in stunting from 16% to 26%. Although economic indicators improved, environmental conditions favored an increase in malaria transmission. ACCM decreased 40% between 2005 and 2010, from 121 (95% confidence interval [CI] 113–129) to 72 (95% CI 66–77) per 1,000, and declines were greater among age groups, epidemiologic zones, and wealth quintiles most at risk for malaria. After considering coverage of malaria interventions, trends in malaria morbidity, effects of contextual factors, and trends in ACCM, it is plausible that malaria control interventions contributed to a reduction in malaria mortality and to the impressive gains in child survival in Senegal. |
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Malaria control interventions protect against malaria parasitemia, severe anemia and all-cause mortality in children less than five years of age in Malawi, 2000–2010
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Hershey C, Florey LS, Ali D, Bennett A, Luhanga M, Mathanga DP, Salgado R, Nielsen CF, Troell P, Jenda G, Yé Y, Bhattarai A |
2017 |
English |
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Child Mortality, Malawi, Intervention, Malaria control, Child Health, Malaria |
Malaria control intervention coverage increased nationwide in Malawi during 2000–2010. Trends in intervention coverage were assessed against trends in malaria parasite prevalence, severe anemia (hemoglobin < 8 g/dL), and all-cause mortality in children under 5 years of age (ACCM) using nationally representative household surveys. Associations between insecticide-treated net (ITN) ownership, malaria morbidity, and ACCM were also assessed.
Household ITN ownership increased from 27.4% (95% confidence interval [CI] = 25.9–29.0) in 2004 to 56.8% (95% CI = 55.6–58.1) in 2010. Similarly intermittent preventive treatment during pregnancy coverage increased from 28.2% (95% CI = 26.7–29.8) in 2000 to 55.0% (95% CI = 53.4–56.6) in 2010. Malaria parasite prevalence decreased significantly from 60.5% (95% CI = 53.0–68.0) in 2001 to 20.4% (95% CI = 15.7–25.1) in 2009 in children aged 6–35 months. Severe anemia prevalence decreased from 20.4% (95% CI: 17.3–24.0) in 2004 to 13.1% (95% CI = 11.0–15.4) in 2010 in children aged 6–23 months. ACCM decreased 41%, from 188.6 deaths per 1,000 live births (95% CI = 179.1–198.0) during 1996–2000, to 112.1 deaths per 1,000 live births (95% CI = 105.8–118.5) during 2006–2010. When controlling for other covariates in random effects logistic regression models, household ITN ownership was protective against malaria parasitemia in children (odds ratio [OR] = 0.81, 95% CI = 0.72–0.92) and severe anemia (OR = 0.82, 95% CI = 0.72–0.94). After considering the magnitude of changes in malaria intervention coverage and nonmalaria factors, and given the contribution of malaria to all-cause mortality in malaria-endemic countries, the substantial increase in malaria control interventions likely improved child survival in Malawi during 2000–2010. |
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Implementing Impact Evaluations of Malaria Control Interventions: Process, Lessons Learned, and Best Practices
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Hershey C, Bhattarai A, Florey LS, McElroy PS, Nielsen CF, Yé Y, Eckert E, Franca-Koh A, Shargie E, Komatsu R, Smithson P, Thwing J, Mihigo J, Herrera S, Taylor C, Shah J, Mouzin E, Yoon S, Salgado R |
2017 |
English |
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Intervention, Malaria control, Impact Evaluation, Malaria |
As funding for malaria control increased considerably over the past 10 years resulting in the expanded coverage of malaria control interventions, so did the need to measure the impact of these investments on malaria morbidity and mortality. Members of the Roll Back Malaria (RBM) Partnership undertook impact evaluations of malaria control programs at a time when there was little guidance in terms of the process for conducting an impact evaluation of a national-level malaria control program. The President’s Malaria Initiative (PMI), as a member of the RBM Partnership, has provided financial and technical support for impact evaluations in 13 countries to date. On the basis of these experiences, PMI and its partners have developed a streamlined process for conducting the evaluations with a set of lessons learned and recommendations. Chief among these are: to ensure country ownership and involvement in the evaluations; to engage stakeholders throughout the process; to coordinate evaluations among interested partners to avoid duplication of efforts; to tailor the evaluation to the particular country context; to develop a standard methodology for the evaluations and a streamlined process for completion within a reasonable time; and to develop tailored dissemination products on the evaluation for a broad range of stakeholders. These key lessons learned and resulting recommendations will guide future impact evaluations of malaria control programs and other health programs. |
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Framework for Evaluating the Health Impact of the Scale-up of Malaria Control Interventions on All-cause Child Mortality in sub-Saharan Africa
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Yé Y, Eisele TP, Eckert E, Korenromp E, Shah J, Hershey CL, Ivanovich E, Newby H, Liliana Carvajal-Velez, Lynch M, Komatsu R, Cibulskis R, Moore Z, Bhattarai A |
2017 |
English |
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ITN, Malaria, Intervention, Evaluation |
Concerted efforts from national and international partners have scaled up malaria control interventions, including insecticide-treated nets, indoor residual spraying, diagnostics, prompt and effective treatment of malaria cases, and intermittent preventive treatment during pregnancy in sub-Saharan Africa (SSA). This scale-up warrants an assessment of its health impact to guide future efforts and investments; however, measuring malaria-specific mortality and the overall impact of malaria control interventions remains challenging. In 2007, Roll Back Malaria's Monitoring and Evaluation Reference Group proposed a theoretical framework for evaluating the impact of full-coverage malaria control interventions on morbidity and mortality in high-burden SSA countries. Recently, several evaluations have contributed new ideas and lessons to strengthen this plausibility design.
This paper harnesses that new evaluation experience to expand the framework, with additional features, such as stratification, to examine subgroups most likely to experience improvement if control programs are working; the use of a national platform framework; and analysis of complete birth histories from national household surveys. The refined framework has shown that, despite persisting data challenges, combining multiple sources of data, considering potential contributions from both fundamental and proximate contextual factors, and conducting subnational analyses allows identification of the plausible contributions of malaria control interventions on malaria morbidity and mortality. |
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Where is the evidence? The use of routinely-collected patient data to retain adults on antiretroviral treatment in low and middle income countries–a state of the evidence review
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do Nascimento N, Barker C, Brodsky I |
2017 |
English |
|
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Retention rates in antiretroviral treatment (ART) in low- and middle-income countries are suboptimal for meeting global "90-90-90" treatment targets. Interventions using routinely collected patient data to follow up with ART defaulters is recommended to improve retention; yet, little is documented on how these data are used in practice. This state of the evidence review summarizes how facilities and programmes use patient data to retain adults on ART in low- and middle-income countries, and what effect, if any, these interventions have on retention.
The authors searched peer-reviewed and grey literature in PubMed, POPLINE, OVID, Google Scholar, and select webpages; screened publications for relevance; and applied eligibility criteria to select articles for inclusion. Over 4,000 records were found, of which 19 were eligible. Interventions assessed within the studies were sorted into three categories: patient tracing (18), data reviews (3), and improved data capture systems (9). Nine studies demonstrated increased retention or reduced lost to follow-up; however, the quality of evidence was weak.
We recommend that future research investigates how various combinations of these interventions are being implemented and their effectiveness on ART retention across diverse country contexts, taking into account cultural, social and economic barriers and differences in countries' HIV epidemics and health information systems. |
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Siaya: Strengthening the Health Information System for Evidence-Informed Decision Making
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MEASURE Evaluation PIMA |
2017 |
English |
KENYA |
Data Demand and Use, HIS, Monitoring, Evaluation |
Good-quality healthcare depends on a strong community health information system (CHIS) to measure and evaluate critical elements of care and provide accurate data for evidence-informed decision making aimed at improving services and outcomes. In 2012, MEASURE Evaluation PIMA staff began working with partners and Siaya County stakeholders to help strengthen the CHIS through baseline assessments, capacity building, strategic mapping, action plans, and consultations. The idea was to improve data availability, quality, and use to inform decision making and improve services. These collaborations further developed the county health management team, resulting in the creation of the monitoring and evaluation (M&E) technical working group. This yielded training of trainers and health workers countywide and the development of the county’s first comprehensive M&E plan, county health profile, and county dashboard, and stronger HIV referral services, malaria surveillance, and use of data to track a range of maternal and child health indicators. Oma Diere was the first community unit to become a model Center of Excellence for mentoring others.
This fact sheet outlines efforts to strengthen the CHIS and promote data-informed decision making in Siaya County, Kenya. |
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Nakuru: Strengthening the Health Information System for Evidence-Informed Decision Making
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MEASURE Evaluation PIMA |
2017 |
English |
KENYA |
Data Demand and Use, HIS, Monitoring, Evaluation |
Good-quality healthcare depends on a strong community health information system (CHIS) to measure and evaluate critical elements of care and provide accurate data for evidence-informed decision making aimed at improving services and outcomes. In 2012, MEASURE Evaluation PIMA staff began working with partners and Nakuru County stakeholders to help strengthen the CHIS, through baseline assessments, capacity building, strategic mapping, action plans, and consultations. The idea was to improve data availability, quality, and use to inform decision making and improve services. These collaborations further developed the county health management team, resulting in the creation of the first monitoring and evaluation (M&E) technical working group among the project’s target counties. This yielded stakeholder forums; training of trainers and health workers countywide; the development of the county’s first comprehensive M&E plan and county health profile; a stronger HIV referral system; more accurate tracking of births and deaths; and a sustainable child protection information management system.
This fact sheet outlines efforts to strengthen the CHIS and promote data-informed decision making in Nakuru County, Kenya. |
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Murang'a: Strengthening the Health Information System for Evidence-Informed Decision Making
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MEASURE Evaluation PIMA |
2017 |
English |
KENYA |
Monitoring, Evaluation, HIS, Data Demand and Use |
Good-quality healthcare depends on a strong community health information system (CHIS) to measure and evaluate critical elements of care and provide accurate data for evidence-informed decision making aimed at improving services and outcomes. In 2014, MEASURE Evaluation PIMA staff began working with partners and stakeholders in Murang’a County to help strengthen the CHIS, through baseline assessments, capacity building, strategic mapping, action plans, and consultations. The idea was to improve data availability, quality, and use to inform decision making and improve services at all levels. These collaborations further developed the county health management team, resulting in the creation of a monitoring and evaluation (M&E) technical working group. This yielded stakeholder forums, training of trainers and health workers countywide, and development of a county M&E plan, county health profile, and county health bulletin. The project also supported initiatives to strengthen HIV referral services and recording of mortality statistics.
This fact sheet outlines efforts to strengthen the CHIS and promote data-informed decision making in Murang'a County, Kenya. |
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Migori: Strengthening the Health Information System for Evidence-Informed Decision Making
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MEASURE Evaluation PIMA |
2017 |
English |
KENYA |
Monitoring, Evaluation, HIS, Data Demand and Use |
Good-quality healthcare depends on a strong community health information system (CHIS) to measure and evaluate critical elements of care and provide accurate data for evidence-informed decision making aimed at improving services and outcomes. In 2013, MEASURE Evaluation PIMA staff began working with partners and Migori County stakeholders to help strengthen the CHIS, through baseline assessments, capacity building, strategic mapping, action plans, and consultations. The idea was to improve data availability, quality, and use to inform decision making and improve services. These collaborations developed the county health management team, which created a monitoring and evaluation (M&E) technical working group. This yielded training of trainers and countywide health workers, mentorship visits at county and subcounty facilities, development of county-level data dashboards, county health profiles, malaria surveillance bulletins, and an HIV services directory. This project also helped strengthen CHIS reporting tools and the recording of births, deaths, and a range of vital statistics measuring reproductive, maternal, child, and newborn health.
Migori County teams shared experiences with other counties and explored strategies for mutual learning. This fact sheet outlines efforts to strengthen the CHIS and promote data-informed decision making in Migori County, Kenya. |
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Machakos: Strengthening the Health Information System for Evidence-Informed Decision Making
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MEASURE Evaluation PIMA |
2017 |
English |
KENYA |
Data Demand and Use, HIS, Monitoring, Evaluation |
Good-quality healthcare depends on a strong community health information system (CHIS) to measure and evaluate critical elements of care and provide accurate data for evidence-informed decision making aimed at improving services and outcomes. In 2012, MEASURE Evaluation PIMA staff began working with partners and Machakos County stakeholders to help strengthen the CHIS, through baseline assessments, capacity building, strategic mapping, action plans, and consultations. The idea was to improve data availability, quality, and use to inform decision making and improve services. These collaborations further developed the county health management team, resulting in the creation of a monitoring-and-evaluation (M&E) technical working group. This yielded training of trainers and health workers countywide, the development of the county’s first comprehensive M&E plan and county health profile, and improved civil registration of vital statistics, the HIV referral system, and child protection information management. The Mutituni Community Unit was selected as a model Center of Excellence to provide guidance and mentoring for other facilities.
This fact sheet outlines efforts to strengthen the CHIS and promote data-informed decision making in Machakos County, Kenya. |
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Kisumu: Strengthening the Health Information System for Evidence-Informed Decision Making
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MEASURE Evaluation PIMA |
2017 |
English |
KENYA |
Data Demand and Use, HIS, Monitoring, Evaluation |
Good-quality healthcare depends on a strong community health information system (CHIS) to measure and evaluate critical elements of care and provide accurate data for evidence-informed decision making aimed at improving services and outcomes. In 2012, MEASURE Evaluation PIMA staff began working with partners and Kisumu County stakeholders to help strengthen the CHIS, through baseline assessments, capacity building, strategic mapping, action plans, and consultations. The idea was to improve data availability, quality, and use to inform decision making and improve services. These collaborations further developed the county health management team, resulting in the creation of a monitoring and evaluation (M&E) technical working group. This yielded training of trainers and health workers countywide, the development of the county’s first comprehensive M&E plan and county health profile, stronger malaria surveillance, HIV referral services, and tracking of a range of maternal and child health indicators.
This fact sheet outlines efforts to strengthen the CHIS and promote data-informed decision making in Kisumu County, Kenya. |
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Kilifi: Strengthening the Health Information System for Evidence-Informed Decision Making
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MEASURE Evaluation PIMA |
2017 |
English |
KENYA |
Data Demand and Use, HIS, Monitoring, Evaluation |
Good-quality healthcare depends on a strong community health information system (CHIS) to measure and evaluate critical elements of care and provide accurate data for evidence-informed decision making aimed at improving services and outcomes. In 2012, MEASURE Evaluation PIMA staff began working with partners and stakeholders in Kilifi County to help strengthen the CHIS, through baseline assessments, capacity building, strategic mapping, action plans, and consultations. The idea was to improve data availability, quality, and use to inform decision making and improve services. These collaborations further developed the county health management team, resulting in the creation of a monitoring and evaluation (M&E) technical working group. This yielded stakeholder forums and training of trainers and health workers countywide; the development of the county’s first comprehensive M&E plan and county health profile; stronger HIV referral services; and more accurate tracking of births, deaths, and a range of maternal and child health indicators. The Mwele Community Unit was selected as the county’s first model Center of Excellence to conduct mentorship visits to other facilities.
This fact sheet outlines efforts to strengthen the CHIS and promote data-informed decision making in Kilifi County, Kenya. |
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Kakamega: Strengthening the Health Information System for Evidence-Informed Decision Making
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MEASURE Evaluation PIMA |
2017 |
English |
KENYA |
Monitoring, Evaluation, Data Demand and Use, HIS |
Good-quality healthcare depends on a strong community health information system (CHIS) to measure and evaluate critical elements of care and provide accurate data for evidence-informed decision making aimed at improving services and outcomes at all levels. In 2012, MEASURE Evaluation PIMA staff began working with partners and Kakamega County stakeholders to help strengthen the CHIS, through baseline assessments, capacity building, strategic mapping, action plans, and consultations. The idea was to improve data availability, quality, and use to inform decision making and improve services. These collaborations further developed the county health management team, resulting in the creation of the monitoring and evaluation (M&E) technical working group. This yielded training of trainers and health workers countywide, the development of the county’s first comprehensive M&E plan and county health profile, and stronger HIV referral services and malaria surveillance.
Kakamega County teams shared experiences with other counties and explored strategies for mutual learning. This fact sheet outlines efforts to strengthen the CHIS and promote data-informed decision making in Kakamega County, Kenya. |
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Homa Bay: Strengthening the Health Information System for Evidence-Informed Decision Making
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MEASURE Evaluation PIMA |
2017 |
English |
KENYA |
Data Demand and Use, HIS, Monitoring, Evaluation |
Good-quality healthcare depends on a strong community health information system (CHIS) to measure and evaluate critical elements of care and provide accurate data for evidence-informed decision making for improved services and outcomes. In 2014, MEASURE Evaluation PIMA staff began working with partners and stakeholders in Homa Bay County to help strengthen the CHIS, through baseline assessments, capacity building, strategic mapping, action plans, and consultations. The idea was to improve data availability, quality, and use to inform decision making and improve services. These collaborations further developed the county health management team, resulting in the creation of a monitoring and evaluation (M&E) technical working group. This yielded training of trainers and health workers countywide, the development of the county’s first comprehensive M&E plan and county health profile, and improved data for malaria surveillance, birth and death registrations, HIV referral services, and child protection services.
Homa Bay County teams shared experiences with other counties and explored strategies for mutual learning. This fact sheet summarizes efforts in Homa Bay County, Kenya to strengthen the CHIS and promote data-informed decision making. |
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Improving Care for People in Ukraine Who Have Tuberculosis and HIV – Findings from a Qualitative Analysis of Integrated Services
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MEASURE Evaluation |
2017 |
English |
UKRAINE |
Tuberculosis, Social services, HIV, HIV care, Intervention, HIV/AIDS, Impact Evaluation, Ukraine |
In 2014, the United States Agency for International Development (USAID) mission in Ukraine asked MEASURE Evaluation to launch an impact evaluation to study two interventions conducted by the Strengthening Tuberculosis Control in Ukraine (STbCU) project to (1) provide social support services to improve tuberculosis (TB) treatment adherence; and (2) improve the integration of TB and HIV services, to reduce mortality through early diagnosis and treatment of TB- and HIV-coinfected clients. MEASURE Evaluation designed two independent but complementary studies to evaluate the impact of these STbCU program efforts: the social support study and the TB-HIV integration study. Both employed a mixed-methods approach, with a quasi-experimental quantitative evaluation design complemented by qualitative descriptive work to inform the findings. This brief summarizes the results of the qualitative research conducted for our evaluation of the TB-HIV integration program.
See the related Helping People with Tuberculosis in Ukraine Stay in Treatment – Findings from a Qualitative Analysis of a Social Support Program resource. |
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Helping People with Tuberculosis in Ukraine Stay in Treatment – Findings from a Qualitative Analysis of a Social Support Program
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MEASURE Evaluation |
2017 |
English |
UKRAINE |
Tuberculosis, HIV care, Social services, HIV/AIDS, Intervention, Ukraine, HIV, Impact Evaluation |
In 2014, the United States Agency for International Development (USAID) mission in Ukraine asked MEASURE Evaluation to launch an impact evaluation to study two interventions conducted by the Strengthening Tuberculosis Control in Ukraine (STbCU) project to (1) provide social support services to improve tuberculosis (TB) treatment adherence; and (2) improve the integration of TB and HIV services, to reduce mortality through early diagnosis and treatment of TB- and HIV-coinfected clients. MEASURE Evaluation designed two independent but complementary studies to evaluate the impact of these STbCU program efforts: the social support study and the TB-HIV integration study. Both employed a mixed-methods approach, with a quasi-experimental quantitative evaluation design complemented by qualitative descriptive work to inform the findings. This brief summarizes the results of the qualitative research conducted for our evaluation of the social support program.
See the related Improving Care for People in Ukraine Who Have Tuberculosis and HIV – Findings from a Qualitative Analysis of Integrated Services resource. |
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Bangladesh Mayer Hashi II – 2015 Baseline Survey Report
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MEASURE Evaluation |
2017 |
English |
Asia, BANGLADESH |
Bangladesh Demographic and Health Survey, postpartum family planning, Bangladesh Maternal Mortality and Health Care Survey, Family Planning, upazila health complex, BCC, behavior change communication, Bangladesh |
An external impact evaluation of the Mayer Hashi Phase II (MH-II) project was requested by the U.S. Agency for International Development (USAID)/Bangladesh. MH-II, which is a follow-on project to the previous Mayer Hashi (MH-I) project, was awarded to EngenderHealth in September 2013. It will be conducted between October 2013 and September 2017. The 2015 Baseline Mayer Hashi Phase II Evaluation Survey is the first of two surveys to evaluate the impact of MH-II in increasing the use of effective family planning (FP) and reproductive health services among the population in Bangladesh. The baseline survey has three main objectives. First, it is designed to provide baseline estimates of the primary and secondary outcomes in areas where MH-II initiated its activities at different times. Second, it aims to assess baseline differences in the outcomes among areas with different lengths of exposure to the project. Third, with an end-line survey planned in early 2017, the baseline survey is designed to support evaluation of project impact through a difference-in-differences (DID) approach comparing pre-post differences in outcomes between areas with different lengths of exposure to the project. |
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Setting New Goals for Family Planning in Kenya – Building on Decades of Progress in Contraceptive Use
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Owino B, Ochako R, Mgamb E, Sidha H, Adeke V |
2017 |
English |
Africa, KENYA, East Africa |
contraceptive prevalence rate, 2020, Kenya, total fertility rate, Reproductive Health, Contraception, Family Planning, Africa |
The Government of Kenya identifies family planning (FP) as a pillar of the improvement of the health status of women and their families, as documented in the Kenya Development Plan Vision 2030, the National Reproductive Health Policy (2007), and the Kenya Health Sector Strategic Plan (2013-2018).
This report describes the development of new goals for modern contraceptive prevalence for Kenya. It explains the rationale for revising the FP goal that Kenya set in 2012 (Kenya National Council for Population and Development, 2012), by looking at Kenya’s situation in the context of the global, historical landscape. |
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Monitoring and Evaluation Capacity Assessment Toolkit: Overview
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MEASURE Evaluation PIMA |
2017 |
English |
KENYA, Global |
HIS, Monitoring, Evaluation |
The Monitoring and Evaluation Capacity Assessment Toolkit (MECAT) is a set of tools to guide organizations through a process that assesses an organization’s current M&E capacity, identifies gaps, and indicates areas to strengthen the organization’s capacity for improving the M&E system.
MECAT is useful at the national, subnational, and programmatic levels to gain insight into numerous aspects of M&E capacity.
This document presents an overview of the MECAT tools. Version française |
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Monitoring and Evaluation Capacity Assessment Toolkit: User Guide
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MEASURE Evaluation PIMA |
2017 |
English |
KENYA, Global |
Monitoring, Evaluation, Health System, Data Demand and Use, MEASURE Evaluation PIMA |
MEASURE Evaluation, funded by the United States Agency for International Development, and its Kenya associate award, MEASURE Evaluation PIMA, have developed a process and toolkit to conduct a standard baseline assessment of M&E capacity.
The Monitoring and Evaluation Capacity Assessment Toolkit (MECAT) is a set of tools that guide organizations through a process to assess their current M&E capacity, identify gaps, and plan ways to strengthen their M&E systems.
MECAT uses four methods and supporting tools in the assessment process: (1) a group assessment, (2) an individual assessment, (3) key informant interviews, and (4) a desk review. With this approach, organizations, national health programs, and subnational health teams can accurately assess program strengths and weaknesses and plan the steps needed to strengthen the M&E functions.
This is a reference document to guide use of the MECAT. |
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Reproductive and Maternal Health Services Unit Monitoring and Evaluation Capacity: End Line Assessment Report
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MEASURE Evaluation PIMA |
2017 |
English |
|
Monitoring, Evaluation, Kenya, Routine data, Maternal Health |
MEASURE Evaluation PIMA (MEval-PIMA) is a project funded by the United States Agency for International Development that seeks to strengthen the capacity of Kenya’s Ministry of Health (MOH) and its counterparts to identify and use quality data for everyday decision making.
As part of the project closeout, MEval-PIMA conducted an end-of-project assessment to document achievements and lessons from efforts to strengthen the monitoring and evaluation (M&E) capacity of the Ministry of Health (MOH), provide data demand and use information for decision making, and communicate and share the project legacy with stakeholders and beneficiaries.
This report focuses on the assessment of the Reproductive and Maternal Health Services Unit (RMHSU). The role of the RMHSU is to coordinate the development of strategies, provide technical support for the implementation of activities aimed at achieving the national reproductive health goals, and monitor and evaluate progress and achievements. Capacity strengthening for M&E is essential to enable RMHSU to perform its M&E functions as part of sector-wide efforts to improve MOH M&E systems in Kenya.
The end line assessment was conducted in a workshop setting using three participatory methods and an individual capacity assessment. Respondents for this exercise were program managers and program officers, including RMHSU M&E officers and data managers.
This report details the process and results for the end line assessment related to the M&E capacity of the RMHSU, and it compares baseline and end line M&E capacity. It concludes with an account of lessons learned and recommendations for the RMHSU, moving forward. |
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Institutional maternal and perinatal deaths: a review of 40 low and middle income countries
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Bailey PE, Andualem W, Brun M, Freedman L, Gbangbade S, Kante M, Keyes E, Libamba E, Moran AC, el Joud DO, Singh K |
2017 |
English |
|
Child Mortality, Maternal Health, Child Health, Maternal Mortality |
Background: Understanding the magnitude and clinical causes of maternal and perinatal mortality are basic requirements for positive change. Facility-based information offers a contextualized resource for clinical and organizational quality improvement. We describe the magnitude of institutional maternal mortality, causes of death and cause-specific case fatality rates, as well as stillbirth and pre-discharge neonatal death rates.
Methods: This paper draws on secondary data from 40 low and middle income countries that conducted emergency obstetric and newborn care assessments over the last 10 years. We reviewed 6.5 million deliveries, surveyed in 15,411 facilities. Most of the data were extracted from reports and aggregated with excel.
Results: Hemorrhage and hypertensive diseases contributed to about one third of institutional maternal deaths and indirect causes contributed another third (given the overrepresentation of sub-Saharan African countries with large proportions of indirect causes). The most lethal obstetric complication, across all regions, was ruptured uterus, followed by sepsis in Latin America and the Caribbean and sub-Saharan Africa. Stillbirth rates exceeded pre-discharge neonatal death rates in nearly all countries, possibly because women and their newborns were discharged soon after birth.
Conclusions: To a large extent, facility-based findings mirror what population-based systematic reviews have also documented. As coverage of a skilled attendant at birth increases, proportionally more deaths will occur in facilities, making improvements in record-keeping and health management information systems, especially for stillbirths and early neonatal deaths, all the more critical.
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Measuring the Strength of National Social Service Systems: 33 Indicators to Help the United States Government and Others Engaged in Strengthening Social Service Systems for Orphans and Vulnerable Children See What Difference Their Investments Are Making
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MEASURE Evaluation |
2017 |
English |
Global |
PEPFAR, AIDS, Orphans and Vulnerable Children, HIV/AIDS, At-Risk Populations |
Effective national systems of economic, social, and health services directly support the achievement of the goal of controlling the HIV/AIDS epidemic, so the U.S. Government and others have made substantial investments to strengthen these systems around the world. But, because there has not been a way to capture and measure them, the results of these investments are largely unknown.
To solve this problem, MEASURE Evaluation, which is funded by the U.S. Agency for International Development (USAID) and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), has developed a set of 33 core indicators to assess the outcomes of efforts to strengthen social service systems. Applying these PEPFAR-funded indicators can help a government and its partners gain a clear picture of what’s working and what needs attention.
This fact sheet gives an overview of these core indicators for social service systems for orphans and vulnerable children. |
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Complexity-Aware Methods
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MEASURE Evaluation |
2017 |
English |
Global |
Health System, Global health, Evaluation |
Rigorous evaluations of health systems and services provide data that enable decision makers to improve programs. The question driving an evaluation can reveal if a health program or health system achieves its intended purpose and whether one approach works better than another. A typical evaluation design involves establishing intervention and control groups and randomizing subjects to the two groups, with baseline and follow-up quantitative surveys.
This and other evaluation designs carry us a long way toward answering questions about delivering effective health services. But these designs can’t answer all the important questions. Sometimes a comparable control group doesn’t exist, or randomization isn’t ethical. Sometimes there are too many variables, all affecting one another. Often, when an evaluation design won’t work, the problem is complexity—a dynamic that involves one or more of the following factors: many interacting variables; nonlinear chains of causation and unpredictability; and contextual factors such as cultural, political, structural, and environmental.
When we can’t use traditional evaluation designs and methods because of these factors, we need some other source of scientific guidance on which approach to take or which program to pursue. Methods that are “complexity-aware” enable us to address the inherent complexity in modern development programs, where environments are dynamic, multiple stakeholders intervene, and programs have many sectors of activity. This capacity statement examines ways that MEASURE Evaluation addresses complexity in designing evaluations that will yield reliable findings. |
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Baseline Assessment of Monitoring and Evaluation Capacities in 17 Counties in Kenya
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MEASURE Evaluation |
2017 |
English |
Africa, KENYA |
county health management team, HIS, Data Quality, Health Information Systems, MEASURE Evaluation PIMA, Kenya, Africa, Data Demand and Use, DDU, Monitoring, Evaluation, DQA, ICT |
The Kenya Health Policy Framework of 2012–2030 provides direction and outlines long-term goals towards the fulfilment of the 2010 Kenyan Constitution and Vision 2030, the country’s long-term development agenda. Effective implementation of the health policy strategies requires a robust monitoring and evaluation (M&E) framework to provide evidence for the achievement of the policy objectives. Currently, national and county governments are responsible for performance monitoring of the health sector. The role of counties in service delivery requires them to have adequate and effective M&E systems to assess progress towards achieving the sector’s objectives and targets.
This report is a summary of assessments that were conducted with the goal of understanding and documenting the capacities of county health management teams (CHMTs). Specifically, they assessed the CHMTs’ capacities to perform M&E functions, identify capacity gaps, and determine the most effective ways to build the county’s capacity for M&E of health interventions.
The assessment was conducted in 17 counties: Kakamega, Bungoma, Garissa, Nakuru, Machakos, Kirinyaga, Kilifi, Kisumu, Nyeri, Siaya, Wajir, Uasin Gishu, Narok, Nairobi, Meru, Mombasa and Kitui. The MEASURE Evaluation PIMA (MEval-PIMA) project, funded by the U.S. Agency for International Development (USAID), conducted the assessment between March and June 2014. |
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Availability and Quality of Emergency Obstetrical and Newborn Care Services in Kenya – Results of Three Annual Health Facility Assessments
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MEASURE Evaluation PIMA |
2017 |
English |
KENYA, East Africa, Africa |
Sustainable Development Goals, Maternal Health, Newborn health, EmONC, CEmONC, AIDS, MEASURE Evaluation PIMA, BEmONC |
Preventing maternal and newborn mortality is a national and global priority. Health facilities serve an important role in providing essential services to manage the leading causes of maternal and newborn mortality. Developed by the World Health Organization (WHO), the United Nations Population Fund (UNFPA), and the United Nations Children’s Fund (UNICEF), emergency obstetrical and newborn care (EmONC) is an integrated strategy that aims to equip health facilities with the capacity to provide evidence-based, cost-effective interventions to attend to maternal and newborn emergencies.
In 2013, the U.S. Agency for International Development (USAID) received increased funding for maternal, newborn, and child health (MNCH) programs in Kenya. Recognizing the significant burden of maternal and newborn death in Kenya and that the limited resources could not cover all aspects of MNCH, USAID sought to use the funds in a focused and effective way, by undertaking a national scale-up of EmONC services.
Beginning in 2014, three successive annual cross-sectional surveys of facilities were conducted to assess readiness to provide core EmONC signal functions and availability of essential MNCH equipment and supplies. Between 2014 and 2016, a total of 1,413 health facility assessments were conducted in 18 counties. More than half of the counties (10 out of 18) were included in all 3 assessments. The 2016 assessments included 528 health facilities (380 health centres and dispensaries and 148 hospitals). Health centres and dispensaries comprised approximately three-quarters of the total number of facilities included across the three years.
Notable improvements were observed in the availability of items required to provide EmONC. The target to attain full readiness to provide EmONC, however, is yet to be achieved in most of the focus counties. The findings of this report provide tangible insights into the scale-up counties’ needs and offer a powerful tool for advocacy and rational resource allocation. |
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Impact Evaluation of a School-Based Sexuality and HIV Prevention Education Activity in South Africa – Baseline Survey Report
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Makina N, Mandal M, Xiong K, Hattori A, Markiewicz M, Beke A, Speizer I |
2017 |
English |
Africa, SOUTH AFRICA |
HIV/AIDS, PEPFAR, scripted lesson plan, Open Data Kit, HIV, herpes simplex virus 2 (HSV-2), AIDS, South Africa, DREAMS, KwaZulu-Natal, Africa, Sexually Transmitted Infections (STIs), socioeconomic status, Adolescent health, Mpumalanga |
Gaining the knowledge and skills necessary to make healthy choices about sexual behavior as adolescent learners transition to young adulthood is key to controlling the potentially devastating effects of the HIV/AIDS epidemic.
In 2015 South Africa’s Department of Basic Education (DBE) and the Education Development Center (EDC), with support from United States Agency for International Development (USAID) through the United States President’s Emergency Plan for AIDS Relief (PEPFAR), invested in developing and piloting scripted lesson plans (SLPs) and supporting activities to increase the rigor and uniformity of the life skills program. Before rolling out the program nationally, DBE and USAID tasked MEASURE Evaluation to conduct an impact evaluation of the activity in two South African provinces.
The evaluation aims to describe the effect of the SLP on herpes simplex virus 2 (HSV-2) incidence or change in prevalence of pregnancy among a cohort of Grade-8 female learners in 2016 as they progress to Grade 10 in 2018.
This report describes the methods of the impact evaluation of the South African school-based sexuality education program and documents findings from baseline data collection undertaken between August and October 2016.
Related content:
https://www.measureevaluation.org/resources/publications/fs-17-209https://www.measureevaluation.org/resources/publications/fs-17-210 |
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Botswana's Gender-Based Violence Referral System Project: Operations Research Initial Report
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Botswana Ministry of Nationality, Immigration and Gender Affairs |
2017 |
English |
BOTSWANA |
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Botswana has one of the highest HIV prevalence rates in the world, and gender-based violence (GBV) has been identified as a significant driver of HIV.
In 2013, the Gender Affairs Department of Botswana’s Ministry of Nationality, Immigration and Gender Affairs engaged MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to collaboratively develop and pilot the Gender-Based Violence Referral System Project (GBVRSP). The goals were to increase community awareness of GBV, improve care and support to survivors, and launch a new mobile-based referral system in four pilot sites.
MEASURE Evaluation conducted operations research to improve understanding of GBVRSP’s process and results.
This report presents the findings of this research. It also offers recommendations related to community perceptions of GBV, provider perceptions and processing of GBV cases, and the GBV referral system.
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Use of Technology to Manage Health Data in Rivers State, Nigeria: A Qualitative Study on Family Planning and Routine Health Information Systems
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Clement Edet, Mina Whyte, Rosemary Ogu, Grace Obomanu, and Agiriye M. Harry |
2017 |
English |
NIGERIA |
|
In line with World Health Organization recommendations, Nigeria is moving toward a central health information system, by adopting DHIS 2 (a web-based software for electronic data management) as part of the national health information management system. To facilitate the transition from paper to electronic data management, Nigeria has invested in trainings, deploying electronic devices, and Internet subscriptions.
With support from MEASURE Evaluation (funded by the United States Agency for International Development), the Rivers State Primary Health Care Management Board carried out this qualitative study to explore the experiences and perceptions of family planning providers and health information officers in implementing technology for district health data collection. The study also aimed to identify factors that affect the sustainability of using technology for data management in Rivers State, Nigeria.
The study involved 56 family planning providers and health information officers at the state, local government, and health facility levels. Data were collected through 21 in-depth interviews and four focus group discussions, using pretested guides developed from the study objectives.
The study found that most of the barriers that respondents identified as complicating the implementation of technology for district health data collection can be addressed through investing in capacity building, providing alternate electricity supply, addressing human resource gaps, improving the data use culture among decision makers, and funding the health sector adequately. |
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Assessment of Malaria Interventions in Four Nigerian States: Final Report
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MEASURE Evaluation, National Malaria Elimination Programme, and the President’s Malaria Initiative |
2017 |
English |
NIGERIA |
Evaluation, Malaria, Nigeria |
In 2014, Nigeria reported more than 7.8 million confirmed cases of malaria and more than 6,000 malaria-related deaths. The National Malaria Elimination Programme of the Federal Ministry of Health—in collaboration with partners—has been working to significantly expand key malaria control interventions.
Nigeria became a President’s Malaria Initiative (PMI) country in 2010, and PMI has been a key partner in the government’s efforts to expand malaria control intervention coverage. Efforts have focused on insecticide-treated nets, targeted indoor residual spraying, intermittent preventive treatment in pregnancy, and effective case management.
In 2015, PMI requested MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID) and PMI—to assess the progress of malaria interventions and outcomes in Cross River, Ebonyi, Nassarawa, and Sokoto States between 2008 and early 2016. The main aim of the assessment is to provide information to guide and streamline future PMI support and strategies for malaria control and elimination in Nigeria.
The malaria intervention assessment used a mixed-methods approach, consisting of secondary data collation, primary data collection, document review, and secondary analysis of existing household survey data.
This report provides recommendations for each examined component area based on the assessment's key findings. |
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Research gaps in routine health information system design barriers to data quality and use in low‐ and middle‐income countries: A literature review
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Kumar M, Gotz D, Nutley T, Smith JB |
2017 |
English |
|
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Despite the potential impact of health information system (HIS) design barriers on health data quality and use and, ultimately, health outcomes in low- and middle-income countries (LMICs), no comprehensive literature review has been conducted to study them in this context. We therefore conducted a formal literature review to understand system design barriers to data quality and use in LMICs and to identify any major research gaps related understanding how system design affects data use. We conducted an electronic search across four scientific databases-PubMed, Web of Science, Embase, and Global Health-and consulted a data use expert. Following a systematic inclusion and exclusion process, 316 publications (316 abstracts and 18 full papers) were included in the review.
We found a paucity of scientific publications that explicitly describe system design factors that hamper data quality or data use for decision making. Although user involvement, work flow, human-computer interactions, and user experience are critical aspects of system design, our findings suggest that these issues are not discussed or conceptualized in the literature. Findings also showed that individual training efforts focus primarily on imparting data analysis skills. The adverse impact of HIS design barriers on data integrity and health system performance may be even bigger in LMICs than elsewhere, leading to errors in population health management and clinical care. We argue for integrating systems thinking into HIS strengthening efforts to reduce the HIS design-user reality gap. |
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Integrating Nutrition in Value Chains in Malawi: Using Most Significant Change Stories to Understand Community Experiences
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Valerie Flax, Agatha Bula, Ryan Seguin, and Gustavo Angeles |
2017 |
English |
MALAWI |
Health, Malawi, Public Health, Nutrition |
Feed the Future is a United States Government initiative that aims to reduce hunger and poverty by accelerating growth in the agricultural sector, improving food security, addressing the root causes of undernutrition, and reducing gender inequality. Integrating Nutrition in Value Chains was the flagship Feed the Future Malawi activity from 2012 to 2016. In agriculture, a value chain program may increase value by improving input supply, cultivation, transportation, storage, or marketing of farm products. Integrating Nutrition in Value Chains targeted groundnut and soybean value chains through farmers’ clubs and worked through community care groups—groups of women who meet to discuss health and provide peer support—to provide nutrition education to pregnant women and women with children younger than five years of age.
The University of North Carolina at Chapel Hill and the Centre for Public Health Research and Development trained 26 volunteer nutrition promoters in Mchinji and Lilongwe Districts to use the most significant change technique to obtain information from participants about their experiences with the program from June 2015–June 2016. Two hundred seventy-seven stories were analyzed using qualitative content analysis methods.
This analysis, supported by the USAID-funded MEASURE Evaluation project found that the care group model for nutrition and health promotion was successful and should be continued or expanded. This report makes a series of recommendations for improving the Feed the Future program in Malawi, based on most significant change stories and input from nutrition promoters. |
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Linking HIV Testing and Counselling in Kenya: Standard Operating Procedures
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MEASURE Evaluation |
2017 |
English |
KENYA |
|
Between 2007 and 2013, new HIV infections in adults in Kenya have decreased by only 7.5 percent. How to significantly reduce new infections and promptly identify those who are HIV-positive and link them to HIV services is a major concern. Targeted HIV testing and counselling strategies have increased the detection rate of people with HIV, and those who test positive for the virus must have effective linkages from testing points to available care, with vigorous follow-up to ensure enrollment and retention in services.
MEASURE Evaluation PIMA conducted a baseline survey with the objective of mapping referral and linkage practices to identify the challenges associated with and barriers to effective systems in 18 health facilities across eight counties. Data for the study drew primarily from desk studies of literature and reports. Quantitative data came from primary sources through a data extraction form, and qualitative data were collected through focus group discussions and key informant interviews using an interview guide.
In this report we suggest a series of recommendations to improve linkage practices in Kenya, based on our findings. |
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Developing Measures of Reproductive Empowerment – A Qualitative Study in Zambia
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Paul M, Mejia C, Muyunda B, Munthali L |
2017 |
English |
Africa, ZAMBIA, Southern Africa |
Reproductive Empowerment, Zambia, Sub-Saharan Africa, reproductive empowerment, reproductive health, Africa, Women, Gender Norms |
Women’s empowerment has been a major focus of development work for decades. The lack of women’s empowerment in social, political, and economic contexts is linked to poor health outcomes. However, the relationship between women’s lack of empowerment and their sexual and reproductive health is unclear. Researchers have recently begun to look at reproduction as a distinct aspect of women’s empowerment, known as reproductive empowerment (RE).
MEASURE Evaluation—funded by the United States Agency for International Development (USAID)—undertook research to develop measures of RE to improve evaluations of interventions aimed at increasing RE. Our research is part of a three-phased activity to conceptualize and develop better measurement tools to accurately assess RE. During the first phase of this project, together with the International Center for Research on Women (ICRW), we created a conceptual framework based on definitions of empowerment and the socioecological model (Sallis, Owen, & Fisher, 2015). Through this framework, we defined RE as the outcome of a transformative process of change whereby individuals expand their capacity to make informed decisions about their reproductive lives, amplify their ability to participate meaningfully in public and private discussions related to reproduction, and act on their preferences and choices to achieve desired reproductive outcomes, free of violence, retribution, or fear. We emphasize that RE is a dynamic process in which women and their partners have resources that impact their agency at three levels: (1) individually, (2) within their relationships and community (the immediate relational level), and (3) with the broader environment (distant relational level).
We also conducted a literature review to see how RE has been measured. From this, we extracted a series of validated scales used to measure aspects of RE. Most scales either measured empowerment in areas not directly related to reproduction or were based on formative research in Southeast Asia; all had limited applicability to sub-Saharan African settings.
To understand the relationship between empowerment and reproductive health outcomes better, our team identified the need for new measures of RE based on the realities of women in sub-Saharan Africa. As the first step, we conducted qualitative research with women and men in Zambia to explore RE.
Access the reproductive empowerment scale and related reports sharing work from Nigeria and findings from a study in Kenya. |
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Integrating Family Planning Data in Kenya's DHIS 2
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Aaga Mitoko, Fredrick Okango, Liza Onyango-Abuje, Paschaliah Obango, Linah Oule, and Domnick Abungu |
2017 |
English |
KENYA |
|
Kenya’s health information system (HIS) for family planning (FP) is fragmented, preventing the integration of data from multiple sources in meaningful information products. This fragmentation limits the accessibility of data for decision making. Although FP is the second most-funded health program in Kenya in terms of money spent on commodities (primarily short-term contraceptive methods), FP funding is not equitably distributed to other components of the health system, such as human resources, infrastructure, and HIS resources and training (including DHIS 2, a web-based health management information system used to monitor health indicators at the county and national levels). With support from MEASURE Evaluation (funded by the United States Agency for International Development), this study investigated integration of FP data in DHIS 2, the factors related to lack of integration, and ways to remedy the lack of integration. Finally, this report presents several recommendations for integrating FP data in Kenya's DHIS 2. |
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Measuring Family Planning Service Delivery: An Assessment of Selected Indicators across Implementing Partners
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Janine Barden-O'Fallon and Zahra Reynolds |
2017 |
English |
Global |
Family Planning, Monitoring, Evaluation, Indicators |
Family planning (FP) service delivery is a key component of the global health program of the U.S. Agency for International Development (USAID), and there is a long tradition of measuring FP service delivery activities and outcomes through indicators that are internationally standardized and program-specific. Although it is essential for understanding the content, quantity, and quality of services being provided with U.S. government assistance, the monitoring and evaluation of FP service delivery faces many challenges. USAID technical advisors asked USAID-funded MEASURE Evaluation to assess a set of 16 indicators and five indicator areas that may be used to measure service delivery activities by USAID’s implementing partners (IPs). Information and feedback on the use of the selected indicators were collected from eight service delivery IPs and seven technical resources. The information was assessed for common trends and reported challenges. Indicator guidance for FP service delivery projects was then developed and applied to the selected indicators.
This assessment provides a summary and analysis of IP feedback and indicator-specific recommendations. It also offers recommendations and guidance for each of the selected indicators and indicator areas, based on whether a project will be using the information for monitoring or process evaluation only or will also be conducting an outcome or impact evaluation.
This report also provides specific criteria to guide USAID and IPs in the selection of FP service delivery indicators, and it can be used to inform USAID service delivery measurement among IPs. |
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HIV-Related Data on Very Young Adolescents
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MEASURE Evaluation |
2017 |
English |
Global, UNITED STATES, Africa |
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Very young adolescents (VYAs)—those between the ages of 10 and 14—represent about half of the 1.2 billion adolescents ages 10–19 in the world. A technical working group that the World Health Organization (WHO) convened in 2010 observed that, although adolescents ages 15–19 have been the main population segment addressed by adolescent health and development programs, the “special needs and concerns of young adolescents ages 10–14—some of whom are already sexually active—have been relatively neglected.” This neglect is, to some extent, a result of a lack of global HIV-related data for VYAs.
The Inter-Agency Task Team on Young People and HIV/AIDS (IATT/YP) strategic information (SI) working group, co-convened by UNICEF and UNFPA and made up of a core group of international and national agencies, including the U.S. Agency for International Development and MEASURE Evaluation, seeks to accelerate the global response to HIV prevention for young people ages 10–24 by improving the availability and accessibility of high-quality data related to youth HIV. Capitalizing on the 2010 WHO meeting, the IATT/YP SI working group met in June 2014 to discuss categories of HIV-related information that can and should be collected for VYAs. This brief focuses on available HIV-related data for VYAs. |
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Core Competencies for Postgraduate Evaluation Courses: Report of the GEMNet-Health Task Group
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MEASURE Evaluation |
2017 |
English |
|
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The Global Evaluation and Monitoring Network for Health (GEMNet-Health) is a global network of public health institutions whose purpose is to foster organizational growth, collaboration, and mutual support for monitoring and evaluation (M&E) of health programs through linkages among members. As countries seek to improve their M&E capacities, they need specific training in evaluation at the postgraduate level. The GEMNet-Health Steering Committee convened a time-limited technical task group to address this need. This Task Group on Core Competencies for Postgraduate Evaluation Courses sought to develop core competencies for a 60-hour master’s-level overview course in evaluation. The aim of the task group was to identify a set of essential competencies and corresponding core elements of curricula for postgraduate evaluation courses, which would help GEMNet-Health member institutions develop a consistent and coordinated approach to evaluation training.
This report presents background on the task group’s approach, including the reasons for following a competency-based approach to evaluation training. Then, building on a review of competencies from postgraduate-level evaluation courses at several dozen universities, the report identifies core evaluation competencies organized by skill level and topic. It concludes with recommendations for core and optional competencies for an overview evaluation course at the master’s level. |
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Effective Linkages from Point of HIV Testing to Care and Treatment in Tanga Region, Tanzania
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David Elias Kayabu, James Samwel Ngocho, Blandina Theophil Mmbaga |
2017 |
Telugu |
TANZANIA |
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HIV testing and counselling services in Tanzania have expanded rapidly to ensure that people living with HIV (PLHIV) receive antiretroviral therapy (ART) and that ART is initiated at the right time. Clients who present late for HIV care and treatment may miss out on timely initiation of prophylaxis and ART, which may accelerate disease progression and lead to an increased rate of HIV transmission within the community. Linkage to care and treatment is an important part of efforts to accelerate HIV prevention, treatment, care, and support, because It offers an opportunity for PLHIV to receive information and services in a timely manner. The objective of this study was to determine the factors influencing effective linkages of newly diagnosed PLHIV from the point of testing to entry in care and treatment centres (CTCs) in Tanga Region, Tanzania.
This cross-sectional study examined five clinics with a high volume of clients in each of the three districts in Tanga Region. Interviews with the sampled CTC clients obtained quantitative data while focus group discussions with healthcare providers and in-depth interviews with CTC clients yielded qualitative information. The outcome of interest was whether a client enrolled in a CTC within three months of his or her first positive HIV test. |
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Bridging the gaps in Mali’s disease surveillance system
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MEASURE Evaluation |
2017 |
English |
MALI |
Disease, Health information systems, Surveillance, RHIS, Ebola, Routine Health Information Systems, Malaria, Data Quality, Mali |
The outbreak of Ebola Virus Disease (EVD) in West Africa in 2014 exposed the weaknesses of disease surveillance systems in resource-limited countries and highlighted the need for better coordination of disease surveillance at the global level. Unprepared to respond to the EVD epidemic, Guinea, Liberia and Sierra Leone were the most affected countries, with over 11,000 lives lost. The epidemic eventually spread to Mali, a neighboring country to Guinea, and resulted in eight cases and an additional six deaths. A number of factors—including poor coordination, insufficient human resources, limited access to information technology, and inadequate data tools—continue to challenge the disease surveillance system in Mali. These result in poor data quality and timeliness for informed decision making in health.
This resource focuses on how MEASURE Evaluation has been supporting the national malaria control program (NMCP) and the Direction National de la Santé (DNS) in strengthening routine health information systems. |
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Validating Estimates of the Size of Key Populations: A Study in Region 4 of Guyana
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Zahra Reynolds, Nastassia Rambarran, and Joel Simpson |
2017 |
English |
GUYANA |
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HIV is a major cause of death in Guyana. Cases are concentrated in the coastal regions, and certain subpopulations face much higher rates of HIV. Before effective interventions for these key populations can be designed, researchers must understand where they are and how to reach them. Previous partnerships between MEASURE Evaluation (funded by the U.S. Agency for International Development [USAID]) and Guyana's National AIDS Programme Secretariat (NAPS), in 2014 and 2015, studied populations of special interest in the HIV epidemic using the Priorities for Local AIDS Control Efforts (PLACE) method. These earlier studies produced analyses of subgroup risk factors and locations that were used to set targets for outreach and testing among key populations.
Because the PLACE study was not designed to produce subnational size estimates, this report outlines a validation study conducted to update those earlier estimates. The study focus on Region 4 of Guyana, an area with a high density of key populations and need for outreach activities. The assessment, completed in the spring of 2017, was managed by the Society Against Sexual Orientation Discrimination (SASOD) with technical oversight from MEASURE Evaluation. Input was also received from national partners, such as the National AIDS Programme Secretariat.
The knowledge generated by this assessment will inform HIV outreach and prevention activities with key populations, primarily in Region 4. It will help outreach organizations better target their activities and determine whether they are reaching those who need services most. |
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East Africa Cross-Border Integrated Health Report
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MEASURE Evaluation |
2017 |
English |
UGANDA, KENYA, RWANDA, TANZANIA |
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This report presents the results of a cross-sectional study describing the health status and behaviors of mobile and vulnerable populations living in or traveling through 12 cross-border sites in the East African countries of Kenya, Rwanda, Tanzania, and Uganda. Findings will be used to better focus interventions to increase survival, improve quality of life, and reduce HIV transmission at cross-border sites.
The study employed a mixed-methods approach combining quantitative and qualitative research techniques. Health and service delivery outcomes were measured at 12 cross-border sites through two data collection components: the Priorities for Local AIDS Control Efforts (PLACE) method and a health facility survey consisting of a quantitative survey focused on services provided, a qualitative interview exploring experiences of healthcare workers based at facilities located in cross-border sites, and abstraction of clinical data to measure specific health indicators. Through qualitative interviews, the study team constructed a cohort of people first enrolled in HIV care and treatment at cross-border sites and interviewed a larger group of participants sampled from public places about their health behaviors and access to health services.
This study resulted in 12 key findings or recommendations concerning cross-border sites in East Africa, including lessons for future studies. |
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How Do Masters of Public Health Programs Teach Monitoring and Evaluation?
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Negandhi H, Negandhi P, Zodpey SP, Kulatilaka H, Dayal R, Hart LJ, Grewe M |
2017 |
English |
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Public Health, Monitoring, Evaluation, Training |
Introduction: The health systems in developing countries face challenges because of deficient monitoring and evaluation (M&E) capacity with respect to their knowledge, skills, and practices. Strengthening M&E training in public health education can help overcome the gaps in M&E capacity. There is a need to advance the teaching of M&E as a core element of public health education.
Objectives: To review M&E teaching across Masters of Public Health programs and to identify core competencies for M&E teaching in South Asian context.
Materials and methods: We undertook two activities to understand the M&E teaching across masters level programs: (1) desk review of M&E curriculum and teaching in masters programs globally and (2) review of M&E teaching across 10 institutions representing 4 South Asian countries. Subsequently, we used the findings of these two activities as inputs to identify core competencies for an M&E module through a consultative meeting with the 10 South Asian universities.
Results: Masters programs are being offered globally in 321 universities of which 88 offered a Masters in Public Health, and M&E was taught in 95 universities. M&E was taught as a part of another module in 49 institutions. The most common duration of M&E teaching was 4–5 weeks. From the 70 institutes where information on electives was available, M&E was a core module/part of a core module at 42 universities and an elective at 28 universities. The consultative meeting identified 10 core competencies and draft learning objectives for M&E teaching in masters programs in South Asia.
Conclusion: The desk review showed similarities in M&E course content but variations in course structure and delivery. The core competencies identified during the consultation included basic M&E concepts. The results of the review and the core competencies identified at the consultation are useful resources for institutions interested in refining/updating M&E curricula in their postgraduate degree programs. Our approach for curriculum development as well as the consensus building experience could also be adapted for use in other situations. |
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Availability of family planning services and quality of counseling by faith-based organizations: a three country comparative analysis
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Barden-O'Fallon J |
2017 |
English |
|
Faith-based organizations, Public Health, Women, Family Planning, Fertility, Families, and Children |
BackgroundFaith-based organizations (FBOs) have a long history of providing health services in developing countries and are important contributors to healthcare systems. Support for the wellbeing of women, children, and families is evidenced through active participation in the field of family planning (FP). However, there is little quantitative evidence on the availability or quality of FP services by FBOs.
MethodsThe descriptive analysis uses facility-level data collected through recent Service Provision Assessments in Malawi (2013–14), Kenya (2010), and Haiti (2012) to examine 11 indicators of FP service and method availability and nine indicators of comprehensive and quality counseling. The indicators include measures of FP service provision, method mix, method stock, the provision of accurate information, and the discussion of reproductive intentions, client’s questions/concerns, prevention of sexually transmitted infections, and return visits, among others. Pearson’s Chi-square test is used to assess the selected indicators by managing authority (FBO, public, and other private sector) to determine statistical equivalence.
ResultsResults show that FBOs are less likely to offer FP services than other managing authorities (p < 0.05). For example, 69% of FBOs in Kenya offer FP services compared to 97% of public facilities and 83% of other private facilities. Offering long-acting or permanent methods in faith-based facilities is especially low (43% in Malawi, 29% in Kenya and 39% in Haiti). There were few statistically significant differences between the managing authorities in comprehensive and quality counseling indicators. Interestingly, Haitian FBOs often perform as well or better than public sector health facilities on counseling indicators, such as discussion of a return visit (79% of FBO providers vs. 68% of public sector providers) and discussion of client concerns/questions (52% vs. 49%, respectively).
ConclusionsResults from this analysis indicate that there is room for improvement in the availability of FP services by FBOs in these countries. Quality of counseling should be improved by all managing authorities in the three countries, as indicated by low overall coverage for practices such as ensuring confidentiality (22% in Malawi, 47% in Kenya and 12% in Haiti), discussion of sexually transmitted infections (18%, 25%, 17%, respectively), and providing services to youth (53%, 27%, 32%, respectively).
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Household Microbial Water Quality Testing in a Peruvian Demographic and Health Survey: Evaluation of the Compartment Bag Test for Escherichia coli
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Wang A, McMahan L, Rutstein S, Stauber C, Reyes J, Sobsey MD |
2017 |
English |
PERU |
Water, Compartment Bag Test |
The Joint Monitoring Program relies on household surveys to classify access to improved water sources instead of measuring microbiological quality. The aim of this research was to pilot a novel test for Escherichia coli quantification of household drinking water in the 2011 Demographic and Health Survey (DHS) in Peru. In the Compartment Bag Test (CBT), a 100-mL water sample is supplemented with chromogenic medium to support the growth of E. coli, poured into a bag with compartments, and incubated. A color change indicates E. coli growth, and the concentration of E. coli/100 mL is estimated as a most probable number. Triplicate water samples from 704 households were collected; one sample was analyzed in the field using the CBT, another replicate sample using the CBT was analyzed by reference laboratories, and one sample using membrane filtration (MF) was analyzed by reference laboratories. There were no statistically significant differences in E. coliconcentrations between the field and laboratory CBT results, or when compared with MF results.
These results suggest that the CBT for E. coli is an effective method to quantify fecal bacteria in household drinking water. The CBT can be incorporated into DHS and other national household surveys as a direct measure of drinking water safety based on microbial quality to better document access to safe drinking water. |
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Achieving sustainability in health information systems: a field tested measure of country ownership
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Watson-Grant S, Xiong K, Thomas JC |
2017 |
English |
|
Health Information Systems, Monitoring, Evaluation, HIS, Sustainability |
BackgroundA country will trust, value, and use, its health information system (HIS) to the extent it has had a role in its creation and maintenance. A sense of ownership contributes in turn to the long-term sustainability of the HIS, and thus the country’s ability to monitor and evaluate population health and health services. To facilitate progress toward greater ownership, we developed and tested a tool to measure the country’s ownership of its monitoring and evaluation (M&E) system.
MethodsThrough a systematic review of the literature, we identified four dimensions of country ownership of an M&E system: partnership, commitment and responsibility, capacity, and accountability. We identified relevant indicators of the dimensions already in use in other tools used to assess M&E systems. We tested the data collection tool with 95 stakeholders of the Tanzanian HIS for HIV/AIDS control.
ResultsWe identified 56 items that addressed elements of the four dimensions. The respondents found our tool for assessing country ownership of an HIS to be clear and relevant, leading to the identification of important issues to be discussed. For example, all stakeholder groups affirmed that the Tanzanian Commission for AIDS is “playing a leadership role in addressing HIV through collaborative partnerships and work across borders to achieve greater impact.” While many respondents disagreed with the statement, “There is an adequate number of government monitoring and evaluation posts at the sub-national level.”
ConclusionsStakeholders found the M&E country ownership tool to address relevant questions clearly. It enabled them to identify successes and challenges within four dimensions of country ownership. It thus holds the potential to lead to an agenda for strengthening country ownership. If implemented every few years, the tool can provide a means of monitoring progress through a set of standardized indicators. As country ownership of M&E increases, so will the long-term sustainability of the HIS.
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Factors Affecting Sex- and Age-Disaggregated Data in Health Information Systems – Lessons from the Field
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MEASURE Evaluation |
2017 |
English |
Africa, KENYA, TANZANIA, ZAMBIA |
Zambia, Gender, Health Information Systems, Data, Kenya, Tanzania, Age-Disaggregated Data, Sex-Disaggregated Data |
Gender is a central component of health equity and must be examined and addressed explicitly in health information systems (HIS) through sex and age-disaggregated data, at a minimum, and ideally, through gender-sensitive data, as well. The data that HIS produce can perpetuate inequalities or promote health equity. When sex and age are not acknowledged and addressed in HIS, gender norms and inequalities that influence health and health-seeking behaviors remain invisible. Disaggregated data allow program managers and decision makers to examine service-delivery, treatment, and health-outcome data in depth, so that they can detect differences between the sexes, age groups, and key populations.
MEASURE Evaluation—funded by USAID and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—has compiled evidence from desk reviews and key informant (KI) interviews in Kenya, Tanzania, and Zambia to illustrate trends and challenges in the collection and use of sex- and age- disaggregated HIS data and provides recommendations to move the field of global health forward. |
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Feasibility of Integrating Social Service and Community Health Data in DHIS 2
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Dawne Walker |
2017 |
English |
BANGLADESH, GHANA, KENYA, LIBERIA, MALI, NIGERIA, SENEGAL, SIERRA LEONE, SOUTH AFRICA, SOUTH SUDAN, SWAZILAND, MALAWI, MOZAMBIQUE, NAMIBIA, NORWAY, UNITED STATES |
HIS, Health information systems, Health data, DHIS 2 |
Governments require information about the health and social service needs of their populations to enable effective policymaking and resource allocation. Most governments have health information systems to track critical health indicators, and these data are often captured in the district health information system software known as DHIS 2. However, these systems are not often linked to the data systems used by social and community services, where people often access care. As a result, the systems are fragmented and unable to provide holistic information for decision making on health and social services.
Could DHIS 2 offer the answer? Here we present what we learned from a literature review and key informant interviews about using DHIS 2 as a platform for managing nonhealth social service and community health data, experiences integrating these data streams in the DHIS 1 and 2 platforms, recommendations for implementation, and whether the systems should be integrated or merely made interoperable. We present a list of prerequisites for an integrated community healthy and social service data system to collect reliable data for decision making. |
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Women's television watching and reproductive health behavior in Bangladesh
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Rahman M, Curtis SL, Chakraborty N, Jamil K |
2017 |
English |
BANGLADESH |
Women, Reproductive Health, Bangladesh |
Bangladesh has made significant social, economic, and health progress in recent decades, yet many reproductive health indicators remain weak. Access to television (TV) is increasing rapidly and provides a potential mechanism for influencing health behavior. We present a conceptual framework for the influence of different types of TV exposure on individual’s aspirations and health behavior through the mechanisms of observational learning and ideational change. We analyze data from two large national surveys conducted in 2010 and 2011 to examine the association between women’s TV watching and five reproductive health behaviors controlling for the effects of observed confounders. We find that TV watchers are significantly more likely to desire fewer children, are more likely to use contraceptives, and are less likely to have a birth in the two years before the survey. They are more likely to seek at least four antenatal care visits and to utilize a skilled birth attendant. Consequently, continued increase in the reach of TV and associated growth in TV viewing is potentially an important driver of health behaviors in the country. |
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Improving Data Quality in Mobile Community-Based Health Information Systems – Guidelines for Design and Implementation
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MEASURE Evaluation |
2017 |
English |
Global |
MHealth, Mobile technology, community-based, Data Quality |
National programs and donor-funded projects increasingly rely on decentralized models of care to expand coverage of health services, ensure linkages to health facilities, and reach the most vulnerable populations. New emphasis has been placed on community-based models in which frontline health workers are expected to provide services and collect and report data. For example, the global “90-90-90” targets recognize that achieving equity in HIV prevention and care will require an emphasis on community-based approaches and systems.
Community-level data can be helpful to health officials as they target programs and make decisions about care and services at lower levels of the health system. The United States President’s Emergency Plan for AIDS Relief (PEPFAR) has embarked on a strategy to deliver the right types of interventions, in the right places, at the right time. This will require accurate, reliable, and timely data at district and subdistrict levels to provide an in-depth picture of community health so that programs can focus on populations most at need (PEPFAR, 2014).
Increasingly, community-based health programs collect data that flow into donor programs and national health information system(s) (HIS). Programs are turning to mobile health (mHealth) technology to address a variety of challenges. The mHealth tools provide solutions to challenges associated with paper-based reporting systems, such as inefficient filing systems and operational challenges including storage space associated with transporting paper forms and receiving data in a timely manner. Mobile technologies can help programs improve the completeness and accuracy of data, tap the potential for real-time reporting, and strengthen communication and supervisory feedback practices. |
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Gender and Participation in Option B+ Programs to Prevent Mother-to-Child Transmission of HIV in Malawi and Uganda
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MEASURE Evaluation |
2017 |
English |
Africa, MALAWI, UGANDA |
HIV, AIDS, Gender, ART, Maternal health, PMTCT, Africa, HIV/AIDS, Uganda, Option B+, Pregnancy, Malawi, Women, Gender Norms |
In Malawi and Uganda, women’s roles center on marriage and motherhood, household duties, and caring for family members and the sick. Women are supposed to consult their husbands and accept their decisions about household and health-related issues. Men’s roles are to lead and represent the family and to earn income for household expenses. These gender roles may constrain women’s access to health services, including participation in programs to prevent (Malawi) or eliminate (Uganda) mother-to-child transmission of HIV.
Countries worldwide are working to achieve the goal of having 90 percent of people diagnosed with HIV on sustained antiretroviral therapy (ART) by 2020. Maintaining 90 percent of HIV-positive women initiated on lifelong ART under the Option B+ PMTCT program has been challenging.
Other studies have documented barriers to PMTCT, but few of these were conducted under Option B+, and they did not specifically consider how gender influences PMTCT program participation. This study fills the gap, by examining the interplay of gender and individual, interpersonal, health system, and community factors related to participation in PMTCT programs. |
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Barriers to and Facilitators of Sex- and Age-Disaggregated Data – Zambia
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MEASURE Evaluation |
2017 |
English |
ZAMBIA, Africa |
Zambia, HIV/AIDS, HIV, AIDS, HIS, Gender, Africa |
Decades of research demonstrate that gender inequality is associated with increased risk of HIV, maternal mortality, child stunting and wasting, poor nutrition, and other negative health outcomes. Data produced by health information systems (HIS) can be disaggregated by gender and age to advance understanding of factors associated with these health outcomes. Such data must be available for analysis and decision making to enhance health outcomes and address inequities across gender and age groups. This report summarizes our study exploring factors that contribute to the collection and use of sex- and age-disaggregated data in Zambia and presents our recommendations for improvements. |
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“If my husband leaves me, I will go home and suffer, so better cling to him and hide this thing”: The influence of gender on Option B+ prevention of mother-to-child transmission participation in Malawi and Uganda
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Flax VL, Yourkavitch J, Okello ES, Kadzandira J, Katahoire AR, Munthali AC |
2017 |
English |
MALAWI, Africa, UGANDA |
AIDS, Pregnancy, ART, Newborn health, Uganda, PMTCT, Gender, Women, Gender Norms, Africa, Malawi, Maternal Health, HIV, Option B+, HIV/AIDS |
The role of gender in prevention of mother-to-child transmission (PMTCT) participation under Option B+ has not been adequately studied, but it is critical for reducing losses to follow-up. This study used qualitative methods to examine the interplay of gender and individual, interpersonal, health system, and community factors that contribute to PMTCT participation in Malawi and Uganda. We conducted in-depth interviews with women in PMTCT, women lost to follow-up, government health workers, and stakeholders at organizations supporting PMTCT as well as focus group discussions with men. We analyzed the data using thematic content analysis. We found many similarities in key themes across respondent groups and between the two countries. The main facilitators of PMTCT participation were knowledge of the health benefits of ART, social support, and self-efficacy. The main barriers were fear of HIV disclosure and stigma and lack of social support, male involvement, self-efficacy, and agency. Under Option B+, women learn about their HIV status and start lifelong ART on the same day, before they have a chance to talk to their husbands or families. Respondents explained that very few husbands accompanied their wives to the clinic, because they felt it was a female space and were worried that others would think their wives were controlling them. Many respondents said women fear disclosing, because they fear HIV stigma as well as the risk of divorce and loss of economic support. If women do not disclose, it is difficult for them to participate in PMTCT in secret. If they do disclose, they must abide by their husbands’ decisions about their PMTCT participation, and some husbands are unsupportive or actively discouraging. To improve PMTCT participation, Ministries of Health should use evidence-based strategies to address HIV stigma, challenges related to disclosure, insufficient social support and male involvement, and underlying gender inequality.
This journal article was originally published in PLoS ONE 12(6): e0178298, and appears on the MEASURE Evaluation website under the terms of the Creative Commons Attribution License. |
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Gender Factors Influencing Participation in the Prevention of Mother-to-Child Transmission of HIV Program in Malawi under Option B+
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Flax VL, Yourkavitch J, Kadzandira J, Munthali AC |
2017 |
English |
MALAWI, Africa |
Women, Gender Norms, ART, Malawi, HIV, Option B+, Newborn health, PMTCT, AIDS, Africa, Pregnancy, HIV/AIDS, Maternal health, Gender |
In Malawi and other sub-Saharan African countries, women’s traditional gender roles center on marriage and motherhood, caring for family members and the sick, and household duties. Women are expected to consult with their husbands and obey their husbands’ decisions. Men’s traditional roles are to be the head of the family; bring in income to pay for shelter, food, and school fees; and represent the family. In contrast to women, who are expected to be faithful and monogamous, men are expected to have more than one wife or girlfriend, as a sign of their masculinity. These traditional gender roles have been noted as challenges to HIV prevention efforts. They may also constrain women’s access to health services, including their participation in the prevention of mother-to-child transmission (PMTCT) program.
Globally, all countries are working toward achieving the goal of having 90 percent of people who are diagnosed with HIV on sustained antiretroviral therapy (ART). This has been difficult to achieve in PMTCT programs in sub-Saharan African countries, owing to weak health care systems and a variety of individual, interpersonal, and cultural factors. A number of studies have examined barriers to PMTCT participation. Common constraints are fear of HIV stigma, fear of divorce or abandonment upon HIV disclosure, ART side effects, lack of funds for transport to the clinic, negative interactions with health workers, and lack of male involvement. Most studies of barriers were conducted prior to the implementation of Option B+, which initiates lifelong ART for HIV-positive pregnant or breastfeeding women. This study fills an important gap in knowledge about Option B+ programs, by examining how gender interplays with individual, interpersonal, health system, and community factors that contribute to the discontinuation of PMTCT participation. |
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Gender Factors Influencing Participation in the Elimination of Mother-to-Child Transmission of HIV Program in Uganda under Option B+
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Yourkavitch J, Flax VL, Okello ES, Katahoire AR |
2017 |
English |
Africa, UGANDA |
Africa, Gender, Newborn health, Uganda, Maternal Health, ART, AIDS, Option B+, PMTCT, HIV/AIDS, HIV |
In Uganda and other sub-Saharan African countries, women’s gender roles center on marriage and motherhood. According to these roles, women’s duties include caring for other members of the household, tending to household chores, and caring for the sick. Women are expected to consult with their husbands and obey their husbands’ decisions in all matters. A man’s primary role is to be the head of the family. Men are expected to bring in income to pay for shelter, food, and school, and they are expected to represent the family. Unlike women, who are expected to be faithful or monogamous, men are expected to have multiple partners (wives or girlfriends), thus signaling their masculinity. As other investigators have observed, these gender roles interfere with HIV prevention efforts. Gender roles may also constrain women’s access to health services, including those for the prevention of mother-to-child transmission of HIV (PMTCT).
Globally, all countries are working toward achieving the goal of having 90 percent of people diagnosed with HIV on sustained antiretroviral therapy (ART) by 2020. PMTCT programs in sub-Saharan Africa have had difficulty pursuing this goal, owing to countries’ weak health systems and a variety of individual, interpersonal, and cultural factors. A number of studies have examined barriers to PMTCT participation. Common constraints are fear of HIV stigma, fear of divorce or abandonment upon HIV disclosure, side effects of ART, lack of funds for transport to the clinic, negative interactions with health workers, and lack of male involvement. Most studies of barriers to PMTCT were conducted prior to the implementation of Option B+, which places HIV-positive pregnant or breastfeeding women on lifelong ART at diagnosis. By examining how gender interacts with individual, interpersonal, health system, and community factors that cause people to discontinue PMTCT, this study fills an important gap in knowledge about Option B+ programs.
In partnership with the Child Health and Development Centre at Makerere University, MEASURE Evaluation—funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Fund for AIDS Relief (PEPFAR)—conducted qualitative research at eight health facilities (four urban and four rural) and their surrounding communities from 2015 to 2016. The purpose of this study was to describe gender-related factors at the individual, interpersonal, and programmatic or systemic levels that influence women’s participation in the elimination of mother-to-child transmission of HIV (EMTCT) program in Uganda. We used in-depth interviews and focus group discussions (FGDs) to obtain data from women participating in EMTCT (n=32), women who were lost to follow-up (LTFU) (n=16), health workers involved in providing EMTCT services (n=8), stakeholders in organizations supporting EMTCT services (n=8), and men in the community (8 focus group discussions (FGDs), n=73 participants). |
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Malaria Surveillance Training Workshops – Assessment of Their Effectiveness
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MEASURE Evaluation |
2017 |
English |
Africa, KENYA, East Africa |
Surveillance, Africa, Training, Malaria, Kenya, MEASURE Evaluation PIMA |
MEASURE Evaluation, a program funded by the U.S. Agency for International Development and the U.S. President’s Malaria Initiative (PMI), has provided significant support for the development of systems monitoring and evaluation tools for national malaria control programs in various African countries. The Kenya National Malaria Control Program, with support from MEASURE Evaluation, developed a curriculum package used to train healthcare workers on malaria surveillance systems. The surveillance training began in 2015 in Kenya and was conducted in two phases in eight counties (four counties in each phase) with support from the Global Fund to Fight AIDS, Tuberculosis and Malaria and PMI. Training workshop participants were data producers and users of malaria surveillance data. In October 2016, following the training, MEASURE Evaluation surveyed participants to get their views on how useful the training was and to assess how well the skills taught were being applied. The survey objectives included assessing participants’ retention of information delivered during the training workshops, assessing participants’ application of knowledge and skills gained at the workshops, and understanding how future training workshops can be improved. This report assesses the effectiveness of healthcare worker training workshops and highlights findings from the assessment. |
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Identifying Households Needing Services for Orphans and Vulnerable Children – Guidelines for Adapting a Beneficiary Identification and Prioritization Tool from Uganda
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MEASURE Evaluation |
2017 |
English |
Africa, UGANDA, East Africa |
toolkit, Uganda, Africa, HVPT, Orphans and Vulnerable Children, Child Health |
The Household Vulnerability Prioritization Tool (HVPT) is a national tool in Uganda developed to help government and implementing partners identify and prioritize households with, affected by, or at high risk for HIV for enrollment in orphans and vulnerable children (OVC) programming. This tool was developed specifically for the Uganda context and in collaboration with the Uganda OVC Technical Working Group.
The purpose of this document is to provide guidelines for other countries and implementing partners overseeing OVC programming, so they can adapt the process that Uganda used and develop an identification tool that suits their own contexts. The document provides a link to the tool that Uganda developed and to adaptions of that tool by Lesotho and South Sudan.
Specifically, this document provides a five-step approach to adapting the HVPT that facilitators can use to organize an identification tool workshop, as well as conduct a pilot test of the tool and refine the tool before full rollout. The document includes talking points, sample exercises, a sample agenda, and templates that can be used during the identification tool workshop. It also contains guidance on how to create a task force after the workshop to draft, pilot, and refine the tool, as well as review implementation later.
MEASURE Evaluation's OVC Household Prioritization Toolkit resources include:
Identifying Households Needing Services for Orphans and Vulnerable Children – Guidelines for Adapting a Beneficiary Identification and Prioritization Tool from Uganda, which is also available in Word format.
Orphans and Other Vulnerable Children Household Vulnerability Prioritization Toolkit (Uganda), which is available in PDF or Word format.
Uganda OVC Household Vulnerability Prioritization Tool (Excel)
Training of Trainers on the OVC Household Vulnerability Prioritization Tool (PowerPoint)
Module 1: Training on Use of the OVC Household Vulnerability Prioritization Tool (PowerPoint)
Module 2: Household Vulnerability Prioritization Tool Database (PowerPoint)
Lesotho Vulnerable Household Identification Tool, which is available in PDF or Word format.
Lesotho Vulnerable Household Identification Tool in Sesotho, which is available in PDF or Word format.
South Sudan OVC Household Vulnerability Prioritization Tool, which is available in PDF or Word format.
These materials may be adapted for use elsewhere, but should be credited to the USAID-funded MEASURE Evaluation. |
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Production and Use of Estimates for Monitoring Progress in the Health Sector: The Case of Bangladesh
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Ahsan KZ, Tahsina T, Iqbal A, Ali NB, Chowdhury SK, Huda TM, Arifeen SE |
2017 |
English |
BANGLADESH |
Data, Health Information Systems, Health System, Bangladesh, Monitoring |
Background: In order to support the progress towards the post-2015 development agenda for the health sector, the importance of high-quality and timely estimates has become evident both globally and at the country level.
Objective and Methods: Based on desk review, key informant interviews and expert panel discussions, the paper critically reviews health estimates from both the local (i.e., nationally generated information by the government and other agencies) and the global sources (which are mostly modeled or interpolated estimates developed by international organizations based on different sources of information), and assesses the country capacity and monitoring strategies to meet the increasing data demand in the coming years. Primarily, this paper provides a situation analysis of Bangladesh in terms of production and use of health estimates for monitoring progress towards the post-2015 development goals for the health sector.
Results: The analysis reveals that Bangladesh is data rich, particularly from household surveys and health facility assessments. Practices of data utilization also exist, with wide acceptability of survey results for informing policy, programme review and course corrections. Despite high data availability from multiple sources, the country capacity for providing regular updates of major global health estimates/indicators remains low. Major challenges also include limited human resources, capacity to generate quality data and multiplicity of data sources, where discrepancy and lack of linkages among different data sources (local sources and between local and global estimates) present emerging challenges for interpretation of the resulting estimates.
Conclusion: To fulfill the increased data requirement for the post-2015 era, Bangladesh needs to invest more in electronic data capture and routine health information systems. Streamlining of data sources, integration of parallel information systems into a common platform, and capacity building for data generation and analysis are recommended as priority actions for Bangladesh in the coming years. In addition to automation of routine health information systems, establishing an Indicator Reference Group for Bangladesh to analyze data; building country capacity in data quality assessment and triangulation; and feeding into global, inter-agency estimates for better reporting would address a number of mentioned challenges in the short- and long-run. |
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Federated Health Information Architecture: Enabling healthcare providers and policymakers to use data for decision-making
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Kumar M, Mostafa J, Ramaswamy R |
2017 |
English |
INDIA |
Data, HIS, Health Information Systems |
Health information systems (HIS) in India, as in most other developing countries, support public health management but fail to enable healthcare providers to use data for delivering quality services. Such a failure is surprising, given that the population healthcare data that the system collects are aggregated from patient records. An important reason for this failure is that the health information architecture (HIA) of the HIS is designed primarily to serve the information needs of policymakers and program managers. India has recognised the architectural gaps in its HIS and proposes to develop an integrated HIA. An enabling HIA that attempts to balance the autonomy of local systems with the requirements of a centralised monitoring agency could meet the diverse information needs of various stakeholders. Given the lack of in-country knowledge and experience in designing such an HIA, this case study was undertaken to analyse HIS in the Bihar state of India and to understand whether it would enable healthcare providers, program managers and policymakers to use data for decision-making. Based on a literature review and data collected from interviews with key informants, this article proposes a federated HIA, which has the potential to improve HIS efficiency; provide flexibility for local innovation; cater to the diverse information needs of healthcare providers, program managers and policymakers; and encourage data-based decision making. |
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HIV-Related Knowledge, Behaviors, and Exposure to the Life Orientation Curriculum among Grade-8 Learners in KwaZulu-Natal
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MEASURE Evaluation |
2017 |
English |
Africa, SOUTH AFRICA |
HIV/AIDS, HIV, AIDS, South Africa, Sexual Behavior, Contraceptive Use, and Reproductive Health, KwaZulu-Natal, Africa, Girls, Adolescent health |
In 2015, the South Africa Department of Basic Education (DBE), with support from the United States Agency for International Development (USAID), invested in developing and piloting scripted lesson plans (SLPs) to increase the uniformity of the implementation of the sexuality education sections of a Life Orientation (LO) curriculum for learners. The Education Development Center (EDC) began piloting the SLP in the 2016 school year.
With support from USAID, and in partnership with DBE, MEASURE Evaluation is conducting an impact evaluation of the activity before its national rollout. The evaluation examines the effect of the SLP on herpes simplex virus 2 (HSV-2) incidence and the change in prevalence of pregnancy among a cohort of Grade-8 female learners as they progress to Grade 10. The study also examines the secondary outcomes of school retention, knowledge, attitudes, and risk behaviors of male and female learners in Grades 8, 9, and 10. The study employs a two-arm, stratified, cluster design with data collection at baseline, midline, and end line. Data are being collected from five education districts in two provinces. This fact sheet presents baseline results from 1,988 Grade-8 female learners and 1,435 Grade-8 male learners enrolled in 62 study schools in KwaZulu-Natal in the 2016 school year. |
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HIV-Related Knowledge, Behaviors, and Exposure to the Life Orientation Curriculum among Grade-8 Learners in Mpumalanga
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MEASURE Evaluation |
2017 |
English |
Africa, SOUTH AFRICA |
Girls, South Africa, AIDS, HIV, Sexual Behavior, Contraceptive Use, and Reproductive Health, Adolescent health, Mpumalanga, HIV/AIDS |
In 2015, the South Africa Department of Basic Education (DBE), with support from the United States Agency for International Development (USAID), invested in developing and piloting scripted lesson plans (SLPs) to increase the uniformity of the implementation of the sexuality education sections of a Life Orientation (LO) curriculum for learners. The Education Development Center (EDC) began piloting the SLP in the 2016 school year.
With support from USAID, and in partnership with DBE, MEASURE Evaluation is conducting an impact evaluation of the activity before it is rolled out nationally. The evaluation examines the effect of the SLP on herpes simplex virus 2 (HSV-2) incidence and the change in prevalence of pregnancy among a cohort of Grade-8 female learners as they progress to Grade 10. The study also examines the secondary outcomes of school retention, knowledge, attitudes, and risk behaviors of male and female learners in Grades 8, 9, and 10. The study employs a two-arm, stratified, cluster design with data collection at baseline, midline, and end line. Data are being collected from five education districts in two provinces. This fact sheet presents baseline results from 1,618 Grade-8 female learners and 1,353 Grade-8 male learners enrolled in 44 study schools in Mpumalanga in the 2016 school year. |
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PLACE Swaziland Adolescent Girls and Young Women, Their Partners, and Men Ages 20–34
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Reynolds Z, Mamba B, Hakasenke I |
2017 |
English |
Africa, SWAZILAND, Southern Africa |
PLACE, Adolescent health, DREAMS, Africa, Swaziland, Girls, Sexual Behavior, Contraceptive Use, and Reproductive Health |
Adolescent girls and young women (AGYW) account for a larger proportion of new HIV infections among their age group compared to their male peers. In order to curb the HIV epidemic in countries with generalized epidemics, it is important to understand the risk behaviors of AGYW and their male partners. This study was designed to identify risk behaviors of AGYW and young men ages 20 to 34 in Swaziland to get a general understanding of the characteristics of male partners of AGYW. These data will be used in activities as part of the DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) Initiative of the United States President’s Emergency Plan for AIDS Relief (PEPFAR) to focus HIV testing services and linkage to care or other high-impact interventions more precisely on male partners.
Specifically, the study was designed to characterize male sexual partners of AGYW, describe sexual partnerships among AGYW and their partners, profile health-seeking behaviors of male partners, and identify spots where AGYW and young men socialize and meet new sexual partners in the 19 tinkhundla identified as priorities by DREAMS. (A tinkhundla is a geographic administrative area smaller than a region.)
The study was a modification of the Priorities for Local AIDS Control Efforts (PLACE) method, a time–location-based sampling strategy developed by MEASURE Evaluation, which is funded by the United States Agency for International Development (USAID) and PEPFAR. The study had three main components. The first was a community informant step in which interviewers asked knowledgeable members of the community where AGYW meet new sexual partners. The second was verification of this list of identified spots. The third was interviews with patrons and workers at those verified spots about their knowledge, attitudes, and behaviors.
The interview team verified 777 spots—drinking spots, kiosks and shops, and bars and clubs, among others—where AGYW meet new sexual partners in the 19 DREAMS tinkhundla. HIV prevention outreach and education at those spots are limited, but informants at more than half of the spots reported that they would be open to further interventions. The most common type of HIV prevention was the availability of free condoms at 45 percent of the spots in the past six months.
Interviews were conducted with 1,641 patrons and workers at 182 of the 777 spots where people meet new sexual partners. Of the 843 young men ages 20 to 34 who were interviewed, 553 said they had had an AGYW sexual partner in the past year. Characteristics of male partners varied by age group: younger male partners were more often single, dependent on family, in school, and unemployed than older male partners.
Male partners more often reported engaging in risky behaviors compared to their female peers. They consumed alcohol more frequently and in greater amounts. Nearly one-third had used marijuana in the past year, 13 percent had been imprisoned or in jail, and 15 percent had slept outside due to homelessness. Male partners had an average of 3.2 sexual partners in the past year, with 31 percent having had three to nine partners. They met these partners on the street, at bars or clubs, at taxi or bus ranks, or at school, among other places. Five percent had paid for sex in the past year. Thirty-seven percent of male partners said they had always used condoms in the past year.
Not all AGYW are engaged in high-risk behavior. Only 26 percent reported ever having had sex, although social desirability bias may affect this figure. The majority of AGYW reported having had only one partner in the past year. But among those who did have a partner, close to half believed their partner had other sexual partners. Additionally, 13 percent of adolescent girls who were sexually active had received money in exchange for sex.
In general, male partners of AGYW had partners who were zero to four years younger. Among adolescent girls, 98 percent said their last male partner was between zero and nine years older, with 20 percent saying their partner was five to nine years older. This percentage was 38 for young women.
Most respondents knew where to get an HIV test; however, fewer had been tested at least once in their lifetimes. Self-reported HIV rates were low in comparison with surveillance data. The highest reported rate was among male partners ages 30 to 34, at 8.9 percent. The lowest was among male partners ages 20 to 24, at 2.4 percent. Thirty-seven percent of male partners were circumcised, suggesting that there is room for further intervention.
All respondents frequently visited the spot where they were interviewed. Mobile testing appeared to be popular among male partners, perhaps offering a greater opportunity to reach people at places they visit frequently. It is prudent for this type of information be used to identify high-impact interventions that can reach high-risk groups both to prevent the spread of HIV and to link those who are HIV-positive to care. |
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Assessing Training Approaches and a Supportive Intervention for Managing Febrile Illness in Tanzania – Tibu Homa Performance Evaluation Report
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Weaver E, Markiewicz M, Kwesigabo G, Lugalla J |
2017 |
English |
Africa, TANZANIA, East Africa |
Africa, Child Health, Intervention, Tanzania, Evaluation |
Integrated management of childhood illnesses (IMCI) is an approach to case management that includes a detailed algorithm for how to assess a child, classify the child’s illness, determine if referral is necessary, treat the child, counsel the mother, and provide follow-up care (World Health Organization [WHO], 2014). Developed by WHO and the United Nations Children’s Fund (UNICEF), IMCI was introduced in Tanzania in 1996. While under-five (U5) mortality in Tanzania has declined over the past two decades, socioeconomic disparities in child mortality persist and are especially prominent in rural areas. The Lake Zone of Tanzania, which surrounds Lake Victoria, has the highest U5 mortality rate in the country. The chief causes of postneonatal deaths in children 1–59 months in Tanzania are estimated to be pneumonia (22%) and malaria (16%) (Liu, et al., 2015). Because severe febrile illness is a key symptom both of malaria and pneumonia, accurate diagnosis and treatment of severe febrile illness is critical to efforts to reduce U5 mortality.
To reduce U5 morbidity and mortality owing to diseases that cause severe febrile illness, the United States Agency for International Development (USAID) Tanzania established the Tibu Homa project (Swahili for “Treat Fever”) in the Lake Zone through a cooperative agreement with University Research Co., LLC. The goals of the project were these: (1) increase availability and accessibility of fundamental facility-based curative and preventive child health services; (2) ensure sustainability of critical child health activities; and (3) increase linkages with the community to promote healthy behaviors and increase knowledge and use of child health services. Tibu Homa was implemented from March 2011–September 2015.
Tibu Homa worked with health facilities to train healthcare workers (HCWs) in IMCI. During Phase 1 of Tibu Homa (2011–2012), HCWs were trained on IMCI through an abbreviated three-day, in-person training focused on febrile illness. This was a modified version of the standard 11-day in-person IMCI training. Beginning in 2013 (Phase 2 of Tibu Homa), distance integrated management of childhood illnesses (dIMCI) replaced the in-person training as required by guidelines at that time of Tanzania’s Ministry of Health and Social Welfare (MOHSW)— now the Ministry of Community Development, Gender, Elderly, and Children (MoHCDGE&C]).
USAID/Tanzania asked the USAID-funded MEASURE Evaluation to conduct a performance evaluation of the association between (1) the training modalities and (2) supportive components implemented by Tibu Homa, with quality of care (QOC). The results are intended to inform the selection of future supportive interventions that may be implemented by USAID/Tanzania or the government of Tanzania (GOT) in conjunction with dIMCI training to enhance HCW compliance with the IMCI algorithm. The broad objectives of the evaluation were to estimate the added value of Tibu Homa’s supportive components.
The evaluation uses a retrospective, mixed-methods approach. Data sources are a cross-sectional quantitative health facility survey, qualitative and costing data collection, secondary time series data, and project document review. Primary outcomes are measures of QOC, which are defined by the WHO Health Facility Survey (HFS) and include the Index of Integrated Assessment (called the “IMCI score”); correct classification; and correct treatment of cases observed or reviewed in patient records. |
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Using DHIS 2 to Strengthen Health Systems
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MEASURE Evaluation |
2017 |
English |
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HIS, Health Information Systems, DHIS 2, Health System, Data |
DHIS 2 is a software platform that the University of Oslo developed in 2006 to manage health information systems (HIS). The first implementation was in India in 2006 and the first national rollout was in Kenya in 2010. Since then, low- and middle-income countries (LMICs) worldwide have adopted the software. DHIS 2 is flexible, adaptable, and extendable through web application program interfaces (APIs), which are useful for building software applications (apps). It can be customized to suit many purposes for health information management and for nonhealth sectors, too.
An optimally functioning DHIS 2 can host a myriad of health data from many sources and can be used to produce information products that facilitate data use. Deployed within a supportive and organized health information system (HIS), it can result in improved health for people. It is a powerful tool, but its effectiveness depends on many factors indicative of strong HIS: leadership and good management, governance of policies and procedures, and the skills of the people who work with the DHIS 2 tool. That is where MEASURE Evaluation plays its important role in the DHIS 2 landscape.
For more than 20 years, the United States Agency for International Development (USAID) has funded MEASURE Evaluation to help strengthen HIS around the world and to measure, evaluate, and share globally strategies that strengthen HIS in LMICs. To that end, the project has been instrumental in helping these countries establish or strengthen their HIS, many of which use DHIS 2. |
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Barriers to and Facilitators of Sex- and Age-Disaggregated Data – Kenya
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MEASURE Evaluation |
2017 |
English |
Africa, KENYA, East Africa |
Kenya, Africa, Data |
The availability of sex- and age-disaggregated data allows program managers and decision makers to examine service delivery, treatment, and health outcome data in depth. This helps them detect differences between the sexes, age groups, and key populations, which can lead to better understanding of the health needs of each of these groups and populations. Access to these data can also ensure that health systems do not perpetuate inequities associated with negative health outcomes. Despite the importance of examining gender and age differences, sex and age disaggregation are not always included or maintained in routine data collection practices and national HIS databases, such as the DHIS 2. Collection and use of gender-related data are increasing globally, but information gaps still prevent full understanding of the factors that facilitate or discourage helpful data disaggregation and use.
To enhance the availability and use of gender data, MEASURE Evaluation—funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—explored factors that contribute to collection and use of sex- and age-disaggregated data in Kenya. Our study used a two-pronged approach: (1) a desk review of key documents and literature, and (2) key informant interviews (KIIs) with national-level data producers and decision makers.
Many variables have an impact on when and how data are disaggregated, but we found common barriers and facilitators around the availability, production, and use of sex- and age-disaggregated data. The most common barriers to producing disaggregated data were low demand and the view that disaggregation was unnecessary. These barriers influenced data-collection tool design. We found that the availability of data by sex and age depended on the tool that was used and what type of data was collected. HIV data were generally disaggregated by sex and age, but there was variation in which age bands were used. Key informants (KIs) for this study said that registers at the facility were disaggregated by sex. This was confirmed by review of data collection tools. However, when aggregated into summary tools, the male and female fields were often aggregated into number of people, as programs did not require disaggregated summary reporting.
We also found that the production of disaggregated data was limited by the availability of resources and the added burden of reporting this type of data. Key informants strongly believed that data being collected should be used, or else it should not be collected. The KIs explored successes and challenges in analyzing and using disaggregated data. They were not sure who was responsible for ensuring disaggregation and providing technical support. Key informants working with PEPFAR data cited successes and supportive strategies more frequently than KIs in other health areas that also had implications for HIV (such as tuberculosis, malaria, and immunizations).
Our desk review revealed that a majority of Kenya’s HIV reports include sex and age disaggregation in their data presentations and discussions. Kenya’s progress in gender integration and sex and age disaggregation should be applauded. Kenya has shown substantial progress and has lessons to share with other countries, as it continues to strengthen data collection, analysis, and use of disaggregated data. Nevertheless, significant challenges remain that will require continued support to address.
At the end of this report, we offer recommendations for increased advocacy and awareness at all levels around the importance of data disaggregation by sex and age. We call for the development of guidelines, materials, and examples of how such data should be analyzed to reveal important findings. We also recommend support from gender-mainstreaming officers throughout program cycles to ensure production and use of sex- and age-disaggregated data. |
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Applying User-Centered Design to Data Use Challenges: What We Learned
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MEASURE Evaluation |
2017 |
English |
Africa, TANZANIA, SOUTH AFRICA |
Data Demand and Use, Tanzania, South Africa, Data, HIS, Africa |
Countries are working to improve health information systems (HIS) to produce higher quality and more timely data. However, the mere existence of these data is not enough to guarantee their use in decision making for program planning and policy development. Data-informed decision making is the outcome of complex system dynamics in which technical, organizational, and behavioral factors interact to create specific facilitators or barriers to data use.
Many different types of stakeholders and individuals are involved in the production and use of data, including health workers, managers, and policymakers. Understanding their motivations, needs, internal decision-making processes, pain points, and experiences as they interact with others and complete work tasks is critical to developing innovative solutions to support the use of data for programmatic decision making at the district level.
MEASURE Evaluation implemented a user-centered design approach to understand the experiences of data users, identify current barriers facing HIS users, and develop creative solutions for tackling these issues.
The design activity followed an iterative process, from cultivating empathy with data users to developing prototypes to address critical barriers to data use. This report describes the design process, activities, and outcomes (prototypes) from a user-centered design activity in Tanzania and South Africa. |
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Equity Trends in Ownership of Insecticide-Treated Nets in 19 sub-Saharan African Countries
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Taylor, C, Florey, L, and Ye, Y |
2017 |
English |
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ITN, Africa, insecticide-treated nets, Sub-Saharan Africa, equity |
Malaria disproportionately affects poor, rural populations, with pregnant women and young children at highest risk. The Roll Back Malaria Partnership, together with the Secretary-General of the United Nations, launched the initiative Cover The Bed Net Gap to achieve the goal of universal bed-net coverage by December 2010.
Finding that previous distribution strategies had led to inequity in insecticide-treated net (ITN) ownership among subgroups, particularly between socioeconomic subgroups, the Cover the Bed Net Gap initiative shifted the distribution of ITNs from targeted distribution to mass distribution campaigns, which aim to provide one ITN for every two household members.
This study assessed the level of equity in bed net ownership before and after the widespread implementation of national ITN distribution strategies in 19 malaria-endemic countries in sub-Saharan Africa.
The study used data from Demographic and Health Surveys as well as Malaria Indicator Surveys. Surveys conducted prior to the launch of the initiative in 2009 were assigned as baseline surveys, and those conducted between 2009 and 2014 were considered endpoint surveys. The study used both country-level and pooled multicountry analyses. Pooled analyses based on malaria transmission risk, were done by dividing geographical zones into either low- and intermediate-risk or high-risk. A calculation of the Lorenz concentration curve and concentration index (C-index) assessed changes in equity.
Out of the 19 countries this study assessed, 13 showed improved equity between the baseline and endpoint surveys, and two countries showed no change. Four countries had worsened equity, with two showing greater increases in coverage of poorer households and two showing greater increases in coverage of richer households.
Findings indicate that bed net distribution campaigns linked to the launch of the Cover The Bed Net Gap initiative, have led to improvement in coverage of ITN ownership across sub-Saharan Africa, with a significant reduction in inequity. |
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Evaluation de la Campagne nationale de 2016 pour la promotion de la planification familiale au Mali
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MEASURE Evaluation |
2017 |
French |
Africa, MALI, West Africa |
Africa, Family Planning, Evaluation, Mali |
Mai 2017
Le Mali possède un des taux de prévalence contraceptive parmi les plus faibles au monde, soit 9,9% selon l’Enquête Démographique et de Santé au Mali 2012–2013. Néanmoins, le Gouvernement du Mali réalise des progrès considérables pour repositionner la planification familiale (PF) en tant qu’intervention essentielle en matière de santé publique et de développement. Un plan stratégique national prévoit, chaque année, l’organisation d’une campagne nationale de promotion de la planification familiale.
Ce rapport présente une évaluation de la campagne nationale pour la promotion de la PF réalisée en 2016 au Mali. Les objectifs à long terme de la campagne de 2016 étaient les suivants : (1) accroître le nombre d’utilisatrices de méthodes PF et (2) réduire les taux de mortalité maternelle et infantile au Mali.
Cette évaluation avait pour but d’évaluer la mise en œuvre de la Campagne nationale de 2016 pour la promotion de la PF. De manière plus spécifique, cette évaluation devait fournir des informations concernant les activités mises en œuvre et le bon déroulement de leur réalisation, les difficultés rencontrées, et déterminer si certains enseignements avaient pu être tirés des diverses initiatives ou si des ajustements étaient nécessaires pour améliorer les futures campagnes et interventions dans le domaine de la PF. Cette évaluation était axée sur les activités du niveau national et des cinq districts d’intervention intensive : Diéma (région de Kayes), Bougouni (région de Sikasso), San (région de Ségou), Koro (région de Mopti) et Nara (région de Koulikoro).
Cette évaluation reposait sur trois types de données :
1) Une revue documentaire a été menée sur la planification, la mise en œuvre et les résultats de la campagne. Au total, 24 indicateurs ont été choisis en examinant les activités envisagées dans le cadre de la campagne. Parmi les documents examinés figuraient le plan d’action de la campagne, le rapport final de la campagne, les relevés des activités et des événements organisés dans les districts d’intervention intensive, les informations recueillies dans le cadre de la campagne, ainsi que le matériel produit et distribué à travers cette initiative.
2) Au total, 21 entretiens ont été réalisés auprès des informateurs clés pour recueillir des informations sur les perceptions de l’efficacité des activités de la campagne, déterminer les obstacles liés à sa mise en œuvre et identifier les forces et les faiblesses de cette initiative.
3) Six groupes de discussion dirigée (GDD) ont été organisés avec des femmes âgées de 18 à 24 ans et vivant dans des communautés d’intervention intensive (Diéma, San, et Bougouni) pour mesurer leur degré d’exposition à la campagne, leurs attitudes vis-à-vis de la campagne annuelle et des messages dispensés, ainsi que les obstacles les plus fréquemment rencontrés dans l’utilisation de la PF.
Les résultats de l‘évaluation nous ont permis de formuler un certain nombre de recommandations, parmi eux que : (1) En améliorant la gestion du dispositif logistique, on veillera à ce que les méthodes contraceptives et les services afférents soient disponibles au niveau de l‘ensemble des points de distribution ; et (2) Le renforcement de système d‘information garantira la disponibilité, tout au long de l‘année, des informations validées sur la prestation de services PF, et ce travail se déroulera de manière continue. Disponible en anglais |
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Assessment of Mali’s 2016 National Campaign for the Promotion of Family Planning
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MEASURE Evaluation |
2017 |
English |
Africa, MALI, West Africa |
Mali, Family Planning |
The Republic of Mali has one of the world’s lowest modern contraceptive prevalence rates, at 9.9% according to the 2012–2013 Mali Demographic and Health Survey. Nevertheless, the government of Mali is making strides to reposition family planning (FP) as an essential public health and development intervention. As part of a national strategic plan, a promotional FP campaign is organized each year.
This report presents an assessment of Mali’s 2016 national FP campaign. The long-term goals of the 2016 campaign were to: (1) increase the number of FP users, and (2) reduce the maternal and infant mortality rate in Mali. The purpose of the assessment—a post-intervention process evaluation—was to identify how well the campaign’s activities were implemented and whether adjustments should be made to improve future FP campaigns and interventions. The assessment focused on the national level and five health districts targeted by intensive intervention: Diéma, Bougouni, San, Koro, and Nara.
The assessment used three types of data:
1) A document review of campaign planning, implementation, and results was conducted. Twenty-four indicators were chosen through a review of anticipated campaign activities. Materials reviewed include the campaign action plan, the campaign final report, records of campaign activities and events occurring in intensive intervention districts, information collected during the campaign, and materials produced and distributed by the campaign.
2) Twenty-one key informant interviews were conducted to collect information on perceptions of the effectiveness of campaign activities, barriers to implementation, and the identification of strengths and weaknesses.
3) Six focus group discussions (FGDs) were held with women ages 18–24 living in communities in intensive intervention districts (Diéma, San, and Bougouni) to gauge exposure to the campaign, attitudes about the annual campaign and campaign messages, and common barriers to the use of FP.
Assessment results suggest a number of recommendations, including that the country improve logistics management to ensure that contraceptive methods and services are available at all distribution points, and strengthen information systems so that validated information on FP service delivery is available on an ongoing basis.
This report is also available in French. |
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The Importance of Gender in Tuberculosis Data
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MEASURE Evaluation |
2017 |
English |
Global |
Monitoring, Evaluation, Gender, Tuberculosis |
Addressing gender when monitoring and evaluating tuberculosis (TB) projects helps ensure equity in access and benefits for men and women. This brief establishes the importance of gender in monitoring and evaluation activities and suggests indicators to reveal and explain gender gaps in TB outcomes. |
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The Importance of Gender in Data on Orphans and Vulnerable Children
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MEASURE Evaluation |
2017 |
English |
Global |
Monitoring, Evaluation, Gender, Orphans and Vulnerable Children |
Addressing gender when monitoring and evaluating projects for orphans and vulnerable children (OVC) helps ensure equity in access and benefits for boys and girls. This brief explores the importance of gender in monitoring and evaluation activities and suggests indicators to reveal and explain gender gaps in OVC outcomes. |
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The Importance of Gender in HIV and AIDS Data
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MEASURE Evaluation |
2017 |
English |
Global |
Monitoring, Evaluation, AIDS, Gender, HIV, HIV/AIDS |
Addressing gender when monitoring and evaluating HIV projects ensures equity in access and benefits for men and women. This brief establishes the importance of addressing gender in monitoring and evaluation activities and suggests indicators to reveal and explain gender gaps in HIV and AIDS outcomes. |
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The Importance of Gender in Family Planning and Reproductive Health Data
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MEASURE Evaluation |
2017 |
English |
Global |
Monitoring, Evaluation, Reproductive Health, Gender, Family Planning |
Addressing gender when monitoring and evaluating family planning and reproductive health (FP/RH) projects and interventions helps to ensure equity in access and benefits for men and women. This brief explores the importance of gender in monitoring and evaluation (M&E) activities and suggests indicators to reveal and explain gender gaps in FP/RH outcomes. |
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The Importance of Gender in Emerging Infectious Diseases Data
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MEASURE Evaluation |
2017 |
English |
Global |
Gender, Infectious disease, Monitoring, Evaluation |
Addressing gender when monitoring and evaluating emerging infectious disease (ID) interventions and programs helps to ensure equity in access and benefits for men and women. This brief explores the importance of gender in monitoring and evaluation (M&E) activities and suggests indicators to reveal and explain gender gaps in emerging ID outcomes. |
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GEMNet-Health Planning Meeting February 23–25, 2017, Cuernavaca, Mexico
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Kulatilaka H, Hart L, and Keck H |
2017 |
English |
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Health infrastructure, Health Systems Strengthening, GEMNet-Health, Mexico |
In February 2017, the Global Evaluation and Monitoring Network for Health (GEMNet-Health) met in Cuernavaca, Mexico, for their planning meeting. The meeting was hosted by the Instituto Nacional de Salud Pública. Representatives from nine of the ten GEMNet-Health partner institutions were present at the meeting, including members of the GEMNet-Health secretariat: MEASURE Evaluation (funded by the United States Agency for International Development).
The purpose of this planning meeting was to review successes of the network since the last meeting, in 2015; develop a list of potential future activities for the network; and then prioritize these activities to develop an updated strategic plan for the network.
The following were the detailed objectives of this meeting:
1. Review GEMNet–Health accomplishments over the past two years.
2. Understand new and current activities related to evaluation and health systems at each of the GEMNet–Health member institutions.
3. Discuss potential collaboration with other organizations including International Initiative for Impact Evaluation (3IE) and Centers for Learning on Evaluation and Results (CLEAR).
4. Share experiences with collaborative activities around evaluation.
5. Discuss strategies for promoting future collaboration among GEMNet–Health member institutions.
6. Generate a list of potential future activities both in evaluation and health information systems for GEMNet-Health; this list will feed directly into the priority setting and strategic planning process.
7. Identify and prioritize future GEMNet–Health activities relating to rigorous evaluation and health systems strengthening.
8. Revise and update the GEMNet–Health Capacity Building and Strategic Plan, including a detailed plan for achieving network priorities discussed on days one and two.
9. Discuss and determine next steps related to transition of Steering Committee and Executive Committee positions, committee structure, and GEMNet-Health Policy on Revenue Sharing for Joint Workshops. |
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Data Use in the Democratic Republic of the Congo’s Malaria Program: National and Provincial Results
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Brodsky I and Nyanzi I |
2017 |
English |
UNITED STATES, Africa, CONGO, THE DEMOCRATIC REPUBLIC OF THE |
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Evidence-informed decision making is essential for the success of health systems, programs, and services. Global commitments to improving health systems and outcomes have led to improved monitoring and evaluation and health information systems, thus providing an opportunity to use data for decision making and not simply for reporting. Overall, the relationships among improved information, demand for data, and continued data use constitute a cycle that leads to improved health programs and policies. Improving data demand and use is necessary to improve the effectiveness and sustainability of a health system.
MEASURE Evaluation, funded by USAID and the United States President’s Malaria Initiative (PMI), undertook an assessment to understand the data-use context for those working in the Democratic Republic of the Congo in the National Malaria Control Program and the Division du Système National d’Information Sanitaire (DSNIS, or Division of the National Health Information System), as well as in Haut Katanga, Kinshasa, and Lualaba provinces. The purpose of this assessment was to identify how data are currently being used for decision making and how future interventions can be designed to promote the demand for and use of data in decision making.
This mixed-methods assessment was based on MEASURE Evaluation’s conceptual approach and logic model, which provides guidance on best practices in data-informed decision making and data use. The model looks at three determinants of data use: technical, organizational, and behavioral. These determinants are adapted from the Performance of Routine Information Systems Management (PRISM) framework developed by Aqil, et al. (Aqil, et al., 2009). The assessment used four tools to assess an organization’s data-use capabilities, as well as key barriers to and facilitators for developing and sustaining a culture of data use.
This report shares the methods and findings of the assessment and recommendations for agencies in the DRC for the use of data in their decision-making processes. |
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Information Products to Drive Decision Making: How to Promote the Use of Routine Data Throughout a Health System
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Geers E, Nghui P, Ekirapa A, Rop V, Mbuyita S, Patrick J, and Kusekwa S |
2017 |
English |
|
Data, Health System, Routine data |
MEASURE Evaluation conducted qualitative studies in Kenya and Tanzania to investigate what types of information products based on health data would be most effective in fostering a culture of data use. The research studied what types of products are available from routine health data, if they could be improved, and how service providers could best use them.
The studies involved interviews with key informants in ministries of health focused on regional, district, and health facility levels to explore how routine data are disseminated, describe organizational support for data use, learn how target audiences understand and interact with available information, and identify supports or barriers to the use of these products in making decisions about health services and health worker performance.
This highly visual “slide-doc” summarizes and presents results of the studies in a compelling way for researchers, health personnel involved in improving health information systems, and communicators interested in science translation.
Access a related webinar recording. |
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Health Information System Performance Monitoring Tool – A Source of Evidence to Help National Authorities Prioritize HIS-Strengthening Interventions
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MEASURE Evaluation |
2017 |
English |
Global |
|
The Health Information System Performance Monitoring Tool (HISPMT) provides evidence to help national authorities prioritize interventions to strengthen health information systems (HIS).
The HISPMT guides HIS managers through a systematic review of the main HIS data sources and provides an objective appraisal of the alignment of each data source with relevant national and international standards. Conducting this kind of review across data sources is important, because countries need data from sources both within and outside the health sector to monitor their health systems, and they also need objective evidence as a basis for prioritizing HIS strengthening investments. The HISPMT can be administered periodically to compare results and monitor the strengthening of the HIS over time.
The HISPMT automatically evaluates the results from the completed modules and the indicator mapping. The summary score for each data source and the relative demand on each data source are plotted on a scatter plot. Presenting the results on the scatter plot allows decision makers and other interested parties to see at a glance how well data sources are performing and the demand for data from each. |
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Building Capacity in Information Management for HIV and AIDS Programs – A Compendium of Tools
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Ellis A, McKeown S |
2017 |
English |
Global |
Health Information Systems, HIV/AIDS, HIS, Capacity Building, HIV |
This compendium—funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—is a guide to nearly 50 tools and other development-oriented materials, such as training curricula and web-based toolkits. It is designed to build the capacity of HIV programs in information management: specifically HIV programs’ health information systems (HIS) and monitoring and evaluation (M&E) systems. The compendium provides access to free, readily available resources for HIV and AIDS programs in developing countries, supporting USAID’s goal of an AIDS-free generation and PEPFAR’s effort to achieve the global 90-90-90 goals: 90 percent of people with HIV diagnosed, 90 percent of those diagnosed on ART, and 90 percent of those on ART virally suppressed by 2020.
All materials are available online in English; many are also published in other languages. They have been selected for inclusion because they are self-guided, thus requiring little or no outside assistance for application.
This compendium gathers tools and other materials that have been designed and implemented to improve capacity to manage HIS and M&E for HIV programs. It can help users select materials that will best address their goals, needs, and priorities in information management for HIV programs and services while building management capacity in this critical area. |
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Frequently Asked Questions about Geographic Information Systems – Tidy Data: The Key to Success with Spatial Data – Tips on Data Structure
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MEASURE Evaluation |
2017 |
English |
Global |
Geographic Information Systems, GIS, Data |
Most work with geographic information systems (GIS) revolves around data. Before a single map is made, a considerable amount of work is usually necessary to make sure the data is mappable.
In the early days of GIS, the software’s handling of data was inflexible. Most programs would accept data in only a few narrowly specific file formats. For instance, they could not read data directly from spreadsheets. Modern GIS software can accommodate many more formats.
However, although GIS is more forgiving now with regard to different file formats, it still has strict requirements regarding the structure of data. No matter the file format, GIS software expects the data to conform to basic standards of tidy data.
This FAQ presents basic information on the concept of tidy data and how GIS rely on it. It is one in a series of FAQs on important topics that are relevant to GIS and spatial data. These FAQs are intended to provide brief answers to common questions and steer you to sources of more detailed information. |
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Frequently Asked Questions about Geographic Information Systems – Using Spatial Data Wisely and Ethically: Privacy and Confidentiality
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MEASURE Evaluation |
2017 |
English |
Global |
GIS, Spatial data, Geographic Information Systems |
This is one in a series of FAQs on important topics that are relevant to geographic information systems (GIS) and spatial data. They are intended to provide brief answers to common questions and steer you to sources of more detailed information. |
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Guidelines on Best Practices for Adolescent- and Youth-Friendly HIV Services – An Examination of 13 Projects in PEPFAR-Supported Countries
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Gage A, Do M, and Grant D |
2017 |
English |
Africa, DOMINICAN REPUBLIC |
Child health, Adolescent health, PEPFAR, HIV, HIV/AIDS |
Adolescents (ages 10–19) and youth (ages 15–24) bear a disproportionate share of the HIV burden, especially in sub-Saharan Africa. However, little is known about what projects are doing to make their interventions adolescent- and youth-friendly and what interventions are effective for changing HIV-related outcomes for these age groups. Program managers and policymakers have little rigorous evidence on how best to invest resources to achieve 90-90-90 targets among adolescents and young people. Recognizing this evidence gap, MEASURE Evaluation—funded by the U.S. Agency for International Development (USAID)—reviewed the evidence on adolescent- and youth-friendly HIV services as a contribution to the goal of an AIDS-free generation that the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is pursuing. This review had three objectives: (1) document knowledge of what is working and what is not working in terms of delivering adolescent- and youth-friendly HIV services, and why strategies and program activities work or do not work; (2) identify useful lessons learned about key elements of successful adolescent- and youth-friendly HIV services; and (3) promote the use and adaptation of best practices for adolescent- and youth-friendly HIV services in order to improve the quality of HIV services delivered to young people and to attract adolescents and youth to retain them in those services.
The 13 projects covered in the compendium are those we received permission to summarize. A review group graded the projects using well-established criteria. These criteria were adolescent and youth involvement, relevance, effectiveness/impact, reach, feasibility, sustainability, replicability or transferability, ethical soundness, and efficiency. Seven best practices, four promising practices, and two emerging practices were identified, of which five provided strong evidence needed to recommend priorities for action.
“Best Practices for Adolescent- and Youth-Friendly HIV Services: A Compendium of Selected Projects in PEPFAR-Supported Countries” reflects the results from a call for best-practices proposals and an examination of peer-reviewed and gray literature in 22 PEPFAR-supported countries. These guidelines are a companion to that document. |
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Best Practices for Adolescent- and Youth-Friendly HIV Services – A Compendium of Selected Projects in PEPFAR-Supported Countries
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Gage A, Do M, and Grant D (eds.) |
2017 |
English |
Africa, DOMINICAN REPUBLIC |
HIV, HIV/AIDS, PEPFAR, Adolescent health |
Adolescents (ages 10-19) and youth (ages 15-24) bear a disproportionate share of the HIV burden, especially in sub-Saharan Africa. However, little is known about what projects are doing to make their interventions adolescent- and youth-friendly and which interventions are effective for changing HIV-related outcomes in this age group. Program managers and policymakers have little evidence derived from rigorous studies on how best to invest resources to achieve 90-90-90 targets among adolescents/young people. In recognition of this evidence, gap, MEASURE Evaluation reviewed the evidence on adolescent- and youth-friendly HIV services as a contribution toward the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) goal of creating an AIDS-free generation. This review had three objectives: (1) document knowledge of what is working and what is not working in terms of delivering adolescent- and youth-friendly HIV services, and why strategies and program activities work or do not work; (2) identify useful lessons learned about key elements of successful adolescent- and youth-friendly HIV services; and (3) promote the use and adaptation of best practices for adolescent- and youth-friendly HIV services in order to improve the quality of HIV services delivered to young people.
Based on a call for proposals regarding best practices and a review of peer-reviewed/grey literature in 22 PEPFAR-supported countries, 13 projects are presented for which permission to publish summaries in the compendium was received.
The goal of this compendium is to answer critical questions that move forward USAID’s mission of supporting (a) the adoption of evidence-based practices in adolescent- and youth-friendly HIV care and services to help at-risk adolescents (ages 10–19 years) and youth (ages 15–24 years) stay HIV-free, and (b) the provision of comprehensive packages of HIV prevention, care, treatment, and retention services to adolescents and youth living with HIV in order to promote their successful transition to adulthood.
See the related "Guidelines on Best Practices for Adolescent- and Youth-Friendly HIV Services – An Examination of 13 Projects in PEPFAR-Supported Countries." |
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Routine Data Quality Assessment Tool - User Manual
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MEASURE Evaluation |
2017 |
English |
Global |
Data Quality, HIV, RDQA |
Strong, robust systems for capturing health program data are essential to tracking progress toward health objectives, such as the Millennium Development Goals, and will be central to supporting data-informed decisions as part of the new Sustainable Development Goals.
The data quality assessment tools were originally developed as part of global efforts to combat AIDS, malaria, and tuberculosis. Ambitious plans for national programs and donor-funded projects were in the works to reduce the burden of disease in countries around the world. Measuring the success and improving the management of these initiatives is predicated on strong monitoring and evaluation (M&E) systems that produce good-quality data related to program implementation.
In the spirit of the “Three Ones,” the “Stop TB Strategy,” and the “Roll Back Malaria Global Strategic Plan,” a number of multilateral and bilateral organizations collaborated to develop the Data Quality Audit (DQA) Tool. This tool captures high-priority indicators from HIV and AIDS, tuberculosis, and malaria programs and offers a common approach to assessing and improving overall data quality. Having a single tool helps to ensure that standards are harmonized and allows for joint implementation by partners and national programs.
Implementing the DQA tool revealed the need for a capacity-building and self-assessment version. To that end, MEASURE Evaluation (funded by the U.S. Agency for International Development), the World Health Organization, the U.S. President’s Emergency Plan for AIDS Relief, and the Global Fund to Fight AIDS, Tuberculosis and Malaria worked together to develop the Routine Data Quality Assessment (RDQA) Tool. We designed it to build the capacity of health programs to assess and improve the quality of their data. The tool has subsequently been applied many times—both by individual health programs and by country health management information systems (HMIS).
The RDQA tool verifies the quality of reported data and assesses the underlying data management and reporting systems for standard program-level output indicators. |
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Using Data to Improve the Safety and Welfare of Children in Kenya
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MEASURE Evaluation PIMA |
2017 |
English |
KENYA |
Child health, MEASURE Evaluation PIMA, Kenya, Health Information Systems |
Kenya has recognized the need for a national system that captures information on children who are orphaned or vulnerable and records the services provided to them by all players working in the area of child health and protection. It is called the Child Protection Information Management System (CPIMS) and is an electronic system that fosters a standardized approach for the timely collection, analysis, reporting, and sharing of child protection data in Kenya.
The CPIMS makes quality data easily available for informed decision making at many levels of the health and child welfare sectors. It promotes links among all child protection programs to enable a coordinated response to children’s needs as outlined in Kenya’s draft National Child Protection Strategy (2014) of the Department of Children Services (DCS) and the United Nations Children’s Fund (UNICEF). The document proposes robust information management and monitoring and evaluation (M&E) of child protection efforts as a key action step. |
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Global Progress in Malaria Control 2010–2015
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MEASURE Evaluation |
2017 |
English |
|
Malaria |
The theme for the World Health Organization’s (WHO) World Malaria Day 2017 is Ending Malaria for Good. The world has made great strides in combatting malaria, moving from widespread prevalence across continents to a point today where the fight is waged in smaller geographies, often at a case management level. In that fight, individuals who test positive for malaria infection are treated along with members of their households—the goal being to preserve their health and to stop transmission of the disease to their families and associates.
MEASURE Evaluation, funded by the U.S. Agency for International Development (USAID), has been a partner in combatting malaria for decades; our work on health information systems and the improved use of data is at the front line of battle. As cases decrease and geographies shrink, health workers rely even more on data to determine who may be infected and if they have accessed treatment. In this infographic, MEASURE Evaluation graphically depicts the encouraging story from WHO of how malaria manifests now across the globe. |
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Malaria Surveillance: Report on Continuous Medical Education of Health Workers
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MEASURE Evaluation PIMA |
2017 |
English |
KENYA |
Surveillance, Malaria, Training, MEASURE Evaluation PIMA |
Malaria surveillance is the ongoing, systematic collection, analysis, and interpretation of malaria-related data, which is essential for the planning, implementation, and evaluation of malaria control programming. Malaria surveillance is closely integrated with the timely dissemination of these data for evidence-based malaria prevention and control. Objective 4 of Kenya’s National Malaria Strategy states that by the year 2018, all of Kenya’s 47 counties should have strong and sustainable monitoring and evaluation (M&E) surveillance systems so that key malaria indicators are routinely monitored and evaluated. Two main surveillance systems are in use in Kenya:
District health information software (DHIS), which takes its name from DHIS 2, the software that runs it: Daily routine facility data—outpatient and inpatient malaria cases, malaria commodity data, and laboratory data—are consolidated and reported each month to the subcounty health management team that is responsible for the entry of these data in the DHIS.
Integrated disease surveillance and response (IDSR) system: Data on clinical malaria cases, laboratory-tested and positive cases, and malaria-related deaths are collected daily at health facilities and reported weekly in the electronic IDSR system.
Health workers in targeted counties received a three-day malaria surveillance training from June to July 2016. The training, which used the surveillance training curriculum of the National Malaria Control Program (NMCP), addressed both data producers and data users and aimed to enhance their understanding of and ability to analyse malaria data and their capacity to identify corrective actions needed to improve malaria programming. Emphasis was placed on data analysis, data interpretation, use of tools to facilitate evidence-informed decision making, and integrating data in decision making processes. The data quality audit (DQA) findings, however, showed that the knowledge gained during the training was not fully translated into practice. The NMCP recognized a need for continuous medical education (CME) and facility mentorship visits as a way to institutionalize the objectives of malaria surveillance. |
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The Importance of Gender in Malaria Data
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MEASURE Evaluation |
2017 |
English |
Global |
Data, Malaria, Gender, Monitoring, Evaluation |
The demand for specific data and indicators incorporating a gender perspective has moved beyond advocates of the rights of women and key populations to include decision-makers at every level and in every area of social and economic development. And while there is greater general awareness of the need for a gender perspective in health policy and programming, not all health areas have considered gender implications equally. Addressing gender when monitoring and evaluating malaria projects helps ensure equity in access and benefits for men and women. This brief explores the importance of gender in monitoring and evaluation activities and suggests indicators to reveal and explain gender gaps in malaria outcomes. |
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Strengthening Mali’s Epidemiological Surveillance System
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MEASURE Evaluation |
2017 |
English |
MALI |
Ebola, Epidemic, Surveillance, Mali |
Disease surveillance tells health planners the prevalence and potential risk posed by contagious diseases in their countries or regions. Before March 2014, Mali depended on a surveillance center in Guinea for information on emerging diseases, but then that country became the epicenter of the emergence of the Ebola virus disease. This outbreak in West Africa revealed the fragility of health systems in developing countries and the lack of coordination among epidemiological surveillance systems worldwide.
Today, Mali relies on the Epidemiological Alert System located in-country, where it is regulated by the National Directorate of Health (DNS) through its Division of Prevention and Control of Disease and the division’s epidemiological surveillance unit. The alert system is supported by the National Institute for Research in Public Health (INRSP) to identify diseases with epidemic potential and is accredited by the World Health Organization (WHO).
Mali’s national epidemic management strategy is based on a new integrated disease surveillance and response system (IDSR). Epidemiological data are collected weekly and the transmission of information is supported by a radio communication network, telephone, fax, mobile phones, and Internet networks. This new system has many shortcomings, such as a lack of coordination among programs, inadequate technical and financial resources, and a lack of good-quality data available in time for decisions at all levels.
To address these issues, the Global Health Security Agenda (GHSA) has stepped in to help Mali strengthen its surveillance system so it can better manage and respond to possible epidemics, such as Ebola. GHSA was launched in February 2014 to help make the world safe from infectious disease threats; to bring together nations to make new, concrete commitments; and to elevate global health security as a priority. In Mali, GHSA is using a multisectoral approach that brings together several partners to improve the system.
Since January 2016, the U.S. Agency for International Development (USAID), through MEASURE Evaluation, has supported GHSA’s effort by providing technical assistance to the DNS to improve the collection, analysis, and availability of epidemiological information in real time. This initiative encompasses 435 community health centers (CSCom) in 19 health districts in the Kayes, Koulikoro, Sikasso, and Bamako regions, near Conakry, Guinea. |
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Strengthening Health Information Systems in Low- and Middle-Income Countries—A Model to Frame What We Know and What We Need to Learn
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MEASURE Evaluation |
2017 |
English |
Africa, Asia, Global |
Health Information Systems, Health Systems Strengthening, LMICs |
Health information is one of six core functions of the health system (USAID, 2015). Health information, generated by health information systems (HIS), supports data-informed decision making at each level of a health system. An HIS encompasses all health data sources required by a country to plan and implement its national health strategy.
Examples of these data sources are electronic health records for patient care, health facility data, surveillance data, census data, population surveys, vital event records, human resource records, financial data, infrastructure data, and logistics and supply data. Health information can inform the planning and targeting of national and subnational health programs to support the achievement of health equity and universal health coverage. In addition, HIS supports a country’s ability to report on progress in meeting the ambitious goals of global initiatives: the Sustainable Development Goals, an AIDS-free generation, ending preventable child and maternal deaths, and the prevention and treatment of malaria.
HIS strengthening is the implementation of one or more interventions targeting one or more components of the HIS to improve the quality and use of data for decision making at all of the health system’s levels. HIS strengthening consists of a range of technical, behavioral, and organizational interventions. The output of a strengthened HIS is the improved availability of high-quality data that are used on a continuous basis for decision making at all levels of the health system.
MEASURE Evaluation has developed a model for strengthening HIS in low- and middle-income countries. The HIS strengthening model (HISSM) is a starting point for framing what we know now and the opportunities we have to learn more about strengthening the HIS. Using the Health Metrics Network (HMN) Framework as a foundation (HMN, 2008), we worked with experts around the globe to develop a model to address four key objectives:
Promote HIS as an essential function of a health system
Define HIS strengthening
Measure HIS performance
Monitor and evaluate HIS interventions
The HISSM is intended for use by HIS managers, MEASURE Evaluation staff, and other project staff implementing HIS interventions. It also supports country-specific and global stakeholders as they assess, plan, design, implement, and monitor and evaluate their HIS interventions. This model will expand and evolve as our working context changes, and as we learn and understand new developments and approaches in strengthening HIS. The dynamic nature of HIS strengthening demands that we regularly review and update the model through the feedback of experts and practitioners. Feedback on the HIS strengthening model will be gathered on an ongoing basis through targeted solicitation and ad hoc contributions and shared through the MEASURE Evaluation HIS strengthening resource center: https://www.measureevaluation.org/his-strengthening-resource-center.
Within this document, in addition to describing the HIS strengthening model, we describe the HIS strengthening process and discuss the HIS as a function that supports the entire health system. We also discuss the importance of the human element in HIS strengthening and the selection of interventions to strengthen HIS, based on appropriate assessment methods, HIS sustainability, and describe the need to measure HIS performance and monitor and evaluate specific HIS interventions. |
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The Links between Women’s Property and Inheritance Rights and HIV in Rural Tanzania
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MEASURE Evaluation |
2017 |
English |
Africa, TANZANIA, East Africa |
HIV/AIDS, HIV, Tanzania, Women |
A better understanding of women’s property and inheritance rights (WPIR) is critical for programs seeking to decrease HIV prevalence and hardships endured by women living with HIV in Tanzania. The International Center for Research on Women (ICRW) (2004) claims that when women are barred from owning property, they are unable to secure resources that would allow them to improve their chances of preventing HIV infection.
HIV infection rates in sub-Saharan Africa remain high, despite ongoing prevention efforts (Oluga, et al., 2010). There are even concerns of human rights violations, where cultural practices such as widow inheritance and sexual cleansing have increased the risk of HIV transmission for widowed women (Agot, et al., 2010). Widow inheritance is a custom in which a relative of a deceased husband, typically the late husband’s brother, inherits the widow as his wife. In sexual cleansing or purification, one of the late husband’s relatives forces the widow to have unprotected sex.
Tanzania today faces a generalized epidemic, with one of the highest HIV prevalence rates in the world and a rising rate of HIV infection.
We constructed a two-stage conceptual framework for concurrent analysis of HIV progression and its influence on the lives of women in their marital families. One participant in Ilemela District commented that the “majority of individuals are not aware of their HIV status due to lack of testing behaviour, hence increased risk for transmission of HIV to their partners.”
The study revealed a deep and complex set of social and economic challenges hindering the use of innovative strategies to mitigate the vulnerability of widows.
A partnership between nonstate actors and government structures, in collaboration with development partners, is recommended to address the needs of women living with HIV or AIDS. |
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Population coverage of artemisinin-based combination treatment in children younger than 5 years with fever and Plasmodium falciparum infection in Africa, 2003-2015: A modelling study using data from national surveys
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Bennett A, Bisanzio D, Yukich JO, Mappin B, Fergus CA, Lynch M, Cibulskis RE, Bhatt S, Weiss DJ, Cameron E, Gething PW, Eisele TP |
2017 |
English |
|
Child Health, ACT, Malaria |
BackgroundArtemisinin-based combination therapies (ACTs) are the most effective treatment for uncomplicated Plasmodium falciparum malaria infection. A commonly used indicator for monitoring and assessing progress in coverage of malaria treatment is the proportion of children younger than 5 years with reported fever in the previous 14 days who have received an ACT. We propose an improved indicator that incorporates parasite infection status (as assessed by a rapid diagnostic test [RDT]), which is available in recent household surveys. In this study we estimated the annual proportion of children younger than 5 years with fever and a positive RDT in Africa who received an ACT in 2003–15.
MethodsOur modelling study used cross-sectional data on treatment for fever and RDT status for children younger than 5 years compiled from all nationally available representative household surveys (the Malaria Indicator Surveys, Demographic and Health Surveys, and Multiple Indicator Cluster Surveys) across sub-Saharan Africa between 2003 and 2015. Estimates for the proportion of children younger than 5 years with a fever within the previous 14 days and P falciparum infection assessed by RDT who received an ACT were incorporated in a generalised additive mixed model, including data on ACT distributions, to estimate coverage across all countries and time periods. We did random effects meta-analyses to examine individual, household, and community effects associated with ACT coverage.
FindingsWe obtained data on 201 704 children younger than 5 years from 103 surveys (22 MIS, 61 DHS, and 20 MICS) across 33 countries. RDT results were available for 40 of these surveys including 40 261 (20%) children, and we predicted RDT status for the remaining 161 443 (80%) children. Our results showed that ACT coverage in children younger than 5 years with a fever and P falciparum infection increased across sub-Saharan Africa in 2003–15, but even in 2015, only 19·7% (95% CI 15·6–24·8) of children younger than 5 years with a fever and P falciparum infection received an ACT. In meta-analyses, children younger than 5 years were more likely to receive an ACT for fever and P falciparum infection if they lived in an urban area (vs rural area; odds ratio [OR] 1·18, 95% CI 1·06–1·31), had household wealth above the national median (vs wealth below the median; OR 1·26, 1·16–1·39), had a caregiver with any education (vs no education; OR 1·31, 1·22–1·41), had a household insecticide-treated net (ITN; vs no ITN; OR 1·21, 1·13–1·29), were older than 2 years (vs ≤2 years; OR 1·09, 1·01–1·17), or lived in an area with a higher mean P falciparum prevalence in children aged 2–10 years (OR 1·12, 1·02–1·23). In the subgroup of children for whom treatment was sought, those who sought treatment in the public sector were more likely to receive an ACT (vs the private sector; OR 3·18, 2·67–3·78).
InterpretationDespite progress during the 2003–15 malaria programme, ACT treatment for children with malaria remains unacceptably low. More work is needed at the country level to understand how health-care access, service delivery, and ACT supply might be improved to ensure appropriate treatment for all children with malaria. |
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Family Planning Services in Kenya during a Transition: Utilization Trends across Counties
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Ndiritu M, Anyango R, Ombech E, Mwita C, Gwer S |
2017 |
English |
Africa, KENYA, East Africa |
Child health, Child Mortality, Maternal Mortality, Kenya, Family Planning, Maternal Health |
Kenya reports one of the highest maternal and child mortality rates in the world. Family planning (FP), which is used both for limiting and spacing pregnancies, is a crucial element in increasing child survival and reducing maternal mortality. Recently, Kenya has been undergoing changes in its health system, transitioning from a centralized to a devolved system of health governance. Thus, county governments are facilitating health services, such as FP provision. We sought to understand the trends in FP utilization within the counties over this period of transition.
The objectives of this study were to estimate the general prevalence of FP use among women of childbearing age and the prevalence of FP use by county; analyze the trends in FP utilization over the period of transition, from 2012 to 2015; and estimate the extent to which counties had integrated reporting of FP services in Kenya’s national district health information system, known by the name of the software that runs it: DHIS 2.
During the four-year period of transition, we observed little change in FP utilization in most counties. We also observed significant disparity in FP utilization between counties in the Central and Western regions and those in the North Eastern and Coast regions. There was significant discrepancy between FP utilizations analyzed from DHIS 2 data and that reported in the KDHS 2014 report.
Data systems are still broken, and existing data are grossly inaccurate. Facility-level health management information systems (HMIS) that interact directly with the DHIS 2 would enhance data accuracy. Overall FP utilization is dismal, and great intercounty disparities exist that call for an affirmative action in counties that are least-served. |
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Women’s Property and Inheritance Rights and HIV in Farming Communities around Lake Victoria, Northwestern Tanzania – A Quantitative Analysis
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Shoki P, Nyenga C, Kasongi D |
2017 |
English |
Africa, TANZANIA, East Africa |
Tanzania, Women, HIV, HIV/AIDS |
Despite the growth of HIV prevention efforts, infection rates in sub-Saharan Africa remain high. Tanzania has one of the highest prevalence rates in the world, at 5.1 percent among 15–49 year olds, according to the 2012 Tanzania HIV/AIDS and Malaria Indicator Survey. The HIV prevalence rate in Tanzania is much higher among women (6.2%) than men (3.8%). The spread of HIV and AIDS is shaped by economic, political, and social factors, particularly gender issues, such as violence against women in all its forms. Widowhood often involves discrimination, deprivation, and suffering. Many women lose their property and other assets following the husband’s death. Property inheritance is always the prerogative of the deceased man’s male kin. The practice of wife inheritance forces the widow to marry her brother-in-law or another male in her late husband’s family. The practice of sexual cleansing or purification forces her to engage in unprotected sex with a male in-law.
Our study was designed to establish the causal relationships between women’s property inheritance rights and HIV and AIDS, by researching the experiences of widowed women living with HIV and AIDS (WLHA) in smallholder farming communities around Lake Victoria, in Tanzania.
Women living with HIV in rural Tanzania continue to be at risk because of inadequate social, economic, legal, and emotional support. Social exclusion and the erosion of asset bases reinforce their vulnerability. Our study revealed a deep, complex set of social and economic challenges that need to be addressed with innovative strategies to ameliorate gender-based stereotypes that disempower women. We offer six recommendations for interventions designed to strengthen the role of WLHA, and to reduce the incidence of transactional sex, gender-based violence, and other societal HIV risk behaviors. |
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Systemic Barriers to MomConnect’s Capacity to Reach Registration Targets – A Process Evaluation
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MEASURE Evaluation-SIFSA |
2017 |
English |
Africa, SOUTH AFRICA |
Antenatal care, Maternal Health, Evaluation, South Africa |
MomConnect, an initiative of South Africa’s National Department of Health, is designed to improve services to mothers and children, by sending preventive healthcare information to pregnant women through mobile-phone text-messaging technology. The idea is for healthcare facilities to register each newly pregnant woman in a national database during her first antenatal care (ANC) visit. Registrants then would receive text messages on their mobile phones at specified stages before and after childbirth. They could also use the technology to provide feedback to the healthcare facility.
The program was launched in August 2014. During the first five months of 2015, healthcare facilities registered 305,000 pregnant women to receive messages through MomConnect. Registrations averaged about 7,334 women per week nationwide, or 39 percent of the 19,000 women appearing weekly for their first antenatal care visits. Although this represents significant progress, the program did not reach its target goal of registering at least 60 percent of first ANC patients at all facilities by June 1, 2015.
National Department of Health officials were interested in understanding why registration targets were not achieved at the facility level. This operational research project was designed to learn more about the following:
MomConnect implementation procedures at facilities
Management and supervisory structures at facilities
Staff training procedures for MomConnect
Common characteristics for high-registration facilities and for low-registration facilities
We used a process evaluation framework for this research. Three districts (each from a different province) were selected to represent urban, periurban, and rural areas. All the facilities were stratified, and then some were selected at random from each district for this study. For each of the three sample districts, we selected five facilities from the highest-performing quartile, five from the lowest-performing quartile, and 10 from the two middle-performing quartiles (20 facilities from each district; 60 facilities total). We interviewed ANC staff members at each facility about the registration process, the training they received, and the management structures in place for MomConnect. We also interviewed supervisors at facilities, district offices, and provincial offices and three training partners.
This report contains recommendations to improve registration throughout the system with new protocols for management, supervision, training, and reporting practices. We recommend using batched or group registration when possible. Retraining for all facilities should incorporate findings from this study. Training should emphasize that registrations must occur during the first ANC visit. To prevent time-outs and improve efficiency and performance, all required registration information should be available before the registration process starts. The challenges identified in this study may be addressed by implementing a new training protocol that includes clear supervisory structures and continual improvement planning, using performance feedback from the MomConnect database. |
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Building Capacity for Resilient Health Systems - Lessons Learned from Sierra Leone, Guinea, and Liberia in the Time of Ebola
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Hart L, Street D, Kulatilaka H |
2017 |
English |
GUINEA, LIBERIA, SIERRA LEONE, Africa |
Health System, Capacity Building, Ebola |
In the wake of the Ebola outbreak, the United States Agency for International Development (USAID)-funded MEASURE Evaluation implemented health systems strengthening interventions, all with a strong capacity building (CB) component, in Liberia, Sierra Leone, and Guinea. All three interventions consisted of an assessment followed by strategic planning. Two technical advisors from MEASURE Evaluation were embedded in these countries’ health ministries for three months to implement the assessment and strategic planning. This effort was followed by virtual technical assistance (TA).
The uniform approach used across the three countries presents a unique opportunity to compare and contrast the experience of CB in different countries. This comparison is of particular interest, because a MEASURE Evaluation-wide capacity building policy that promotes this same process—an assessment followed by action planning—was recently enacted for all CB efforts.
The purpose of this report is to provide insight into strategies for CB for resilient health systems, by documenting and comparing the experience of capacity assessment followed by strategic planning in Guinea, Sierra Leone, and Liberia. Information was gathered from key informant interviews with MEASURE Evaluation staff and supplemented by an extensive desk review of MEASURE Evaluation’s internal documentation.
Lessons learned consisted of insights into the importance of assessing and planning for CB, the value of stakeholder engagement within that process, ideas for planning for the transition of responsibilities from MEASURE Evaluation to the ministry of health, the need for realistic scopes of work, and the value of implementing such an intervention during a time of crisis. Implementing an assessment of the health information system—including both system and staff capacity—in each country allowed the rest of the process to be tailored to that country’s needs. This allowed for each country to plan for systematic CB going forward.
By engaging stakeholders throughout the process, these strategic plans are more likely to find champions in the countries and to be implemented after MEASURE Evaluation’s activities end. Different transition experiences in each country imparted valuable knowledge about various aspects of these handoffs. These experiences were part of a larger lesson involving intervention in a time of crisis. Crisis situations present urgent staffing challenges and role changes are needed to address emergent issues quickly. This type of instability can make any intervention difficult to implement, but is especially challenging for CB efforts that rely on the presence of specific people within a health system in order to move forward.
These lessons provide important information to guide future CB efforts. The importance of systematic CB—including assessment and planning—further validates best practices at MEASURE Evaluation and elsewhere. Given the global focus on human resources for health—of which CB is an important part—and health systems strengthening, we hope that these insights will also be of use outside of the project. |
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Monitoring and Evaluation Toolkit for the Scale-Up of Emergency Obstetric and Newborn Care (EmONC) in Kenya
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MEASURE Evaluation PIMA |
2017 |
English |
Africa, KENYA |
Maternal Health, Kenya, Obstetric care, Monitoring, Evaluation, Newborn health, EmONC |
The call to address the high rates of maternal and newborn mortality has received unprecedented support from governments and development partners over recent years. Increased investments in programs targeting maternal and newborn health have fueled demand for reliable and timely data to promote the rational allocation of resources where the burden of deaths is greatest. In Kenya, the Ministry of Health and county governments have committed to ensuring universal access to emergency obstetric and newborn care (EmONC). The United States Agency for International Development (USAID) is a major partner of the Government of Kenya (GOK) in the effort to increase the national coverage of EmONC under its Ending Preventable Child and Maternal Deaths Strategy.
EmONC is an integrated strategy developed by the World Health Organization (WHO), the United Nations Population Fund (UNFPA) and the United Nations Children’s Fund (UNICEF) that aims to equip health facilities with the capacity to provide evidence-based, cost-effective interventions to attend to the leading causes of maternal and newborn mortality. Two levels of care are recognized under this approach: basic (BEmONC) and comprehensive (CEmONC). BEmONC, provided at primary care facilities such as dispensaries and health centers, has seven essential medical interventions, known as signal functions. CEmONC, provided at hospitals, covers the seven BEmONC signal functions plus two more.
The toolkit incorporates experiences from the first two phases of the national EmONC scale-up exercise launched in July 2013. The national scale-up of the monitoring and evaluation (M&E) of EmONC was based on the theoretical framework drawn from the Donabedian model, which categorizes quality of care in three interlinked unidirectional dimensions: (1) structure, (2) process, and (3) outcome. Through periodic assessments of health facility capacity to provide the EmONC signal functions, it is possible to infer the progressive capabilities to reduce maternal and newborn mortality.
This toolkit is the result of collaborative work by MEASURE Evaluation PIMA, USAID, the Maternal and Child Survival Program (MCSP), University Research Company/ASSIST, APHIAplus, AMPATH PLUS implementing partners, the Ministry of Health (MOH), and county health management teams targeted in the initial phase of the national scale-up of BEmONC.
This toolkit is intended primarily for county M&E officers, reproductive health coordinators, and other members of county health management teams and partners involved in implementing EmONC. It is also useful for national M&E officers and other professionals and donors who are involved in maternal and newborn health programs. |
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Using Routine Data to Improve Antiretroviral Treatment Retention: Examples and Lessons Learned from the Literature and Experts in the Field
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do Nascimento N, Barker C, Li M |
2017 |
English |
Global |
HIV, Routine data, ART |
As is almost always the case, the key to helping people be healthy lies with people. In the case of increasing retention in antiretroviral therapy (ART), one key is a strong cadre of community health workers, empowered by a staff of data managers who provide quality data and good data analysis.
Good-quality data and better use of them are the low-hanging fruit to achieve retention on ART—because we can do that now.
All this may sound simple. It’s not. Harnessing data to increase ART retention involves a diverse set of skilled practitioners, motivated to collect, analyze, and use routine health facility data. It also requires quality controls for data, sharing data across systems, and the support of country health-program managers and facility staff to sustain achievements.
This document summarizes the three main ways that routine data are currently used to improve adult ART retention in low-resource settings, challenges to their use, and recommendations on how to strengthen data use for improved HIV outcomes. |
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Guide pour l’intégration du genre dans une évaluation d’un cadre et système de suivi et évaluation
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MEASURE Evaluation |
2017 |
French |
Global |
|
Ce document propose des conseils concrets sur la manière dont les organisations peuvent intégrer de façon explicite et globale le genre dans leurs systèmes de suivi et évaluation (S&E). Il décrit comment faire en sorte que chaque composante d’un système de S&E soit sensible au genre et donne des indications sur la manière d’évaluer un système de S&E pour s’assurer que le genre soit entièrement intégré dans l’ensemble du système pour mener de façon appropriée la collecte, la compilation, l’analyse, la diffusion et l’utilisation des données de genre pour la prise de décision.
Ce document explique pourquoi il est important d’appliquer la question genre dans les processus et structures de S&E, il contextualise le genre dans un système de S&E. Ensuite il guide sur la manière d’adresser et d’aborder la question genre dans chacune des composantes d’un système de S&E. Ce guide comprend des exemples de questions d’évaluation spécifiques au genre qui peuvent être intégrées dans un système de S&E, il fournit aussi des conseils sur la façon de planifier et de conduire l’évaluation d’un système de S&E.
Ce guide est destiné aux programmes nationaux de santé et aux responsables du S&E, au personnel du programme de santé en charge du S&E au niveau local, aux agents chargés du S&E dans différents organismes ou organisations, et aux partenaires en développement qui viennent en appui aux systèmes nationaux et locaux en matière de S&E. |
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Investigating Risky Sexual Behaviours among Youth in the Context of the HIV Epidemic in Mbeya Region, Tanzania
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Mutasingwa LV, Mbirigenda SK |
2017 |
English |
Africa, TANZANIA, East Africa |
HIV, HIV/AIDS, Adolescent health, Sexual Behavior, Youth |
Mitigating HIV and AIDS among youth has been a major policy agenda both internationally and nationally, within Tanzania. Two concerns associated with mitigation efforts are increasing sexual activity at young ages and a burgeoning population of out-of-school youth whom poverty, lack of supervision, and unemployment seem to push into alternative life patterns that present risks to their health. This situation poses a serious challenge for Tanzania, where half the population is categorised as young.
The study focused on 54 individuals (27 males and 27 females) from three identified categories: youth ages 15–24 years old (30 respondents); gatekeepers (16 respondents); and health service providers (8 respondents). Data collection involved qualitative techniques: in-depth interviews (IDIs), focus group discussions (FGDs), and document review.
The majority of youth studied had heard about HIV and its related effects; however, condom use, and attendance at SRH services is very low among this population. The government, parents, nongovernmental organisations (NGOs), religious institutions, and health service providers play a role in addressing risky sexual behaviours among youth. Parents have some responsibility for engagement by youth in risky sexual practices: poor marital relationships and instability in the home, supervising their children poorly, failing to communicate with their children about HIV and prevention, and putting their children in unsafe and vulnerable situations. However, many other factors contribute to participation by youth in risky sexual practices.
Despite increased government and NGO measures against HIV and attempts to minimise youths’ vulnerability to the disease, the community still does not fully support these efforts, and youth behaviour change remains a challenge. The study recommends that the Tanzanian government remain engaged and demonstrate leadership by effectively contributing to initiatives that address the HIV epidemic and create an environment supportive of access and use by youth to SRH services. |
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Kilifi County Family Planning – January to June 2016
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MEASURE Evaluation PIMA |
2017 |
English |
Africa, East Africa, KENYA |
Facility management, Kenya |
The current status of Kenya’s modern contraceptive prevalence rate (mCPR) is 53%. The goal is 58% mCPR by 2020, and 66% mCPR by 2030.
There is low use of contraceptives in Kilifi County compared with the average national rate. To reduce the burden of unwanted pregnancies and the risk of maternal deaths of teenage mothers from unsafe abortions, more effort is required to address the high unmet need for contraceptives among youth and adolescents.
Key Issues for Family Planning Programming in Migori County include:
High youth and adolescent burden of unwanted pregnancies
Low uptake of available family planning opportunities
Reliance on short-acting methods
Commodity security
Poor use of data for decision making
We can do more, by focusing on the sexual and reproductive health issues of adolescents and youth. Meeting their family planning demands would accelerate the use of family planning. As a starting point, health or other facilities offering youth-friendly services need to be mapped for a better understanding of their accessibility and coverage of preferred products for adolescents. Such information would assist programs to make decisions on how to make these services accessible.
Creating wider access to all contraceptive options, especially long-acting methods that are relatively effective, can substantially reduce unwanted pregnancies, unsafe abortions, and pregnancy-related maternal mortality. |
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Migori County Family Planning – January to June 2016
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MEASURE Evaluation PIMA |
2017 |
English |
KENYA, Africa, East Africa |
HIV, Kenya |
The current status of Kenya’s modern contraceptive prevalence rate (mCPR) is 53%. The goal is 58% mCPR by 2020, and 66% mCPR by 2030.
There is low use of contraceptives in Migori County compared with the average national rate. To reduce the burden of unwanted pregnancies and the risk of maternal deaths of teenage mothers from unsafe abortions, more effort is required to address the high unmet need for contraceptives among youth and adolescents.
Key Issues for Family Planning Programming in Migori County include:
A high youth and adolescent burden of unwanted pregnancies
Low uptake of available family planning opportunities
Reliance on short-acting methods and significant shift to long-acting methods
Commodity security
Poor use of data for decision making
We can do more, by focusing on the sexual and reproductive health issues of adolescents and youth. Meeting their family planning demands would accelerate the use of family planning. As a starting point, health or other facilities offering youth-friendly services need to be mapped for a better understanding of their accessibility and coverage of preferred products for adolescents. Such information would assist programs to make decisions on how to make these services accessible.
Creating wider access to all contraceptive options, especially long-acting methods that are the relatively effective, can substantially reduce unwanted pregnancies, unsafe abortions, and pregnancy-related maternal mortality in developing countries. |
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Murang’a County Family Planning – January to June 2016
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MEASURE Evaluation PIMA |
2017 |
English |
Africa, KENYA, East Africa |
Kenya, Family Planning |
The current status of Kenya’s modern contraceptive prevalence rate (mCPR) is 53%. The goal is 58% mCPR by 2020, and 66% mCPR by 2030. To reduce the burden of unwanted pregnancies and the risk of maternal deaths of teenage mothers from unsafe abortions, more effort is required to address the high unmet need for contraceptives among youth and adolescents.
Key Issues for Family Planning Programming in Murang’a County include:
A growing youth and adolescent burden of unwanted pregnancies
Low uptake of available family planning opportunities among adolescents and youth
Reliance on short-acting methods
Commodity security
Poor use of data for decision making
We can do more, by focusing on the sexual and reproductive health issues of adolescents and youth. A first step is to train providers on youth- friendly services and facilitate health facilities to become youth friendly.
Creating wider access to all contraceptive options, especially long-acting methods that are the relatively effective, can substantially reduce unwanted pregnancies, unsafe abortions, and pregnancy-related maternal mortality. |
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Estimating Numbers of Orphans and Vulnerable Children – A Test of Regression Modeling
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Brodish P, Charyeva Z, Foreit K |
2017 |
English |
Africa, Global |
PEPFAR, Orphans and Vulnerable Children, HIV |
An earlier study reported a tight linear fit between national adult HIV prevalence and the percentage of children living in a household with at least one HIV-positive adult. MEASURE Evaluation extended this analysis to all existing DHS data sets with HIV testing, to determine the feasibility of using regression modeling to estimate the size of two priority groups: (1) children living with at least one adult who is HIV-positive, and (2) orphans and coresident children living with at least one adult who is HIV-positive.
At the national level, we found reasonably tight linear relationships between HIV prevalence among adults and the proportion of children living with at least one HIV-positive adult and between adult HIV prevalence and the proportion of orphans and coresident children living with at least one HIV-positive adult. However, at the subnational level, owing to small sample sizes, we found greater variation at the same level of HIV prevalence in the proportion of children living with an HIV-positive adult. Although the slopes and intercepts of the national and subnational regression lines are almost the same, the confidence intervals for the subnational level estimates are very wide and many data points fall outside the prediction.
PEPFAR has given priority for OVC programs to 21 countries. Of these, 17 have a recent biomarker survey: Burundi, Cameroon, Cote d'Ivoire, Democratic Republic of Congo, Ethiopia, Haiti, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. For these countries, we recommend using the results of our secondary DHS analyses for programmatic estimates. Our Excel workbook includes point estimates and 95-percent confidence intervals at both the national and subnational levels of the proportions of children who live in a household with an HIV-positive adult and the proportion of children who are orphans or coresident children living in a household with an HIV-positive adult, and extrapolates the observed proportions to numbers of children.
At present, four countries in the PEPFAR OVC portfolio do not have a recent DHS survey with HIV testing: Botswana, Nigeria, South Africa, and South Sudan. For these countries, the linear regression is a reasonable way to estimate at the national level the proportion of children who live in a household with an HIV-positive adult and the proportion of children who are orphans or coresident children living in a household with an HIV-positive adult. We have created an Excel workbook to predict these two indicators at the national level and to extrapolate the predicted proportions to numbers of children.
Access the Population Size Estimation Tool for Programs Serving Orphans and Vulnerable Children tool at www.measureevaluation.org/resources/publications/tl-18-07/.
Access the DHS estimates for the size of OVC groups at the national and sub-national levels tool at www.measureevaluation.org/resources/publications/tl-18-08/. |
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A Review of Family Planning Outcomes in Integrated Health Programs and Research Recommendations
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Barden-O’Fallon J, Adamou B, Mejia C, Agala C |
2017 |
English |
Global |
Family Planning, Health, Health outcomes |
Research on the integration of health services is abundant and has been undertaken to investigate the many assumptions related to service integration: namely, that integrated services are cost-effective, efficient, and lead to improved health outcomes. Most research on integration outcomes has focused on short-term outcomes; less is known about longer-term outcomes, particularly the health benefits of integration. Additionally, family planning (FP) outcomes are not always a focus of research and evaluations and are not routinely measured by programs. As a result, many questions on the specific outcomes and impacts of integration on FP programming remain.
The main objectives of this review are to assess the recent evidence base on the effects of integrated programming on FP services and outcomes, gather lessons learned for FP services in integrated programs, and provide recommendations for future research. Although the review builds on the evidence base on FP- integrated programs, the paper differs from previous reviews by focusing on questions relevant to FP program stakeholders. |
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Brief on the Routine Health Information System Curriculum
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MEASURE Evaluation |
2017 |
English |
|
Health Information Systems, Data Quality, Routine Health Information Systems |
The USAID-funded MEASURE Evaluation project developed a new online curriculum on routine health information systems (RHIS), working with other leaders in the field of RHIS—the World Health Organization; the Free University of Brussels/European Agency for Development and Health (AEDES); the University of Oslo, in Norway; the National Institute of Public Health (INSP), in Mexico; the University of Queensland, in Australia; and the Public Health Foundation of India.
RHIS (also called health facility and community information systems) regularly generate data that have been collected at public and private health facilities and institutions, as well as at community-level healthcare posts and clinics. The purpose of this curriculum is to enhance participants’ capacity to conceptualize, design, develop, govern, and manage an RHIS, and use the information the system generates to improve public health practice and service delivery.
One one-page flier describes the curriculum and provides links to its various components. |
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Effects of individual, household and community characteristics on child nutritional status in the slums of urban Bangladesh
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Ahsan KZ, El Arifeen S, Al-Mamun A, Khan SH, Chakraborty N |
2017 |
English |
BANGLADESH |
Nutrition, Bangladesh, Child Health |
BackgroundBangladesh urban population is expected to overtake rural population by 2040, and a significant part of the increase will be in slums. Wide disparities between urban slums and the rest of the country can potentially push country indicators off track unless the specific health and nutrition needs of the expanding slum communities are addressed. The study aims at describing the individual, household and community determinants of undernutrition status among children living in major urban strata, viz. City Corporation slums and non-slums, in order to understand the major drivers of childhood undernutrition in urban slum settings.
MethodsData are derived from Bangladesh Urban Health Survey conducted in 2013. This survey is a large-scale, nationally representative of urban areas, household survey designed specifically to provide health and nutrition status of women and children in urban Bangladesh.
ResultsData showed that 50% of under-5 children in slums are stunted and 43% are underweight, whereas for non-slums these rates are 33 and 26% respectively. In terms of severity, proportion of under-5 children living in slums severely underweight or stunted are nearly double than the children living in non-slums. Logistic analyses indicate that mother’s education, child’s age, and household’s socio-economic status significantly affects stunting and underweight levels among children living in the urban slums. Logistic models also indicate that all individual-level characteristics, except exposure to mass media and mother’s working outside home, significantly affect undernutrition levels among children living on non-slums. Among the household- and community-level characteristics, only household’s socioeconomic status remains significant for the non-slums.
ConclusionsPoor nutritional status is a major concern in slum areas, particularly as this group is expected to grow rapidly in the next few years. The situation calls for specially designed and well targeted interventions that take into account that many of the mothers are poorer and less educated, which affects their ability to provide care to their children.
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Evaluation Research on Results-Based Financing: An Annotated Bibliography of Health Science Literature on RBF Indicators for Reproductive, Maternal, Newborn, Child, and Adolescent Health
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Craig L |
2017 |
English |
|
Child Health, Newborn health, Reproductive Health, Adolescent health, Results-based financing, Maternal Health |
This annotated bibliography offers a critical review of peer-reviewed and gray literature, published between 2002 and 2016, and relevant to indicators for the monitoring and evaluation of results-based financing (RBF) initiatives for reproductive, maternal, neonatal, child, and adolescent health (RMNCAH). Unlike a systematic review, this annotated bibliography does not aim to be a comprehensive assessment of the research on RBF for health. Rather, it seeks to describe the conceptual contribution and practical experiences of experts in using indicators to assess performance and quality throughout RMNCAH-focused RBF schemes.
The review includes peer-reviewed articles, toolkits, technical briefs, case studies, and evaluation reports. Microsoft PowerPoint presentations, posters, and books are not included. Articles were identified via key informant interviews, online database searches, and website reviews. For Google Scholar and the PubMed databases, search terms were indicators, results based financing, performance based financing, performance based funding, quality, reproductive, maternal, neonatal, child, and adolescent health. Gray literature was identified through searches of the following regional, multilateral, and donor websites: RBFHealth, World Bank, World Health Organization, BlueSquare, United States Agency for International Development (USAID), USAID TRAction Project, Salud Mesoamerica Initiative, Pan American Health Organization, the United Nations Children’s Fund, and the USAID-funded MEASURE Evaluation. Review of the listed references of pertinent articles yielded additional resources. |
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Understanding Data Demand and Use in Kenya – Successes and Challenges in Kakamega, Kilifi, and Kisumu Counties
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MEASURE Evaluation PIMA |
2017 |
English |
Africa, KENYA, East Africa |
Kenya, MEASURE Evaluation PIMA, Data Demand and Use, Data |
Evidence-based decision making is essential for the success of health systems, programs, and services. Global commitments to improving health systems and outcomes have led to improved monitoring and evaluation (M&E) and better health information systems, thus providing an opportunity to use data for decision making and not simply for reporting. MEASURE Evaluation has developed a conceptual approach and logic model that guides the health sector in adopting best practices in data-informed decision making and data use.
Overall, the relationship between improved information, demand for data and continued data use creates a cycle that leads to improved health programs and policies. Improving data demand and use is necessary to make a health system more effective and sustainable.
Data demand and use (DDU) is a core component of MEASURE Evaluation PIMA’s objectives to strengthen M&E at the national and subnational levels of Kenya’s health care system. The DDU strategic approach is the foundation of the overall goal of the PIMA project to build sustainable M&E capacity to use quality health data for evidence-based decisions and program planning in the following six areas: malaria; civil registration and vital statistics; reproductive health; referral systems strengthening; disease surveillance; and orphans and vulnerable children.
At the beginning of the PIMA project, the M&E Capacity Assessment Tool (MECAT) was used to determine the M&E capacity of PIMA beneficiaries at the national and county levels. Findings from the MECAT showed that across all counties where PIMA was going to provide support over the project lifetime, no data use strategies existed and some counties only had a data use approach mentioned in a strategic plan or draft M&E work plans. At the national level, data use infrastructure was weak since most national programs did not have guidelines or plans on data use.
Following the mid-term review of the project in Year 3, PIMA set out to conduct a DDU learning exercise in Year 4 to provide data on the extent to which select counties have integrated data for decision making into routine programming and planning processes.
PIMA provided extensive technical assistance and support to each of the three counties selected for this exercise. This support included the formation of M&E technical working groups (TWGs), assistance with data review meetings, assistance with program planning and budgeting, and training in data demand and use tools and approaches. |
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MER OVC Essential Survey Indicators – Frequently Asked Questions (FAQs)
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MEASURE Evaluation |
2017 |
English |
Global |
Orphans and Vulnerable Children, Monitoring, Evaluation, Child health |
This document includes Frequently Asked Questions (FAQs) raised by stakeholders involved in designing and implementing surveys to collect the PEPFAR Monitoring, Evaluation, and Reporting (MER) Orphan and Vulnerable Children (OVC) Essential Survey Indicators. MEASURE Evaluation has compiled answers to these questions and has produced this resource to enable the sharing of lessons learned across stakeholders. |
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Five Ways We Help to Change the World
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MEASURE Evaluation |
2017 |
English |
Global |
Health Information Systems, HIS, Global health |
Each day, the United States Agency for International Development (USAID) meets the world’s challenges head-on. The environment, poverty, conflict, and health top the list. To improve global health and health security, USAID calls on MEASURE Evaluation with a mission to harness the unprecedented global capacity to generate digital data so it can be used to improve the health of people in developing countries.
We work across the globe helping countries gather high-quality data and employ them to improve health outcomes. We build local capacity to conduct evaluations that contribute to establishing and sustaining high-performing health information systems (HIS).
This overview of Phase IV, Project Year 2 (October 2015 to September 2016) takes a close look at the impact of the project’s efforts to strengthen HIS and public health programming. We work on many fronts in scores of activities. This overview examines what we do through the lens of five key themes that resonate globally, to illustrate how we:
Help to build strong, resilient HIS
Evaluate HIS and program impact
Respond to special initiatives or emerging needs for health information
Support information to combat HIV, especially in support of USAID’s “test, treat, and retain” strategy
Focus special attention on women and youth
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Working for Stronger Health Information Systems
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MEASURE Evaluation |
2017 |
English |
Global |
Health information systems, Health Systems Strengthening |
USAID created MEASURE Evaluation to strengthen health information systems (HIS) to harness the power of high-quality data for decision making for better health outcomes around the world. To that end, we create tools and approaches for rigorous evaluations, develop the expertise of institutions and individuals, share information, spark collaboration, and expand the evidence base so countries can make better decisions today and develop the capacity to sustain good health outcomes over time.
This work involved four result areas:
Result 1. Strengthen the collection, analysis, and use of routine health data
Result 2. Improve country-level capacity to manage HIS resources and staff
Result 3. Improve and apply methods, tools, and approaches
Result 4. Increase capacity for rigorous evaluation
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MEASURE Evaluation Accomplishments in Phase III - Improving Decision Making in Global Public Health
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MEASURE Evaluation |
2017 |
English |
Global |
Global health, Public Health |
In this Phase, MEASURE Evaluation was focused on increasing capacity in low- and middle-income countries to collect quality data to build a body of evidence around health, improve analysis of those data, and help bring about better use of data for decision making to improve the health of people.
The project did this in six main ways: sharing data and knowledge, mentoring health professionals to improve skills, building systems to support collection and analysis of data, fostering innovative ways to gather and use data, leading in national and global circles to shape policies and best practice, and evaluating the effectiveness of public health policies and interventions. This report summarizes the accomplishments of the project during those six years. |
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MEASURE Evaluation’s Work in Health System Strengthening: Global Models, Tools, and Resources to Measure and Improve Health Information System Performance
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MEASURE Evaluation |
2017 |
English |
Global |
Health System, HIS, Health Systems Strengthening, Health Information Systems |
The Learning Agenda is MEASURE Evaluation’s response to a request by the United States Agency for International Development (USAID) to explain the effects of investments in strengthening health information systems (HIS). As part of the Learning Agenda, we have launched the Health Information System Strengthening Resource Center. The Resource Center serves as an online repository of learning, information sharing, and resources for HIS development and strengthening. This brief catalogs the resources that have been or are being developed under MEASURE Evaluation’s HIS Learning Agenda for the Resource Center. Health Systems Strengthening - M&E and Learning is a package of health systems strengthening (HSS) resources that provide advice and direction on how to set up monitoring, evaluation, and learning processes. |
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Identifying the Need for Evaluation Capacity Assessment Tools and Guidance
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Franca-Koh A, Moonzwe L |
2017 |
English |
Global |
Evaluation |
In 2011, the U.S. Agency for International Development (USAID) published its Evaluation Policy (USAID, 2011). The policy emphasizes the need to conduct more evaluations of its programs to ensure greater accountability and learning, and it outlines best practices and requirements for conducting evaluations. Since releasing the policy, USAID has commissioned an increasing number of evaluations of its programs (USAID, 2016).
The importance of evaluations for international public health programs has been long recognized (CDC, 1999, 2011; RAND, 2005; WHO, 2001), with demand for such evaluations coming from both internal and external sources. Donors or those external to program implementation seek evidence of accomplishments and accountability for resources spent, whereas those involved in program implementation seek evidence to inform and improve program design (WHO, 2001). Within USAID, the need for more evaluations was driven by the understanding that evaluations provide information and analysis that prevent mistakes from being repeated and increase the likelihood of greater yield from future investments (USAID, 2011). Finally, there is overall recognition that evaluations should be of high quality and driven by demand, and that results should be communicated to relevant stakeholders (PEPFAR, 2014).
Despite the increased demand for evaluations, there is limited evaluation capacity in many countries where international development programs are implemented (RAND, 2005). Before strategies to strengthen evaluation capacity can be implemented, it is important first to assess existing evaluation capacity and develop action plans accordingly.
We conducted a review of existing assessment tools and guidance documents related to assessing organizations’ capacity to carry out evaluations of international public health programs in order to determine the adequacy of those materials. Here, we summarize the key findings of our review of the literature and provide recommendations for the development of future tools and guidance documents. |
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Size of Key Populations in the Dominican Republic - 2016 Estimates
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MEASURE Evaluation |
2017 |
English |
DOMINICAN REPUBLIC |
Dominican Republic, Key Populations, HIV/AIDS, HIV |
In the field of HIV prevention and treatment of AIDS, there is increased emphasis on monitoring progress toward stopping the spread of the virus. Not only have evidence-based approaches been in demand, but there are new goals intended to slow the epidemic so that it can be stopped in 2030. In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) put forth the targets that by 2020, 90 percent of all people living with HIV will know their HIV status, 90 percent of all people with diagnosed HIV infection will be receiving sustained antiretroviral therapy, and 90 percent of all people receiving antiretroviral therapy will have viral suppression (UNAIDS, 2014). The Dominican Republic is on its way to tracking the numbers of people tested, on treatment, and virally suppressed, but without knowing the number of people estimated to be HIV-positive, it is impossible to calculate progress toward these goals. Key populations such as female sex workers (FSWs), men who have sex with men (MSM), and transgender (TG) people are disproportionately infected by HIV in the Dominican Republic, making it imperative to know the size of each key population to estimate the number of people expected to be HIV-positive. (The focus of HIV prevention efforts for TG in the Dominican Republic is on TG women: people who were assigned male at birth but who present as women.) This report describes an activity undertaken to provide these population estimates for each province and nationally for use in monitoring progress toward these global goals.
Recent surveys have documented higher prevalence of HIV and syphilis among key populations than among all adult men and women in the Dominican Republic. The 2013 Demographic and Health Survey (DHS) measured a prevalence of HIV among women ages 15 to 49 as 0.7 percent and among men as 0.9 percent, resulting in a national prevalence of 0.8 percent. However, the 2012 Integrated Biological and Behavioral Surveillance Survey (IBBSS) carried out in five cities found HIV prevalence among FSWs to be between 1.7 percent and 6.3 percent, and among MSM and TG women to be between 3.9 percent and 6.9 percent. Syphilis prevalence was higher than HIV among these populations, with between 6.0 percent and 12.1 percent of FSWs, 9.8 percent and 13.9 percent of MSM and TG women testing positive. Similar results were found in the Priorities for Local AIDS Control Efforts (PLACE) study in 2014, with 2.5 percent of FSWs having a positive HIV test and 5.4 percent a positive syphilis test; 3.9 percent of MSM with HIV and 4.9 percent with syphilis; and 18.2 percent of TG women with HIV and 21.2 percent with syphilis (MEASURE Evaluation, 2014).
Estimating the number of sex workers, gay or bisexual men, and TG women is not a new undertaking in the Dominican Republic. A 2014 report reviewed existing estimates and put forth one national estimate for each population, in addition to addressing the complexity of these calculations. The resulting estimates of MSM and TG women relied on different methods and mostly on data from the capital city. No estimate of FSWs was provided in that report. The National Strategic Plan for STI and HIV/AIDS 2015–2018 refers to an estimate of FSWs from 2004. No estimates for provinces or regions of the country were available.
The aim of the present study was to provide information useful for monitoring progress toward the UNAIDS 90-90-90 goal, as well as for programs. The main objective was to estimate the number of FSWs, MSM, and TG women in each province and nationally with input from local stakeholders. The study team selected a method to fill the need for a systematic approach to calculating size estimates of each population that incorporates data collected from each health region in the country and that uses other available data to extrapolate estimates to areas where primary data were not collected. This method is consistent with current recommendations of international technical working groups.
MEASURE Evaluation implemented this study in 2016 in collaboration with three local organizations: the Center for Advocacy and Human Solidarity (CEPROSH), the Center for Comprehensive Investigation and Orientation (COIN), and the Institute for Dermatology and Skin Surgery Dr. Huberto Bogaert Díaz (IDCP). |
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Geographic information system for improving maternal and newborn health: recommendations for policy and programs
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Molla YB, Rawlins B, Makanga PT, Cunningham M, Ávila JEH, Ruktanonchai CW, Singh K, Alford S, Thompson M, Dwivedi V, Moran AC,and Matthews Z |
2017 |
English |
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Geographic Information Systems, GIS, Maternal Health, What's New, Child Health |
This correspondence argues and offers recommendations for how geographic information systems (GIS) applied to maternal and newborn health data could potentially be used as part of the broader efforts for ending preventable maternal and newborn mortality. These recommendations were generated from a technical consultation on reporting and mapping maternal deaths that was held in Washington, DC from January 12 to 13, 2015 and hosted by the United States Agency for International Development’s (USAID) global Maternal and Child Survival Program (MCSP). Approximately 72 participants from more than 25 global health organizations, government agencies, donors, universities, and other groups participated in the meeting.
The meeting placed emphases on how improved use of mapping could contribute to the post-2015 United Nation’s Sustainable Development Goals (SDGs) agenda in general and to contribute to better maternal and neonatal health outcomes in particular. Researchers and policy makers have been calling for more equitable improvement in maternal and newborn health (MNH), specifically addressing hard-to-reach populations at subnational levels. Data visualization using mapping and geospatial analyses play a significant role in addressing the emerging need for improved spatial investigation at subnational scale. This correspondence identifies key challenges and recommendations so GIS may be better applied to maternal health programs in resource-poor settings. The challenges and recommendations are broadly grouped into three categories: ancillary geospatial and MNH data sources, technical and human resources needs, and community participation. |
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Prioritizing ICT Interventions for Health
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MEASURE Evaluation SIFSA |
2017 |
English |
SOUTH AFRICA |
ICTs, Intervention, ICT, Health |
Information and communication technologies (ICTs)—which include eHealth and mHealth—have begun to change the way healthcare is delivered in resource-limited settings. Examples of these changes are tracking of women throughout pregnancy, maintaining supplies of essential medical commodities, and promoting behaviour change and service uptake via text messages (Mendozo, Okoko, Morgan, & Konopka, 2013). Mobile health (mHealth) technologies have been seen as a driving force behind the “ICT for health” revolution in global development. The South African mHealth Strategy 2015–2019 defines mHealth as the use of mobile computing, medical sensors, or other communication technology in the delivery of health-related services (National Department of Health, 2015).
Though there have been many successful mHealth interventions, there have also been many partial successes or outright failures, leading people to believe that most ICT projects in developing countries fail or are unable to scale up past the pilot stage (Heeks, 2002).
In general, ICT priorities should be determined in the context of achieving local, national, and global health priorities. Data from existing health information systems should be used in decision making and in the design of monitoring and evaluation (M&E) systems. However, this often is not the case. Instead, priorities are often determined through ad hoc decisions, instead of using established guidelines.
This brief examines a method of weighting criteria that can provide guidance for setting priorities for health interventions and ICTs, specifically. It illustrates a way to improve transparency and avoid ad hoc decisions in the allocation of healthcare resources. |
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How MEval-SIFSA’s MomConnect Interventions Contributed to mHealth Strategy Implementation – A Learning Agenda Assessment in South Africa
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MEASURE Evaluation - SIFSA |
2017 |
English |
Africa, SOUTH AFRICA |
South Africa, Maternal Health, MEval-SIFSA, MHealth |
MEASURE Evaluation–Strategic Information for South Africa (MEval-SIFSA) and other key stakeholders, provided technical support for the rollout of the MomConnect mobile health (mHealth) intervention. Though the project maintained a diverse portfolio of activities, supporting the implementation of the mHealth strategy (2015–2019) of South Africa’s Department of Health (DOH) was one of its major goals. Recognizing its role in both MomConnect and the mHealth strategy implementation, MEval-SIFSA designed this assessment to document the intersection of these two activities. Specifically, this assessment sought to answer the question, “How have MEval-SIFSA’s MomConnect interventions contributed to mHealth strategy implementation?” The assessment asks how MomConnect has contributed to, enabled, or catalysed the implementation of key aspects of the mHealth strategy.
The study was a mixed methods assessment that relies primarily upon key informant interviews (KIIs) with individual representatives of key stakeholder organizations in both the private and public sector. The assessment was designed to inform MEval-SIFSA’s learning agenda, but it also has applications outside of the project for a wide array of mHealth stakeholders in South Africa.
The assessment found that knowledge and use of the mHealth strategy is fairly limited among respondents, apart from those directly involved in its development. Although respondents see the necessity of having an mHealth strategy to articulate DOH priorities and set standards and norms, they all felt that the strategy has yet to be implemented in any significant way.
The following are specific ways MomConnect has had an impact on the mHealth environment more broadly, but not the mHealth strategy specifically: raising the visibility of mHealth, contributing to health information system (HIS) interoperability conversations, providing a case study for national scale-up of an mHealth intervention, and standing as an example of broad stakeholder engagement. Many respondents saw MomConnect as a forerunner that paved the way for future mHealth activities to be successfully implemented.
MomConnect was implemented within the unique South African context, and much of its success can be attributed to the enabling environment that was ripe for this type of intervention. Implementation efforts benefitted from significant government support and political will, sufficient funding and donor support, strong technical partnerships, individual champions, and good timing.
Noting the need to improve mHealth strategy implementation to increase the likelihood that future mHealth activities would succeed, respondents called for stronger DOH leadership, greater government transparency in planning and contracting, more practical guidelines for how to implement policies, dedicated funding for mHealth activities, and the formation of committees to ensure the success of strategy implementation. Respondents saw these activities as necessary for South Africa to have a rich and diverse mHealth environment that meets the DOH goal of improving health. |
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Routine Health Information Systems: A Curriculum on Basic Concepts and Practice - Syllabus
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MEASURE Evaluation |
2017 |
English |
Global |
HIS, Health Information Systems, RHIS, Routine Health Information Systems |
Also available in Word
A strong health information system (HIS) that produces reliable, timely, and good-quality data is among several factors enabling health program managers to monitor, evaluate, and improve health system performance and make evidence-informed decisions. Since the 1990s, knowledge and understanding of the role of HIS development in global health systems have improved. Despite this, use of information for evidence-informed decision making—particularly data produced by routine health information systems (RHIS)—is still very weak in most low- and middle-income countries (LMICs).
Routine health information systems (also called health facility and community information systems) generate data at regular intervals (no longer than a year) that have been collected at public and private health facilities and institutions, as well as at community-level healthcare posts and clinics. Most of the data, which document health status, health services, and health resources, are gathered by healthcare providers as they go about their work, but supervisors and ongoing health facility surveys contribute information, as well.
To improve RHIS and ultimately, health outcomes, a global group of experts developed this basic course on RHIS in 2015–2016 and pilot-tested it in New Delhi in June 2016. The course responds to an immense and urgent need to build the capacity of the health workforce in LMICs. Its purpose is to enhance participants’ capacity to conceptualize, design, develop, govern, and manage an RHIS, and use the information the system generates to improve public health practice and service delivery.
In this core course, students will study the design, implementation, and strengthening of RHIS, which is the most common source of information on health services management and programs. An RHIS also provides regular information for many core indicators of the national health strategy. Using practical case studies, participants will learn how to improve the performance of an RHIS, by producing reliable data to inform decisions at all levels of the health system. They will also come to understand the important contribution of information and communication technology (ICT).
MEASURE Evaluation's online RHIS Curriculum is accessible by clicking here. |
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Routine Health Information Systems: A Curriculum on Basic Concepts and Practice - Facilitators’ Guide
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MEASURE Evaluation |
2017 |
English |
Global |
Health information systems, Routine Health Information Systems |
Also available in Word
A strong health information system (HIS) that produces reliable, timely, and good-quality data is among several factors enabling health program managers to monitor, evaluate, and improve health system performance and make evidence-informed decisions. Since the 1990s, knowledge and understanding of the role of HIS development in global health systems have improved. Despite this, use of information for evidence-informed decision making—particularly data produced by routine health information systems (RHIS)—is still very weak in most low- and middle-income countries (LMICs).
Routine health information systems (also called health facility and community information systems) generate data at regular intervals (no longer than a year) that have been collected at public and private health facilities and institutions, as well as at community-level healthcare posts and clinics. Most of the data, which document health status, health services, and health resources, are gathered by healthcare providers as they go about their work, but supervisors and ongoing health facility surveys contribute information, as well.
To improve RHIS and ultimately, health outcomes, a global group of experts developed this basic course on RHIS in 2015–2016 and pilot-tested it in New Delhi in June 2016. The course responds to an immense and urgent need to build the capacity of the health workforce in LMICs. Its purpose is to enhance participants’ capacity to conceptualize, design, develop, govern, and manage an RHIS, and use the information the system generates to improve public health practice and service delivery.
In this core course, students will study the design, implementation, and strengthening of RHIS, which is the most common source of information on health services management and programs. An RHIS also provides regular information for many core indicators of the national health strategy. Using practical case studies, participants will learn how to improve the performance of an RHIS, by producing reliable data to inform decisions at all levels of the health system. They will also come to understand the important contribution of information and communication technology (ICT).
This facilitators’ guide is part of a package of training materials for the RHIS course. It explains how to present the modules outlined in the syllabus: a separate, shorter document that provides an overview of the course.
MEASURE Evaluation's online RHIS Curriculum is accessible by clicking here. |
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Use of Routine Health Information to Inform Budgetary Allocations for Reproductive Health in Cross River State, Nigeria
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Hassan A |
2017 |
English |
Africa, West Africa, NIGERIA |
Family Planning, Nigeria, Reproductive Health, Routine Health Information Systems |
The relevance of reproductive health (RH) and family planning (FP) for the global and national development agenda as well as socioeconomic development of communities, families, and individuals is a major issue in the sustainable development era. Negative reproductive health outcomes are common in Nigeria. The 2013 Demographic and Health Survey (DHS) showed that the total fertility rate (TFR) of 5.3 was higher than the wanted fertility rate (4.7) in Cross River State. This implies that the average number of children a woman wants is less than the number she currently has. The unmet need for family planning (30.8%) is almost twice the national average. Despite the situation, the use of modern contraceptives in the state has declined from 16.3 percent in 2008 to 14.4 percent in 2013 (NPC & ICF Macro, 2009; NPC & ICF International, 2014). The uptake of FP services has been hampered by many challenges, including contraceptive commodity stockouts and unavailability of consumables.
Government demonstrates its commitment to health by speaking out, making public declarations in favor of health, linking health to development, creating budget lines, and ensuring prompt release of budgeted funds for the purpose for which it was budgeted; and by effective and equitable delivery of quality service (Bujari & McGinn, 2013). To ensure that decisions on budgetary allocations are evidence-based, it is essential to understand the budget process. Donald and Ahmed (2013) examined the budget process in Cross River State. Despite the highly sophisticated budget process in the state, FP was not considered a critical issue by government officials and policymakers. Hence, there is no budget line for FP commodities and distribution in the state except for the support received from the United Nations Population Fund (UNFPA) (Donald & Ahmed, 2013). Also, the budget for reproductive health is placed under the budget for maternal and child health. However, not much is known about the inner workings of the budget process within the State Ministry of Health (SMOH) and the local government councils, such as the process of allocating proportions of the budget to specific items under maternal and child health, and the use of routine health information to inform such budgetary allocations. In addition, there is little documentation of the process to guide advocacy efforts.
The survey used a cross-sectional design. Both qualitative (key informant interviews [KIIs]) and quantitative (structured questionnaires) research methods were employed for the survey. The research team conducted a desk review of existing FP data in the state and Calabar Municipal LGA (Local Government Area).
The HMIS remains extremely relevant when considering budgetary allocations for RH and FP in planning, policymaking, program design, and implementation. This study revealed that budgetary allocations for program M&E are perceived as the major difference between the private and public sectors, where the private sector is seen as been more engaged in oversight functions. Training on data management is imperative in order to ensure availability of quality data for decision making by policymakers. Even though the participants have a fairly good understanding of data management, they believe they need further training as this will strengthen their capacity to understand and use data. In turn, this is an important way to enhance service delivery in the health sector because virtually nothing can be done well without data acting as the raw material for planning and appropriation. |
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MEASURE Evaluation Capability Statement: Evaluation
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MEASURE Evaluation |
2017 |
English |
Global |
capability statement, Evaluation |
MEASURE Evaluation has experience conducting a wide range of types of evaluation, including impact evaluation. In addition to building the evidence of what works for programs, we add to global knowledge about health system strengthening interventions, such as the effects of improvements of routine health information systems; the effects of investments in HIV on other health systems; and the effects of adopting integrated or multisectoral programs and referral systems. Another area of expertise is the evaluation of structural interventions, such as those related to underlying gender norms.
To help build the capacity of local professionals to conduct rigorous evaluations, MEASURE Evaluation weaves together the functions of evaluation implementation with experiential learning and training. These professionals can turn to us for technical advice as they implement evaluations, acquiring and reinforcing their skills in the process. We also support opportunities for formal training, through local and regional workshops and by incorporating advanced methods in graduate school curricula.
MEASURE Evaluation offers expertise in a full range of evaluation procedures, including the development of rigorous study designs, protocol development, ethical research practices (including access to U.S.-based and in-country ethics review boards), sample-size estimations, questionnaire development, statistical methods, costing methods, qualitative methods, and biomarker measurement. |
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Total Market Approach to Family Planning
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Dominique Meekers, Sarah C. Haynes, Kathryn Kampa |
2016 |
English |
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Total market approach, Family Planning |
To expand the market in contraceptives and address couples’ unmet need for family planning, effective coordination is needed among the three sectors that deliver contraceptive products and services in developing countries: the public sector, the nonprofit sector, and the commercial sector.
A total market approach (TMA) to family planning gathers and uses data to strengthen collaboration among these sectors. Its ultimate goal is to create an efficiently segmented market that provides women access to a full range of family planning products and services. Although many countries are interested in adopting a TMA to inform their family planning policies and strategies, there is little consistency in the steps they take to make this decision. To address this need, MEASURE Evaluation, in collaboration with the Evidence Project and PATH, has developed several resources to standardize how countries assess their need and readiness for a TMA.
Learn more about this resources and access the full collection, including Module 1, at https://www.measureevaluation.org/our-work/family-planning/tma-resources/total-market-approach-to-family-planning |
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Surveillance à base communautaire dans une approche Une Seule Santé au Sénégal Les étapes de mise en oeuvre
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MEASURE Evaluation |
2016 |
French |
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Surveillance, Senegal, Infectious disease |
Le projet MEASURE Evaluation, avec le soutien de l’Agence des Etats-Unis pour le développement international (USAID), a mis en oeuvre un nouveau système pour la surveillance à base communautaire (SBC) des maladies infectieuses au Sénégal. |
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Automatic analysis of neonatal video data to evaluate resuscitation performance
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Guo Y, Wrammert J, Singh K, KC A, Bradford K, Krishnamurthy A |
2016 |
English |
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Child Health, Neonatal care, Child Mortality, Newborn health |
Approximately 3% of births require neonatal resuscitation, which has a direct impact on the immediate survival of these infants. This report proposes an automatic video analysis method for neonatal resuscitation performance evaluation, which helps improve the quality of this procedure. More specifically, we design a deep learning based action model, which incorporates motion and spatial information in order to classify neonatal resuscitation actions in videos.
First, we use a Convolutional Neural Network to select regions containing infants and only keep those that are motion salient. Second, we extract deep spatial-temporal features to train a linear SVM classifier. Finally, we propose a pair-wise model to ensure consistent classification in consecutive frames. We evaluate the proposed method on a dataset consisting of 17 videos and compare the result against the state-of-the-art method for action classification in videos. To our best knowledge, this work is the first to attempt automatic evaluation of neonatal resuscitation videos and identifies several issues that require further work. |
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Availability and Use of Sex-Disaggregated Data in Tanzania: An Assessment
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MEASURE Evaluation Tanzania |
2016 |
English |
TANZANIA |
Gender, Health Information Systems, Routine Health Information Systems |
MEASURE Evaluation has been working to support the Government of Tanzania at national and subnational levels to ensure data quality for sex-disaggregated and gender-sensitive data, and to better use data from routine health information systems (RHIS) for health and social service program and policy decision making. In support of these efforts, MEASURE Evaluation-Tanzania conducted a data and gender assessment of the national and subnational RHIS to understand the current availability and use of sex-disaggregated and gender-sensitive indicators. |
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HIV Service Constraint Analysis through Data Triangulation – A Procedural Guideline
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Sapirie, Stephen |
2016 |
English |
Global |
HIV, Data |
This guideline describes a team-based, learn-by-doing process designed to help health districts assess constraints on HIV service delivery and to plan, conduct, and monitor strategic interventions. The steps in this process help districts:
Analyze local data
Identify priority subdistrict areas that are burdened by disease
Design interventions to overcome constraints and strengthen performance
This process works best with low-profile facilitation by staff or consultants experienced in team-based learning and the use of locally available data. National health administrations, lead institutions, and collaborative projects can also adapt the process to meet national and local needs.
The goals of this process are:
To provide a practical opportunity for district health teams (national service and implementing partner [IP] project staff) to analyze routine and periodic HIV data that are available to their service facilities and offices, in order to identify current service gaps and their underlying causes
To inform national programs and institutions of learning that support HIV service monitoring and improvement while building health team capacity for data analysis and use
To foster the establishment of national institutional homes for leading and supporting such data use on a continuing and expanding basis
To help the U.S. Agency for International Development (USAID) institutionalize the use of DATIM (Data for Accountability, Transparency, and Impact) indicators for monitoring and managing HIV strategies, such as 90-90-90 and DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe), and of priority services of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) at the service site and district level
To encourage national district health services to focus on areas with highest HIV prevalence and transmission rates, especially underserved communities
USAID officials have asked MEASURE Evaluation to shorten the process and focus district team attention on HIV services. This abbreviated process will support the assembly and analysis of diverse types and sources of data in order to identify service gaps and determine their underlying causes. The procedure covers the design of interventions to address service gaps in subdistrict areas that most need assistance to reduce HIV transmission and to improve identification and management of HIV cases (as in the 90-90-90 strategy). |
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Intégration d’un module de système d’alerte précoce dans le DHIS 2 en Côte d’Ivoire
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MEASURE Evaluation |
2016 |
French |
Africa, COTE D'IVOIRE, West Africa |
Cote D’Ivoire, DHIS 2 |
À la demande de l’équipe chargée de la lutte contre la maladie à virus Ébola de Global Health de l’Agence américaine pour le développement international (USAID), le projet MEASURE Evaluation a fourni une assistance technique au Ministère de la santé de la Côte d’Ivoire aux fins de renforcer le système d’alerte précoce du Système de surveillance épidémiologique des maladies à tendance épidémique et nouvelles du pays. Cette mission a été accomplie en collaboration avec l’Institut national d’hygiène publique (INHP), qui avait identifié l’intégration des données communautaire dans le système de surveillance épidémiologique comme une priorité nationale. |
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Strategic Planning for Health Information Systems – A Supplement to the Health Metrics Network’s Guidance
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Sapirie, Stephen |
2016 |
English |
Global |
HIS, Health Information Systems |
Management Sciences for Health (MSH) developed the original Guidance for the Health Information Systems (HIS) Strategic Planning Process: Steps, Tools and Templates for HIS Systems Design and Strategic Planning in 2007; the Health Metrics Network (HMN) published the most recent version (the sixth) in 2009. This guidance document was created to foster principles and methods to help national health administrations respond to HIS assessment findings. The guidance outlined the phases and steps that national working groups can use to address the common needs and gaps in their HIS. The guidance consisted of principles, steps, intermediate products, formats, and proposed plan outlines to inform sound systems analysis and intervention design, planning, and implementation. The guidance detailed the processes recommended for achieving each step, sometimes offering alternative methods, as well. During the development of the guidelines, the authors had the opportunity to try out some of the phases and steps in countries that were being supported by HMN to formulate a development strategy and plan.
Over the years, many users reported that the processes described in the document were too complicated and required national health administrations to take on too much subsystem development. HIS strategy developers reported they wanted something simpler. Over the same period, eHealth has evolved and should be a larger part of the overall HIS covered in the guidance.
Because HMN no longer exists, MEASURE Evaluation supported an effort to review the original guidance to improve it and address problems reported by those who used it for strategic planning. This supplement, like the original guidance document, is intended to be used by national HIS planners, designers, and managers, along with international advisors to the strategic planning process.
Nine years after the creation of the original HIS guidance, this supplement aims to answer the following questions:
Does a national HIS warrant a six- to eight-month planning effort by a large, multifaceted group of nationals and international advisors?
Does the recommended set of phases and steps in the guidance actually produce a full set of products that identify priority HIS development needs, how the needs can be addressed, and how the chosen interventions can be implemented and paid for? Can something shorter and simpler serve the same purposes?
Are there problems with the process, the plan, or the plan’s implementation that are difficult to resolve? Could the process be dropped altogether in certain situations?
In answering these questions, we came up with suggestions to improve the steps and processes needed to plan an HIS, and these are presented here. |
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The MomConnect mHealth initiative in South Africa: Early impact on the supply side of MCH services
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Barron P, Pillay Y, Fernandes A, Sebidi J, Allen R |
2016 |
English |
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MCH, MHealth, South Africa, Maternal Health, SIFSA, MEval-SIFSA |
MomConnect is an mHealth initiative giving pregnant women information via SMS. We report on an analysis of the compliments and especially complaints component of the feedback. We scrutinised the electronic databases containing information on the first seventeen months of operation of MomConnect. During this time, 583,929 pregnant women were registered on MomConnect, representing approximately 46 per cent of pregnant women booking their pregnancy in the public sector in South Africa. These women gave feedback on services received: 4173 compliments and 690 complaints. Nearly three quarters (74 per cent) of all complaints were resolved. The complaints were classified into those related to health services (29 per cent), staff (22 per cent), health systems (42 per cent) and other (6 per cent). These complaints were fed back to managers in the health facilities. This has resulted in improvements in the quality of services, e.g. decreased drug stock-outs and change of behaviour of some health workers. |
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Regulating mHealth in South Africa
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MEASURE Evaluation SIFSA |
2016 |
English |
Africa, SOUTH AFRICA |
ICT, MHealth, South Africa, ICTs |
The delivery of health-related services via information and communications technologies (ICT) is referred to as eHealth. The South African mHealth strategy (2015–2019) defines mobile health—or mHealth—as a subset of eHealth, which involves the use of mobile computing, medical sensors, or other communication technology in the delivery of health services. mHealth has the potential to empower clients with information to inform their healthcare decisions and link them to health services.
Many types of mHealth projects and applications can compromise client privacy or confidentiality. For example, an application may store sensitive client data without any controls on who is allowed to access it. Or clients may be negatively affected by incorrect medical advice from information applications, or misdiagnosed through remote conversations with health providers. To avoid these and other negative scenarios, it is essential that regulations to protect clients be in place and enforced.
Although mHealth regulations currently in place in South Africa have a number of gaps, regulatory bodies will be able to address many of them in the medium to long term. People involved in the design and implementation of mHealth projects should keep abreast of regulatory developments to ensure they are in compliance. |
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Explaining trends and patterns in attitudes towards wife-beating among women in Nigeria: analysis of 2003, 2008, and 2013 Demographic and Health Survey data
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Oyediran, KA |
2016 |
English |
NIGERIA |
Gender, GBV, Nigeria |
This paper examines the patterns and trends in attitudes towards wife-beating among women in Nigeria and their determinants. Using the Nigeria Demographic and Health Survey datasets, a multivariate logistic regression was fitted to assess the relationships between sociocultural factors and a woman’s attitude towards being beaten by her spouse. The results indicate a significant change over time in the percentage of Nigerian women supporting or accepting the notion that a man is justified in beating or hitting his wife. The findings show that during interviews in 2003, 2008, and 2013, 62.4, 45.7, and 37.1% of women, respectively, believed that wife-beating was justified for at least one of the reasons given. Education, place of residence, wealth index, ethnic affiliation, religious affiliation, women’s autonomy in household decision-making, and frequency of listening to the radio were significantly related to acceptance of wife-beating over the years. The study underscores the importance of these factors to the development of policies addressing gender-based violence and urges special attention and intervention to mitigate the effect of the cultural practices that underlie domestic violence against women in Nigeria. |
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Tamaño de las poblaciones clave en la República Dominicana
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MEASURE Evaluation |
2016 |
Spanish |
DOMINICAN REPUBLIC |
Dominican Republic |
En la República Dominicana (Dominican Republic), se estima la prevalencia del VIH en un 0,8 por ciento, pero poblaciones clave tales como mujeres trabajadoras del sexo (TRSX), hombres que tienen sexo con hombres (HSH), y personas transgénero (Trans) se ven desproporcionadamente afectadas por la epidemia. (El enfoque de los esfuerzos de prevención del VIH para Trans en la República Dominicana se encuentra en mujeres transgénero: personas a quienes se les asignó género masculino al nacer, pero que se presentan como de sexo femenino. De aquí en adelante cuando se escribe "Trans" se refiere específicamente a "mujeres transgénero"). Es imprescindible saber el tamaño de cada población clave a fin de hacer una estimación en cuanto al número de personas que se espera sean VIH-positivas. Al conocer el tamaño de la población clave también permitirá al país posicionar de manera eficaz sus programas y recursos para alcanzar los objetivos mundiales para el 2020: el 90 por ciento de todas las personas que viven con el VIH conocen su estado serológico respecto al VIH, el 90 por ciento de todas las personas diagnosticadas con el VIH están recibiendo terapia antirretroviral sostenida, y el 90 por ciento de todas las personas que reciben terapia antirretroviral tiene una supresión viral (Programa Conjunto de las Naciones Unidas sobre el VIH/SIDA [ONUSIDA], 2014).
En 2016, el Centro de Promoción y Solidaridad Humana (CEPROSH), el Centro de Investigación y Orientación Integral (COIN), y el Instituto Dermatológico Dominicano y Cirugía de Piel Dr. Huberto Bogaert Díaz (IDCP) colaboraron con MEASURE Evaluation para responder a esta necesidad. El objetivo principal de esta actividad fue obtener una estimación del número de TRSX, HSH y, Trans en cada provincia y en toda la nación, mediante el aporte de las partes interesadas.
Se utilizaron modelos estadísticos para calcular el tamaño de la población clave en cada provincia. Los modelos extrapolados calcularon en forma directa el tamaño de la población clave de los municipios donde no existían tales datos. Los datos de los estudios de Prioridades para los Esfuerzos Locales de Control del SIDA (PLACE, por sus siglas en inglés) se utilizaron para calcular las estimaciones en forma directa en los municipios donde tuvo lugar PLACE en 2014 (MEASURE Evaluation, 2014) y PLACE Lite en 2016. MEASURE Evaluation, financiado por la Agencia de los Estados Unidos para el Desarrollo Internacional (USAID) y el Plan de Emergencia del Presidente de los Estados Unidos para el Alivio del SIDA (PEPFAR), desarrollaron PLACE como un enfoque a la asignación programática. Más de 20 países han utilizado la herramienta para informar acerca de sus programas de prevención del VIH, muchos de los cuales también se han utilizado para calcular el tamaño de las poblaciones clave (Weir, et al., 2005). Para la extrapolación, los modelos de la República Dominicana contaron con los datos provenientes de encuestas nacionales, tales como la Encuesta Demográfica y de Salud del 2013 (Centro de Estudios Sociales y Demográficos [CESDEM] y ICF International, 2014) y el censo del 2010 (Oficina Nacional de Estadística, 2016).
Los resultados obtenidos del modelo y los datos de PLACE son similares a los que se hacen referencia en el Plan Estratégico Nacional para la Respuesta a las ITS y el VIH/SIDA (PEN), 2015-2018 (Ministerio de Salud Pública y el Consejo Nacional para el VIH y el SIDA [CONAVIHSIDA], 2014) en cuanto a las TRSX (91.171) y Trans (3.900). Sin embargo, se estimó que el número de HSH fue mayor en ese documento (124.472) en comparación con los que resultaron del modelo de regresión. Cabe señalar que las cifras del PEN se basaron en un método diferente de estimación para cada población, y que esos métodos no se beneficiaron de los datos de una muestra representativa desde el punto de vista geográfico.
Las estimaciones relativas al número de TRSX, HSH y Trans calculadas utilizando un método sistemático ya están disponibles para las partes interesadas directas que trabajan en el VIH en la República Dominicana para informar acerca del establecimiento de objetivos de programas de prevención para un número de personas que pertenecen a las poblaciones clave alcanzadas. Ver Tabla 4 en la sección "Resultados" de este informe para obtener la lista completa. |
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Measuring Process Improvements Supported by mHealth Initiatives
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MEASURE Evaluation SIFSA |
2016 |
English |
Global, Africa, SOUTH AFRICA |
MHealth, South Africa, Intervention |
The South African mHealth Strategy 2015–2019 defines mobile health—or mHealth—as the use of mobile computing, medical sensors, or other communication technology in the delivery of health-related services. mHealth has the potential to empower patients with information to inform their healthcare decisions and link them to health services.
As with a traditional healthcare initiative, measuring the efficacy of an mHealth intervention is critical to understanding the impact on outcomes and processes that such interventions bring. While there has been criticism over the lack of evidence to support investment in mHealth, the focus on providing rigorous evidence via randomized controlled trials or other intensive evaluation methods may lead to simpler and less cost-intensive methods being ignored.
An alternative to randomized controlled trials and other, similar resource-intensive methods is the performance measurement approach. This approach uses the regular collection and analysis of data to assess improvements in performance and quality of care. This brief provides an overview of the different types of performance measurements, along with tools and resources for implementing improvement studies. |
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Improving Quality of Malaria Data in Mali Supports Better Decision Making in the Health Sector
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MEASURE Evaluation |
2016 |
English |
MALI, Africa, West Africa |
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Since the introduction of the Routine Malaria Information System (MRIS) in 2011, Mali’s National Malaria Control Program (NMCP) has not been able to adequately support the platform. Factors including limited funding—and insufficient staff training, equipment, and internet connectivity—have led to a lack of timely data reporting in several regions, limiting the program’s ability to target services most effectively.
In Mali, the Planning and Statistics Unit (Cellule de Planification et de la Statistique) of the Ministry of Health is preparing for nationwide rollout of DHIS 2. This ambitious effort, conducted with support from MEASURE Evaluation, includes the customization of malaria indicators and the integration of the MRIS database into the DHIS 2 platform. The issue of the quality of data in the MRIS is therefore now more urgent.
Data that will be migrated into and collected by the newly integrated DHIS 2 platform need to be high quality for use to inform programmatic and policy decisions. Because the NMCP had previously assessed data quality using tools not specifically designed to measure all aspects of data quality—including accuracy and consistency—it requested MEASURE Evaluation’s assistance. |
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Contextual factors affecting health information system strengthening
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Thomas JC |
2016 |
English |
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Health System, Data Quality, Health Systems Strengthening, Health Information Systems |
At the turn of the century, several major efforts were initiated to combat HIV/AIDS and other major epidemics affecting low- and middle-income countries (LMICs). They were accompanied by initiatives to enable recipient countries to collect and use data to guide their public health programmes. These health information systems (HIS) typify systems in that they have multiple interacting components, and they are embedded within larger systems. Components of a larger system act as the context for all lower-level systems. Their effects can be pervasive, and thus be taken for granted or regarded as unchangeable. We identify four contextual factors that affect efforts to strengthen HIS: hierarchical roles, aid funding, corruption, and competing priorities. We provide examples of each as experienced by those working to strengthen HIS in LMICs. Each of these contextual factors can seriously diminish the effectiveness of HIS strengthening efforts and their long-term sustainability. We propose research questions about each that would enable those engaged in HIS strengthening to work effectively and sustainably. |
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Home-Based Care (HBC) Needs Assessment among U.S. Government-Supported Areas in Tanzania
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Cannon M, Charyeva Z, Mahunga P, Lwezaura S |
2016 |
English |
Africa, TANZANIA, East Africa |
HIV care, HIV/AIDS, HIV, Tanzania |
To address the HIV epidemic and meet the needs of people living with HIV and AIDS (PLHIV), Tanzania’s Ministry of Health and Social Welfare—which, since October 2015, has been called the Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC)—adopted home-based care (HBC) as a component of the continuum of care promoted by the World Health Organization (WHO) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR).
This study seeks to obtain a better understanding of how best to deliver HBC services in the context of changing client needs, as effective and accessible treatment is transforming HIV from a terminal to a chronic condition. MEASURE Evaluation, funded by the United States Agency for International Development (USAID) and PEPFAR, conducted a survey of PLHIV to assess the condition of HBC clients living with HIV and determine needs for and satisfaction with HBC services among those clients. This study took place in five regions of Tanzania between May and August 2015. Study findings can be used to help ensure effective service delivery to better meet the changing HBC client population and to show decision makers how to improve HBC policy and operational guidelines. In particular, findings from this study could be integrated in MOHCDGEC training on HBC guidelines and implementing partner HBC operating guidelines. |
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Evaluating Structural Interventions – Guidance for HIV prevention programs
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Hart L, Iskarpatyoti BS, Mandal M, Thomas JC |
2016 |
English |
Global |
Evaluation, HIV/AIDS, HIV |
Structural interventions aim to improve health outcomes by altering the social, economic, and legal-political environment in which health processes and outcomes are embedded (Blankenship, et al., 2006; Parkhurst, 2013). By targeting structural factors such as poverty and education, structural interventions aim to influence the underlying context of HIV risk (Blankenship, et al., 2006). Investment in structural interventions and their evaluations has lagged behind that in behavioral and biomedical interventions for HIV prevention. Additionally, methodological challenges in evaluating structural interventions have contributed to the relative dearth of evidence about their effectiveness (Gupta, et al., 2008; Heise & Watts, 2013). In addition to showing that a structural intervention works in a particular context, it is important to provide evidence for why, under what circumstances, for whom, and at what cost the intervention is effective (Heise & Watts, 2013).
The process of evaluating structural interventions is much the same as that of evaluating other interventions. However, in this guidance we highlight strategies and considerations that are uniquely important in the former.
Although numerous challenges exist in evaluating structural interventions, current evidence indicates their promise for HIV prevention. By planning for evaluations early, working with stakeholders, determining a theory of change, carefully selecting research questions, and selecting the most appropriate research design, those in the HIV-prevention field can continue to determine which interventions are most effective. |
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Sampling and Evaluation – A Guide to Sampling for Program Impact Evaluation
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Lance P, Hattori A |
2016 |
English |
Global |
Impact Evaluation, Evaluation, Sampling |
Program evaluation, or impact evaluation, is a way to get an accurate understanding of the extent to which a health program causes changes in the outcomes it aims to improve. Program impact studies are designed to tell us the extent to which a population's exposure to or participation in a program altered an outcome, compared to what would have happened in the absence of the program. Understanding whether a program produces intended changes allows society to focus scarce resources on those programs that most efficiently and effectively improve people's welfare and health.
The usual objective in program impact evaluation is to learn about how a population of interest is affected by the program. Programs are typically implemented in geographic areas where populations are large and beyond our resources to observe in their entirety. Therefore, we have to sample. Sampling is the process of selecting a set of observations from a population to estimate a chosen parameter—program impact, for example—for that population.
This manual explores the challenges of sampling for program impact evaluations—how to obtain a sample that is reliable for estimating impact of a program and how to obtain a sample that accurately reflects the population of interest.
The manual is divided into two sections: (1) basic sample selection and weighting and (2) sample size estimation. We anticipate that readers might get the most utility and comprehensive understanding from reading entire chapters rather than trying to cherry-pick portions of the discussions within them, as one might with a reference manual. This manual is more like a textbook.
Further, the manual is aimed at practitioners—in particular, those who design and implement samples for impact evaluation at their institution. Our discussions assume more than a basic understanding of sampling and some mathematical skill in applying sampling theory. That said, we are less interested in theory than in its practical application to solve sampling problems encountered in the field. We hope this manual will be a comprehensive and practical resource for that task. |
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What systems are essential to achieving the sustainable development goals and what will it take to marshal them?
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Thomas J, Silvestre E, Salentine S, Reynolds H, Smith J |
2016 |
English |
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Health Systems Strengthening, Health System, Sustainable Development Goals, Health Information Systems |
The sustainable development goal (SDG) for health is linked to 67 indicators, eight times more than its predecessor, the Millenium Development Goals. In many low- and middle-income countries (LMICs), the information infrastructure is not yet able to collect and use the data needed for the indicators. As they seek to be responsive to the SDG agenda, LMICs must not lose sight of their local data needs; they should be cautious about embracing untested electronic technologies for data collection, analysis, and use; carefully balance the care provision and data collection responsibilities of care providers; and use evidence of what works in strengthening their health information systems (HIS). While attending to these concerns, countries can look for instances in which SDG indicators are in sync with their own HIS goals. |
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Data Science for Global Health
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Lance P, Spencer J, Janko M |
2016 |
English |
Global |
Global health, Data Science, Data |
Ours is an age of explosive growth in data. Traditional data sources are ever deeper and richer with each passing day. Even more rapidly, new sources of powerful data are emerging. The result is a stunning, exponentially growing torrent of data from every corner of the globe and about nearly every dimension of human life and activity.
This offers challenges and opportunities for society in general and for global health professionals in particular. The increasing amount of data can lead to more insight, better policy and programs, and improvements in people’s lives. However, data can also create noise and confusion if it isn’t used effectively.
In short, data science is a production process, and its central challenge is to integrate the functions just described. Much as the practice of data science often involves merging disparate data sources into a whole far more powerful than the sum of its parts, the process of data science intrinsically involves coordinating the identification of information needs, data exploration, analysis, and the communication of data products so that these activities are far more productive and effective than they could be on their own.
This whitepaper introduces global health professionals to data science. Data science is a production process for generating actionable information. It helps us find, understand, and communicate knowledge hidden in the growing data deluge. In global health, successful data science efforts can extract value from data that might otherwise go unused, and use it to inform policy and support programmatic decision making. |
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The association between household bed net ownership and all-cause child mortality in Madagascar
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Meekers D, Yukich JO |
2016 |
English |
MADAGASCAR |
Child Health, Child Mortality, Malaria, Madagascar |
BackgroundMalaria continues to be an important cause of morbidity and mortality in Madagascar. It has been estimated that the malaria burden costs Madagascar over $52 million annually in terms of treatment costs, lost productivity and prevention expenses. One of the key malaria prevention strategies of the Government of Madagascar consists of large-scale mass distribution campaigns of long-lasting insecticide-treated bed nets (LLIN). Although there is ample evidence that child mortality has decreased in Madagascar, it is unclear whether increases in LLIN ownership have contributed to this decline. This study analyses multiple recent cross-sectional survey data sets to examine the association between household bed net ownership and all-cause child mortality.
ResultsData on household-level bed net ownership confirm that the percentage of households that own one or more bed nets increased substantially following the 2009 and 2010 mass LLIN distribution campaigns. Additionally, all-cause child mortality in Madagascar has declined during the period 2008–2013. Bed net ownership was associated with a 22% reduction in the all-cause child mortality hazard in Madagascar.
ConclusionsMass bed net distributions contributed strongly to the overall decline in child mortality in Madagascar during the period 2008–2013. However, the decline was not solely attributable to increases in bed net coverage, and nets alone were not able to eliminate most of the child mortality hazard across the island.
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Using Survey Data to Identify Opportunities to Reach Women with an Unmet Need for Family Planning: The Example of Madagascar
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Meekers D, Ratovonanahar R, Andrianantoandro T, Randrianarisoa H |
2016 |
English |
MADAGASCAR |
Maternal Health, Family Planning, Fertility, Madagascar |
In several African countries fertility levels have stagnated or increased slightly. However, many women still report an unmet need for family planning. Therefore achieving further fertility declines requires programs that increase demand for family planning, but that also address the existing unmet need. One way to improve contraceptive access in a cost-effective manner might be to integrate family planning services into other existing health services.
This paper analyzes secondary data from the 2012–2013 Millennium Development Goals (MDG) survey in Madagascar to estimate the number of women with an unmet need for family planning that might benefit from integrating family planning services into other health services. In Madagascar, one third of the demand for family planning is not met; an estimated 820,000 women have an unmet need for family planning. A substantial portion of these women can be reached by integrating family planning services into existing maternal and child health services. Health providers are uniquely positioned to help address method-related reasons for non-use of family planning, such as concerns about health problems and side-effects. Given the large unmet need for family planning, programs should not exclusively focus on increasing the demand for family planning, but also seek new ways to address the existing unmet need.
Our study illustrates that simple analyses of existing health survey data can be an important tool for informing the design of programs to tackle this unmet need. |
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Service readiness, health facility management practices, and delivery care utilization in five states of Nigeria: a cross-sectional analysis
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Gage AJ, Ilombu O, Akinyemi AI |
2016 |
English |
NIGERIA |
Nigeria, Maternal Health, Pregnancy, Health Facilities |
BackgroundExisting studies of delivery care in Nigeria have identified socioeconomic and cultural factors as the primary determinants of health facility delivery. However, no study has investigated the association between supply-side factors and health facility delivery. Our study analyzed the role of supply-side factors, particularly health facility readiness and management practices for provision of quality maternal health services.
MethodsUsing linked data from the 2005 and 2009 health facility and household surveys in the five states in which the Community Participation for Action in the Social Sector (COMPASS) project was implemented, indices of health service readiness and management were developed based on World Health Organization guidelines. Multilevel logistic regression models were run to determine the association between these indices and health facility delivery among 2710 women aged 15–49 years whose last child was born within the five years preceding the surveys and who lived in 51 COMPASS LGAs.
ResultsThe health facility delivery rate increased from 25.4% in 2005 to 44.1% in 2009. Basic amenities for antenatal care provision, readiness to deliver basic emergency obstetric and newborn care, and management practices supportive of quality maternal health services were suboptimal in health facilities surveyed and did not change significantly between 2005 and 2009. The LGA mean index of basic amenities for antenatal care provision was more positively associated with the odds of health facility delivery in 2009 than in 2005, and in rural than in urban areas. The LGA mean index of management practices was associated with significantly lower odds of health facility delivery in rural than in urban areas. The LGA mean index of facility readiness to deliver basic emergency obstetric and neonatal care declined slightly from 5.16 in 2005 to 3.98 in 2009 and was unrelated to the odds of health facility delivery.
ConclusionSupply-side factors appeared to play a role in health facility delivery after controlling for socio-demographic factors. Improving uptake of delivery care would require greater attention to rural–urban inequities and health facility management practices, and to increasing the number of health facilities with fundamental elements for delivery of basic emergency obstetric and neonatal care.
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mHealth for Health Information Systems in Low- and Middle-Income Countries – Challenges and Opportunities in Data Quality, Privacy, and Security
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Wambugu S, Villella C |
2016 |
English |
Africa, KENYA, TANZANIA, Global |
Data Quality, Health Information Systems, MHealth, Data, LMICs |
Governments, nongovernmental organizations (NGOs), and international development organizations are working to improve health outcomes through better national health systems. One of the six building blocks for strong national health systems is the use of health information systems (HIS), according to the World Health Organization. A well-functioning HIS provides timely and relevant information about health outcomes and performance of the components of the health system (WHO, 2007). Governments and organizations working in low- and middle-income countries (LMICs) are seeking ways to improve health-related information and communication technologies (ICTs) to improve data availability and accessibility (Sanner, Roland, & Braa, 2012). Moreover, tools and systems that can help healthcare workers become more efficient and effective are especially crucial in LMICs facing health personnel shortages (Agarwal, Perry, Long, & Labrique, 2015).
For mHealth to assume a fully integrated role in healthcare, it must be provided in a way that gives patients and providers confidence that patient privacy will be protected and the confidentiality and security of patient information will be assured. Data need to be credible and consistent, and collected and stored securely in a trusted electronic health record with managed access for patients, caregivers, and healthcare professionals (Kumar & Wambugu, 2015).
MEASURE Evaluation undertook this assessment to study how mobile phone user behavior among health workers in LMICs may affect data quality, including data privacy, security, and confidentiality. Through this assessment, the research team also learned that technical issues associated with mobile technology can affect data quality and security. We documented emerging best practices and challenges, studied reports in available peer-reviewed journals and gray literature, and gathered insights through interviews and consultations in two countries: Kenya and Tanzania. |
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Types of Evaluations Conducted by MEASURE Evaluation
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MEASURE Evaluation |
2016 |
English |
Global |
Health System, Evaluation |
MEASURE Evaluation has extensive experience conducting rigorous evaluations. Our work supports health systems, health systems interventions, and programs that address issues of family planning and reproductive health; HIV and AIDS; maternal, neonatal, and child health; malaria;and tuberculosis—all of which are part of the portfolio of the Bureau of Global Health of the United States Agency for International Development (USAID). The purpose of the evaluations we conduct is to provide evidence of how and why interventions are or are not working in practice, to further progress in USAID’s key focus areas of ending preventable child and maternal deaths (EPCMD), achieving an AIDS-free generation, strengthening health systems, and preventing and combatting infectious diseases.
MEASURE Evaluation supports the international development goal of maximizing program results, by systematically collecting and analyzing information about and evidence on health program performance and impact. Evaluation findings provide accountability to stakeholders and donors and inform decisions— supporting organizational learning, strengthening health systems, and improving program effectiveness, so that people live healthier lives. |
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Routine Health Information Systems
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MEASURE Evaluation |
2016 |
English |
Global |
Health Information Systems, RHIS, HIS, Routine Health Information Systems |
Over the past decades, knowledge and understanding have grown regarding the role that health information systems play in improving global health. Even so, using data to make evidence-informed decisions is still weak in most low- and middle-income countries. This is particularly true for data produced by routine health information systems (RHIS).
MEASURE Evaluation, funded by the U.S. Agency for International Development (USAID), has provided technical and financial assistance for RHIS strengthening for more than 15 years. We have contributed to best practices at the global level, and to the strengthening of RHIS data collection, quality, analysis, and use at the country level. One of the project’s mandates is to strengthen the collection, analysis, and use of these data to achieve high-quality health service delivery.
Our main strategic approaches for strengthening RHIS focus on developing and reinforcing a country’s long-term planning for an integrated HIS, including all data sources, health metrics, and tools. We are also helping to create district-managed and denominator-based RHIS at subnational levels. |
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Criteria for Successful Integration of Community Health and Social Service Data in DHIS 2
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MEASURE Evaluation |
2016 |
English |
Global, Africa |
Data, Health Information Systems, HIS, DHIS 2 |
Governments depend on information about the health and social service needs of their population to enable effective policymaking and resource allocation. Most governments have established a health information system (HIS) to track critical health indicators, and these data are often captured in the district health information system software known as DHIS 2. However, the nationally adopted health management information system (HMIS) platforms, such as DHIS, are not often linked to the data systems used by social and community services, where people often access care. As a result, the systems are fragmented and unable to provide holistic information for decision making on health and social services.
In many countries, parallel nonhealth information systems for social and community services are being scaled up. This process is typically driven by various funding priorities and reporting requirements. With this proliferation of systems comes the risk that community health workers will duplicate the efforts of facility health workers. This can lead to double-counting individuals within the system. The solution might seem to be to integrate disparate systems, but this, too, poses challenges. Information flow may not be the same in social services and health sectors, because ministries often have different national and subnational structures and their own ways and frequency of collecting and reporting data. Data definitions may not align, collection tools may not be standardized, and technology may not be compatible across sectors. Data management is also likely to differ, and as a result data quality standards and data reporting frequency may not be compatible.
DHIS 2 has its origins in the health sector, but it is becoming a routine aggregated data management system of choice in other ¹ The University of Oslo developed DHIS 2 as a routine HIS platform for global use. DHIS 2 is a free and open-source health management information system used to manage, analyze and report health facility-level aggregated data. It is currently being deployed in more than 47 countries across four continents. Recent DHIS 2 applications are being used both for community-level health data and social service data, for example. This presents an opportunity to examine criteria that could support the integration of community health and social service data in DHIS 2. Doing so could reduce the number, burden, and expense of parallel systems in countries, opening the door to a comprehensive health and social service information system. |
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Monitoring the Integration of Family Planning and HIV Services: A Manual to Support the Use of Indicators to Measure Progress toward PEPFAR’s 90-90-90 Targets and Protect Women’s Reproductive Rights
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Freyder M, Craig L, Kaji A |
2016 |
English |
Africa, Global |
Family Planning, HIV/AIDS, HIV, Reproductive Health |
This manual was developed for the family planning (FP) and HIV programs of the United States Agency for International Development (USAID), by the USAID-funded MEASURE Evaluation. We recommend that all USAID missions use additional indicators to track FP/HIV service delivery and client-focused outcomes; examples of such additional indicators appear below in this manual. These indicators have been developed and adapted to help program managers and service delivery providers track information on FP outcomes in HIV service delivery settings. United States Government (USG) programs will use the PEPFAR indicator to demonstrate the scope of FP/HIV integration in their programming. The other indicators will help illustrate the outcomes of the integration.
Women of reproductive age are simultaneously at risk both for HIV and unwanted pregnancy, particularly in sub-Saharan Africa. There, women living with HIV (WLHIV) and women at risk for HIV—especially adolescent girls and young women, sex workers, and female injecting drug users—also face high unmet need for FP. The integration of FP and HIV services is a strategy that is increasingly used to meet the contraceptive needs of HIV-positive women and couples. A new collaborative vision of PEPFAR and USAID seeks to ensure that women living with HIV and women at high risk for HIV have access to a full range of contraceptive options and to safe conception and safe pregnancy counseling.
See a related brief. |
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Monitoring the Integration of Family Planning and HIV Services: Indicators Both to Measure Progress toward the 90-90-90 Targets and Ensure the Reproductive Rights of All Women
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MEASURE Evaluation |
2016 |
English |
Global, Africa |
Women, Family Planning, Reproductive Health, HIV, HIV/AIDS |
The HIV epidemic disproportionately affects women of reproductive age, especially in sub-Saharan Africa, where nearly 60 percent of people living with HIV are women. In support of the global 90-90-90 targets, the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommends reducing the number of unintended pregnancies among women living with HIV (WLHIV). Voluntary family planning (FP) services not only would reduce the number of children acquiring HIV but also reduce the risk for pregnancy-related complications and improve the health of WLHIV, by giving these women the means to space pregnancies (Joint United Nations Programme on HIV/AIDS [UNAIDS], 2014a; UNAIDS, 2014b). Improving the overall health of a woman will help her remain on HIV treatment and achieve viral suppression.
This brief, developed by the USAID-funded MEASURE Evaluation, outlines key elements of FP and HIV service integration as well as common challenges that limit their effectiveness. It is particularly useful to program managers and to technical and monitoring and evaluation (M&E) officers who are interested in determining whether integrated voluntary FP services being offered at HIV service delivery points (SDPs) are achieving their intended goals. The brief is a companion to a manual on this topic that MEASURE Evaluation also developed: Monitoring the Integration of Family Planning and HIV Services: A Manual to Support the Use of Indicators to Measure Progress toward PEPFAR’s 90-90-90 Targets and Protect Women’s Reproductive Rights (Freyder, Craig, & Kaji, 2016). The manual presents a set of indicators for monitoring the scope and outcomes of FP and HIV service integration. It is intended for use by USAID missions, but program managers elsewhere can benefit from it, as well. |
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Botswana PEPFAR Gender Analysis
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Ramatala I, Bloom S, Machao G |
2016 |
English |
Southern Africa, BOTSWANA, Africa |
Gender, HIV, Botswana, PEPFAR, GBV |
In 2014, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) required that all country teams conduct a gender analysis (GA) of their respective HIV epidemics and country responses. The aim of the GA was to identify gender-related factors in current programming that pose barriers to preventing new HIV infections, accessing testing services, starting antiretroviral therapy (ART), and adhering to treatment protocols. Therefore, undertaking gender analyses to identify gender-related factors and barriers in countries has been recognized as critical to controlling the epidemic. The GA process mandated by PEPFAR in each of its funded countries was to yield a set of pragmatic recommendations that could be employed to strengthen the PEPFAR response in countries. In this way, the gender analyses will help facilitate the achievement of the 2020 global goal of the 90-90-90: 90 percent of people living with HIV knowing their status, 90 percent of people diagnosed with HIV will receive sustained ART, and 90 percent of people being treated will have viral suppression.
It has long been recognized that gender inequality exacerbates a range of negative health outcomes in varying contexts around the world. More recently, gender inequalities, and gender-based violence (GBV) in particular, have been recognized as major drivers of the HIV epidemic worldwide. The gender staff of the Botswana USAID Mission requested that MEASURE Evaluation collaborate with them on the PEPFAR GA. |
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Bangladesh Nongovernmental Organization Health Service Delivery Project 2014 Baseline Urban Survey Report
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MEASURE Evaluation |
2016 |
English |
BANGLADESH |
Bangladesh, Service delivery, Health Services |
The United States Agency for International Development (USAID)/Bangladesh requires an external impact evaluation of the “Nongovernmental (NGO) Health Service Delivery Project” (NHSDP) program that was awarded to Pathfinder International in December 2012. The impact evaluation will use a difference-in-difference (DID) strategy to determine program impact. This design requires collecting baseline and endline data in program intervention areas and similar comparison areas, which serve as the counterfactual for the impact evaluation. The main objective of the 2014 NHSDP baseline survey was to measure USAID performance indicators related to health and family planning that the program seeks to improve in program intervention areas and in similar comparison areas (where NHSDP is not in operation). The survey provides baseline characteristics for assessing the program’s performance at the population level. Additionally, the survey collected information on individual, household, and neighborhood-level characteristics associated with health outcomes and health behaviors. |
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Bangladesh Nongovernmental Organization Health Service Delivery Project 2014 Baseline Rural Survey Report
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MEASURE Evaluation |
2016 |
English |
BANGLADESH |
Bangladesh, Health Services |
The United States Agency for International Development (USAID)/Bangladesh requires an external impact evaluation of the “Nongovernmental Organization (NGO) Health Service Delivery Project” (NHSDP) program that was awarded to Pathfinder International in December 2012. The impact evaluation will use a difference-in-difference (DID) strategy to determine program impact. This design requires collecting baseline and endline data in program intervention areas and similar comparison areas, which serve as the counterfactual for the impact evaluation. The main objective of 2014 NHSDP baseline survey was to measure USAID performance indicators related to health and family planning that the program seeks to improve in program intervention areas and in similar comparison areas (where NHSDP is not in operation). The survey provides baseline characteristics for assessing the program’s performance at the population level. Additionally, the survey collected information on individual, household, and neighborhood-level characteristics associated with health outcomes and health behaviors. |
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Ending Preventable Child and Maternal Deaths
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MEASURE Evaluation |
2016 |
English |
Global |
Maternal Health, Child Health, Maternal Mortality, EPCMD, Child Mortality |
The U.S. Agency for International Development (USAID) focuses its global health efforts on delivering meaningful results in three key areas: ending preventable child and maternal deaths (EPCMD), creating an AIDS-free generation, and protecting communities from infectious diseases. Work on all of these goals contributes to EPCMD.
MEASURE Evaluation’s work on EPCMD is chiefly at the level of the national health system. Ending preventable child and maternal deaths requires improved health services, especially for the most vulnerable and marginalized within a society. MEASURE Evaluation supports health systems, by helping governments collect and analyze data that reveal gaps for maternal and child survival services and supports responsiveness to those needs. We conduct evaluations of services and programs to see what is working. We advocate sound policies on maternal and newborn care to avert preventable deaths. We help countries strengthen their health information systems so that decisions are evidence-informed. |
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Global Evaluation and Monitoring Network for Health (GEMNet-Health) Scope of Evaluation Activities
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MEASURE Evaluation |
2016 |
English |
Global |
Capacity Building, GEMNet-Health |
The purpose of GEMNet-Health is to foster organizational growth, collaboration, and peer-to-peer support for monitoring and evaluation (M&E) of health programs globally through ongoing and future institutional linkages among members, beginning with a core of MEASURE Evaluation’s current and former training partners. The aim is for GEMNet-Health to serve as a stable, sustainable, and independent global network for M&E training, technical assistance, and research.
This factsheet provides an overview of GEMNet-Health's evaluation activities. |
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Supporting the Rollout of Longitudinal Management Information Systems for Programs Serving Orphans and Vulnerable Children
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MEASURE Evaluation PIMA |
2016 |
English |
KENYA |
MEASURE Evaluation PIMA, HIV, PEPFAR, HIV/AIDS, Orphans and Vulnerable Children |
Programs for orphans and vulnerable children (OVC) aim to mitigate the impact of HIV and AIDS on children, adolescents, and their families through organizations that assess and provide services.
Data are crucial for planning and decision making and to ensure that OVC programs provide targeted support. U.S. Government (USG)-funded OVC programs collect and assess data on services delivered to individual cases over time. These data used to be collected by community health volunteers, who often relied on memory and who manually recorded OVC case data in exercise books. This process resulted in the loss of critical information and led to the production of delayed or inaccurate reports, which made it difficult to provide targeted services and assess their performance.
To address this challenge, MEASURE Evaluation PIMA (MEval-PIMA)—funded by the United States Agency for International Development (USAID) and the President’s Emergency Plan for AIDS Relief (PEPFAR)—was tasked to support the rollout of an electronic OVC longitudinal management information system (OLMIS). OLMIS helps USG-funded OVC programs to capture, report on, and track accurate data and, subsequently, to use the data for decision making. |
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Challenges and Promising Solutions for Improving the Use of Geospatial Data for PEPFAR Decision Making
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John Spencer and Becky Wilkes |
2016 |
English |
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HIV/AIDS, GIS, PEPFAR, Geospatial analysis, Geographic Information Systems |
To promote and improve the use of geospatial data by the U.S. President’s Emergency Plan for AIDS Relief (PEFPAR) implementing partners, MEASURE Evaluation—funded by the United States Agency for International Development (USAID) and PEPFAR—convened a meeting of the Geographic Information Systems (GIS) Working Group in Washington, DC, on June 23, 2016. The group has been meeting at least annually since the year 2000, giving GIS specialists and users a regular opportunity to share their experiences with spatial data and platforms, and to keep up to date on recent developments in GIS technology and its uses for global public health. Over the years, several springboard discussions from these meetings have resulted in publications and have also led to further collaborative work within the project.
This report provides a detailed account of the workshop proceedings. |
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How MEASURE Evaluation Supports DREAMS
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MEASURE Evaluation |
2016 |
English |
Global |
HIV/AIDS, PEPFAR, HIV, AIDS, DREAMS |
In partnership with numerous private donors, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) launched DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) in 2015. This initiative is designed to reduce HIV incidence in adolescent girls and young women in 10 sub-Saharan African countries by 25 percent by the end of 2016 and by 40 percent by the end of 2017.
DREAMS is delivering a core package of evidence-informed HIV prevention interventions to benefit girls and young women who are HIV-negative but who live in regions of high HIV prevalence in the 10 target countries. With support from PEPFAR, MEASURE Evaluation is conducting research to inform DREAMS programming, as well as the monitoring and evaluation (M&E) of DREAMS programs in Swaziland, Mozambique, and South Africa—all to help achieve the global health goal of an AIDS-free generation.
MEASURE Evaluation provides critical data for program managers and decision makers to effectively design and target their programs and to make program course corrections in order to better reach PEPFAR’s test, treat, and retain goals. These include:
Rapid assessments to monitor and improve HIV prevention program coverage in high-risk areas, using the PLACE and other venue-based research methods.
Male sexual partner characterization studies.
Process, outcome, and impact evaluations focused on adolescents and gender.
Analyses of data drawn from multiple sources to contribute to the M&E of youth-focused programs.
Development and selection of indicators to measure the implementation, progress, and impact of DREAMS.
Youth-focused and gender-sensitive desk reviews.
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The Mayer Hashi Large-Scale Program to Increase Use of Long-Acting Reversible Contraceptives and Permanent Methods in Bangladesh: Explaining the Disappointing Results. An Outcome and Process Evaluation
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Rahman M, Haider MM, Curtis SL, Lance PM |
2016 |
English |
BANGLADESH |
Evaluation, Bangladesh, Contraception, Family Planning |
Background: Bangladesh has achieved a low total fertility rate of 2.3. Two-thirds of currently married women of reproductive age (CMWRA) want to limit fertility, and many women achieve their desired fertility before age 30. The incidence of unintended pregnancy and pregnancy termination is high, however. Long-acting reversible contraceptives (LARCs), consisting of the intrauterine device and implant, and permanent methods (PM), including female sterilization and vasectomy, offer several advantages in this situation, but only 8% of CMWRA or 13% of method users use these methods.
Program: The Mayer Hashi (MH) program (2009–2013) aimed to improve access to and the quality of LARC/PM services in 21 of the 64 districts in Bangladesh. It was grounded in the SEED (supply–enabling environment–demand) Programming Model. Supply improvements addressed provider knowledge and skills, system strengthening, and logistics. Creating an enabling environment involved holding workshops with local and community leaders, including religious leaders, to encourage them to help promote demand for LARCs and PMs and overcome cultural barriers. Demand promotion encompassed training of providers in counseling, distribution of behavior change communication materials in the community and in facilities, and community mobilization.
Methods: We selected 6 MH program districts and 3 nonprogram districts to evaluate the program. We used a before–after and intervention–comparison design to measure the changes in key contraceptive behavior outcomes, and we used a difference-in-differences (DID) specification with comparison to the nonprogram districts to capture the impact of the program. In addition to the outcome evaluation, we considered intermediate indicators that measured the processes through which the interventions were expected to affect the use of LARCs and PMs.
Results: The use of LARCs/PMs among CMWRA increased between 2010 and 2013 in both program (from 5.3% to 7.5%) and nonprogram (from 5.0% to 8.9%) districts, but the rate of change was higher in the nonprogram districts. Client–provider interaction and exposure to LARCs/PMs were lower in the program than nonprogram districts, and the MH program districts had higher vacancies of key providers than the nonprogram areas, both indications of a more difficult health system environment.
Conclusion: The weaknesses in the health system in the MH districts apparently undermined the effectiveness of the program. More attention to system weaknesses, such as additional supportive supervision for providers, might have improved the outcome.
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Planning Guide for a Total Market Approach to Increase Access to Family Planning – Module 2: In-depth Analyses of the Family Planning Market
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Meekers D, Haynes S, Kampa K |
2016 |
English |
Global |
Family Planning, Total market approach |
The objective of a total market approach (TMA) for family planning is to increase use of family planning products and services by means of a rational and efficiently segmented market in which key groups have access to a full range of family planning products and services (USAID, n.d.). TMA may also help reduce dependence on public funding. TMA requires a coordinated approach in which family planning suppliers and donors from the three sectors—the public, nongovernmental organization (NGO), and commercial sectors—work together and use their comparative advantage to grow the total market (Brady, Wedeen, Hutchings, & Parks, 2016; Pollard, 2007). Because coordination between the sectors is an important element of TMA, it is more likely to succeed when a specific entity takes responsibility for stewarding this coordination. Ideally, the government will take on this role (Brady, et al., 2016).
A landscaping exercise is recommended to assess the levels of interest of the government, donors, and key stakeholders from the other sectors to pursue TMA programming (Brady et al., 2016). If they decide to move forward, the government and its partners should make TMA decisions that are based on a thorough analysis of data about aspects of the family planning market, which may include consumer use and preferences, their willingness and ability to pay for products and services, and data about trends in the family planning market itself.
This requires an in-depth analysis of the family planning market. Such an analysis should build on the desk review of the literature and the stakeholder analysis conducted during the TMA landscaping exercise, by incorporating additional data or conducting new analyses of data.
This document reviews the issues involved in in-depth analyses of the family planning market that can be used to inform the development of a TMA.
Access MEASURE Evaluation's related TMA resources:
Handbook for Research on the Family Planning Market Volume 1
Handbook for Research on the Family Planning Market Volume 2
Planning Guide - Module 1
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Veiller à la prise en compte du genre
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MEASURE Evaluation |
2016 |
French |
Global |
Gender |
Un leader dans le domaine du suivi-évaluation (S&E) sensible aux questions de genre, MEASURE Evaluation renforce les capacités des personnes et des organisations de collecter, analyser, et utiliser des informations sanitaires liées au genre afin d’améliorer la prise de décisions programmatiques et politiques aux niveaux local, national, et mondial.
MEASURE Evaluation apporte également une expertise et des compétences dans les domaines suivants :
La spécification, conception, et élaboration SIS pour les données sur les programmes contre
la VBG et d’autres programmes qui intègrent les considérations du genre
La sélection et élaboration des indicateurs sensibles à la dimension du genre afin de mesurer la mise en oeuvre, les progrès, et les impacts des programmes
La conception des plans de S&E et des outils de collecte de données sensibles à la dimension du genre, ainsi que des stratégies de S&E et les outils connexes pour l’intensification des programmes qui intègrent les considérations du genre
De nouveaux outils et ressources pour le S&E sensible à la dimension du genre et l’utilisation des données connexes
Des méthodes, normes, et lignes directrices d’assurance qualité pour les données liées au genre
La réalisation d’évaluations de besoins en informations liées au genre
Des plans de dissémination et d’utilisation de données pour les informations liées au genre
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Participatory Development for a Sustainable Health Management Information System
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MEASURE Evaluation |
2016 |
English |
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Health Information Systems, HIS, Mali, Health Systems Strengthening, Data |
Information systems often fail, both in developed and developing countries. But in developing countries, the situation is made worse because the resources necessary to implement systems, the capacity to develop and maintain systems, and buy-in from stakeholders are often lacking. In Mali, even though stakeholders were successfully aligned from the outset of the process of implementing DHIS 2 as an integrated health management information system (HMIS), the following challenges still remained:
Developing a system to meet user needs, support their work practices, and still fit the context.
Avoiding a mismatch between work processes embedded in the system and real conditions on the ground.
Building local ownership to sustain the integrated HMIS and avoid it being perceived as belonging to one partner.
MEASURE Evaluation felt confident that introducing and customizing DHIS 2 as an integrated data warehouse would be an unprecedented opportunity to gradually bring about desirable changes. The project proposed strategies that helped harmonize reporting forms, build ownership and working solutions, and improve local capacity to maintain and evolve the system.
The project engaged multiple stakeholders with a range of technical expertise in the participatory design and implementation of capacity building. Training workshops have resulted in harmonized reporting tools and strengthened local expertise in DHIS 2. |
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Modèle de renforcement des systèmes d’information sanitaire de MEASURE Evaluation: Un résumé
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MEASURE Evaluation |
2016 |
French |
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Health Information Systems |
Le modèle de renforcement des systèmes d’information sanitaire (MRSIS) mis au point par MEASURE Evaluation présente les connaissances actuelles du projet et oriente notre travail, alors que nous continuons à découvrir commen les systèmes d’information sanitaire (SIS) des pays à revenus faibles et intermédiaires sont conçus, développés et mis en oeuvre au fil du temps pour appuyer les systèmes de santé et améliorer les résultats sanitaires. En approfondissant nos connaissances à l’aide d’études et de nos propres activités, nous détaillerons le modèle, en mettant l’accent sur les caractéristiques essentielles d’un SIS, les relations qui les unissent, et les influences externes d’un système. |
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Defining Quality of HIV Services for MSM and Transgender Women: Results of a Systematic Review
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Andrinopoulos K, Do M, Wares K, Scholl AD |
2016 |
English |
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Key Populations, HIV/AIDS, HIV, Health Services |
MEASURE Evaluation synthesized the current literature related to quality of HIV services for men who have sex with men (MSM) and transgender women, and proposed a simple, easy-to-use definition of and framework for quality. The report provides the health sector and policy makers a step toward a better understanding, operationalization, and assessment of the quality of HIV services for MSM and transgender women. It incorporates three dimensions of quality that can be operationalized at three different levels: provider, organization, and health system. It also takes into consideration the perspectives both of HIV providers and clients.
Based on the literature reviewed, the authors proposed the following definition of quality: Quality HIV services for MSM and transgender women are those that are based on scientific evidence of the appropriate package of services. They are delivered in a culturally and technically competent manner through efficient and effective linkages across a variety of service delivery models that ensure continuity of care (that is, facility-based, community-based, public, and private settings) and HIV service types (diagnosis, treatment, retention, and ancillary services supporting these). Quality services are voluntary, confidential, and timely. They are delivered in a stigma-free environment, by providers who are equipped to address HIV and other overlapping health problems and concerns of MSM and transgender women, and who understand the culture, values, and social challenges faced by these populations. |
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New MEASURE Evaluation Resources to Increase Access to Family Planning Through a Total Market Approach
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MEASURE Evaluation |
2016 |
English |
Global |
Family Planning, Total market approach |
An estimated 225 million women in developing countries want to delay or stop childbearing but are not using any contraceptive method. To expand the market in contraceptives and address this unmet need for family planning, effective coordination is needed among the three sectors that deliver contraceptive products and services in developing countries: the public sector, the nonprofit sector, and the commercial sector. Without that, the actions of one sector can undermine those of the other two, with the unintended consequence of limiting rather than expanding women’s access and choices.
A total market approach (TMA) to family planning gathers and uses data to strengthen collaboration among these sectors. Its ultimate goal is to create an efficiently segmented market that provides women access to a full range of family planning products and services.
MEASURE Evaluation, in collaboration with the Evidence Project (both funded by the U.S. Agency for International Development) and PATH, has developed resources to standardize how countries assess their need and readiness for a TMA. This factsheet provides an introduction to the resources.
Access the resources:
Handbook for Research on the Family Planning Market Volume 1
Handbook for Research on the Family Planning Market Volume 2
Planning Guide - Module 1
Planning Guide - Module 2
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Handbook for Research on the Family Planning Market Volume 2: Tool and Resources for an In-depth Analysis of the Family Planning Market
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Dominique Meekers, Sarah C. Haynes, Kathryn Kampa |
2016 |
English |
Global |
Family Planning, Total market approach |
To thoroughly plan for a total market approach for family planning, it is advisable to conduct an in-depth analysis of the family planning market. Volume 1 of this handbook covers key TMA indicators, data requirements and measurement issues for the key indicators, data sources, how to analyze patterns and trends in key indicators, measurement of government capacity to steward the TMA process, and approaches to advocate and disseminate findings from an in-depth analysis of the family planning market.
This second volume includes several tools and resources (such as computer syntax to calculate various wealth indices, model questionnaires, etc.) that can help facilitate such an in-depth analysis of the family planning market. The tools and resources are intended to be used in conjunction with the main body of the handbook (Volume 1).
A planning guide for a total market approach to increase access to family planning is also available.
Access MEASURE Evaluation's related TMA resources:
Handbook for Research on the Family Planning Market Volume 1
Planning Guide - Module 1
Planning Guide - Module 2
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Handbook for Research on the Family Planning Market Volume 1: Using Data to Inform a Total Market Approach to Family Planning
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Dominique Meekers, Sarah C. Haynes, Kathryn Kampa |
2016 |
English |
Global |
Data, Total market approach, Family Planning |
USAID envisions that by 2020 all the priority countries they support will have “the capacities to design, implement, and sustain high-performing family planning programs that include all three sectors for information, product and service delivery in a rational, efficient, and equitable way." This document will contribute to that goal by enhancing the in-country capacity to conduct market analyses to inform the design of TMA program.
The specific aims are to advise TMA planners about the data that should be collected to inform the TMA plan, to promote the standardization of indicators, to provide general guidance for basic data analyses.
Since this document focuses on data analyses to inform TMA planning, it is likely to be most useful to local researchers who will be responsible for collecting and analyzing the data that will be used to inform a subsequent TMA plan, and for communicating the findings of the analysis to various TMA stakeholders. The secondary audience consists of the various stakeholders, including program implementers, policy-makers, government officials, donors, and other researchers.
The second volume of the handbook includes several tools and resources that can help facilitate such an in-depth analysis of the family planning market. A planning guide for a total market approach to increase access to family planning is also available.
Access MEASURE Evaluation's related TMA resources:
Handbook for Research on the Family Planning Market Volume 2
Planning Guide - Module 1
Planning Guide - Module 2
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Rapport d’évaluation de la performance du Système d’Information Sanitaire de Routine (SISR) et de la Surveillance Intégrée de la Maladie et la Riposte (SIMR)
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Ly M, N’Gbichi JM, Lippeveld T, Ye Y |
2016 |
French |
Africa, Global |
Evaluation, Health Information Systems |
Le Plan Stratégique de renforcement du Système National d’Information Sanitaire (SNIS) de Madagascar (2013-2017), élaboré avec l’implication de toutes les parties prenantes, vise à renforcer et améliorer le système de collecte, de rapportage, de gestion, et d’utilisation de l’information sanitaire à tous les niveaux de la pyramide sanitaire. L’implication de tous les acteurs de la santé vise à améliorer la coordination et la standardisation des interventions pour une bonne qualité de l’information sanitaire. Afin de mieux assurer l’alerte précoce des maladies à déclaration obligatoire comme le paludisme, la peste, la poliomyélite, et la fièvre virale hémorragique, la Direction de la Veille Sanitaire et de la Surveillance Epidémiologique (DVSSE) de Madagascar, avec l’appui des partenaires, a mis en œuvre la Surveillance Intégrée de la Maladie et la Riposte (SIMR) et la surveillance sentinelle du paludisme. Malgré les efforts de renforcement du Système d’Information Sanitaire de Routine (SISR) et de la SIMR, l’intégration de certains indicateurs dans le système d’information de gestion (SIG)/rapport mensuel d’activités (RMA) des centres de santé de base (CSB), l’inaccessibilité à temps réel des données sanitaires et le parallélisme des systèmes de surveillance des programmes verticaux constituent un problème pour la satisfaction des besoins en information de tous les utilisateurs du système. Ainsi ces problèmes ont entraîné des difficultés dans la standardisation des activités de suivi et évaluation, mais également dans la planification stratégique et programmatique, car certaines informations spécifiques à certains programmes ne sont pas toujours disponibles aux planificateurs. Afin de mieux répondre aux besoins des services et des programmes de santé mis en œuvre dans le pays, la DVSSE et la Direction des Etudes et de la Planification (DEP), avec l’appui technique du projet MEASURE Evaluation de l’Agence des Etats-Unis pour le développement international (USAID) et à travers le financement de la President’s Malaria Initiative (PMI), ont mené une évaluation du SISR et de la SIMR en utilisant la méthodologie PRISM (Performance de la Gestion des Systèmes d’Information de Routine) et l’approche de l’Organisation Mondiale de la Santé (OMS) pour l’évaluation des systèmes de surveillance intégrée.
The 2018 version of the PRISM Series, updated and with new modules (Toolkit, User’s Kit, and Training Kit) is available here: https://www.measureevaluation.org/prism |
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Measurement and Accountability for Health in Bangladesh: A Status Report
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MEASURE Evaluation |
2016 |
English |
BANGLADESH, South Asia |
Bangladesh, Health, Data |
The United States Agency for International Development (USAID), the World Bank, and the World Health Organization (WHO) convened a global summit—Measurement and Accountability for Results in Health (MA4Health)—at the World Bank’s headquarters, in Washington, DC, in June 2015. There, more than 600 participants from 60 countries, representing development partners, country governments, and civil society organizations, endorsed the Health Measurement and Accountability Roadmap and 5-Point Call to Action. The Call to Action identified a set of priority actions and targets to strengthen data and accountability systems. Two countries had been invited to be co-sponsors of the summit: Bangladesh, because of its readiness to measure progress in health during the post-2015 period, and South Africa, for the high quality of its cause-of-death data, which aid understanding of the national and subnational health situation.
At the summit, Bangladesh agreed to host a follow-on regional conference, and this was held in Dhaka in April 2016. This conference had the following objectives:
• Facilitate the regional and country response to data needs
• Engage with development partners to improve health data systems
• Share and strengthen country-led monitoring and evaluation (M&E) plans
This paper outlines the progress that Bangladesh’s Ministry of Health and Family Welfare (MOHFW) has made toward the country’s measurement and accountability objectives. We review the health, nutrition, and population (HNP) data system (routine and ad hoc) and identify the financial requirements for strengthening health information system (HIS) and M&E functions for the next five years. |
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PEPFAR Monitoring, Evaluation, and Reporting: Collecting the Essential Survey Indicators of Orphans and Vulnerable Children Well-Being through Outcomes Monitoring - Facilitator's Guide to the Data Collector Training
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MEASURE Evaluation |
2016 |
English |
Global |
Data, PEPFAR, Orphans and Vulnerable Children, HIV, Child Health |
As part of its monitoring, evaluation, and reporting (MER) guidance, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) launched a set of essential indicators for orphans and vulnerable children (OVC) programs. These outcome indicators reflect internationally accepted developmental milestones and collectively measure holistic well-being for children and their families over time. Indicators track the ways OVC programs gain from and contribute to the broader HIV and child protection response. These outcome indicators are designated as “essential survey indicators,” meaning that PEPFAR requires countries to collect these indicators biennially (every two years). These outcome data will support improved, evidence-informed strategic portfolio development, programming, and resource allocation decisions both at the country level and the headquarters level.
This manual has been created to support training specifically for collecting the MER essential survey indicators through outcomes monitoring. Access the accompanying PowerPoint presentations. |
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Trafficking and Health: A Systematic Review of Research Methods
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Cannon AC, Arcara J, Graham LM, Macy RJ |
2016 |
English |
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Trafficking, Key Populations |
Trafficking in persons (TIP) is a human rights violation with serious public health consequences. Unfortunately, assessing TIP and its health sequelae rigorously and reliably is challenging due to TIP's clandestine nature, variation in definitions of TIP, and the need to use research methods that ensure studies are ethical and feasible.
To help guide practice, policy, and research to assess TIP and health, we undertook a systematic literature review of 70 peer-reviewed, published articles to (a) identify TIP and health research methods being used, (b) determine what we can learn about TIP and health from these varied methodologies, and (c) determine the gaps that exist in health-focused TIP research.
Results revealed that there are various quantitative and qualitative data collection and analysis methods being used to investigate TIP and health. Furthermore, findings show that the limitations of current methodologies affect what is known about TIP and health. In particular, varying definitions, participant recruitment strategies, ethical standards, and outcome measures all affect what is known about TIP and health. Moreover, findings demonstrate an urgent need for representative and nonpurposive recruitment strategies in future investigations of TIP and health as well as research on risk and protective factors related to TIP and health, intervention effectiveness, long-term health outcomes, and research on trafficked people beyond women trafficked for sex. We offer recommendations for research, policy, and practice based on review results. |
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A Brief Guide to Identify Information Needs and Use Data for PEPFAR Country and Regional Planning
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MEASURE Evaluation |
2016 |
English |
Global |
HIV/AIDS, Data, PEPFAR, HIV |
The 2015 strategy for the United States President’s Emergency Plan For AIDS Relief (PEPFAR) involves the use of all available data, “down to the most granular site level,” to inform decisions about priority locations, populations, interventions, and partnerships within a target country in order to achieve epidemic control (Birx, 2014a; Birx, 2014b; DOS–OGAC, 2014, p. 7). A combination of program performance, service quality, and expenditure data is used to ensure that PEPFAR investments align with a country’s epidemic profile as well as health facilities with a high patient volume for HIV testing and counseling (HTC), prevention of mother-to-child transmission (PMTCT), and antiretroviral therapy (ART) (PEPFAR, 2015a). Epidemic control is defined as “the point at which new HIV infections fall below the numbers of AIDS-related deaths” (DOS–OGAC, 2014, p.8). In order to achieve epidemic control, PEPFAR adopted the UNAIDS 90-90-90 target: 90 percent of people living with HIV know their status, 90 percent of those with known status are receiving ART, and 90 percent of those on ART achieve viral suppression (PEPFAR, 2015a).
In January 2015, PEPFAR published extensive guidance for teams working in targeted areas to develop country and regional operational plans that follow this global strategic approach. Additional draft guidance for 2016 was circulated in November 2015 for stakeholder comments (PEPFAR, 2015b). The 2016 PEPFAR guidance documents outline eight modular planning steps, including: (1) understand current context, (2) assess alignment of current investments and program focus, (3) determine priority locations/populations and set targets for country-wide epidemic control, (4) determine support to system-level interventions, (5) determine a package to sustain services and expected volume, (6) project resources required and reconcile that figure with the funding level, (7) set PEPFAR targets, and (8) develop a monitoring strategy (PEPFAR, 2015b). Country PEPFAR planning is expected to be an iterative process, with teams most likely having to look back at previous steps to reassess their decisions about where and why to focus their programs as well as seek collaboration from stakeholders to reach shared targets.
MEASURE Evaluation developed a simplified framework to facilitate the process of developing Country Operational Plans for PEPFAR teams. This framework links potential data sources to key programmatic questions. It starts with a systematic assessment of context, then guides PEPFAR teams on how to link this context with assessments of evidence-based interventions, partnerships, geographic targeting, and when to involve stakeholders to achieve epidemic control targets while also investing in health systems strengthening. Investments in health systems will ensure gains are sustained by partner countries.
The framework focuses the research approach and helps to build an evidence-based epidemic control strategy by linking information needs and potential data sources. This systematic approach will assist PEPFAR teams to analyze and interpret their data with other key stakeholders to develop collective support and ownership for a Country Operation Plan that will have a significant impact on the HIV/AIDS epidemic. |
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Community-based Health Information Systems in the Global Context: A Review of the Literature
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MEASURE Evaluation |
2016 |
English |
Global |
Global health, HIS, Health Information Systems, Community-based health information systems |
In developing countries, high disease burden from HIV, malaria, tuberculosis, poor nutrition, and high maternal mortality often intersects with low access to health services (Global Fund, 2014). Community workers (CWs), including community health workers (CHWs), community health extension workers (CHEWs) and community social service providers, have met critical service gaps. Generally, CWs are affiliated with either health facilities or community-based organizations. These providers live in the communities they serve and provide outreach services to people who may otherwise not receive them. The work of community worker providers has helped to improve health, especially maternal, child, and newborn outcomes (Lunsford, 2015; Golding, 2014).
National governments and donors are increasingly emphasizing and supporting the work of CWs to expand health care coverage (de la Torre, 2014). The important role of CWs has been emphasized in recent global health policy, such as USAID’s policy for ending preventable child and maternal deaths (EPCMD) (USAID, 2015) and the President’s Malaria Initiative. Similarly, there is a recognition that decentralized, community-based approaches to HIV care and support will be required to meet UNAIDS’ 90-90-90 target (90% of all people living with HIV will know their status, 90% of people diagnosed with HIV to receive antiretroviral treatment (ART), and 90% of all people receiving ART will be virally suppressed by 2020) (UNAIDS, 2014). Community-based programs implemented by CWs are uniquely suited to help achieve the goals laid out in these policies in the most vulnerable parts of the world. Furthermore, as global health systems move toward universal health coverage, CWs will become even more important to increase health equity (Golding, 2014).
CWs require key health information to do their jobs, and their managers require information to monitor their work. Likewise, Governments and donors require information to better plan community health programs, and to monitor progress against goals. This information, how it is collected, and how it flows, is how we define a community-based health information system(s) (CBHIS). These systems should involve data collection, management, and analysis of health and related services provided to communities outside of facilities (de la Torre, 2014). They should enable information to be shared among community-based services and between community-based services and higher-level health facilities. Moreover, to some extent, they should feed into national health management information system(s) (HMIS). CBHIS have the potential to engage community members, provide them with an avenue to health services, and hold them accountable, contributing to the goals of sustainability (Jeremie, 2014; Sabitu, 2004).
Little is known about how CBHIS are being implemented globally. This literature review seeks to explore the innovations in and different manifestations of CBHIS in developing countries. |
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Guidelines for Integrating Gender into an M&E Framework and System Assessment
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MEASURE Evaluation |
2016 |
English |
Global |
Monitoring, Evaluation, Gender |
This document offers concrete guidance on how organizations can comprehensively and explicitly integrate gender in their monitoring and evaluation (M&E) systems. It describes how to make each component of a functioning M&E system gender-sensitive and provides guidance on how to assess an M&E system to ensure that gender is fully integrated throughout the system for appropriate collection, compilation, analysis, dissemination, and use of gender data for decision making.
This document outlines why it is important to apply a gender lens to M&E processes and structures and contextualizes gender in an M&E system. It then walks you through how to think about gender and address it in each of the components of an M&E system. This guide includes examples of gender-specific assessment questions that can be integrated in an M&E system assessment and provides guidance on how to plan and conduct an M&E system assessment.
This guidance document is intended for national health program and M&E managers, subnational health program staff with M&E responsibilities, M&E officers from different agencies or organizations, and development partners who provide M&E support to national and subnational M&E systems. |
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Country Ownership in International Development: Toward a Working Definition
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Watson-Grant S, Xiong K, Thomas J.C. |
2016 |
English |
Global |
Development, Country ownership |
Country ownership in development aid assumes that with recipient countries’ interest and participation, “owning” aid-funded initiatives will lead to more successful outcomes. But there is no universally accepted definition of country ownership. We conducted a systematic literature review to identify aspects of country ownership mentioned in peer-reviewed and gray literature, and identified four themes: 1) power and legitimacy; 2) commitment and responsibility 3) capacity; and 4) accountability. We also analyzed and compared similarities and differences in how different documents define these dimensions, with the results providing a framework for measuring country ownership of development initiatives. Measurement approaches must recognize that factors within and among these dimensions interact with one another in complex ways. Use of measures to identify steps toward more ownership entails conversations among stakeholders about necessary change. |
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M&E Fundamentals: A Self-Guided Minicourse [EPUB edition]
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Frankel N, Gage A |
2016 |
English |
Global |
Monitoring, Monitoring, Evaluation, Evaluation |
Monitoring and Evaluation (M&E) is an essential component of any intervention, project, or program. This mini-course covers the basics of program monitoring and evaluation in the context of population, health and nutrition programs. It also defines common terms and discusses why M&E is essential for program management.
At the end of this course, you will be able to:
Identify the basic purposes and scope of M&E
Differentiate between monitoring functions and evaluation functions
Describe the functions of an M&E plan
Identify the main components of an M&E plan
Identify and differentiate between conceptual frameworks, results frameworks, and logic models
Describe how frameworks are used for M&E planning
Identify criteria for the selection of indicators
Describe how indicators are linked to frameworks
Identify types of data sources
Describe how information can be used for decision-making
Note: This is an EPUB e-book and is intended for reading on non-Kindle devices. To read it on your iPad, iPhone, or Mac OS device, please open it in iBooks. To read it on your Android device, you may upload the ebook to Google Play Books by following the instructions at https://support.google.com/googleplay/answer/3097151. To read it on a Windows PC, try the Calibre software from http://calibre-ebook.com or consider the Simple EPUB Reader extension for the Google Chrome web browser or the EPUBReader add-on for the FireFox web browser. This publication is also available in PDF and Kindle formats. |
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M&E Fundamentals: A Self-Guided Minicourse [Kindle edition]
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Frankel N, Gage A |
2016 |
English |
Global |
Monitoring, Monitoring, Evaluation, Evaluation |
Monitoring and Evaluation (M&E) is an essential component of any intervention, project, or program. This mini-course covers the basics of program monitoring and evaluation in the context of population, health and nutrition programs. It also defines common terms and discusses why M&E is essential for program management.
At the end of this course, you will be able to:
Identify the basic purposes and scope of M&E
Differentiate between monitoring functions and evaluation functions
Describe the functions of an M&E plan
Identify the main components of an M&E plan
Identify and differentiate between conceptual frameworks, results frameworks, and logic models
Describe how frameworks are used for M&E planning
Identify criteria for the selection of indicators
Describe how indicators are linked to frameworks
Identify types of data sources
Describe how information can be used for decision-making
Note: This is a Kindle format e-book and is intended for reading on Kindle devices. To read this MOBI file on your Kindle device, please follow the instructions at http://www.amazon.com/gp/sendtokindle/email. This publication is also available in PDF and EPUB formats.
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Manuel des normes et procédures de gestion du Système national d’information sanitaire
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Burundi Ministry of Public Health and AIDS Control (Ministère de la Santé Publique et de la Lutte contre le Sida), MEASURE Evaluation, Belgian Development Agency (CTB) |
2016 |
French |
Africa, BURUNDI, East Africa |
Health Information Systems, HIS, Burundi |
The manual of standards and procedures for management of Burundi’s health information management system (HMIS) documents and defines standards and functions for the HMIS, in line with Burundi’s National Health Information System Strategic Plan for 2011–2015.
The manual described the standards, procedures, and functions of each level of the health system to support efficient operation of the HMIS. The standards and procedures include health data collection, information flow, and data management at all levels. The manual also provides definitions of key indicators, a data dictionary, and data analysis techniques.
Three main chapters complement each other: (1) The first describes the HMIS framework and provides definitions of all indicators that can be generated by the system; (2) The second highlights data analysis procedures demonstrating different methods for causal analysis, processes for monitoring indicators, and feedback mechanisms; (3) The third presents a metadata dictionary for how data are generated and organized in the health information software (GESIS).
The manual resulted from a collaboration among implementing partners and Burundi’s Ministry of Public Health and AIDS Control to strengthen the national health information system. Key partners included the PAISS project of the Belgium Technical Cooperation (CBT) project, and MEASURE Evaluation, funded by the U.S. Agency for International Development (USAID). In collaboration with the Directorate of the National Health Information System (Direction du Système National d’Information Sanitaire, or DSNIS), PAISS and MEASURE Evaluation drafted the manual, which was reviewed during workshops by a technical working group and later validated by a steering committee formed by the Ministry of Public Health and AIDS Control. MEASURE Evaluation also supported publication and dissemination of the manual. |
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Evaluation des besoins pour la mise en oeuvre de la surveillance sentinelle de VIH/SIDA à travers les activités de consultations prénatales au Burundi
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Rwantabagu JP, Bisore S, Munezero F, Nkunzimana A, Iriwacu B, Ly M, Moise I |
2016 |
French |
BURUNDI, Africa, East Africa |
HIV, Burundi, HIV/AIDS |
In 2010 in Burundi, sentinel surveillance of HIV and AIDS was interrupted in 2010 due to issues such as irregular availability of commodity supplies, lack of equipment, and low levels of relevant skills among staff. A needs assessment was conducted to revitalize the sentinel surveillance system in Burundi; it focused on antenatal care visits.
The needs assessment was conducted with the participation of many stakeholders supporting the National AIDS Control Program (NACP). The USAID-funded MEASURE Evaluation project led the study design and helped with development of the assessment protocol, training of survey staff, and supervision of data collection in the field. The assessment involved qualitative interviews with health providers and a literature review. Study activities were carried out under the coordination of a steering committee set up by the Ministry of Public Health and AIDS Control. MEASURE Evaluation Burundi provided support to the Monitoring and Evaluation Unit staff of the NACP for data analysis and report writing.
A technical group reviewed and validated the tools and the assessment report. The assessment provided recommendations for key actions to be taken at each level of the health system to support and sustain the sentinel surveillance system. Findings were shared with major stakeholders and a joint plan of action was developed, highlighting the potential role of all partners in strengthening sentinel surveillance. |
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Monitoring & Evaluation in Family Planning: Strengths, Weaknesses, and Future Directions
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Barden O’Fallon J, Bisgrove E |
2016 |
English |
Global |
Monitoring, Evaluation, Monitoring, Evaluation, Family Planning |
Long-term investment and prioritization of monitoring and evaluation (M&E) in family planning (FP) programs has resulted in well-established and available validated indicators, measureable outcomes, and improved program performance. For the most part, projects and programs have the tools and materials available to satisfactorily implement M&E strategies. Nonetheless, many gaps and weaknesses in M&E still need to be addressed.
This paper offers recommendations to improve the practice of M&E in FP programs based on an assessment of past and current M&E effort. We also identify future needs, areas of application, and tensions that will need to be addressed as the field advances. The information used for the analysis came from document reviews, a field survey of FP M&E professionals, and interviews with experts in the field of FP M&E. |
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Data Visualization That Works - Facilitating HIV Program Targeting: Case Examples and Considerations
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MEASURE Evaluation |
2016 |
English |
Global |
Data, HIV, Data visualization |
Electronic health information systems offer health data in digital formats that are more complete, timelier, and more robust. These technologies offer a promise that health systems—and therefore health—can be improved with an increasing in evidence-informed decision making.
Access to data, however, is not sufficient. Data must be processed, analyzed, and presented to decision makers in usable formats. Data visualization can help would-be data users to see patterns, trends, and correlations that might go undetected in text-based or numerically-based data.
MEASURE Evaluation sought to understand how data visualization tools are being used in the field to improve HIV programs and to see what kind of impact they have on decision making.
Multiple software platforms, either open-source or proprietary, are available to facilitate data visualization and often are interactive, providing tools to develop charts, maps, infographics, timelines, and other visuals. Our interviews with respondents uncovered important facilitators and barriers to the development of data visualization and its successful use in decision making.
This paper presents six fundamentals for data visualization and four case studies to illustrate their application in various program settings.
Watch a related webinar recording. |
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Investing in health information management: The right people, in the right place, at the right time
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Makinde OA, Mami MI, Oweghoro BM, Oyediran KA, Mullen S |
2016 |
English |
NIGERIA |
Health Facilities, Health System, Nigeria, HIS, Health Information Systems |
Review of the academic curriculum for training health information management professionals in Nigeria
Routine health records generated at health facilities are significant for evaluating the performance of health systems and for directing efforts towards areas of most need (Aqil et al., 2009). The primary officers responsible for the management of health records and generating statistics in health facilities are health information management professionals. The skills of these professionals—who are the gatekeepers for health records that are necessary to assess the performance of the health system—need to be adequate and appropriate to meet the need for high-quality data.
Health information management professionals are responsible for managing patients’ health service records and hospital information systems across health facilities in Nigeria. Yet, many health facilities in Nigeria do not have qualified health information management professionals manning their health records units. To determine needs, an assessment of monitoring and evaluation (M&E) managers from donor-funded health programs in Nigeria was carried out by the USAID-funded MEASURE Evaluation project on the quality of health information management professionals. The assessment found many were inadequately skilled in information and communications technology (ICT) skills needed to function effectively and to play leadership roles in hospital information systems.
A subsequent review of the curriculum for training health information management professionals was therefore conducted by the Federal Ministry of Health of Nigeria (FMOH) and the Health Records Officers Registration Board of Nigeria (HRORBN), with support from MEASURE Evaluation. It found that health records management is evolving across the world—including in developing countries—and that training programs need to evolve to meet the increasing application of ICT in this sector.
After several sessions among stakeholders in Nigeria, a new curriculum that addresses all the identified educational deficiencies was designed to equip graduates of health information management programs with skills to be able to function effectively in health facilities and in other professional roles. The curriculum creates new opportunities in Nigeria for improving the quality of health information management training programs and increasing the number of skilled health information management professionals, a step that will in turn strengthen the health system. The authors of the review noted, however, that implementing the new curriculum requires investment in qualified tutors in fields such as ICT, health informatics, electronic medical records, database management, and M&E. |
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CRVS Strengthening With SAVVY Implementation
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|
2016 |
English |
Africa, MALAWI |
CRVS, Vital Registration, SAVVY, Verbal Autopsy |
The majority of countries in sub-Saharan Africa lack a fully functioning civil registration and vital statistics (CRVS) system. These countries rely primarily on population-based surveys and censuses to generate fertility and mortality data, which are essential elements in determining health issues and services needs in any country.
In recent years, a number of countries in the region have initiated efforts to strengthen their nascent CRVS systems. In particular, Malawi, Tanzania, and Zambia have implemented Sample Vital Registration with Verbal Autopsy (SAVVY) as part of a sustained, incremental effort to gather this essential data. SAVVY was developed by MEASURE Evaluation and the U.S. Census Bureau and is a family of methods that allows the direct measurement of vital events and the determination of causes of death in a nationally representative sample of small areas, or in selected ‘sentinel’ locations. The components of SAVVY include demographic surveillance that registers resident population, mortality surveillance to report and register deaths in a resident population, and verbal autopsy (VA) to determine likely cause of death through interviews with next of kin and caretakers.
The regional workshop, held at the Umodzi Park Conference Center in Lilongwe, Malawi, February 23rd through 25th, 2016, was designed to improve knowledge among the three countries about processes, institutions, and structures required to implement SAVVY, and to share details on how each has designed and implemented SAVVY within their countries. Specifically, the three countries shared how they work with civil registration agencies locally; their steps for linking SAVVY findings with facility-based health information systems and newly developed CRVS systems so that the causes of death SAVVY finds can be captured in the CRVS system; and how they have educated and informed stakeholders and donors of SAVVY accomplishments and potential—both to generate ongoing donor support and to build a constituency for SAVVY and new CRVS systems to complement each other.
Attendees included officials from ministries of health (MOH), partners implementing SAVVY activities, national statistics offices and registration officials, and donors such as the Bill & Melinda Gates Foundation, the Centers for Disease Control and Prevention (CDC), the Data for Health Initiative (D4H), the Karonga Prevention Study/Malawi Epidemiology and Intervention Research Unit (KPS/MEIRU), the U.S. Census Bureau, the World Health Organization (WHO), and MEASURE Evaluation. |
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Defining Electronic Health Technologies and Their Benefits for Global Health Program Managers: Apps Competition
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MEASURE Evaluation |
2016 |
English |
|
MHealth |
App competitions are a subset of hackathons. They are also known as app challenges. These contests challenge participants to produce computer or mobile applications to meet defined objectives and criteria. Usually, prizes are awarded to participants who develop the best applications. There are two main types of app competitions:
In-person app competitions. Participants are invited to attend an event lasting a day or several days to collaborate and develop a product that meets the objectives and requirements announced at the beginning of the event. In-person competitions are more commonly known in the technology sector as hackathons, but hackathons are more loosely defined as collaborations to achieve a common goal and may not involve competition. Hackathons that are mentioned in this document will refer to those that involve competition.
Online app competitions. The objectives and parameters of the challenge are posted online and participants have a set deadline to submit a product or solution.
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Best Practices in Strengthening Community Health Information Systems
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MEASURE Evaluation PIMA |
2016 |
English |
KENYA |
Health Systems Strengthening, Kenya, MEASURE Evaluation PIMA, Health Information Systems |
This report describes the lessons learned and best practices towards strengthening the capacity of the community health information systems (CHIS) in Kenya to generate complete and quality data and promote data use for decision making. The work reported here was part of the support provided to the Community Health Services Unit (CHSU), (formerly the Division of Community Health Services) through the MEASURE Evaluation PIMA project (MEval‐PIMA). |
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Six Essential Functions of a High-Performing Health Information System
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MEASURE Evaluation |
2016 |
English |
|
Health Systems Strengthening, Data, Health System, Health Information Systems |
To achieve the greatest health, public health practitioners and policy makers must be able to use data to perform these six essential functions:
Monitor trends in health outcomes and services
Ensure that data are trustworthy
Make decisions quickly and efficiently
Identify what works
Ensure the coordination and equity of health services
Manage resources for the greatest benefit
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Nutrition and HIV
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MEASURE Evaluation |
2016 |
English |
Global |
Nutrition, HIV, HIV/AIDS |
PEPFAR 3.0 focuses on sustainable control of the HIV epidemic and delivering on the promise of an AIDS-free generation. The plan supports a data-driven approach to control, with strategic investment in high-impact interventions for populations at highest risk in areas of greatest HIV incidence. Ambitious targets set by the Joint United Nations Programme on HIV/AIDS (UNAIDS) have been identified as markers of this plan’s success: by 2020, 90 percent of people living with HIV (PLHIV) will know their status, 90 percent of those diagnosed will be receiving antiretroviral therapy (ART), and 90 percent of those on ART will achieve viral suppression.
The PEPFAR-supported NACS framework was created to increase the inclusion of nutrition services in routine healthcare delivery at the facility and community level. PEPFAR has also worked closely with the World Health Organization (WHO) in efforts such as the Partnership for HIV-Free Survival (PHFS) to expand pregnant and breastfeeding women’s access to lifelong ART (Option B+) for the prevention of mother-to-child transmission (PMTCT) and to increase maternal, infant, and child nutrition through the optimal uptake of WHO’s 2010 breastfeeding guidelines.
To build on these advances, rigorous and robust methods are needed to measure and synthesize data, strengthen technical capacity, harness cost-effective solutions, reach more people with effective programs, and share knowledge in timely and productive ways. The U.S. Agency for International Development (USAID), with its partners, is leading initiatives to provide technical guidance and support for countries to achieve global nutrition and HIV goals. MEASURE Evaluation is well equipped to lead USAID’s efforts in these areas. |
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MEASURE Evaluation’s Health Information System Strengthening Model: A Summary
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MEASURE Evaluation |
2016 |
English |
|
HIS, Health Information Systems |
MEASURE Evaluation’s Health Information System Strengthening Model (HISSM) articulates the project’s current understanding and guides us as we continue to learn how health information systems (HIS) in low- and middle-income countries are designed, developed, and implemented over time to support health systems and improve health outcomes.
Visit MEASURE Evaluation’s Health Information System Strengthening Resource Center. |
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Suivi et évaluation des programmes de lutte contre le paludisme – Cours en ligne
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Herrera S, Ivanovich E, Ye Y, Garley A |
2016 |
French |
|
Monitoring, Evaluation, Malaria |
L'objectif principal du cours est de décrire les concepts fondamentaux de suivi et évaluation (S&E) spécifiquement pour les programmes de prévention et de lutte contre le paludisme et d'identifier les composantes essentielles ainsi que les plans de suivi et d'évaluation des programmes de lutte contre le paludisme. Ce cours donne un aperçu sur les concepts fondamentaux de suivi et évaluation des programmes de prévention et de lutte contre le paludisme. Il donne aussi un aperçu général sur les notions de base du paludisme, l’importance et le rôle du S&E, ainsi que les éléments essentiels d’un plan de S&E, les différents cadres et les indicateurs de S&E pour les programmes de lutte contre le paludisme. Nous allons identifier les principales sources de données communes de S&E des programmes de lutte contre le paludisme, leurs forces, ainsi que leurs faiblesses. Le cours donnera aussi un aperçu sur l'analyse, l'interprétation, et la présentation des données relatives au paludisme.
ObjectifsA la fin de ce cours, vous serez en mesure de:
Décrire les concepts fondamentaux et des approches pratiques pour le suivi et l'évaluation des programmes de lutte contre le paludisme.
Distinguer le suivi de l'évaluation et décrire le rôle de l’évaluation.
Identifier les composantes des plans de S&E pour les programmes de lutte contre le paludisme et en préparer un.
Décrire les différents cadres utilisés dans le S&E pour les programmes de lutte contre le paludisme.
Identifier un bon indicateur, développer des indicateurs appropriés pour le contrôle et la pré-élimination du paludisme.
Identifier les sources et les systèmes de données communes pour les programmes de lutte contre le paludisme.
Identifier les graphiques appropriés pour la présentation des données.
TempsEnviron 4-6 heures
Après avoir réussi à l'examen, l'étudiant recevra un certificat. L'étudiant doit pour ce faire recevoir une note de passage de 80 pour cent au moins à l'examen final pour pouvoir imprimer le certificat. Chaque étudiant aura un nombre illimité de tentatives pour atteindre la note de passage pour l'examen final. |
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Principes fondamentaux de la recherche en matière de mise en oeuvre
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MEASURE Evaluation Implementation Research Technical Working Group 2016 |
2016 |
French |
|
Implementation research |
Ce module, Principes fondamentaux de la recherche en matière de mise en oeuvre (RMO), est une introduction au vocabulaire, aux concepts, aux outils et aux stratégies utilisés dans la RMO. Il se veut une orientation pratique et utile à la RMO pour les chercheurs et les responsables de la mise en oeuvre des programmes.
Après avoir terminé le cours, les apprenants seront en mesure de comprendre les termes-clés de la RMO et d’identifier ses concepts de base, ses cadres de recherche et ses volets de programmes, ainsi que des questions appropriées dans le domaine. Les objectifs spécifiques sont :
Identifier les caractéristiques de la RMO
Décrire la mise en oeuvre et le passage à l’échelle et expliquer la relation de la RMO à ces processus
Principes fondamentaux de la recherche en matière de mise en oeuvre à ces processus
Classer les questions et la recherche connexe qui se situent dans le domaine de la RMO
Résumer les caractéristiques du cadre de recherche et identifier les stratégies pour les appliquer à la RMO
Reconnaître comment la RMO s’applique à des problèmes de mise en oeuvre différents
Classer les priorités en matière de RMO dans les demandes de subvention
Etablir une liste des rôles des différents intervenants dans la RMO et identifier les moyens appropriés pour intégrer les parties prenantes à la planification de la RMO et à la communication et diffusion des résultats
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Association Between Schistosoma haematobium Exposure and Human Immunodeficiency Virus Infection Among Females in Mozambique
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Brodish PH, Singh K |
2016 |
English |
MOZAMBIQUE, SOUTH AFRICA, TANZANIA, ZIMBABWE |
HIV/AIDS, HIV, Sub-Saharan Africa, schistosomiasis |
Recent evidence suggests an association between human immunodeficiency virus (HIV) and female genital schistosomiasis (FGS) in sub-Saharan Africa, especially in Mozambique, South Africa, Tanzania, and Zimbabwe. Women with FGS have increased numbers of HIV target cells and cell receptors in genital and blood compartments, potentially increasing the risk of HIV transmission per sexual exposure, and the association may explain the high female:male ratio of HIV prevalence unique to sub-Saharan Africa.
We investigated this association in Mozambique by linking two georeferenced, high-quality secondary data sources on HIV prevalence and Schistosoma haematobium: the AIDS Indicator Survey, and the Global Neglected Tropical Diseases (GNTD) open-source database, respectively. We constructed a schistosomiasis exposure covariate indicating women reporting “unimproved” daily drinking water sources and living no more than 2–5 km from high-endemic global positioning system (GPS) coordinates in the GNTD. In logistic regression analyses predicting HIV-positive status, we show that exposure increases the odds of HIV-positive status by three times, controlling for demographic and sexual risk factors. |
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Data Quality for Monitoring and Evaluation Systems
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MEASURE Evaluation |
2016 |
English |
Global |
Monitoring, Evaluation, Data Quality, Data |
PEPFAR emphasizes the need for data quality to be at the core of HIV program activities. To improve data quality, PEPFAR guidance suggests that countries employ more stringent and systematic data quality assurance procedures, which can be achieved with data quality assessments—capabilities at the core of the work MEASURE Evaluation is doing in this arena.
In its portfolio for assuring data quality, MEASURE Evaluation includes monitoring and evaluation systems designed to produce tools that can be used to document progress toward goals and objectives and to improve health programs. Better quality data can result in better decision making in health sector planning and improved health outcomes. If the data produced by these systems are incomplete, inaccurate, or not timely—owing to insufficient capacity in the health system or inadequate system design—MEASURE Evaluation can assist in addressing those deficiencies and improving data quality. Better quality data can result in better decision making in health sector planning and improved health outcomes.
MEASURE Evaluation has developed training materials to help countries improve their capacity for data quality assurance, and has conducted operations research to help institutionalize data quality assurance techniques. |
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Gender Counts: A systematic review of evaluations of gender-integrated health interventions in low- and middle-income countries
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Schriver B, Mandal M, Muralidharan A, Nwosu A, Dayal R, Das M, Fehringer J |
2016 |
English |
|
Gender, Evaluation |
As a result of new global priorities, there is a growing need for high-quality evaluations of gender-integrated health programmes. This systematic review examined 99 peer-reviewed articles on evaluations of gender-integrated (accommodating and transformative) health programmes with regard to their theory of change (ToC), study design, gender integration in data collection, analysis, and gender measures used. Half of the evaluations explicitly described a ToC or conceptual framework (n = 50) that guided strategies for their interventions. Over half (61%) of the evaluations used quantitative methods exclusively; 11% used qualitative methods exclusively; and 28% used mixed methods. Qualitative methods were not commonly detailed. Evaluations of transformative interventions were less likely than those of accommodating interventions to employ randomised control trials. Two-thirds of the reviewed evaluations reported including at least one specific gender-related outcome (n = 18 accommodating, n = 44 transformative). To strengthen evaluations of gender-integrated programmes, we recommend use of ToCs, explicitly including gender in the ToC, use of gender-sensitive measures, mixed-method designs, in-depth descriptions of qualitative methods, and attention to gender-related factors in data collection logistics. We also recommend further research to develop valid and reliable gender measures that are globally relevant. |
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Tools and Support to Achieve 90-90-90 Targets and Save Lives
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MEASURE Evaluation |
2016 |
English |
Global |
HIV, HIV/AIDS, PEPFAR |
Controlling the AIDS pandemic will require a comprehensive approach, including gains achieved by the initiation of and adherence to antiretroviral therapy (ART) that strategically targets geographic areas and populations where HIV prevalence is high—or where there is potential for the most impact.
HIV-affected countries therefore have an increasing need for high-quality data to identify the areas and populations that have the greatest numbers of HIV-affected people or the greatest risk for HIV transmission. Countries have a corresponding need for improved capacity to collect and analyze data, conduct evaluations, and encourage data use to measure progress toward the 90-90-90 targets.
MEASURE Evaluation provides tools, guidance, and capacity building to help countries reach their 90-90-90 targets and to substantiate their progress. MEASURE Evaluation also fills a need to help a ministry of health understand the consequences of the PEPFAR pivot, which may have shifted the distribution of PEPFAR funding in the country from one location to another. |
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Health Facility Readiness to Provide Emergency Obstetric and Newborn Care in Kenya: Results of a 2014 Assessment of 13 Kenyan Counties with High Maternal Mortality
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MEASURE Evaluation PIMA |
2016 |
English |
Africa, KENYA, East Africa |
Kenya, Health Facilities, MEASURE Evaluation PIMA, EmONC, Maternal Mortality |
Most maternal and neonatal deaths in low-income countries, including Kenya, are attributable to a handful of preventable causes. Kenya’s Ministry of Health, working closely with county governments and other partners, is committed to expanding the coverage of emergency obstetric and newborn care (EmONC) to all health facilities nationwide. Emergency obstetric and newborn care equips health workers with skills, life-saving medicines, and equipment to manage the leading causes of maternal and newborn death.
In July 2013, in partnership with the U.S. Agency for International Development (USAID), the Ministry of Health embarked on a program to expand EmONC services to 15 counties spanning the country’s 10 major regions. The program began with assessments of the needs of selected facilities in 14 counties. These surveys were conducted to identify the specific changes that would be needed to expand services and to provide baseline data for purposes of monitoring and evaluation—to be able to tell what works.
In 2014, county teams, with support from USAID-funded APHIAplus partners—the Maternal and Child Survival Project (MSCP) and AMPATH PLUS—explored the EmONC needs further, focusing on the 13 Kenyan counties with the highest maternal and neonatal mortality rates. The research teams studied the preparedness of 376 health facilities (278 health centers and dispensaries and 98 hospitals) to provide emergency obstetric and newborn care. MEASURE Evaluation PIMA analyzed the research findings and disseminated them to county teams. Those teams then developed develop county and facility action plans. Having the data to determine areas of greatest need will help focus efforts to improve health services and save lives. |
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Referral Network Analysis for Improved HIV Care in Homa Bay County, Kenya: Final Report
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Agala CB, Xiong K, Thomas JC, Powell R |
2016 |
English |
East Africa, KENYA, Africa |
HIV/AIDS, Network analysis, Kenya, HIV, ART |
This paper reports on a network analysis of healthcare providers in Homa Bay, Kenya. It presents a quantitative description of how these providers coordinate their activities and identifies ways to improve the care they offer to people living with HIV. As part of the analysis, we paid particular attention to referrals linking HIV testing and the provision of antiretroviral therapy (ART), because these are an important element in the achievement of the 90-90-90 goals of the Joint United Nations Programme on HIV/AIDS (UNAIDS).
BackgroundPeople living with HIV have many clinical, nutritional, and social needs, all of which can seldom be met by a single provider. Providers typically focus on their own services and not the comprehensive needs of the patients. This is often reflected in a lack of coordination among care providers. But in fact, patient care is better when providers are aware of appropriate services at other facilities and refer patients to them. In a county whose HIV prevalence is among the highest in Kenya, we identified the organizations providing some aspect of HIV care and investigated the ways in which they work—or don’t work—together to cover the comprehensive needs of those they serve.
AnalysisWe identified 56 organizations and interviewed a representative from each of them about their services and their connections with the other 55. Referral connections among them in the past 30 days were relatively rare, averaging less than two; 13 organizations made no referrals at all. Notably, five facilities that test for HIV did not refer their clients to an ART provider. We found two distinct clusters of connected organizations: one in Homa Bay Township and the other in Rangwe Subcounty. When we convened the organizations and presented our results to them, they expressed interest in establishing better connections and referrals.
ConclusionsHoma Bay has an opportunity to improve care for people with HIV simply by making better use of the services already available, without deploying new ones. This can be achieved by informing each organization of the services provided by each of the others, and by bringing the organizations together to plan and monitor the services’ coordination. These steps could be implemented separately in each of the two organizational clusters. |
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Aligning Stakeholders for Health Information Systems Strengthening: One Step at a Time
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MEASURE Evaluation |
2016 |
English |
West Africa, Global, Africa, MALI |
Health Information Systems, HIS, Health Systems Strengthening, Mali |
Implementing health information systems (HIS), whether in private or public sectors, is challenging due to many factors, including shortage of human and financial resources and leadership necessary to sustain HIS functioning. These challenges are of particular concern in developing countries where HIS and the accompanying information technology (IT) can have a huge impact on improving service delivery. Strong health information systems are the backbone of strong health systems. A properly functioning HIS gets the right information into the right hands at the right time, enabling policymakers, managers, and individual service providers to make informed choices about everything from patient care to national budgets. Strong health information systems support greater transparency and accountability by increasing access to information.
Two key challenges in Mali for full implementation of an HIS are the difficulty of taking pilot projects to scale, and a singular focus on IT or technical solutions when, in fact, a much broader approach to improve technical, behavioral, and organizational performance of the HIS is needed. For example in Mali, as in many countries, the governance and management of the HIS, including both financial and human resources and the roles and responsibilities of key contributors at each level of the health system, are equally if not more important than technical factors.
To address these issues, the USAID-funded MEASURE Evaluation project in Mali proposed a “stepwise” (or step-by-step) approach to align stakeholders implementing disparate HIS initiatives into a “network” in support of one national health management information system (HMIS) for Mali. |
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A Primer on the Privacy, Security, and Confidentiality of Electronic Health Records
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Kumar M, Wambugu S |
2016 |
English |
Global |
Electronic Health Records, EHealth, Information systems |
The use of electronic health records (EHRs) is widespread in developed countries but is only gradually displacing the use of paper records. Advocates of health information technology promote EHRs, because they improve quality of care, reduce cost, enhance patient mobility, are more reliable, and enable evidence-based medicine. However, the transition from paper-based to EHR systems in low- and middle-income countries poses some unique challenges for privacy and confidentiality, security, and data integrity and availability that can outweigh the benefits.
All of these challenges become more pressing with the rapid uptake of Internet services to share and access health information. Threats to the integrity of health information systems and the data they contain are real. Cyber security is required to prevent, detect, and act on unauthorized access to a health system and its information. Therefore, ensuring privacy, security, confidentiality, integrity, and availability of protected health information (PHI) in EHRs is absolutely necessary.
With the growing need for healthcare providers to share and access health information across diverse and dispersed information systems and organizational boundaries, the interoperability of information systems has assumed greater significance for improved quality of care, efficiency, and patient safety. |
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Quick Investigation of Quality: A User's Guide for Monitoring Quality of Care in Family Planning
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MEASURE Evaluation |
2016 |
English |
Africa, Asia, Global |
Service quality, Family Planning, Data, Monitoring |
This user’s guide contains materials needed to design and implement the Quick Investigation of Quality (QIQ) in a given country. QIQ refers to the set of three related data collection instruments designed to monitor 25 indicators of quality of care in clinic-based family planning programs.
This volume offers an overview of the QIQ (objectives, a short list of indicators, and methodological and ethical issues), guidelines for sampling and training of field personnel, instruments and guidelines for data collection, and summary results from the short list of indicators (tabular and graphic forms). Developed with funding from the USAID Office of Population, this method provides a low-cost, practical means to routinely monitor quality of care in family planning and other reproductive health services. USAID missions can use it in the R4 process, as can other organizations interested in tracking quality.
MEASURE Evaluation, working in collaboration with members of the Monitoring and Evaluation Subcommittee of the Maximizing Access and Quality (MAQ) initiative assumed the lead role in developing and testing this method in five countries—Ecuador, Morocco, Turkey, Uganda, and Zimbabwe. |
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Review of Family Planning Quality of Care Measurement Tools and Applications
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Schriver B, Barden-O'Fallon J |
2016 |
English |
Global |
Family Planning |
This review provides a landscape of what has been and is currently being done to measure quality of care in family planning programs and includes assessments of FP quality in public and private health services in low- and middle-income countries published between 1990 and 2015. The authors conducted a systematic search of electronic databases (PubMed, POPLINE, Scopus), organizational websites (Marie Stopes International [MSI], International Planned Parenthood Federation [IPPF], Population Services International [PSI], the World Health Organization [WHO], Family Planning 2020 [FP2020], Performance Monitoring and Accountability 2020 [PMA2020], the Guttmacher Institute, and conference websites (international conferences on FP; American Public Health Association annual meeting) from January–September, 2015. The search strategy included peer-reviewed articles, grey literature, and unpublished documents or reports from organizations working in FP. We used keywords “quality of care,” “FP,” “framework,” “indicators,” “measurement,” “evaluation,” “monitoring” and various permutations of these phrases. When tools were identified, forward searches were conducted to identify all applications and follow-up studies. |
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Monitoring and Evaluation of Malaria Programs - Online Course
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Herrera S, Ivanovich E, Yé Y, Garley A |
2016 |
English |
Global, Africa, Asia |
Malaria, Monitoring, Evaluation |
The new 2020 version the course is now available here.
The main purpose of the course is to describe the fundamental concepts of monitoring and evaluation as they specifically relate to malaria prevention and control programs and to identify the essential components of monitoring and evaluation (M&E) plans for malaria programs. The course will provide a general overview of malaria basics, the scope and important functions of M&E, and an introduction to monitoring and evaluation specifically for malaria programs. The course will walk learners through the essential elements of an M&E plan, including the different M&E frameworks and indicators for malaria programs. Common M&E data sources for malaria programs will be introduced, in addition to the main strengths and weaknesses of these sources. The course will provide an overview of data analysis, interpretation and presentation of malaria-related data.
ObjectivesAt the end of this course, you will be able to:
Describe the fundamental concepts and practical approaches to monitoring and evaluation of malaria programs.
Differentiate between monitoring and evaluation and describe the role that evaluation serves.
Identify the components of M&E plans for malaria programs and how to prepare one.
Describe the different frameworks used in M&E for malaria programs.
Identify what a good indicator is and how to develop appropriate indicators for malaria control and pre-elimination.
Identify common data sources and systems for malaria programs.
Identify appropriate graphs for presenting data.
TimeApproximately 4-6 hours
Upon successful completion of the course and exam, the student will receive a certificate. The student must receive a passing grade of 80 percent on the final course exam to print the certificate. Each student will have an unlimited number of attempts to achieve the passing grade for the final course exam.
The new 2020 version the course is now available here. |
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How MEASURE Evaluation Helps PEPFAR Deliver Results
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MEASURE Evaluation |
2016 |
English |
SWAZILAND, GHANA |
capability statement, PEPFAR, HIV/AIDS |
PEPFAR 3.0 aims to deliver on the promise of an AIDS-free generation. It includes new initiatives, such as DREAMS (Determined, Resilient, Empowered, AIDS-free, and Safe Women), a partnership to reduce HIV infections among adolescent girls and young women in 10 sub-Saharan African countries, and ACT (Accelerating Children’s HIV/AIDS Treatment Initiative to Save Lives). It employs new systems for collecting data, such as DATIM (Data for Accountability, Transparency and Impact), which brings together a consistent set of data elements from MER (monitoring, evaluation, and reporting), SIMS (site information management systems), and EA (economic assessments). The combination of DATIM and country-level health information systems (HIS), together with strategic information, surveillance, and rigorous implementation science and impact evaluation, can allow effective use of data for decision making in designing country operational plans (COPs) that align with a country’s epidemiological context and steer a path toward achieving the 90-90-90 targets.
Never before have missions been asked to synthesize, weigh, and consider so much data in the pursuit of cost-effective programming. This presents both an opportunity and a challenge. The MEASURE Evaluation project is one way USAID helps missions to capitalize on opportunities and overcome challenges to deliver results for their partners and the citizens they serve. |
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Making Gender Count
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MEASURE Evaluation |
2016 |
English |
Global |
PLACE, GBV, gender, Gender, capability statement |
This fact sheet provides a summary of MEASURE Evaluation's gender portfolio, as well as a summary of our Priorities for Local AIDS Control Efforts (PLACE) method as PLACE relates to youth.
MEASURE Evaluation is a leader in the field of gender-sensitive monitoring and evaluation (M&E). MEASURE Evaluation increases the capacity of individuals and organizations to collect, analyze, and use gender-related health information for better program and policy decision making at local, national, and global levels. The gender portfolio staff has expertise in a wide range of state-of-the-art, gender-sensitive M&E and health information systems (HIS), approaches, and tools, including analysis of sex-disaggregated and gender-sensitive indicators to identify potential gender-related patterns in program use and effects; HIS specification, design, and development for data on gender-based violence (GBV); capacity building to address gender in HIV and GBV program M&E; and development and selection of gender-sensitive indicators (i.e., those that try to directly measure gender).
Since the inception of PLACE, which identifies and maps populations who are most at risk in terms of HIV infections, the method has included a focus on female youth. The method provides a risk profile of female youth who attend venues identified as places where people meet new sexual partners. Although all PLACE studies can provide data on youth, several PLACE studies have specifically focused on youth or oversampled youth. |
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Learning Agenda
|
MEASURE Evaluation |
2016 |
English |
Global |
HIS, Health Information Systems |
The mandate for MEASURE Evaluation, funded by the U.S. Agency for International Development (USAID), is to work globally to strengthen capacity in low-resource countries to gather, analyze, and use data in robust health information systems (HIS) for decision making to achieve better health outcomes. MEASURE Evaluation and USAID have defined indicators and targets to measure countries’ progress toward robust HIS, but there is a level above such granular measurement that also will greatly inform this effort. We call it the Learning Agenda, as described in this fact sheet.
As we embark on this effort, we have defined broad questions to help us develop a theoretical framework to understand what a high-performing health information system looks like:
What are the factors and conditions of HIS performance progress? How should we measure key HIS concepts and functions?
What are the stages of progression to a strong HIS? What comes first, typically? Or is there a typical pattern of progression?
What are the characteristics of a strong HIS? What seem to be the drivers of HIS improvement and what strategies do those drivers suggest?
Visit a related Health Information Systems Strengthening Resources Center.
Related Content
Easing the Data Collection Burden on Healthcare Providers by Strengthening Health Information Systems
Improving Continuity of Care by Strengthening Health Information Systems |
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Health Informatics
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MEASURE Evaluation |
2016 |
English |
Global |
informatics, health informatics, capability statement |
Quality data are essential in public health settings to facilitate good decisions on policy and service provision and to track health trends and the effectiveness of interventions. Health informatics (HI), sometimes called "digital health," "eHealth," or "mHealth," is a health information system empowered and amplified by technology. MEASURE Evaluation is the U.S. Agency for International Development’s primary mechanism for strengthening health information systems and is contributing thought leadership and support for the implementation of HI. We focus on overcoming challenges to developing strong national health information systems and help to create the enabling environment so such systems can develop. We also are helping countries to establish program-specific systems, such as for malaria, especially where a full HI system is not yet possible but where the need for subsets of data is critical.
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Health Information Systems
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MEASURE Evaluation |
2016 |
English |
Global |
capability statement, Health Information Systems |
Strong health systems are central to achieving better health outcomes, and strong health information systems (HIS) are the backbone of strong health systems. A properly functioning HIS gets the right information into the right hands at the right time, enabling policymakers, managers, and individual service providers to make informed choices about everything from patient care to national budgets. Strong health information systems support greater transparency and accountability by increasing access to information. Unfortunately, many low and middle-income countries (LMICs) have a long way to go to achieve these goals.
MEASURE Evaluation works with global, national, and local partners to strengthen HIS. Dedicated to achieving sustainable improvements in health system performance and health outcomes, the project builds capacity to generate, manage, and use health information both at national and subnational levels. MEASURE Evaluation seeks to foster greater ownership and accountability for HIS, and promotes the use of data for decision making. |
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Fact Sheet: Evaluating Orphans and Vulnerable Children Outcomes
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MEASURE Evaluation |
2016 |
English |
Global |
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New indicators and tools developed by MEASURE Evaluation, with support from the OVC technical working group of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), simplify and standardize the data needed to set measurable goals for an OVC intervention. Using them, program designers and administrators can now answer five questions fundamental to the planning and evaluation of OVC programs worldwide:
What are the educational, health, protection, and psychosocial characteristics of children and their caregivers in my area?
Where do the children most in need of program support live?
How many children need services or support?
What kinds of support do my program’s registered beneficiaries need, as a group, for their education, health, protection, and psychosocial well-being?
Is my program achieving (or did it achieve) the impact I expected on the children and households served?
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Gender and Malaria in Kenya
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Kenya Ministry of Health, Malaria Control Unit |
2015 |
English |
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Malaria, PIMA, Gender, Kenya |
This gender and malaria review focuses on the monitoring and evaluation aspects of various documents, strategic plans, and current practices in the path toward a malaria-free Kenya.
The report is also available online at https://www.measureevaluation.org/pima/malaria/gender-and-malaria-in-kenya |
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Measuring Maternal Mortality: Three Case Studies Using Verbal Autopsy with Different Platforms
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Curtis SL, Mswia RG, Weaver EH |
2015 |
English |
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Maternal Health, Maternal Mortality, Vital Registration, Verbal Autopsy |
BackgroundAccurate measurement of maternal mortality is needed to develop a greater understanding of the scale of the problem, to increase effectiveness of program planning and targeting, and to track progress. In the absence of good quality vital statistics, interim methods are used to measure maternal mortality. The purpose of this study is to document experience with three community-based interim methods that measure maternal mortality using verbal autopsy.
MethodsThis study uses a post-census mortality survey, a sample vital registration with verbal autopsy, and a large-scale household survey to summarize the measures of maternal mortality obtained from these three platforms, compares and contrasts the different methodologies employed, and evaluates strengths and weaknesses of each approach. Included is also a discussion of issues related to death identification and classification, estimating maternal mortality ratios and rates, sample sizes and periodicity of estimates, data quality, and cost.
ResultsThe sample sizes vary considerably between the three data sources and the number of maternal deaths identified through each platform was small. The proportion of deaths to women of reproductive age that are maternal deaths ranged from 8.8% to 17.3%. The maternal mortality rate was estimable using two of the platforms while obtaining an estimate of the maternal mortality ratio was only possible using one of the platforms. The percentage of maternal deaths due to direct obstetric causes ranged from 45.2% to 80.4%.
ConclusionsThis study documents experiences applying standard verbal autopsy methods to estimate maternal mortality and confirms that verbal autopsy is a feasible method for collecting maternal mortality data. None of these interim methods are likely to be suitable for detecting short term changes in mortality due to prohibitive sample size requirements, and thus, comprehensive and continuous civil registration systems to provide high quality vital statistics are essential in the long-term. |
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GIS Techniques for M&E of HIV/AIDS and Related Programs [Kindle edition]
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Spencer J, Stewart J, Wilkes B |
2015 |
English |
Global |
HIV/AIDS, Monitoring, Evaluation, Geographic Information Systems, GIS, HIV |
This course presents a practical guide for using a geographic information system (GIS) to integrate, visualize, and analyze geographically-referenced data extracted from the Demographic and Health Surveys (DHS) and other key data sets to facilitate monitoring and evaluation (M&E) of HIV/AIDS and related health programs. To make the course accessible to learners without commercial GIS software licenses, the course focuses on the use of free and open source software (FOSS).
Upon completion of the course, learners will be able to:
Define a GIS and articulate the value of using a GIS to integrate, visualize, and analyze program data.
Differentiate the primary uses of several free and open source GIS software options.
Explain the fundamentals of geographic data, including the shapefile format.
List the principal geo-referenced sources for HIV/AIDS data and explain how their geographic structure can be leveraged for M&E of HIV/AIDS and related programs.
Recognize the types of M&E questions that can be answered using the highlighted data sets and GIS software packages.
Use the free and open source GIS software package, QGIS, to perform essential GIS tasks needed to respond to typical M&E questions.
Although the course is designed primarily for M&E professionals working for or with HIV/AIDS programs in countries receiving Global Health Initiative/PEPFAR support, analysts and decision makers from other public health programs will benefit from the techniques and data sources explained.Note: This is a Kindle format e-book and is intended for reading on Kindle devices. To read this MOBI file on your Kindle device, please follow the instructions at http://www.amazon.com/gp/sendtokindle/email. This publication is also available in PDF and EPUB formats. |
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GIS Techniques for M&E of HIV/AIDS and Related Programs [EPUB edition]
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Spencer J, Stewart J, Wilkes B |
2015 |
English |
Global |
HIV/AIDS, Monitoring, Evaluation, Geographic Information Systems, GIS, HIV |
This course presents a practical guide for using a geographic information system (GIS) to integrate, visualize, and analyze geographically-referenced data extracted from the Demographic and Health Surveys (DHS) and other key data sets to facilitate monitoring and evaluation (M&E) of HIV/AIDS and related health programs. To make the course accessible to learners without commercial GIS software licenses, the course focuses on the use of free and open source software (FOSS).
Upon completion of the course, learners will be able to:
Define a GIS and articulate the value of using a GIS to integrate, visualize, and analyze program data.
Differentiate the primary uses of several free and open source GIS software options.
Explain the fundamentals of geographic data, including the shapefile format.
List the principal geo-referenced sources for HIV/AIDS data and explain how their geographic structure can be leveraged for M&E of HIV/AIDS and related programs.
Recognize the types of M&E questions that can be answered using the highlighted data sets and GIS software packages.
Use the free and open source GIS software package, QGIS, to perform essential GIS tasks needed to respond to typical M&E questions.
Although the course is designed primarily for M&E professionals working for or with HIV/AIDS programs in countries receiving Global Health Initiative/PEPFAR support, analysts and decision makers from other public health programs will benefit from the techniques and data sources explained.Note: This is an EPUB e-book and is intended for reading on non-Kindle devices. To read it on your iPad, iPhone, or Mac OS device, please open it in iBooks. To read it on your Android device, you may upload the ebook to Google Play Books by following the instructions at https://support.google.com/googleplay/answer/3097151. To read it on a Windows PC, try the Calibre software from http://calibre-ebook.com or consider the Simple EPUB Reader extension for the Google Chrome web browser or the EPUBReader add-on for the FireFox web browser. This publication is also available in PDF and Kindle formats. |
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GIS Techniques for M&E of HIV/AIDS and Related Programs
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Spencer J, Stewart J, Wilkes B |
2015 |
English |
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HIV, Geographic Information Systems, GIS, Monitoring, Evaluation, HIV/AIDS |
This course presents a practical guide for using a geographic information system (GIS) to integrate, visualize, and analyze geographically-referenced data extracted from the Demographic and Health Surveys (DHS) and other key data sets to facilitate monitoring and evaluation (M&E) of HIV/AIDS and related health programs. To make the course accessible to learners without commercial GIS software licenses, the course focuses on the use of free and open source software (FOSS).
Upon completion of the course, learners will be able to:
Define a GIS and articulate the value of using a GIS to integrate, visualize, and analyze program data.
Differentiate the primary uses of several free and open source GIS software options.
Explain the fundamentals of geographic data, including the shapefile format.
List the principal geo-referenced sources for HIV/AIDS data and explain how their geographic structure can be leveraged for M&E of HIV/AIDS and related programs.
Recognize the types of M&E questions that can be answered using the highlighted data sets and GIS software packages.
Use the free and open source GIS software package, QGIS, to perform essential GIS tasks needed to respond to typical M&E questions.
Although the course is designed primarily for M&E professionals working for or with HIV/AIDS programs in countries receiving Global Health Initiative/PEPFAR support, analysts and decision makers from other public health programs will benefit from the techniques and data sources explained.
Available in EPUB and Kindle editions and as an online certificate course. |
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County Health Profile
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MEASURE Evaluation-PIMA |
2015 |
English |
KENYA, Africa, East Africa |
Health, Kenya, MEASURE Evaluation PIMA |
In 2014, a baseline assessment on M&E capacity was conducted by MEASURE Evaluation-PIMA across Kenyan counties where PIMA was implementing activities. The assessment sought to identify, among other things, the status of behavioural, organizational, and technical capacity in use of data for programming. Overall, the counties were found not to have data-use strategies in place that would enhance a weak culture of evidence-based decision making. Further, dissemination and use of data were not clearly defined, with some counties stating that dissemination doesn’t happen regularly.
One of MEval-PIMA’s products that helps counties assess their performance is a county health profile. This profile contains quarterly performance data on selected indicators that have been identified as critical in county health sector strategic plans.
The main objective of a county profile is to support the CHMT to prioritize key health issues that need to be addressed, and to make informed decisions and plans based on an analysis of data reflected in various health indicators. Data presented in the profile further enable the county team to identify gaps in indicators or data collected, consider data quality concerns, and develop action plans to address issues identified.
The expected key outputs for a county health profile are: timely reporting on all health indicators; quality data that is timely, accurate, consistent and complete; and structured and regular updates on core performance indicators that inform evidence-based decisions and plans for programming. |
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Assessment of the Effectiveness of Malaria Monitoring and Evaluation Regional Workshops and Online Training Course
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MEASURE Evaluation |
2015 |
English |
Africa, Global |
Malaria |
Substantial investments have been made in the last decade to improve the quality of services and coverage of major malaria control interventions and accelerate progress toward malaria elimination. As these investments continue and grow, sound programmatic decisions require strong monitoring and evaluation (M&E) systems to document progress in malaria control and ensure accountability of resources invested. In sub-Saharan Africa (SSA), the challenges M&E systems face sometimes impede efforts for generating evidence needed for informed decision making. In addition to the limited financial resources that malaria M&E systems in SSA face, they also must deal with poor access to technology and a lack of personnel with the required M&E knowledge and skills. Consequently, the quality of data generated by existing M&E systems has been questionable.
MEASURE Evaluation has been a significant supporter for M&E systems of national malaria control programs. One means of support has been MEASURE Evaluation’s efforts to strengthen malaria M&E capacity by offering M&E training targeting mainly M&E professionals who work on malaria at national, regional, and district levels; professionals who work on USAID projects; and employees of nongovernmental organizations (NGOs). The training has been through in-person regional workshops and online training courses. The two-week intensive in-person workshop format was used from 2010 to 2014 in annual workshops in Ghana (Anglophone) and Burkina Faso (Francophone).
To identify strengths, weaknesses, and areas that need improvement, MEASURE Evaluation undertook an assessment of the in-person workshops and online training course. This report provides the results of the training program evaluation, based on information from participants’ surveys at the in-person workshops, participants’ supervisors or referees who supported participants’ application to attend the M&E training course, and other stakeholders interested in malaria M&E. Additional information came from users of the online training course who did not complete the end-of-course certification exam and students who completed the online course and examination. MEASURE Evaluation and USAID PMI will use this assessment to guide the design and implementation of future malaria M&E training programs. |
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Regional Workshop on Monitoring and Evaluation of Malaria Programs Activity Report - Ouagadougou, Burkina Faso
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MEASURE Evaluation |
2015 |
English |
Africa, Global |
Malaria, Burkina Faso, Monitoring, Evaluation, Workshop |
The fifth Regional Workshop on Monitoring and Evaluation (M&E) of Malaria Programs brought together 20 M&E professionals from seven countries to explore concepts and practical approaches to M&E in malaria programs, discuss the application of tools and data systems, experience hand-on development of M&E plans, and share best practices and lessons learned. The workshop, held in Ouagadougou, Burkina Faso, June 29–July 10, 2015, at the University of Ouagadougou, Burkina Faso had these objectives:
To provide training on fundamental concepts and practical approaches to M&E in malaria programs
To discuss the application of tools and data systems used to monitor and evaluate malaria programs
To provide participants with hands-on experience in developing M&E plans
To share M&E experiences from other countries
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Regional Workshop on Monitoring and Evaluation of Malaria Programs Activity Report - Accra, Ghana
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MEASURE Evaluation |
2015 |
English |
Global, Africa |
Workshop, Monitoring, Evaluation, Malaria, Ghana |
The sixth Regional Workshop on Monitoring and Evaluation (M&E) of Malaria Programs brought together 17 M&E professionals from seven countries to explore concepts and practical approaches to M&E in malaria programs, discuss the application of tools and data systems, experience hands-on development of M&E plans, and share best practices and lessons learned. The workshop, held in Accra, Ghana, June 8–19, 2015, at the University of Ghana, School of Public Health (UGSPH), Legon, had these objectives:
To provide training on fundamental concepts and practical approaches to M&E in malaria programs
To discuss the application of tools and data systems used to monitor and evaluate malaria programs
To provide participants with hands-on experience in developing M&E plans
To share M&E experiences from other countries
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Encontro Anual Conjunto dos Responsaveis dos Sistemas Nacionais da Informação Sanitária (SNIS) e da Vigilância Integrada da Doença e Risposta (VIDR) com os Parceiros Técnicos e Financeiros do Espaço CEDEAO: RELATORIO GERAL
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West African Health Organization, Organisation Ouest Africaine de la Santé, Organização Oeste Africana da Saúde |
2015 |
Portuguese |
Africa, West Africa |
Health Information Systems, HIS, Ebola |
A reunião conjunta 2015 dos Responsáveis dos Sistemas Nacionais da Informação Sanitária (SIS) e da Vigilância Integrada da Doença e Riposta (VIDR) da região CEDEAO (Comunidade Económica dos Estados da África do Oeste) teve lugar de 18–21 de Maio 2015 em Acra, Gana. Convocada na sequência da crise Ebola, ainda em curso em alguns Estados Membros, os participantes reuniram-se para analizar o tema do “Reforço da Capacidade Operacional dos Sistemas da Informação Sanitária no pós-Ebola e na região Oeste Africana.”
O encontro, albergado pelo Ministério da Saúde do Gana, foi co-organizado pela Organização Oeste Africana da Saúde (OOAS) e a Agência dos EUA para o Desenvolvimento Internacional (USAID), com o apoio da MEASURE Evaluation, da União Económica e Monetária Oeste Africana (UEMOA), e da Organização Mundial da Saúde (OMS). Mais de 150 participantes provenientes dos 15 Estados Membros que compõem a CEDEAO — juntamente com os parceiros regionais e internacionais, Organizações não-governamentais, instituições acadêmicas, e o sector privado — analizaram as lições aprendidas relativamente ao desempenho dos sistemas da informação sanitaria, considerações de ordem técnica e política, assim como as necessidades e as prioridades para acção. Através da partilha da informação, das experiências e das perspectivas, o encontro forneceu um importante quadro para elaborar soluções à questão de longa data do alcance da “interoperabilidade” dos sistemas da informação sanitaria em África Ocidental — isto quer dizer, a capacidade dos governos, dos prestadores dos cuidados sanitários e das comunidades de acessarem e trocarem de informação sobre a saúde.
Os objectivos fixados para o encontro foram de:
Analisar a organização e o desempenho dos sistemas nacionais da informação sanitária e dos sistemas de vigilância da doença e riposta em poder identificar as forças, as fraquezas e as lições tiradas durante a crise do Ebola
Identificar mecanismos e acções concretas para apoiar a integração da gestão dos sistemas de informação sanitária nos Estados Membros
Elaborar planos de acção para fortalecer a capacidade institucional e operacional dos sistemas da informação sanitária nacionais em Estados Membros e seguir a pista da implementação das intervenções propostas.
À medida que os países transitam da situação de responder à epidemia do Ebola à do planeamento do mais longo prazo, necessitarão conceber sistemas de informação sanitaria que sejam sustentáveis e pilotados pelas necessidades dos países. Para realizar isto, o reforço das capacidades do pessoal a todos os níveis é crucial — incluindo o reforço das capacidades para a análise e aproveitamento dos dados ao nível mais baixo do sistema sanitário, de modo que os estabelecimentos e as comunidades possam reconhecer os problemas e adoptar a acção apropriada. Abordagens de coordenação e de harmonização que visam fortalcer os sistemas da informação sanitaria fazem parte integrante do compromisso partilhado internacionalmente de prevenir a devastação social e económica assim como o sofrimento humano que as doenças infecciosas são capazes de infligir. Fortalecer a capacidade operacional dos sistemas de informação sanitaria na região Oeste Africana também avançarão os esforços mais amplos visando melhores cuidados sanitários e melhor saúde para todos. |
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Rencontre annuel conjointe des responsables des systèmes nationaux d'information sanitaire (SNIS) et de la surveillance intégrée de la maladie et riposte (SIMR) avec les partenaires techniques et financiers de l’espace CEDEAO: RAPPORT GENERAL
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West African Health Organization, Organisation Ouest Africaine de la Santé, Organização Oeste Africana da Saúde |
2015 |
French |
Africa, West Africa |
Ebola, Health Information Systems |
La réunion conjointe 2015 des responsables des systèmes nationaux d'information sanitaire (SIS) et de la surveillance intégrée de la maladie et riposte (SIMR) de l’espace CEDEAO (Communauté économique des Etats de l'Afrique de l'Ouest) s’est tenue du 18 au 21 mai 2015 à Accra au Ghana. Convoqués suite au déclenchement de la crise de la maladie à virus Ebola qui est toujours en cours dans certains Etats membres, les participants ont discuté autour du thème « Renforcer la capacité opérationnelle des systèmes d'information sanitaire post-Ebola en Afrique de l'Ouest ».
Organisée par le ministère Ghanéen de la Santé, cette conférence a été co-organisée par l’Organisation ouest africaine de la Santé l’Organisation Ouest Africaine de la Santé (OOAS) et l’Agence des Etats-Unis pour le développement international (USAID), avec l’appui de MEASURE Evaluation, l’Union Economique et Monétaire Ouest Africaine l’Union économique et monétaire ouest africaine (UEMOA), et l’Organisation Mondiale de la Santé l’Organisation mondiale de la Santé (OMS). Plus de 150 participants venus des 15 pays membres de la CEDEAO ainsi que les partenaires régionaux et internationaux, les organisations non gouvernementales, les institutions académiques et le secteur privé ont passé en revue les leçons apprises relatives à la performance des systèmes d'information sanitaire, les considérations techniques et politiques, et les besoins et priorités d'action. Par des échanges d’informations, d’expériences et de perspectives, la réunion a servi de cadre majeur à l’élaboration de solutions à cette préoccupation qui est de réussir à long terme « l’interopérabilité » des systèmes d'information sanitaire en Afrique de l’Ouest ; c’est-à-dire donner la capacité aux gouvernements, aux prestataires de soins de santé et aux communautés à accéder à et à échanger des informations relatives à la santé.
La réunion avait pour objectifs de:
Analyser l'organisation et la performance des systèmes nationaux d'information sanitaire et les systèmes de surveillance épidémiologique et de riposte afin d’en identifier les forces, les faiblesses et les leçons apprises dans la crise de la maladie à virus Ebola ;
Identifier des mécanismes et des actions concrètes pour soutenir l'intégration des systèmes de gestion de l’information sanitaire dans les Etats membres ;
Elaborer des plans d'action pour renforcer la capacité institutionnelle et opérationnelle des systèmes nationaux d'information sanitaire dans les Etats membres et suivre la mise en œuvre des interventions proposées.
Au moment où les pays passent de la riposte à l’épidémie d’Ebola à une planification sur le plus long terme, ils se devront de concevoir des systèmes d'information sanitaire qui soient durables et axés sur les besoins de chaque pays. Pour atteindre cet objectif, le renforcement des capacités du personnel à tous les niveaux se veut essentiel, notamment le renforcement des capacités en analyse et en utilisation des données au niveau le plus bas du système sanitaire, pour que les établissements de soins de santé et les collectivités soient en mesure d’identifier les problèmes et d’en prendre les mesures appropriées. La coordination et l’harmonisation des approches en vue de renforcer les systèmes d'information sanitaire constituent un aspect essentiel de l'engagement partagé à l'échelle internationale pour empêcher la dévastation sociale et économique et la souffrance humaine que les maladies infectieuses peuvent infliger. Le renforcement de la capacité opérationnelle des systèmes d'information sanitaire dans la région ouest africaine fera également progresser les efforts à une plus grande échelle en vue d’améliorer les soins de santé et une meilleure santé pour tous. |
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Annual Joint Meeting of National Health Information System (NHIS) and Integrated Disease Surveillance and Response (IDSR) Managers with Technical and Financial Partners in the ECOWAS Region: General Report
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West African Health Organization, Organisation Ouest Africaine de la Santé, Organização Oeste Africana da Saúde |
2015 |
English |
Africa, West Africa |
Health Information Systems, Ebola, HIS |
The 2015 Joint Meeting of National Health Information Systems (NHIS) and of Integrated Disease Surveillance and Response (IDSR) Managers from the ECOWAS (Economic Community of West African States) region was held May 18–21, 2015 in Accra, Ghana. The conference, hosted by the Ghana Ministry of Health, was co-organized by the West African Health Organization (WAHO) and the U.S. Agency for International Development (USAID), with support from MEASURE Evaluation, the West African Economic and Monetary Union (UEMOA), and the World Health Organization (WHO). More than 150 participants from the 15 member countries that make up ECOWAS—along with regional and international partners, nongovernmental organizations, academic institutions, and the private sector—discussed lessons learned related to the performance of health information systems, technical and policy considerations, and needs and priorities for action. The meeting provided an important framework to develop solutions to the long-term issue of achieving health information systems “interoperability” in West Africa—that is, the ability of governments, health care providers, and communities to access and exchange information about health.
Meeting objectives were to:
Analyze the organization and performance of national health information systems and disease surveillance and response systems to identify strengths, weaknesses, and lessons learned in the Ebola crisis
Identify mechanisms and concrete actions to support the integration of health management information systems in member countries
Develop action plans to strengthen the institutional and operational capacity of national health information systems in member countries and to track implementation of proposed interventions
As countries move from responding to the Ebola epidemic to longer-term planning, they will need to design health information systems that are sustainable and are driven by country needs. To achieve this, capacity building of personnel at all levels is crucial—including capacity building in data analysis and use at the lowest level of the health system, so that facilities and communities will be able to recognize problems and take appropriate action. Coordinating and harmonizing approaches to strengthen health information systems is an essential part of the internationally shared commitment to prevent the social and economic devastation and human suffering that infectious diseases are capable of inflicting. Strengthening the operational capacity of health information systems in the West African region will also advance broader efforts for better health care and better health for all. |
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Defining Electronic Health Technologies and Their Benefits for Global Health Program Managers: Open Data
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MEASURE Evaluation |
2015 |
English |
Global |
EHealth, Global health, Data |
Open data is data that “anyone is free to access, use, modify, and share.” Open data are “public” data. They help citizens, governments, the private sector, and others easily access data to see trends in disease patterns, service coverage, and financing that might not be visible otherwise.
In recent years, demand for open data in developing countries has been significant—a hopeful trend for proponents of the use of government data to improve health governance and health status. Although the concept is relatively new in global health, public access to data through open data policies is often connected to transparency and citizen engagement with the government. Open data can help developing countries more easily access data so that they can see trends in disease patterns, service coverage, financial expenditures, and other relevant areas. This information can be used to improve the efficiency and coverage of public health services. Open data can also contribute to growth in the private health sector, by identifying underserved areas and generating new health businesses.
MEASURE Evaluation, funded by USAID, has a mandate to strengthen health information systems in low- and middle-income countries (LMICs). For the past 20 years, our support for these systems has been building capacity and accountability for LMICs to move toward the global priorities of an AIDS-free generation and ending preventable child and maternal deaths. |
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Defining Electronic Health Technologies and Their Benefits for Global Health Program Managers: Data Interoperability and Data Integration
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MEASURE Evaluation |
2015 |
English |
Global |
EHealth, Data, Global health |
Data interoperability and integration enable multiple systems to communicate with one another and exchange data. These strategies have long been part of efforts to strengthen national health information systems. Now, with the proliferation of electronic health information systems, they are being applied within global health information systems.
Both interoperability and integration rely heavily on a common framework of standards. Unifying information from systems that used to stand alone makes it much easier for program managers to answer questions about a health system as a whole.
MEASURE Evaluation is working worldwide to improve the interoperability and integration of data systems. Our specific focus is on routine health information systems.
Access resources, including a recording and presentation slides, from a webinar on interoperability and crowdsourcing. |
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Defining Electronic Health Technologies and Their Benefits for Global Health Program Managers: Hackathons
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MEASURE Evaluation |
2015 |
English |
Global |
EHealth, Global health |
Hackathon is a contraction of the words “hack” and “marathon. Hackathons are short-term events that bring together technology professionals of various affiliations to create something that previously did not exist.
Many hackathons in the information technology (IT) community are “fast-paced contests to code software”, while others are more collaborative. Regardless of the process and incentives used, hackathons enable coders, programmers, and data visualization specialists in a compressed period to develop a product (a specific computer code or data visualization scheme, such as an infographic), a prototype (an early version of an application, game, or other output), or a concept (an early idea for a product), or to overcome a problem (export specific software or fix a software glitch).
MEASURE Evaluation is exploring how hackathons can address data gaps and support decision making in HIV programs. |
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Defining Electronic Health Technologies and Their Benefits for Global Health Program Managers: Data Science and Big Data
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MEASURE Evaluation |
2015 |
English |
Global |
Data Science, Global health, EHealth, Data |
The world is generating an ever-growing mountain of data. According to an estimate by IBM, 90 percent of the world’s data were generated in the past two years. Moreover, in 2020, the amount of data the world generates will be 20 times greater than the amount generated in 2011. Data science is an emerging field that capitalizes on this growing data environment and emphasizes creative uses of data to discover the stories that data contain.
While hard to quantify, big data is in the magnitude of petabytes or terabytes, while the average electronic medical record database is in megabytes—four times smaller than a big data repository.
Big data can be understood in terms of the “Three V’s”: “higher volume, greater variety and quicker velocity” data, coming from “sensors, social media sites, online photos and videos, online purchase records, mobile phone record signals and call records.” Data science’s methods of collection, analysis, and communication are suitable not only for high-volume and velocity data but also for data of lower volume and velocity.
For more than 20 years, MEASURE Evaluation has helped countries build their capacity to collect and use high-quality health data for evidence-based decision making and programming. Building on this history, we are conducting a proof of concept activity on how data science techniques can help answer global health questions, including improving health program management. |
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Defining Electronic Health Technologies and Their Benefits for Global Health Program Managers: Dashboards
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MEASURE Evaluation |
2015 |
English |
Global |
EHealth, Global health |
There is no widespread consensus on the definition of a data dashboard. However, the definition developed by Stephen Few, describing “a visual display of the most important information needed to achieve one or more objectives; consolidated and arranged on a single screen so the information can be monitored at a glance”—is used in many disciplines.
Dashboards are linked to one or more data sources, most commonly relational databases that store data and populate the dashboard on a routine basis. Well-designed dashboards pull together data from various sources and analyze and present them in formats useful to decision makers.
Dashboards are being used increasingly in global health program management. Varying with the availability of data, these dashboards are customized to highlight performance indicators, geographic representation of data, epidemiological data, cost data, and data quality, etc. at the different levels of a health system. |
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Using Geographic Information Systems to Meet Global Health Challenges
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Cunningham M |
2015 |
English |
Global |
Geographic Information Systems, GIS, Health System, Global health |
Recent years have seen tremendous growth in interest in geographic information system (GIS) technology. These systems manage data, facilitate analysis, and generate effective information products that can support decision making. Considerable investment in health systems has increased the availability of reliable data, making GIS well suited to support global health and development activities.
At its most effective, GIS is a tool employed in pursuit of a larger objective, such as improving response to disease outbreaks, increasing access to treatment, or reducing maternal mortality. It enhances the ability of program managers to distribute services efficiently and equitably. As a supporting tool, its value may be overlooked if attention is limited to service delivery and health outcomes.
This document presents specific examples of how GIS has served programs associated with key global health and development priorities. It is intended for program managers, technical specialists, and decision makers. |
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Defining Electronic Health Technologies and Their Benefits for Global Health Program Managers: Crowdsourcing
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MEASURE Evaluation |
2015 |
English |
Global |
EHealth, Global health |
Crowdsourcing conflates the words “outsourcing” and “crowd.” It appears to have been introduced in print by Wired magazine in 2006 to describe an approach to accomplishing a task by soliciting input from the public, or a specific subset of the public. Since then, both the word and the concept have been applied in many contexts.
Broad global access to the Internet and mobile phone networks has expanded the potential size of “the crowd” far beyond what was possible with traditional communication tools a decade ago. Today, one can engage a huge, often geographically disperse group of individuals through social media (Twitter, Facebook, etc.), text message and mobile phone applications, websites and games on the Internet, or through other Internet- and cloud-based platforms. These people can help accomplish discrete tasks for a small fee or free of charge.
Crowdsourcing has been used increasingly in global health. All four types of crowdsourcing have been applied, but crowdsourcing for knowledge discovery appears to be most promising as a tool to facilitate the management of health programs globally. |
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Defining Electronic Health Technologies and Their Benefits for Global Health Program Managers: Geospatial Analysis
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MEASURE Evaluation |
2015 |
English |
Global |
Global health, EHealth, Geospatial analysis |
Geospatial analysis can be described as the use of geographic data (such as GPS coordinates, street names, or other geographic identifiers) to identify spatial relationships, patterns, and trends in data. This can include statistical methods, spatial statistics techniques (such as interpolation or network analysis), or the layering of different geographically coded data sets in order to discover geographic patterns in data using a geographic information system, or GIS.
Geographic information systems enable the linking of data sets with geographic data to spatially assess relationships and trends. In health, geospatial analysis software is used to discover patterns of disease outbreaks and their response to interventions; identify catchment areas for health facilities; and identify areas of high priority for investment and interventions.
Spatial analysis and metrics can also be calculated to go beyond simply displaying data on a map. For instance, network analysis allows you to estimate time for travel based on the road network, rather than just straight-line estimates of distance. All of these analyses can be pivotal for better health program management and program targeting. |
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Transforming Gender Norms, Roles, and Power Dynamics for Better Health: Evidence from a Systematic Review of Gender-integrated Health Programs in Low-and Middle-Income Countries
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Muralidharan A, Fehringer J, Pappa S, Rottach E, Das M, and Mandal M |
2015 |
English |
Global |
Health programs, LMICs, Gender Norms, Gender |
The Gender, Policy and Measurement program, funded by the Asia bureau of the United States Agency for International Development, undertook a comprehensive, systematic review of the impact of gender-integrated programs on health outcomes. The findings are primarily intended to inform the work of government officials, donors, nongovernmental organizations, and other key stakeholders involved in health programming in India, as well as other low- and middle-income countries around the world. The Transforming Gender Norms, Roles, and Power Dynamics review is guided by the perspective that all health programs must employ evidence-based strategies that promote gender equity and empower women and men to achieve better health.
This review provides evidence of the most effective gender-integrated strategies used by programs in low- and middle-income countries worldwide. Its results underscore the need to conduct gender analysis in order to understand how health needs and behaviors differ among women, men, and transgender people; to identify evidence-based strategies that respond to and mitigate the specific gender barriers faced by these groups; and to incorporate these strategies into programs. To promote these programs’ sustainability and widespread reach, gender-aware strategies should be integrated and scaled up through government health systems in collaboration with nongovernmental organizations and other private sector partners. |
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Using the Data Demand, Quality, and Use Facilitated Group Self-Assessment Tool
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MEASURE Evaluation SIFSA |
2015 |
English |
Africa, SOUTH AFRICA |
MEval-SIFSA, South Africa, Data, Data Quality, Data Demand and Use |
The South African Department of Health (DoH) generates volumes of data from its routine health information system (RHIS). By June 2014, over one billion patient encounters were recorded in the national DoH electronic software application, DHIS (Schönfeldt, 2014). Data are collected monthly on about 150 indicators from about 4,000 health facilities nationwide, within 52 districts of the nine provinces. Despite the high volume of data collected by the DoH, a national audit of performance information reported that data are generally of low quality and there is little use of information (Department of Health, 2013). The DoH requested the MEASURE Evaluation–Strategic Information for South Africa (MEval-SIFSA) project’s support to enhance its capacity in strategic information, including data demand and use (DDU) and to understand the effects of capacity enhancement.
MEval-SIFSA developed the tool in order to monitor measurable changes in DDU improvement over time. The tool was adapted to the context of the DoH in order to measure the capacity of teams or programs at any level of the health care system. The tool draws on key concepts from the Performance of Routine Information System Management (PRISM)—a conceptual framework that recognises the broader context in which the RHIS operates—and published literature on good practice in data demand and use. |
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Status of Data Demand, Quality and Use: Baseline Results of Assessed Health Districts in South Africa
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MEASURE Evaluation SIFSA |
2015 |
English |
Africa, SOUTH AFRICA |
Data Quality, Data, South Africa, Data Demand and Use |
The South African Department of Health (DoH) generates volumes of data from the routine health information system (RHIS), which consists of health data reporting from about 3,800 health facilities in 52 districts of the nine provinces. However, the audit of performance information by the Auditor General reported that data are generally of low quality and there is little use of the available information (DoH, 2013). Results of a rapid assessment conducted in 2013 by the MEASURE Evaluation–Strategic Information for South Africa (MEval-SIFSA) project showed that the main causes of under-utilisation of data were: data use is not part of clinicians’ in-service training; managers and clinicians focus on service provision/“pushing queues” and consider data an extra burden/diversion from core business; data reporting is erroneously considered data use; and managers, clinicians, and other health care workers lack knowledge, skills, and confidence in calculating targets for indicators, data analysis, interpretation, and use.
This fact sheet reports the consolidated data demand and use(DDU) baseline status of six districts in South Africa that are PEPFAR focus/supplemental/special focus high-burden DoH districts. The tool has been administered at provincial, district, and health facility levels. |
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Fifteen Years of Sector-Wide Approach (SWAp) in Bangladesh Health Sector: An assessment of progress
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Ahsan KZ, Streatfield PK, Ijdi RE, Escudero GM, Khan AW, Reza MM |
2015 |
English |
BANGLADESH |
Population, Bangladesh, Monitoring, Evaluation, Health System, Health Systems Strengthening, Nutrition |
The Ministry of Health and Family Welfare (MOHFW) of the Government of Bangladesh embarked on a sector-wide approach (SWAp) modality for the health, nutrition, and population (HNP) sector in 1998. This programmatic shift initiated a different set of planning disciplines and practices along with institutional changes in the MOHFW. Over the years, the SWAp modality has evolved in Bangladesh as the MOHFW has learned from its implementation and refined the program design.
This article explores the progress made, both in terms of achievement of health outcomes and systems strengthening results, since the implementation of the SWAp for Bangladesh’s health sector. We conducted secondary analyses of survey data from 1993 to 2011 as well as a literature review of published and grey literature on the SWAp to health in Bangladesh for this assessment. Results of the assessment indicate that the MOHFW made substantial progress in health outcomes and health systems strengthening. The SWAps facilitated the alignment of funding and technical support around national priorities, and improved the government’s role in program design as well as in implementation and development partner coordination.
Notable systemic improvements have taken place in the country systems in monitoring and evaluation, procurement, and service provision; these have improved functionality of health facilities to provide essential care. Implementation of the SWAp has, therefore, contributed to an accelerated improvement in key health outcomes in Bangladesh over the last 15 years. The health SWAp in Bangladesh offers an example of a successful adaptation of such an approach in a complex administrative structure. Based on the lessons learned from implementation of the SWAp in Bangladesh, the MOHFW will need to play a stronger stewardship and regulatory role to reap the full benefits of a SWAp in its subsequent programming. |
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Evaluation FAQ: What Sample Size Do I Need for an Impact Evaluation?
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MEASURE Evaluation |
2015 |
English |
Global |
Evaluation |
An appropriate study sample size and method of selection is critical to the success of any evaluation. In an impact evaluation, with a comparison drawn between a treatment group and a comparison group or showing a change over time, the following factors should be considered during the design phase. This will ensure that an adequate sample is selected to answer your primary evaluation questions. |
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The Triple Threat of Pregnancy, HIV Infection and Malaria: Reported causes of maternal mortality in two nationwide health facility assessments in Mozambique, 2007 and 2012
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Bailey PE, Keyes E, Moran AC, Singh K,Chavane L, Chilundo B |
2015 |
English |
MOZAMBIQUE |
Maternal Health, HIV/AIDS, Mozambique, Pregnancy, Malaria |
BackgroundThe paper’s primary purpose is to determine changes in magnitude and causes of institutional maternal mortality in Mozambique. We also describe shifts in the location of institutional deaths and changes in availability of prevention and treatment measures for malaria and HIV infection.
MethodsTwo national cross-sectional assessments of health facilities with childbirth services were conducted in 2007 and 2012. Each collected retrospective data on deliveries and maternal deaths and their causes. In 2007, 2,199 cases of maternal deaths were documented over a 12 month period; in 2012, 459 cases were identified over a three month period. In 2007, data collection also included reviews of maternal deaths when records were available (n = 712).
ResultsInstitutional maternal mortality declined from 541 to 284/100,000 births from 2007 to 2012. The rate of decline among women dying of direct causes was 66% compared to 26% among women dying of indirect causes. Cause-specific mortality ratios fell for all direct causes. Patterns among indirect causes were less conclusive given differences in cause-of-death recording. In absolute numbers, the combination of antepartum and postpartum hemorrhage was the leading direct cause of death each year and HIV and malaria the main non-obstetric causes. Based on maternal death reviews, evidence of HIV infection, malaria or anemia was found in more than 40% of maternal deaths due to abortion, ectopic pregnancy and sepsis. Almost half (49%) of all institutional maternal deaths took place in the largest hospitals in 2007 while in 2012, only 24% occurred in these hospitals. The availability of antiretrovirals and antimalarials increased in all types of facilities, but increases were most dramatic in health centers.
ConclusionsThe rate at which women died of direct causes in Mozambique’s health facilities appears to have declined significantly. Despite a clear improvement in access to antiretrovirals and antimalarials, especially at lower levels of health care, malaria, HIV, and anemia continue to exact a heavy toll on child-bearing women. Going forward, efforts to end preventable maternal and newborn deaths must maximize the use of antenatal care that includes integrated preventive/treatment options for HIV infection, malaria, and anemia. |
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Assessing the Continuum of Care Pathway for Maternal Health in South Asia and Sub-Saharan Africa
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Singh K, Story WT, Moran AC |
2015 |
English |
|
Sub-Saharan Africa, Africa, Antenatal Care, Maternal Health, Maternal Mortality |
ObjectiveWe assessed how countries in regions of the world where maternal mortality is highest—South Asia and sub-Saharan Africa—are performing with regards to providing women with vital elements of the continuum of care.
MethodsUsing recent Demographic and Health Survey data from nine countries including 18,036 women, descriptive and multilevel regression analyses were conducted on four key elements of the continuum of care—at least one antenatal care visit, four or more antenatal care visits, delivery with a skilled birth attendant, and postnatal checks for the mother within the first 24 hours since birth. Family planning counseling within a year of birth was also included in the descriptive analyses.
ResultsResults indicated that a major drop-out (>50 %) occurs early on in the continuum of care between the first antenatal care visit and four or more antenatal care visits. Few women (<5 %) who do not receive any antenatal care go on to have a skilled delivery or receive postnatal care. Women who receive some or all the elements of the continuum of care have greater autonomy and are richer and more educated than women who receive none of the elements.
ConclusionUnderstanding where drop-out occurs and who drops out can enable countries to better target interventions. Four or more ANC visits plays a pivotal role within the continuum of care and warrants more programmatic attention. Strategies to ensure that vital services are available to all women are essential in efforts to improve maternal health.
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La méthode PLACE
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MEASURE Evaluation |
2015 |
French |
Global |
HIV, PLACE |
La pandémie du VIH est globale, mais l’épidémie varie considérablement d’un pays à l’autre ; et à l’intérieur d’un pays le taux de prévalence du VIH diffère selon la région, le secteur, et même la communauté. En fait, deux épidémies locales de VIH ne peuvent pas être identiques. Les épidémies locales sont occasionnées par les réseaux sexuels et de consommation de drogues injectables dans des contextes locaux spécifiques—soit urbain, rural, le long d’une route importante, dans un village de pêche, ou le long des itinéraires de trafic de stupéfiants. Bien que l’épidémie de VIH soit globale, toute transmission est locale. Pour être efficaces, des réponses locales devraient être conçues en fonction du contexte local et des conducteurs de la transmission.
La méthode PLACE bénéficie…
aux gens vivant dans des contextes à faibles ressources qui sont les plus à risque de contracter et de transmettre le VIH et qui bénéficient d’une réponse communautaire améliorée en matière de tests de sensibilisation et de distribution de préservatifs;
aux partenaires des personnes les plus susceptibles de transmettre le VIH ;
aux fournisseurs de prestation de services locaux, y compris ceux qui distribuent des préservatifs et qui veulent identifier où atteindre les populations-clés ;
aux fournisseurs locaux de dépistage et de traitement du VIH qui veulent identifier qui n’a pas été pris en compte à travers les programmes de dépistage et de traitement actuels ;
aux équipes de surveillance, de suivi et d’évaluation aux niveaux national et local qui veulent suivre la prévalence du VIH, les comportements à risque et la couverture du programme chez les populations-clés ;
aux planificateurs stratégiques au niveau national qui veulent identifier où cibler les ressources de prévention du VIH.
Accéder au Manuel PLACE et d'autres ressources. |
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Standards for Integration of HIV/AIDS Information Systems into Routine Health Information Systems
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Boone D, Cloutier S |
2015 |
English |
Africa, HAITI, KENYA |
Information systems, Health Information Systems, Routine Health Information Systems, HIV, HIV/AIDS |
In recent years, there has been a strong push to strengthen national health systems in developing countries. In its framework for action, the World Health Organization (WHO) describes a health system as consisting of “all organizations, people and actions whose primary intent is to promote, restore or maintain health.” It further elaborates on the six building blocks that comprise a health system: health service delivery; health workforce; health information; medical products, vaccines and technologies; health financing; and leadership and governance. These building blocks are interdependent and must interact synergistically to produce a positive impact on health outcomes. There is widespread agreement that, unfortunately, national health systems are not performing at an optimal level and that improved health outcomes cannot be realized without strengthening the health system.
One of the main data sources of an HIS is a routine health information system (RHIS), which is a health facility and/or community-based system to collect, analyze, and use relevant information for decision making on priority health services.
According to WHO, “a well-functioning health information system is one that ensures the production, analysis, dissemination, and use of reliable and timely information on health determinants, health system performance and health status.’’ However, attainment of sustainable population health in many developing countries is made increasingly challenging given the current weaknesses of many national HIS.
This guide describes approaches and standards for integration of vertical information systems with the RHIS. It uses HIV/AIDS information systems primarily, as examples of best practices and what is required for achieving integration with RHIS. These principals are cross-cutting, however, and can be applied to nearly any disease or program-specific information system. General aspects of information system integration are first presented, followed by the case of HIV/AIDS integration. The concept of interoperability as a method for achieving the goals of integration is then presented, with generic models and country examples of different types of integration. |
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Data Science for Health Decision Making
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MEASURE Evaluation |
2015 |
English |
Global |
Public Health, Health, Data Science, Data |
Data science is a tool relatively new to the field of public health. The public health field is just beginning to explore what data science can do to improve health outcomes. Data science is the process of finding, developing, and communicating actionable information that stems from multiple sources. For instance, data science might bring together information from household surveys, routine health information systems (RHIS), and non-traditional sources like mobile phone data to model outbreaks of disease or predict effects of health interventions.
MEASURE Evaluation is exploring the potential of data science to strengthen health systems and improve monitoring and evaluation and more generally yield previously unobtainable, policy-relevant, actionable information. We are identifying best practices for data science in global health, and developing tools that facilitate the management, analysis, and communication of data using the data science framework. |
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Sample Monitoring and Evaluation of Scale-up Strategy for a Gender-Integrated Health Governance Project
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MEASURE Evaluation, Health Policy Project, Suaahara Project |
2015 |
English |
Asia, NEPAL, South Asia |
Monitoring, Evaluation, Health, Gender |
This document sets out the strategy for monitoring and evaluation of scale-up of a gender-integrated health governance project in Nepal. The Gender, Policy, and Measurement (GPM) Program (jointly implemented by the Health Policy Project and MEASURE Evaluation) has partnered with the Suaahara Project, a community-focused program dedicated to improving the health of pregnant and lactating women and children under two years of age. The partnership aim is to design, implement, and evaluate a scalable capacity strengthening intervention for Health Facility Operation and Management Committees (HFOMCs) in Nepal to ensure issues related to gender and social inclusion (GESI) are addressed as part of the delivery of quality health services. As part of this endeavor, GPM and Suaahara have created a strategy to prospectively monitor and evaluate the scale-up of this intervention.
This document does not presume to be a how-to guide for monitoring and evaluating scale up; instead, it should be considered an example of how M&E of scale-up can be approached and applied to current and future global public health programs. Example domains, indicators, and benchmarks could reasonably be applied to interventions covering a range of health-related topics. |
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Overview of Security Considerations for eHealth
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MEASURE Evaluation SIFSA |
2015 |
English |
Southern Africa, Africa, SOUTH AFRICA |
South Africa, EHealth |
Security is of fundamental importance when dealing with health information, especially data that contains identifiable patient information, which may be particularly sensitive.
The South African National eHealth Strategy explicitly states the need for regulations on privacy, confidentiality, and security and the need to protect information and patient privacy at all times. It is therefore important that when electronic patient records are rolled out, thorough security is implemented. This requires assigning a dedicated specialised team to information security.
There are many security domains that need to be considered when deploying eHealth systems. Personally identifiable health data is particularly sensitive and its security must be ensured. Because of this, security professionals should be involved at all stages of the design, development, procurement, and implementation of patient-based health information systems. Significant attention must be paid to access controls and assessing risk. When risks and vulnerabilities are found, there should be a plan in place to mitigate that risk. |
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Interoperability Considerations in the Design, Development, and Implementation of mHealth Projects
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|
2015 |
English |
SOUTH AFRICA |
MHealth, MEval-SIFSA, Data, South Africa, Health System |
Interoperability describes the extent to which systems and devices can exchange data and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and subsequently present that data in a way that can be understood by a user.
For example, if a community health worker collects information about a pregnant woman on a mobile phone during a home visit and refers the woman to a clinic for antenatal care, the nurse at that antenatal clinic should be able to easily access the pregnant woman’s information on the clinic system. This can only happen if the data collection application used by the community health worker is interoperable with the antenatal clinic’s information system.
In order for electronic health (eHealth) systems to be interoperable, they must adhere to common standards for exchanging data. Standards provide a common framework for communicating, which enables system interoperability. Standards are generally established by consensus and approved by a recognized body.
As more mHealth initiatives are implemented at national scale in South Africa, it is important that interoperability is a cornerstone of their deployment. The government will need to take the lead and ensure that these projects design and implement systems that are interoperable with the rest of the health information system. |
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Integration as a Health Systems Strengthening Intervention: Case Studies from Senegal and Malawi
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|
2015 |
English |
MALAWI, SENEGAL |
Malawi, Health System, Senegal, Health Information Systems, Health Systems Strengthening |
Integration of health services has been adopted in recent years as a strategy to improve the availability of and access to quality services for people.
To better understand the reasons to adopt integration approaches and the various changes to services, policies, and systems that would support integration, MEASURE Evaluation, with the support of the U.S. Agency for International Development (USAID), conducted an assessment involving 10 countries to better understand the reasons to adopt integration approaches. Following the results of this assessment, MEASURE Evaluation initiated case studies in Senegal and Malawi to conduct more in-depth assessments of the integration process and to synthesize learning that will help host countries, USAID missions, and implementing partners, in the planning, implementation, and monitoring and evaluation (M&E) of integrated health services.
Related Content
Health Service Integration in Senegal: A Case Study
Integrated Service Delivery in Malawi: A Case Study
Intégration des services de santé au Sénégal: Etude de Cas |
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Privacy and Security for mHealth Projects in South Africa
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MEASURE Evaluation SIFSA |
2015 |
English |
Africa, SOUTH AFRICA, Southern Africa |
South Africa, MHealth, MEval-SIFSA, Privacy |
According to a 2011 World Health Organization report, governments cite issues related to data privacy, data security, and the protection of individual health information as two of the top barriers to the expansion of mHealth.
Protecting personal health information that is collected and transmitted over mobile devices is essential to bringing any mHealth project to scale and ensuring the mHealth platforms can be built upon in the future, while safeguarding the rights of people using the healthcare system. |
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Moving from Paper-Based Systems to Electronic Systems in South Africa
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MEASURE Evaluation SIFSA |
2015 |
English |
Africa, SOUTH AFRICA, Southern Africa |
MEval-SIFSA, EHealth, Electronic Health Records, South Africa |
In 2005, the World Health Assembly recognized e-Health as the way to achieve cost-effective and secure use of information and communications technologies (ICTs) for health and related fields, and urged its member states to consider drawing up long-term strategic plans for developing and implementing eHealth services and infrastructure in their health sectors. The South African government published its National eHealth Strategy for 2012 to 2016 in September 2012.
The South African National eHealth Strategy aims to “provide a clear roadmap that guides the health system from a largely paper-based system with some electronic data collection to an integrated, interoperable, national patient-based information system that improves the efficiency of clinical care, produces the indicators required by management, and facilitates patient mobility.”
To identify the current state of eHealth in South Africa, the eHealth strategy referenced the landscape analysis of health information systems (HIS) in developing countries, funded by the Bill & Melinda Gates Foundation. This landscape analysis identified five stages of eHealth implementation based upon data flow and collection, data utilization and integration, resources and capacity, scope, and scale. |
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mHealth for Behavior Change Communication Brief: Why mHealth messaging?
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MEASURE Evaluation SIFSA |
2015 |
English |
Africa, Southern Africa, SOUTH AFRICA |
MHealth, MEval-SIFSA, Mobile technology, South Africa |
Evidence has shown that effective communication message programs can improve a number of health behaviors for a variety of populations. Mobile messaging has been shown to be successful for many health behaviors, including medication adherence, chronic disease self-management, and disease prevention.
Mobile messaging programs have targeted diverse topics ranging from medication adherence for antiretroviral drug regimens to pregnancy-related knowledge and antenatal care visits for pregnant women. Additional information about existing evidence for mHealth can be found at https://www.mhealthevidence.org/
There have been several large-scale implementations of nation-wide mobile messaging programs including: MomConnect, a South African National Department of Health (NDoH) program which uses SMS to register pregnant women in South Africa and provide stage-based messages throughout pregnancy and up to the child’s first birthday; the Stop Smoking Services SMS program, a United Kingdom National Health Service (NHS) program which aims to help smokers achieve smoking cessation; and similarly the SmokefreeTXT program, a United States National Cancer Institute (NCI) program which also aims to help smokers achieve smoking cessation. Mobile phone messaging programs and campaigns such as these provide opportunities to meet some of the health care related needs of individuals living in low-resource settings by providing accurate and appropriate health care information. |
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Good Practices in Issuing Mobile Devices to Healthcare Workers
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MEASURE Evaluation SIFSA |
2015 |
English |
Africa, SOUTH AFRICA, Southern Africa |
South Africa, MHealth, Mobile technology, Health Workers |
Mobile health, or mHealth, is defined as the use of mobile computing, medical sensors, or other communication technology in the delivery of health-related services. mHealth has the potential to empower patients with information to inform their healthcare decisions and link them to health services. Providers and health managers can use mHealth to access data for decision making and for the improvement of health systems performance.
Despite this potential, some mHealth initiatives have struggled to deliver benefits, in part due to a lack of coordination and a duplication of effort between programs implementing mHealth initiatives. This is further exacerbated by the complications of distributing mobile devices to healthcare workers. If devices are assigned in an uncoordinated manner by multiple projects, then each project will face a similar set of challenges and health workers could potentially be given many different mobile devices, resulting in duplication of cost and effort.
The South African mHealth Strategy 2015–2019 provides some tangible ways to address these coordination and duplication challenges. It states that the Department of Health should “provide guidelines for mHealth projects providing tablets/smartphones to healthcare workers [which]… all face common problems around SIM recharge methods, broken/lost devices, training and security.”
This technical brief describes an approach focused on the One Device Principle for mobile health and shows how it can be used to promote greater coordination among projects. It will also detail the major issues that need to be addressed when distributing devices to healthcare workers. |
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Good Practices for the Implementation and Management of a National Master Patient Index
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MEASURE Evaluation SIFSA |
2015 |
English |
Africa, SOUTH AFRICA, Southern Africa |
ICTs, EHealth, Health System, South Africa |
The World Health Organisation (WHO) defines eHealth as “the use of information and communication technologies (ICTs) for health.” According to the WHO, “eHealth is concerned with improving the flow of information, through electronic means, to support the delivery of health services and the management of health systems.”
The South Africa National eHealth strategy (2012) provides a roadmap for the implementation of eHealth in the country. As part of the eHealth foundations section, it states the need for “implementation of a national patient master index for unique patient identification.”
The (South African) National Health Normative Standards Framework for Interoperability in eHealth (HNSF) was released in 2014 to provide guidelines around ensuring interoperability between the various systems in the health sector. Among the recommendations in the HNSF is the establishment of a patient registry to manage patients in the health system. |
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Dual Indices for Prioritizing Investment in Decentralized HIV Services at Nigerian Primary Health Care Facilities
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Fronczak N, Oyediran KA, Mullen S, Kolapo UM |
2015 |
English |
NIGERIA |
Health Systems Strengthening, PEPFAR, Health Services, Health System, HIV/AIDS, Health Facilities, Nigeria |
Decentralizing health services, including those for HIV prevention and treatment, is one strategy for maximizing the use of limited resources and expanding treatment options. However, few methods exist for systematically identifying where investments for service expansion might be most effective in terms of meeting needs and rapid availability of improved services. The Nigerian Government, the United States Government under the President's Emergency Plan for AIDS Relief (PEPFAR) program, and other donors are expanding services for prevention of mother-to-child transmission (PMTCT) of HIV to primary health care facilities in Nigeria. Nigerian primary care facilities vary greatly in their readiness to deliver HIV/AIDS services.
In 2012, MEASURE Evaluation assessed 268 PEPFAR-supported primary health care facilities in Nigeria and developed a systematic method for prioritizing these facilities for expansion of PMTCT services. Each assessed facility was scored based on two indices with multiple, weighted variables: one measured facility readiness to provide PMTCT services and the other measured local need for the services and feasibility of expansion. These two scores were compiled and the summary score used as the basis for prioritizing facilities for PMTCT service expansion. The rationale was that using need and readiness to identify where to expand PMTCT services would result in more efficient allocation of resources. A review of the results showed that the indices achieved the desired effect—that is prioritizing facilities with high need even when readiness was problematic and also prioritizing facilities where rapid scale-up was feasible.
This article describes the development of the two-part index and discusses advantages of using this approach when planning service expansion. The authors' objective is to contribute to development of methodologies for prioritizing investments in HIV, as well as other public health arenas, that should improve cost-effectiveness and strengthen services and systems in resource-limited countries. |
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Prompt Access to Effective Malaria Treatment among Children under Five in Sub-Saharan Africa: a Multi-country Analysis of National Household Survey Data
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Shah JA, Emina JB, Eckert E, Ye Y |
2015 |
English |
Africa |
Sub-Saharan Africa, Malaria, ACT, Child Health |
BackgroundScaling up diagnostic testing and treatment is a key strategy to reduce the burden of malaria. Delays in accessing treatment can have fatal consequences; however, few studies have systematically assessed these delays among children under five years of age in malaria-endemic countries of sub-Saharan Africa. This study identifies predictors of prompt treatment with first-line artemisinin combination therapy (ACT) and describes profiles of children who received this recommended treatment.
MethodsThis study uses data from the most recent Demographic and Health Survey, Malaria Indicator Survey, or Anaemia and Parasite Prevalence Survey conducted in 13 countries. A Chi square automatic interaction detector (CHAID) model was used to identify factors associated with prompt and effective treatment among children under five years of age.
ResultsThe percentage of children with fever who received any anti-malarial treatment varies from 3.6 % (95 % CI 2.8–4.4 %) in Ethiopia to 64.5 % (95 % CI 62.7–66.2 %) in Uganda. Among those who received prompt treatment with any anti-malarial medicine, the percentage who received ACT ranged from 32.2 % (95 % CI 26.1–38.4 %) in Zambia to nearly 100 % in Tanzania mainland and Zanzibar. The CHAID analysis revealed that country of residence is the best predictor of prompt and effective treatment (p < 0.001). Depending on the country, the second best predictor was maternal education (p = 0.004), place of residence (p = 0.008), or household wealth index (p < 0.001).
ConclusionsThis study reveals that country of residence, maternal education, place of residence, and socio-economic status are key predictors of prompt access to malaria treatment. Achieving universal coverage and the elimination agenda will require effective monitoring to detect disparities early and sustained investments in routine data collection and policy formulation. |
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Perspectives of Health Care Providers on the Provision of Intermittent Preventive Treatment in Pregnancy in Health Facilities in Malawi
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Yoder PS, Nsabagasani X, Eckert E, Moran A, Ye Y |
2015 |
English |
MALAWI |
Pregnancy, Antenatal Care, Health Facilities, Malawi |
BackgroundNearly 20 years after the adoption by the government of Malawi of the provision of intermittent preventive treatment in pregnancy (IPTp) for malaria, only 55% of pregnant women received at least two doses of sulfadoxine-pyrimethamine (SP) in 2010. Although several reasons for the low coverage have been suggested, few studies have examined the views of health care providers. This study examined the experiences of the nurses and midwives in providing antenatal care (ANC) services.
MethodsThis study was conducted in health facilities in Malawi that provide routine ANC services. Providers of ANC in Malawi were selected from in eight health care facilities of Malawi. Selected providers were interviewed using a semi-structured interview guide designed to address a series of themes related to their working conditions and their delivery of IPTp.
ResultsNurses displayed detailed knowledge of ANC services and the rationale behind them. Nurses understood that they should provide two doses of IPTp during a pregnancy, but they did not agree on the timing of the doses. Nurses gave SP as directly observed therapy (DOT) at the clinic. Nurses did not give SP pills to women to take home with them because they did not trust that women would take the pills. Women who resisted taking SP explained they do not take drugs if they had not eaten, or they feared side effects, or they were not sick. Reasons for not giving the first or second dose of SP included a delay in the first ANC visit, testing positive for HIV, and presenting with malaria. None of the nurses were able to show any specific written guidelines on when to give SP. The challenges faced by the nurses include being overworked and persuading women to take SP under observation.
ConclusionThe findings show that the nurses had gained the knowledge and technical skills to provide appropriate ANC services. With regard to IPTp, nurses need guidelines that would be available at the health facility about how and when to give SP. The adoption of the WHO guidelines and their diffusion to health care facilities could help increase the coverage of IPTp2 (at least two doses of sulfadoxine-pyrimethamine) in Malawi. |
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Intégration des services de santé au Sénégal: Etude de Cas
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MEASURE Evaluation |
2015 |
French |
Africa, West Africa, SENEGAL |
Health Services, Senegal |
L’intégration des services dans le secteur de la santé a été adoptée au cours des dernières années comme une stratégie visant à améliorer la disponibilité et l’accès à des prestations de services de qualité pour les populations. Ces études de cas ont été lancées au Sénégal et au Malawi afin d’analyser d’une façon plus approfondie le processus d’intégration. Ces pays ont été sélectionnés parce qu’ils avaient manifesté une volonté de participer à une étude plus approfondie et étaient en train de mettre à l’échelle, ou quasi à l’échelle, une intervention de prestation de services intégrée. Ce rapport présente les résultats issus du cas du Sénégal.
Au Sénégal, le Ministère de la Santé et de l’action sociale (MSAS) et ses partenaires ont mis en place un paquet de services essentiels, le Plan opérationnel de passage à l’échelle nationale des interventions à haut impact sur la mortalité infanto-juvénile (POPAEN), 2010-2014. La conception de ce paquet de services répond aux priorités définies au niveau local, dont la réduction de la morbidité et de la mortalité maternelle, néonatale et infantile. Pour favoriser la santé communautaire, au coeur de cette stratégie, le gouvernement du Sénégal a développé un Plan national stratégique de santé communautaire (2014-2018).
Cette étude a utilisé la méthodologie et ne cherchait pas à être représentative, donc ces résultats, notamment au niveau des clients et des prestataires, ne peuvent pas forcément être généralisés au reste du pays. Cependant, la diversité des types de répondants et des sites d’étude devrait inspirer une certaine confiance que les résultats reflètent l’expérience typique au Sénégal, en particulier au niveau national. Ces conclusions devraient être pertinentes pour les planificateurs et les bailleurs dans d’autres contextes qui voudraient planifier et mettre en oeuvre des interventions intégrées, ainsi que des systèmes capables de suivre et évaluer ces interventions. |
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Tanzania Global Health Initiative
|
|
2015 |
English |
TANZANIA |
Tanzania, MEASURE Evaluation Tanzania, Monitoring, Evaluation |
The MEASURE Evaluation Tanzania (MEASURE Evaluation TZ) project contributes to the achievement of the USAID Tanzania Global Health Initiative Strategy's intermediate result 2.2, “improving integration and effectiveness of monitoring and evaluation systems.” Strong health programs guided by quality data and information are essential for countries to understand the health issues their citizens face and the gaps to be addressed in order to safeguard public health overall and improve quality of life for everyone. This fact sheet shares MEASURE Evaluation’s approach and progress in helping the government achieve this result. |
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Ebola: The Ethics of Thinking Ahead
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Thomas JC, Miller R |
2015 |
English |
|
Ebola |
This commentary argues that Ebola epidemic’s reach into the United States revealed that we remain unprepared to respond quickly and ethically to the ethical challenges of international transmission of a highly pathogenic disease. Guidelines for nonclinical actions, such as interactions with communities and structures for ethical decision making, are largely missing. It calls for a system to guide ethical responses to fast-moving epidemics and pandemics. |
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Developing Core Competencies for Monitoring and Evaluation Tracks in South Asian MPH Programs
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Negandhi H, Negandhi P, Tiwari R, Sharma A, Zodpey S, Kulatilaka H, Tikyani S |
2015 |
English |
Asia |
Monitoring, Evaluation, Public Health, Asia |
BackgroundMonitoring and evaluation (M&E) provides vital information for decision-making and its structures, systems and processes are expected to be integrated throughout the life-cycle of public health programs. The acquisition of these skills should be developed in a structured manner and needs educational systems to identify core competencies in M&E teaching. This article presents our work on harmonizing M&E competencies for Masters-level programs in the South Asian context and undertaking the global review of M&E track/concentration offered in various Masters of Public Health (MPH) programs.
MethodsThrough an online search and snow-balling, we mapped institutions offering M&E tracks/concentrations in Masters of Public Health (MPH) programs globally. We obtained detailed information about their M&E curriculum from university websites and brochures. The data on curricular contents was extracted and compiled. We analyzed the curricular contents using the framework for core competencies developed by the Association of Schools of Public Health (ASPH); and the Miller’s triangle. This data was then used to inform a consultative exercise aimed at identifying core competencies for an M&E track/concentration in MPH programs in the South Asian context.
ResultsOur curricular review of M&E content within MPH programs globally showed that different domains or broad topic areas relating to M&E are covered differently across the programs. The quantitative sciences (Biostatistics and Epidemiology) and Health Policy and Management are covered in much greater depth than the other two domains (Social & Behavioral Sciences and Environmental Health Sciences). The identification of core competencies for an M&E track/concentration in the South Asian context was undertaken through a consultative group exercise involving representation from 11 institutions across Bangladesh, India, Nepal and Sri Lanka. During the consultation, the group engaged in a focused discussion to reach consensus on a set of 15 core competencies for an M&E track in South Asian MPH programs.
ConclusionThis work presents an opportunity for institutions to identify and re-examine their M&E competencies as a part of their specialized tracks within MPH programs. Our curricular analysis approach has the potential for adaptation and further use in curriculum analysis across different academic specialties. |
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An Information System for Gender-Based Violence Care and Support: Botswana
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Bloom SS, Curran J |
2015 |
English |
BOTSWANA |
gender-based violence, Gender, GBV, Botswana, Health Information Systems |
In Botswana, an estimated 60 percent of women and girls have experienced gender-based violence (GBV) at some point during their lives. At the request of USAID Botswana, MEASURE Evaluation is working with the government’s Gender Affairs Department (GeAD) in the Ministry of Labour and Home Affairs to design a referral system for GBV survivor care and support services, and to develop an information system to track referrals made and completed. A new system has been planned and is ready to be piloted.
The new system will use mobile-based technology to link multiple services that serve GBV survivors – such as schools, police and legal services, and health services – and to track when referrals are made and when a client makes use of them. The new system will maintain a case history on clients, eliminating the need for survivors to repeat their stories each time they seek services at a new agency. The system also will enable the GeAD to identify where the referral system is working efficiently, where demand may be overtaking supply, and where bottlenecks exist. |
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Integrated Service Delivery in Malawi: A Case Study
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MEASURE Evaluation |
2015 |
English |
MALAWI, Africa, Southern Africa |
Service delivery, Malawi, Health System |
Integration of services has been adopted in recent years across the health sector as a strategy to improve the availability and access to quality services for populations. Case studies were launched in Senegal and Malawi to conduct in-depth assessments of the integration process. These countries were selected because they expressed a willingness to participate and were in the process of scaling up an integrated service delivery intervention. This report presents the findings from Malawi.
The purpose of this study was to document the changes required within the health system to make service integration a reality with the support of such implementing partners as Support for Service Delivery Integration (SSDI). The study also aimed to document how the monitoring and evaluation (M&E) systems have been or could be strengthened to better monitor and evaluate integration, including documentation of indicators and information sources in use.
This study used the case study methodology and did not seek to be representative; so these results, particularly in terms of clients and providers, can not necessarily be generalized to the rest of the country. However, the diversity of the types of respondents and study sites should inspire some confidence that the results reflect the typical experience in Malawi, especially at the national level. These findings should be relevant to planners and donors in other contexts who would plan and implement integrated interventions and systems that monitor and evaluate the interventions. |
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Health Service Integration in Senegal: A Case Study
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MEASURE Evaluation |
2015 |
English |
SENEGAL, Africa, West Africa |
Senegal, Health Services |
Integration of services has been adopted in recent years across the health sector as a strategy to improve the availability and access to quality services for populations. Case studies were launched in Senegal and Malawi to conduct in-depth assessments of the integration process. These countries were selected because they expressed a willingness to participate and were in the process of scaling up an integrated service delivery intervention. This report presents the findings from Senegal.
The purpose of this study was to document the changes required within the health system to make service integration a reality. The study also aimed to document how the monitoring and evaluation systems have been or could be strengthened to better monitor and evaluate integration, including documentation of indicators and information sources in use.
This study used the case study methodology and did not seek to be representative, so these results, particularly in terms of clients and providers, can not necessarily be generalized to the rest of the country. However, the diversity of the types of respondents and study sites should inspire some confidence that the results reflect the typical experience in Senegal, especially at the national level. These findings should be relevant to planners and donors in other contexts who would plan and implement integrated interventions and systems that monitor and evaluate the interventions. |
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Rapid Assessment of Ebola-Related Implications for Reproductive, Maternal, Newborn and Child Health Service Delivery and Utilization in Guinea
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Barden-O'Fallon J, Barry MA, Brodish P, Hazerjian J |
2015 |
English |
GUINEA |
Guinea, Child health, Service delivery, Ebola, Reproductive Health, Maternal Health, Newborn health |
Introduction: Since March 2014, Guinea has been in the midst of the largest, longest, and deadliest outbreak of Ebola Virus Disease ever recorded. Due to sub-optimal health conditions prior to the outbreak, Guinean women and children may have been especially vulnerable to worsening health care conditions. A rapid assessment was conducted to better understand how the delivery and utilization of routine RMNCH services may have been affected by the extraordinary strain placed on the health system and its client population by the Ebola outbreak in Guinea.
Methods: Data were collected January-February 2015 in a convenience sample of public and private facilities in areas of the country that were Ebola active, calm and inactive. Monthly data on a number of RMNCH services were collected by facility record abstraction for the period from October 1, 2013 through December 31, 2014. Structured interviews were also held with facility directors and RMNCH service providers.
Results: Data on RMNCH services from forty five public facilities were obtained. A statistically significant decline of 31% was seen in outpatient visits between October-December 2013 (before the Ebola outbreak) and October-December 2014 (the advanced stage of the Ebola outbreak). Service declines appeared to be greater in hospitals compared to health centers. Child health services were more affected by the Ebola epidemic than other assessed health areas. For example, the number of children under five seen for diarrhea and Acute Respiratory Infection (ARI) showed a large decrease over the one-year period in both hospitals (60% for diarrhea and 58% for ARI) and health centers (25% and 23%, respectively). Results also suggest that the negative effects on service availability (such as reduced hours, closures, and service suspensions) are likely to be regional and/or facility-specific. Providers reported a number of improved infection control behaviors as a result of the Ebola outbreak, including more frequent hand-washing and the use of disinfectants. Nevertheless, 30% of interviewed staff had not received any training on Ebola infection control.
Discussion: Although there may be differences in RMNCH service delivery and availability in selected versus non-selected facilities, a large number of indicators were assessed in order to provide needed information on the effects of the Ebola crisis on routine RMNCH service delivery and uptake in Guinea. This information is an important and timely contribution to ongoing efforts to understand and respond to the adverse effects of the Ebola crisis on essential RMNCH services in Guinea. |
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Data Demand and Information Use Approach
|
|
2015 |
English |
SOUTH AFRICA |
Data Quality, Data Demand and Use, SIFSA, Health Information Systems, South Africa, DDU |
The MEASURE Evaluation–Strategic Information for South Africa Project (MEval-SIFSA) is helping the Department of Health at national, provincial, and district levels to identify data needs, improve data quality, better analyze data and use evidence for decision making. This fact sheet describes challenges the Department of Health and its partners face as they seek to improve the health care system. It outlines the data demand and information use approach that focuses on routine health information to generate better quality data that is more useful for policy makers and implementers. It addresses technical, organizational, and individual determinants that affect data demand and use. |
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Planificación Familiar en América Latina y el Caribe: Logros de 50 Años: Resumen Ejecutivo
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Bertrand J, Ward V, Roberto Santiso-Gálvez R |
2015 |
Spanish |
Latin America and the Caribbean, COLOMBIA, DOMINICAN REPUBLIC, EL SALVADOR, GUATEMALA, HAITI, MEXICO, PARAGUAY, NICARAGUA |
Latin America, Family Planning |
La planificación familiar es una intervención protectora de vidas que beneficia a mujeres, familias, comunidades y naciones. Al permitir que las mujeres aplacen la maternidad, espacien los nacimientos, y eviten los embarazos no deseados, la planificación familiar puede prevenir hasta una de cada tres muertes maternas. Además de los múltiples beneficios, los gobiernos y donantes han acogido la planificación familiar porque salva vidas.
Este informe examina el período de 50 años desde mediados de la década de los años sesenta que produjo un marcado descenso en la fecundidad, y un aumento constante en el uso de anticonceptivos en la región de América Latina y el Caribe (ALC). La actual tasa de prevalencia anticonceptiva (todos los métodos) del 74 por ciento se encuentra entre las más altas de cualquier región del mundo en desarrollo.
Además, el informe se basa en ocho estudios de caso asociados en el que se examinan las experiencias de algunos países de la región: Colombia, República Dominicana, El Salvador, Haití, Guatemala, México, Nicaragua y Paraguay. Los estudios de caso se inspiraron en las entrevistas a fondo llevadas a cabo en esos países, y realizadas para el presente informe. |
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Family Planning in Latin America and the Caribbean: The Achievements of 50 Years: Executive Summary
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Bertrand J, Ward V, Roberto Santiso-Gálvez R |
2015 |
English |
Latin America and the Caribbean, COLOMBIA, EL SALVADOR, DOMINICAN REPUBLIC, HAITI, GUATEMALA, MEXICO, NICARAGUA, PARAGUAY |
Latin America, Family Planning, Maternal Health |
Family planning is a lifesaving intervention that benefits individual women, families, communities and nations. By allowing women to delay childbearing, space births, and avoid unintended pregnancies, family planning can prevent as many as one in three maternal deaths. In addition to multiple other benefits, governments and donors have embraced family planning because it saves lives.
This report examines the 50-year period starting in the mid-1960s that witnessed a dramatic decline in fertility and steady increase in contraceptive use in the Latin America and Caribbean (LAC) region. The current contraceptive prevalence rate (all methods) of 74 percent is among the highest of any region in the developing world.
In addition, the Family Planning in Latin America and the Caribbean: The Achievements of 50 Years report is informed by eight associated case studies that examine the experiences of selected countries of the region: Colombia, Dominican Republic, El Salvador, Guatemala, Haiti, Mexico, Nicaragua, and Paraguay. The case studies drew on the in-depth interviews held in those countries and conducted for this report. |
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Une évaluation rapide des effets de la flambée d’Ebola sur la prestation et utilisation des services de santé génésique, maternelle, néonatale, et infantile en Guinée
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Barry A, Barden O’Fallon J, Hazerjian J, Brodish P |
2015 |
French |
GUINEA |
Guinea, Newborn health, Ebola, Maternal Health, Child health, Reproductive Health |
La Guinée a été le point zéro de la flambée récente de la maladie à virus Ebola. Le taux de mortalité attribuée à Ebola en Guinée était de 66 %, nettement plus élevé que les taux des deux autres pays ouest-africains les plus affectés : la Sierra Leone (32 %) et le Liberia (45 %). Face à la fermeture des cliniques, aux patients qui évitent les établissements sanitaires de peur de contracter Ebola et aux patients présentant des symptômes semblables à ceux d’Ebola qu’on renvoie chez eux, les experts en matière de santé s’inquiètent que d’autres maladies, telles que le paludisme, la pneumonie et la fièvre typhoïde, ne seront pas soignées, et que des soins de routine comme ceux qui favorisent la santé maternelle et infantile ne seront pas fournis. L’USAID/Guinée a donc demandé à MEASURE Evaluation d’entreprendre l’évaluation rapide décrite dans le présent rapport. Le but de l’étude était de mieux comprendre les effets d’Ebola sur la prestation et utilisation des services SGMNI de routine, plutôt que de formuler des recommandations pour y répondre. |
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A Rapid Assessment of Ebola-related Implications for RMNCH Service Delivery and Utilization in Guinea
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Barry A, Barden O’Fallon J, Hazerjian J, Brodish P |
2015 |
English |
GUINEA |
Ebola, Maternal Health, Child health, Reproductive Health, Guinea, Newborn health |
Guinea was ground zero for the 2014 outbreak of Ebola virus, and those infected suffered a mortality rate of 66% – higher than that of the other two West African countries also severely affected: Sierra Leone (32% mortality) and Liberia (45%). Health experts have been concerned that other critical health issues such as malaria, pneumonia, and typhoid, as well as routine care for maternal and child health, might go unattended due to closures of clinics, patients avoiding facilities for fear of contracting Ebola, or patients with Ebola‐like symptoms being turned away. To address this need, in 2015 MEASURE Evaluation conducted a rapid assessment to understand better the effects of Ebola on delivery and utilization of routine reproductive, maternal, newborn, and child health (RMNCH) services, described in this report. |
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Planificación Familiar en Nicaragua: Logros de 50 Años
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Santiso-Gálvez R, Ward VM, Bertrand JT |
2015 |
Spanish |
NICARAGUA |
Latin America, Family Planning, Nicaragua |
Esta publicación constituye uno de los ocho estudios de caso que se desarrollaron en el marco de un análisis más amplio denominado Family Planning in Latin America and the Caribbean: The Achievements of 50 Years (Planificación Familiar en América Latina y el Caribe: Logros de 50 Años). Como su título indica, el informe principal documenta y analiza los logros en toda la región desde que comenzó el financiamiento de la Agencia de los Estados Unidos para el Desarrollo Internacional (USAID) a inicios de la década de los años sesenta.
Otros estudios de caso de esta serie revisan los logros en planificación familiar en Colombia, la República Dominicana, El Salvador, Guatemala, Haití, México y Paraguay.
Planificación Familiar en América Latina y el Caribe: Logros de 50 Años: Resumen Ejecutivo |
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Improving Referrals and Integrating Family Planning and HIV Services through Organizational Network Strengthening
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Thomas JC, Reynold HW, Alterescu X, Bevc C, Tsegave A |
2015 |
English |
|
HIV/AIDS, Family Planning, Contraception, organizational network analysis |
Integrated human immunodeficiency virus (HIV) and family planning services improve quality of care, increase uptake of services, and result in positive effects on outcomes such as contraceptive use and pregnancy incidence. Nevertheless, there have been few evaluations of scalable integration strategies.
To reduce unmet patient needs by increasing referral coordination for HIV and family planning (measured as network density), MEASURE Evaluation conducted organizational network analysis of organizations providing services for HIV care or family planning in two of Addis Ababa’s 10 sub-cities. In one, the researchers sought to increase referrals through three network strengthening meetings. The network analysis was conducted again in both sub-cities to measure any changes since baseline, and the researchers also quantitatively measured reported client service needs in both sub-cities before and after the intervention with two cross-sectional samples of face-to-face interviews with clients.
In the sub-city with the intervention, the number of referral connections between organizations, measured as network density, increased 55%. In the control community, the density decreased over the same period. Reported unmet client service needs declined more consistently across services in the intervention community. This quasi experiment demonstrated that (1) an organizational network analysis can inform a network-strengthening intervention, (2) a modest network strengthening intervention can enhance client referrals in the network, (3) improvement in client referrals was accompanied by a decrease in client-reported unmet needs, and (4) a series of network analyses can be a useful evaluation tool.
This research was the first quantitatively evaluated study of network strengthening in a developing country, and the first anywhere with a control network for comparison. |
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Family Planning Needs of Adolescents in Predominantly Rural Communities in the Central Part of Ghana
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Enuameh Y, Tawiah C, Afari-Asiedu S, Nettey OEA, Sulemana A, Mahama E, Adjei G, Boamah E, Manu A, Gyaase S, Zandoh C, Amanfo N, Asante KP, Letsa T, Owusu-Agyei S |
2015 |
English |
|
Contraception, Family Planning, Ghana |
The article presents findings of a descriptive analysis of data from a cross-sectional study of adolescents aimed at identifying their family planning needs and the best approaches to addressing them in the Kintampo Districts of Ghana. Data for the analysis, supported by MEASURE Evaluation, were drawn from the family planning module of a sexual and reproductive health survey carried out by the Kintampo Health and Demographic Surveillance System in 2011. Adolescents in this study experienced high marital (1.6% of females and 0.4% of males) and pregnancy rates (11.5% of females and 1.5% of males). Their knowledge of contraceptive methods was high (87.7% of females and 82% of males), but utilization of contraception was low (17.9% of females and 6% of males). Most study participants viewed family planning as important to their health and wellbeing (59.6% or females and of 58.6% males). A minority of adolescents perceived that contraceptive use was solely the responsibility of women (41.1% of females and 32.4% of males); and that the use of contraceptives could lead to promiscuity among women (43.8% of females and 42.5% of males). Those adolescents who previously had unwanted pregnancies reported that they would have accepted some help in preventing it (33.1% of females and 9.1% of males).
Recommendations made by respondents included creating a friendly atmosphere for adolescents by those providing family planning services. Other suggestions were ensuring that family planning services are available and accessible to adolescents, and educating adolescents on the diverse methods available. |
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Planificación Familiar en Colombia: Logros de 50 Años
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Bertrand JT, Santiso-Gálvez R, Ward VM |
2015 |
Spanish |
COLOMBIA |
Latin America, Family Planning |
Esta publicación constituye uno de los ocho estudios de caso que se desarrollaron en el marco de un análisis más amplio denominado Family Planning in Latin America and the Caribbean: The Achievements of 50 Years (Planificación Familiar en América Latina y el Caribe: Logros de 50 Años). Como su título indica, el informe principal documenta y analiza los logros en toda la región desde que comenzó el financiamiento de la Agencia de los Estados Unidos para el Desarrollo Internacional (USAID) a inicios de la década de los años sesenta.
Otros estudios de caso de esta serie revisan los logros en planificación familiar en la República Dominicana, El Salvador, Guatemala, Haití, México, Nicaragua y Paraguay.
Planificación Familiar en América Latina y el Caribe: Logros de 50 Años: Resumen Ejecutivo |
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Planificación Familiar en República Dominicana: Logros de 50 Años
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Santiso-Gálvez R, Ward VM, Bertrand JT |
2015 |
Spanish |
DOMINICAN REPUBLIC |
Dominican Republic, Latin America, Family Planning |
Esta publicación constituye uno de los ocho estudios de caso que se desarrollaron en el marco de un análisis más amplio denominado Family Planning in Latin America and the Caribbean: The Achievements of 50 Years (Planificación Familiar en América Latina y el Caribe: Logros de 50 Años). Como su título indica, el informe principal documenta y analiza los logros en toda la región desde que comenzó el financiamiento de la Agencia de los Estados Unidos para el Desarrollo Internacional (USAID) a inicios de la década de los años sesenta.
Otros estudios de caso de esta serie revisan los logros en planificación familiar en Colombia, El Salvador, Guatemala, Haití, México, Nicaragua y Paraguay.
Planificación Familiar en América Latina y el Caribe: Logros de 50 Años: Resumen Ejecutivo |
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Planificación Familiar en El Salvador: Logros de 50 Años
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Santiso-Gálvez R, Ward VM, Bertrand JT |
2015 |
Spanish |
EL SALVADOR |
Latin America, Family Planning |
Esta publicación constituye uno de los ocho estudios de caso que se desarrollaron en el marco de un análisis más amplio denominado Family Planning in Latin America and the Caribbean: The Achievements of 50 Years (Planificación Familiar en América Latina y el Caribe: Logros de 50 Años). Como su título indica, el informe principal documenta y analiza los logros en toda la región desde que comenzó el financiamiento de la Agencia de los Estados Unidos para el Desarrollo Internacional (USAID) a inicios de la década de los años sesenta.
Otros estudios de caso de esta serie revisan los logros en planificación familiar en Colombia, República Dominicana, Guatemala, Haití, México, Nicaragua y Paraguay.
Planificación Familiar en América Latina y el Caribe: Logros de 50 Años: Resumen Ejecutivo |
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La planification familiale en Haïti: Les accomplissements des 50 dernières années
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Ward VM, Santiso-Gálvez R, Bertrand JT |
2015 |
French |
HAITI |
Family Planning, Latin America, Haiti |
Cette publication est l'une des huit études de cas développées dans le cadre d'une analyse plus large intitulée Family Planning in Latin America and the Caribbean: The Achievements of 50 Years (La planification familiale en Amérique Latine et dans les Caraïbes: Les accomplissements des 50 dernières années). Comme son titre l'indique, ce rapport documente et analyse le travail accompli dans toute la région depuis les premiers financements de l'USAID au début des années 1960.
Autres études de cas dans cette série portent sur des accomplissements de la famille planification réalisés en Colombia, République Dominicaine, El Salvador, Guatemala, le Mexique, le Nicaragua et le Paraguay. |
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Planificación Familiar en Guatemala: Logros de 50 Años
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Santiso-Gálvez R, Ward VM, Bertrand JT |
2015 |
Spanish |
GUATEMALA |
Latin America, Family Planning, Guatemala |
Esta publicación constituye uno de los ocho estudios de caso que se desarrollaron en el marco de un análisis más amplio denominado Family Planning in Latin America and the Caribbean: The Achievements of 50 Years (Planificación Familiar en América Latina y el Caribe: Logros de 50 Años). Como su título indica, el informe principal documenta y analiza los logros en toda la región desde que comenzó el financiamiento de la Agencia de los Estados Unidos para el Desarrollo Internacional (USAID) a inicios de la década de los años sesenta.
Otros estudios de caso de esta serie revisan los logros en planificación familiar en Colombia, República Dominicana, El Salvador, Haití, México, Nicaragua y Paraguay.
Planificación Familiar en América Latina y el Caribe: Logros de 50 Años: Resumen Ejecutivo |
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Planificación Familiar en Paraguay: Logros de 50 Años
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Santiso-Gálvez R, Ward VM, Bertrand JT |
2015 |
Spanish |
PARAGUAY |
Latin America, Family Planning |
Esta publicación constituye uno de los ocho estudios de caso que se desarrollaron en el marco de un análisis más amplio denominado Family Planning in Latin America and the Caribbean: The Achievements of 50 Years (Planificación Familiar en América Latina y el Caribe: Logros de 50 Años). Como su título indica, el informe principal documenta y analiza los logros en toda la región desde que comenzó el financiamiento de la Agencia de los Estados Unidos para el Desarrollo Internacional (USAID) a inicios de la década de los años sesenta.
Otros estudios de caso de esta serie revisan los logros en planificación familiar en Colombia, República Dominicana, El Salvador, Guatemala, Haití, México y Nicaragua.
Planificación Familiar en América Latina y el Caribe: Logros de 50 Años: Resumen Ejecutivo |
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Formation pour les collecteurs de données des enquêtes PEPFAR : Guide du facilitateur
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2015 |
French |
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PEPFAR |
Les collecteurs de données appliquant les outils d'enquête des orphelins et enfants vulnérables (OEV) du Plan d’urgence du Président pour la lutte contre le SIDA (PEPFAR) doivent être formés adéquatement. C'est la raison pour laquelle MEASURE Evaluation a mis au point un manuel et du matériel de formation pour les collecteurs de données. Les groupes souhaitant utiliser les outils d'enquête des OEV devront adapter ce manuel et matériel de formation pour refléter les objectifs et la conception de leur étude particulière. Par ailleurs, la structure de la formation pour les collecteurs de données devrait être analogue, quels que soient les objectifs ou la conception l'étude. En plus, il existe des domaines thématiques comme les entretiens avec des enfants qui sont pertinents à tous les types d'études des OEV et questions de recherche sur les OEV. Ce manuel de formation vise à apporter autant de directives que possible pour les futurs collecteurs de données qui prévoient d'utiliser ces outils.
Ce manuel de formation compte trois objectifs principaux :
montrer aux participants comment les programmes PEPFAR recommandent d'utiliser ces outils ;
vérifier l'application standard et routinière des mesures de protection des enfants et des normes éthiques de la recherche; et
faciliter le travail des chercheurs locaux et internationaux qui souhaitent utiliser les outils d'évaluation des programmes des OEV.
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Impact Evaluation of Approaches to Strengthen Health Facility Operation and Management Committees in Nepal: Summary of the Baseline Report
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Fehringer J, Bhandari P, Ghimire D, Lohani JR, Dawadi B, Acharya V, Adhikari B |
2015 |
English |
NEPAL |
Impact Evaluation, Health Facilities, Nepal |
This summary report highlights key findings from a baseline survey report on an impact evaluation of approaches to strengthen Health Facility Operation and Management Committees (HFOMCs) in Nepal. The baseline survey is a product of a partnership to design, implement, and evaluate a scalable capacity strengthening intervention for HFOMCs to ensure issues related to gender and social inclusion (GESI) are addressed as part of the delivery of quality government health services in maternal, newborn, and child health, as well as family planning services. The Gender, Policy, and Measurement Program (GPM), implemented by the Health Policy Project (HPP) and MEASURE Evaluation, partnered with Suaahara, a community-focused program dedicated to improving the health of pregnant and lactating women and children less than two years of age. Suaahara and GPM are integrating GESI and community participation components into existing government of Nepal guidelines, processes, and training for HFOMCs. The Strengthening HFOMCs through a Community Engagement Approach project includes two capacity strengthening approaches to be evaluated.
The aim of the evaluation is to understand the value added from including GESI and community engagement intervention components on household and community-level health outcomes, as well as on health care utilization of women and children under two years old in Nepal. Using quantitative baseline and endline data from household, individual, and community surveys, and a variety of qualitative methods, the evaluation will compare the effectiveness of Approach A with the effectiveness of Approach B, which are being implemented in Syangja and Baglung, respectively. A third arm (in Parbat) will serve as the control, in which no intervention activities will be implemented.
MEASURE Evaluation led the baseline data collection for the impact evaluation. Local Nepal data collection partners, the Institute for Social and Environmental Research-Nepal (ISER-N) and Research Inputs & Development Internatonal (RIDA), carried out quantitative and qualitative data collection, respectively, from July 2014 to October 2014. This report summarizes key findings from that baseline quantitative and qualitative data. The endline data collection and subsequent analyses, using both baseline and endline data to determine the impact of the intervention approaches, will be carried out in 2016.
A complete report of the baseline survey is also available. |
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Impact Evaluation of Approaches to Strengthen Health Facility Operation and Management Committees in Nepal: Baseline Report
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Fehringer J, Bhandari P, Ghimire D, Lohani JR, Dawadi B, Acharya V, Adhikari B |
2015 |
English |
NEPAL |
Impact Evaluation, Health Facilities, Nepal |
This baseline report is a product of a partnership to design, implement, and evaluate a scalable capacity strengthening intervention for Health Facility Operation and Management Committees (HFOMCs) in Nepal to ensure issues related to gender and social inclusion (GESI) are addressed as part of the delivery of quality government health services in maternal, newborn, and child health, as well as family planning services. The Gender, Policy, and Measurement Program (GPM), implemented by the Health Policy Project (HPP) and MEASURE Evaluation, partnered with Suaahara, a community-focused program dedicated to improving the health of pregnant and lactating women and children less than two years of age. Suaahara and GPM are integrating GESI and community participation components into existing government of Nepal guidelines, processes, and training for HFOMCs. The Strengthening HFOMCs through a Community Engagement Approach project includes two capacity strengthening approaches to be evaluated.
The aim of the evaluation is to understand the value added from including GESI and community engagement intervention components on household and community-level health outcomes, as well as on health care utilization of women and children under two years old in Nepal. Using quantitative baseline and endline data from household, individual, and community surveys, and a variety of qualitative methods, the evaluation will compare the effectiveness of Approach A with the effectiveness of Approach B, which are being implemented in Syangja and Baglung, respectively. A third arm (in Parbat) will serve as the control, in which no intervention activities will be implemented.
MEASURE Evaluation led the baseline data collection for the impact evaluation. Local Nepal data collection partners, The Institute for Social and Environmental Research-Nepal (ISER-N) and Research Inputs & Development International (RIDA), carried out quantitative and qualitative data collection, respectively, from July 2014 to October 2014. This report summarizes key findings from that baseline quantitative and qualitative data. The endline data collection and subsequent analyses, using both baseline and endline data to determine the impact of the intervention approaches, will be carried out in 2016.
A summary report of the baseline survey is also available. |
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Civil Registration and Vital Statistics
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MEASURE Evaluation |
2015 |
English |
Global |
vital statistics, CRVS, capability statement, civil registration |
Information on births and deaths by age, sex, and cause of death is the cornerstone of public health planning. It is used to allocate resources and to determine which programs are effective. However, each year about 40 percent of births and two-thirds of deaths are still not registered. The essential role of civil registration and vital statistics (CRVS) is recognized by country and multilateral agencies working to improve global health. CRVS data are needed to monitor many of the United Nations goals for global health by the year 2030, known as the sustainable development goals, or SDGs. And the reduction of maternal and child deaths are a top priority of the U.S. Agency for International Development (USAID), as expressed in the report on ending preventable child and maternal deaths (EPCMD) and the AIDS-free generation (AFG).
MEASURE Evaluation is USAID’s primary mechanism for strengthening health information systems, including CRVS. The project has more than a decade of experience working closely with low- to middle-income (LMIC) countries to improve their CRVS systems. This fact sheet describes standard and innovative approaches to measuring CRVS data, including in settings where a complete CRVS system isn’t fully functional, but there are multiple other sources of data.
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Family Folders: Low-Resource Health Data with a Big Impact
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2015 |
English |
ETHIOPIA |
Family Planning, Health System, Ethiopia, Fertility, Families, and Children |
In a southern region of Ethiopia, data reported in November 2012 showed for every woman who arrived at a health post for a first checkup during pregnancy, many did not return and slightly fewer than half came in for the recommended fourth visit. But only a year later, data in the same region showed two-thirds of pregnant women made that fourth visit. Regional data also revealed that in November 2012, close to 6,000 babies were born in qualified health centers. A year later, there were 12,000 births in health centers – a 103 percent increase.
Clearly, something is changing – with dramatic results. It’s not a new computer system and it’s not a huge financial investment. It’s a simple shift in how health facilities gather and use information in a paper-based "Family Folder" kept for every family in the area so health workers can follow up. The Family Folder is an innovation at the most basic level of Ethiopia’s health system – the rural health post. It is tied to a reformed national health information management system (HMIS), funded in part by the U.S. Agency for International Development, working with MEASURE Evaluation’s HMIS Scale-up Project. |
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Справочное пособие Показатели в области гендерного равенства и ВИЧ
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Bloom SS, Negroustoueva S |
2015 |
Russian |
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Russia, Gender |
Гендерное равенство это концепция, согласно которой все люди, как мужчины, так и женщины, свободны в вопросах развития сво-ей личности и своего выбора, без каких бы то ни было ограничений, накладываемых стереотипами, строго за-данными гендерными ролями или предрассудками. Гендерное равенство означает, что различные формы пове-дения, устремления и потребности женщин и мужчин рассматриваются, оцениваются и одобряются на равной основе. Это не означает, что женщины и мужчины должны стать одинаковыми; это означает, что права, обязан-ности и возможности людей не должны зависеть от того, кем они родились – мужчинами или женщинами. |
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Binge Drinking among Men Who Have Sex with Men and Transgender Women in San Salvador: Correlates and Sexual Health Implications
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Peacock E, Andrinopoulos K, Hembling J |
2015 |
English |
EL SALVADOR |
HIV/AIDS, Key Populations |
High rates of heavy alcohol use among men who have sex with men (MSM) and transgender women (TW) have been linked to increased vulnerability for HIV and poor mental health. While theories explaining elevated drinking levels among sexual minorities have been forwarded, few investigations have assessed the potential pathways using empirical data, particularly with an explicit focus on self-stigma and among MSM and TW in low- and middle-income countries. This study examined the relationship between stigma-related stress (specifically, self-stigma and concealment of one's sexual orientation) and binge drinking in a sample of MSM and TW (n = 670) in San Salvador, El Salvador, recruited using respondent-driven sampling.
Levels of alcohol consumption among participants were high: only 39 % of the sample did not drink alcohol or did not binge drink, while 34 % engaged in binge drinking at least weekly. Among MSM, high self-stigma was associated with binge drinking at least weekly (adjusted relative risk ratio (aRRR) = 2.1, p < 0.05). No such relationship was found with less than weekly binge drinking. Among both MSM and TW, having a female partner was associated with binge drinking less than weekly (aRRR = 3.3, p < 0.05) and binge drinking at least weekly (aRRR = 3.4, p < 0.05), while disclosure of sexual orientation to multiple types of people was associated with binge drinking less than weekly (aRRR = 2.9 for disclosure to one-two types of people, p < 0.01; aRRR = 4.0 for disclosure to three-nine types of people, p < 0.01). No such relationship was found with at least weekly binge drinking. Binge drinking at least weekly was marginally associated with a number of sexual health outcomes, including high number of lifetime partners (adjusted odds ratio (aOR) = 1.7, p < 0.10), inconsistent condom use with a non-regular partner (aOR = 0.5, p < 0.10), and decreased intention to test for HIV in the next 12 months (aOR = 0.6, p < 0.10). With the exception of inconsistent condom use with a non-regular partner (aOR = 0.4, p < 0.05), binge drinking less than weekly was not associated with increased sexual risk behavior and was actually associated with increased intention to test for HIV in the next 12 months (aOR = 2.8, p < 0.01).
These findings support multiple pathways linking stigma-related stress to alcohol use. Specifically, those with high self-stigma and identity concealment may be using alcohol as a maladaptive coping and emotion regulation strategy, while those who have disclosed their sexual orientation to multiple types of people may be more engaged with the sexual minority community, likely in bars and other venues where permissive norms for alcohol use prevail. That this frequency of binge drinking does not appear to be associated with increased sexual risk behavior (and may even be associated with increased intention to test for HIV in the next 12 months) lends further support to the suggestion that these individuals with healthy concepts of the self (as indicated by high levels of disclosure and low levels of risky sexual behavior) may engage in binge drinking because of the influence of the social environment. Further research is needed to establish the pathways linking stigma-related stress to heavy alcohol use so that points of intervention can be identified. |
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Bangladesh Urban Health Survey 2013 Final Report
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NIPORT, icddr,b, MEASURE Evaluation |
2015 |
English |
BANGLADESH |
Bangladesh, Health |
The 2013 Bangladesh Urban Health Survey (UHS) is a representative household survey of slums and non-slums of City Corporations and other urban areas that was implemented through a collaborative effort of the National Institute of Population Research and Training (NIPORT), Measure Evaluation, University of North Carolina at Chapel Hill, USA, and icddr,b. Associates for Community and Population Research, a Bangladeshi private research agency, conducted the field survey in the City Corporation areas, municipalities and large towns with population over 45,000.
The 2013 UHS is a follow-up survey conducted after seven years from the first UHS conducted in 2006. Primarily the survey was designed to examine the changes in the health and service utilization profile of the urban population with explicit attention to examine differences between slum and non-slum groups. The information collected in the 2013 UHS will be instrumental in determining directions for the urban health program in Bangladesh. Data concerning important urban health issues like migration, fertility and family planning, maternal and newborn health, childhood mortality, child health, feeding practices, and nutritional status etc. are crucial in designing policies and programs. Hopefully, intra-urban differentials in health service utilization between two surveys will be helpful to demonstrate an increased commitment to improving the lives of urban people in Bangladesh. |
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Seminar on Strengthening the Routine Health Information System of the Ministry of Health and Family Welfare in Bangladesh
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Kabir H, Chowdhury SK |
2015 |
English |
BANGLADESH |
Bangladesh, Routine Health Information Systems |
The U.S. Agency for International Development (USAID) and its implementing partners are collaborating with the Bangladesh Ministry of Health and Family Welfare (MOHFW) to help develop a routine health information system (RHIS) in the country. A seminar held January 13, 2015 as part of the next phase of activities for strengthening the RHIS was organized by USAID partners implementing the RHIS in Bangladesh.
Among issues that emerged from the seminar are the following:
There is a need for bringing collection of data and their use for health service delivery into a regulatory framework so as to ensure the privacy of sensitive personal data and to stop misuse.
Strengthening RHIS is urgently needed to ensure comprehensive, quality routine data and use of information for decision making at different levels, from local to central.
There should be a strong coordination mechanism in order to avoid duplication of work among different stakeholders.
Providing a unique health ID to track all service recipients should be explored.
Focus should be given to a common web-based platform to ensure interoperability and avoid duplication of efforts.
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Exposure to Spousal Violence in the Family, Attitudes and Dating Violence Perpetration Among High School Students in Port-au-Prince
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Gage A |
2015 |
English |
HAITI |
Haiti, Violence |
This study examined the associations of exposure to spousal violence in the family and personal and peer attitudes with dating violence (DV) perpetration among high school students in Port-au-Prince, Haiti. Participants were 342 high school students in Grades 10 to 12 who stated that they had ever been on a date.
Multiple linear regression methods were used to examine correlates of the scale of DV perpetration. Findings showed that personal acceptance of DV mediated the association between exposure to wife-perpetrated and husband-perpetrated spousal violence in the family and DV perpetration for girls. Boys who were exposed to husband-perpetrated spousal violence in the family had significantly higher levels of psychological DV perpetration than those who were not. Contrary to expectations, exposure to wife-perpetrated spousal violence in the family was negatively associated with psychological and physical/sexual DV perpetration by boys, after controlling for other factors.
Overall, perceived peer tolerance of DV was more strongly associated with DV perpetration than personal tolerance of DV, and was the only significant correlate of psychological DV perpetration for girls. Perceived peer attitudes also moderated the association between boys’ exposure to spousal violence in the family and DV perpetration. Implications for future research and policy are discussed. |
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Family Planning in Latin America and the Caribbean: The Achievements of 50 Years
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Bertrand JT, Ward VM, Santiso-Gálvez R |
2015 |
English |
Latin America and the Caribbean |
Latin America, Family Planning |
This report examines the 50-year period starting in the mid-1960s that witnessed a dramatic decline in fertility and steady increase in contraceptive use in the Latin America and Caribbean (LAC) region. The current contraceptive prevalence rate (all methods) of 74 percent is among the highest of any region in the developing world.
Many factors have contributed to the dramatic decline in fertility in the LAC region over the past 50 years: increased educational levels, improved economic conditions, decreased infant and child mortality, rapid urbanization, political stability, and changing cultural norms, among others. While recognizing the influence of these factors on fertility, what role did use of family planning play in fertility decline in the region? What lessons can be drawn for other developing countries committed to a development path that strengthens family planning services and improves health and living standards for their people? This report examines the specific role of family planning in accelerating fertility decline in the LAC region.
In addition to this regional overview, an executive summary and a series of eight case studies on family planning achievements within specific countries is available for Colombia, Dominican Republic, El Salvador, Guatemala, Haiti, Mexico, Nicaragua, and Paraguay. |
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Family Planning in Colombia. The Achievements of 50 Years
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Bertrand JT, Santiso-Gálvez R, Ward VM |
2015 |
English |
COLOMBIA |
Family Planning |
This publication is one of eight case studies that were developed as part of a broader review entitled Family Planning in Latin America and the Caribbean: The Achievements of 50 Years. As its title implies, the larger review documents and analyzes the accomplishments in the entire region since the initiation of U.S. Agency for International Development (USAID) funding in the early 1960s.
Family planning has become so deeply entrenched as a social norm in Colombia that it no longer constitutes the special area of interest that it did in the 1960s and 1970s. Nonetheless, challenges remain.
Other case studies in this series review family planning achievements in Dominican Republic, El Salvador, Guatemala, Haiti, Mexico, Nicaragua, and Paraguay. An executive summary for the report is also available. |
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Family Planning in Dominican Republic. The Achievements of 50 Years
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Santiso-Gálvez R, Ward VM, Bertrand JTA |
2015 |
English |
DOMINICAN REPUBLIC |
Dominican Republic, Reproductive Health, Family Planning |
This publication is one of eight case studies that were developed as part of a broader review entitled Family Planning in Latin America and the Caribbean: The Achievements of 50 Years. As its title implies, the larger review documents and analyzes the accomplishments in the entire region since the initiation of U.S. Agency for International Development (USAID) funding in the early 1960s.
It is evident that the family planning program in the Dominican Republic has made tremendous strides, particularly in expansion of coverage. However, program sustainability requires coordination of efforts, political will, technical capacity, and financial support to reduce unmet need.
Other case studies in this series review family planning achievements in Colombia, El Salvador, Guatemala, Haiti, Mexico, Nicaragua, and Paraguay. An executive summary for the report is also available. |
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Family Planning in El Salvador. The Achievements of 50 Years
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Santiso-Gálvez R, Ward VM, Bertrand JT |
2015 |
English |
EL SALVADOR |
Latin America, Family Planning |
This publication is one of eight case studies that were developed as part of a broader review entitled Family Planning in Latin America and the Caribbean: The Achievements of 50 Years. As its title implies, the larger review documents and analyzes the accomplishments in the entire region since the initiation of U.S. Agency for International Development (USAID) funding in the early 1960s.
El Salvador has made enormous progress in terms of family planning over the past five decades. It has reduced fertility rates; it has developed a robust legal and regulatory framework for FP; it has allocated resources for procuring contraceptives for its population; it now offers information and contraceptive services to the entire population of the country with the active participation of civil society organizations, especially women’s organizations.
Other case studies in this series review family planning achievements in Colombia, Dominican Republic, Guatemala, Haiti, Mexico, Nicaragua, and Paraguay.
An executive summary for the report is also available. |
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Family Planning in Guatemala. The Achievements of 50 Years
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Santiso-Gálvez R, Ward VM, Bertrand JT |
2015 |
English |
GUATEMALA |
Guatemala, Reproductive Health, Family Planning |
This publication is one of eight case studies that were developed as part of a broader review entitled Family Planning in Latin America and the Caribbean: The Achievements of 50 Years. As its title implies, the larger review documents and analyzes the accomplishments in the entire region since the initiation of U.S. Agency for International Development (USAID) funding in the early 1960s.
Family planning and reproductive health now form part of Guatemala’s national agenda. Demand and services have increased; the newest challenge is to tailor services to increase access and meet the needs and preferences of potential clients, especially young people and members of indigenous groups. As the number of services increases and access advances, it will be important to improve the quality of services (e.g., assuring that they are user-friendly and culturally appropriate). Existing medical and institutional barriers must be removed and users must be able to demand quality care as a human right.
Other case studies in this series review family planning achievements in Colombia, Dominican Republic, El Salvador, Haiti, Mexico, Nicaragua, and Paraguay. An executive summary for the report is also available. |
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Family Planning in Mexico. The Achievements of 50 Years
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Ward VM, Santiso-Gálvez R, Bertrand JT |
2015 |
English |
MEXICO |
Mexico, Family Planning |
This publication is one of eight case studies that were developed as part of a broader review entitled Family Planning in Latin America and the Caribbean: The Achievements of 50 Years. As its title implies, the larger review documents and analyzes the accomplishments in the entire region since the initiation of U.S. Agency for International Development (USAID) funding in the early 1960s.
Mexico is an important family planning success story in the region and the world. Since its earliest inception, the Mexican family planning program has been a vital component of the social and health sector in Mexico. Visionary Mexican leaders created an enduring system of legislation, policy frameworks and regulations that ensure that family planning remains an integral part of the health system today.
Other case studies in this series review family planning achievements in Colombia, Dominican Republic, El Salvador, Guatemala, Haiti, Nicaragua, and Paraguay. An executive summary for the report is also available. |
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Family Planning in Nicaragua. The Achievements of 50 Years
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Santiso-Gálvez R, Ward VM, Bertrand JT |
2015 |
English |
NICARAGUA |
Family Planning, Nicaragua |
This publication is one of eight case studies that were developed as part of a broader review entitled Family Planning in Latin America and the Caribbean: The Achievements of 50 Years. As its title implies, the larger review documents and analyzes the accomplishments in the entire region since the initiation of U.S. Agency for International Development (USAID) funding in the early 1960s.
Nicaragua has made significant progress in improving its macro-level primary health care indicators, reducing maternal mortality and increasing contraceptive prevalence. There has also been increased participation by the Instituto Nicaragense de Seguridad Social (INSS) in providing family planning services and commodities, thus reducing the burden on health ministry facilities. The government has shown its strong commitment to comprehensive services to improve the health of the population.
Other case studies in this series review family planning achievements in Colombia, Dominican Republic, El Salvador, Guatemala, Haiti, Mexico, and Paraguay. An executive summary for the report is also available. |
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Family Planning in Paraguay. The Achievements of 50 Years
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Santiso-Gálvez R, Ward VM, Bertrand JT |
2015 |
English |
PARAGUAY |
Latin America, Family Planning |
This publication is one of eight case studies that were developed as part of a broader review entitled Family Planning in Latin America and the Caribbean: The Achievements of 50 Years. As its title implies, the larger review documents and analyzes the accomplishments in the entire region since the initiation of U.S. Agency for International Development (USAID) funding in the early 1960s.
Paraguay has one of the highest contraceptive prevalence rates in Latin America, as well as an effective market segmentation. However, challenges remain, such as the need to reach adolescents with sexual and reproductive health information and services.
Other case studies in this series review family planning achievements in Colombia, Dominican Republic, El Salvador, Guatemala, Haiti, Mexico, and Nicaragua. An executive summary for the report is also available. |
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Family Planning in Haiti. The Achievements of 50 Years
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Ward VM, Santiso-Gálvez R, Bertrand JT |
2015 |
English |
HAITI |
Haiti, Family Planning |
This publication is one of eight case studies that were developed as part of a broader review entitled Family Planning in Latin America and the Caribbean: The Achievements of 50 Years. As its title implies, the larger review documents and analyzes the accomplishments in the entire region since the initiation of U.S. Agency for International Development (USAID) funding in the early 1960s.
The family planning movement in Haiti began in the 1960s, only a short time after family planning activities had been initiated in many other countries in the Latin American and Caribbean region. Initially, doctors and demographers worked together to encourage government policies around the issue and to begin private sector service provision programs in much the same way early family planning activities occurred elsewhere. Yet, in comparison with other countries within the region, Haiti’s progress on reproductive health has been slow.
Other case studies in this series review family planning achievements in Colombia, Dominican Republic, El Salvador, Guatemala, Mexico, Nicaragua, and Paraguay. An executive summary for the report is also available. |
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A Guide on Conducting a Post-Census Verbal Autopsy to Estimate Maternal Mortality
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Singh K, Hart L |
2015 |
English |
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Maternal health, Verbal Autopsy, Maternal Mortality |
Large disparities exist in terms of maternal and under-five mortality between rich and poor countries and also between rich and poor within countries. In order to improve maternal and child health, countries need data to inform programs and policies. In terms of maternal mortality, getting accurate estimates is a challenge for many low- and middle-income countries. These countries often lack complete vital registration systems, which include reporting of all births and deaths. Data from health facilities alone do not capture the deaths that occur in homes or non-facility environments. Countries that are able to obtain estimates often only have these estimates at a national level, though maternal mortality may vary widely by sub-region within a country. In addition, few low- or middle-income countries have information regarding cause of maternal mortality at either a national or sub-national level. This guide presents a methodology of using a post-census verbal autopsy in conjunction with the World Health Organization's International Classification of Disease (ICD) guidelines. This methodology can enable countries to obtain the information they need at both national and sub-national levels for effective programs and policies. |
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The Effect of Access to Contraceptive Services on Injectable Use and Demand for Family Planning in Malawi
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Skiles MP, Cunningham M, Inglis A, Wilkes B, Hatch B, Bock A, Barden-O’Fallon J |
2015 |
English |
MALAWI |
Contraception, Malawi, Family Planning |
Context: Previous studies have identified positive relationships between geographic proximity to family planning services and contraceptive use, but have not accounted for the effect of contraceptive supply reliability or the diminishing influence of facility access with increasing distance.
Methods: Kernel density estimation was used to geographically link Malawi women’s use of injectable contraceptives and demand for birth spacing or limiting, as drawn from the 2010 Demographic and Health Survey, with contraceptive logistics data from family planning service delivery points. Linear probability models were run to identify associations between access to injectable services—measured by distance alone and by distance combined with supply reliability—and injectable use and family planning demand among rural and urban populations.
Results: Access to services was an important predictor of injectable use. The probability of injectable use among rural women with the most access by both measures was 7‒8 percentage points higher than among rural dwellers with the least access. The probability of wanting to space or limit births among urban women who had access to the most reliable supplies was 18 percentage points higher than among their counterparts with the least access.
Conclusions: Product availability in the local service environment plays a critical role in women’s demand for and use of contraceptive methods. Use of kernel density estimation in creating facility service environments provides a refined approach to linking women with services and accounts for both distance to facilities and supply reliability. Urban and rural differences should be considered when seeking to improve contraceptive access. |
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National Most Vulnerable Children Monitoring and Evaluation Plan
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United Republic of Tanzania, Ministry of Health and Social Welfare |
2015 |
English |
TANZANIA |
Child Health, Monitoring, Evaluation |
The purpose of this national most vulnerable children (MVC) monitoring and evaluation (M&E) plan is to provide guidance for tracking the implementation of the Tanzania National Costed Plan of Action for Most Vulnerable Children NCPA II (2013–2017). The NCPA II calls for a government-led and community-driven MVC response to facilitate MVC access to adequate care, support, protection, and basic social services. Because multiple sectors committed to implementing NCPA II, standardized M&E activities are needed for effective and efficient coordination of MVC program interventions. The M&E plan guides stakeholders on how to monitor and evaluate the implementation of the NCPA II and determine whether its goal and objectives are being met.
The Ministry of Health and Social Welfare (MoHSW), through the Department of Social Welfare (DSW) and other stakeholders, implemented the first National Costed Plan of Action (2007–2010) for most vulnerable Children (MVC) to respond to the problem of vulnerable children in Tanzania. This plan of action was reviewed in 2011, and the recommendations that resulted were used to guide the development of the Second National Costed Plan of Action for MVC (NCPA II). The NCPA II was launched in February 2013 and is a five-year program (2013–2017). |
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Rapport d’Evaluation du Système d’Information Sanitaire de Routine par l’Approche et les Outils PRISM
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|
2015 |
French |
BURUNDI |
Evaluation, PRISM |
L’objectif de cette étude était d’évaluer la performance du Système d’Information Sanitaire de routine (SISR), Burundi, en termes de qualité des données et d’utilisation de l’information en vue de formuler des recommandations pour améliorer les pratiques et corriger les faiblesses éventuelles.
The 2018 version of the PRISM Series, updated and with new modules (Toolkit, User’s Kit, and Training Kit) is available here: https://www.measureevaluation.org/prism |
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Guidelines for Data Management Standards in Routine Health Information Systems
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Heywood A, Boone D |
2015 |
English |
|
Data, Routine Health Information Systems |
The regular use of reliable information from a well-designed routine health information system (RHIS) is indispensable for ensuring and sustaining improvements in health system performance. Using reliable information from RHIS over time is an important aid to improving health outcomes, tackling disparities, enhancing efficiency, and fostering innovation.This document proposes standards on data management for RHIS, based on the results of an expert workshop, held in Johannesburg, South Africa, in May 2012. RHIS is a subsystem of health information systems (HIS), devoted to routine reporting of health sector service statistics for management, planning, and evaluation. (Other HIS subsystems include census, civil registration, population surveys, individual records, and resource records.) These guidelines are based on field experiences from all over the world and are considered “standards” or, at a minimum, “best practices.” Wherever possible, they are illustrated by case studies or use cases. |
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Strengthening Tuberculosis Control in Ukraine: Impact Evaluation Baseline Survey, Ukraine 2014
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|
2015 |
English |
UKRAINE |
Tuberculosis, Impact Evaluation |
The Strengthening Tuberculosis Control in Ukraine (STbCU) project, awarded in 2012 to Chemonics International in partnership with Project HOPE and the New Jersey Medical School Global Tuberculosis Institute, works to improve the health of Ukrainians by reducing the burden of tuberculosis (TB). The project focuses on strategic actions to strengthen systems for routine TB services, as well as address the challenges of diagnosis and treatment for multidrug-resistant TB (MDR-TB) and TB-HIV co-infection.
In 2014, the MEASURE Evaluation project, upon the request of the U.S. Agency for International Development (USAID) mission in Kiev, initiated an impact evaluation to study two STbCU programmatic priorities: 1) providing social support services to improve TB treatment adherence; and 2) improving integration of TB and HIV services to reduce mortality through early diagnosis and treatment for TB-HIV co-infected patients. To evaluate the impact of these program efforts, MEASURE Evaluation designed two independent but complementary studies: the Social Support study and the TB-HIV Integration study.
This report provides information on the study designs and findings at baseline from data collected in four STbCU target oblasts (Dnipropetrovsk, Kharkiv, Odessa, and Zaporizhzhya) and three comparison sites (Kiev City, Mykolaiv, and Zhytomyr). This baseline work shows the positive role that social support services had on health outcomes for a majority of the individuals who received services in the oblasts studied, although some of the most at-risk groups were less likely to have accessed those services. Additional analyses to control for provider referrals will improve these estimates. |
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Bangladesh Marketing Innovation for Health Baseline Survey 2013-2014
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|
2015 |
English |
BANGLADESH |
Bangladesh, Health |
The U.S. government awarded a highly-targeted and evidence-based program, Marketing Innovation for Health, to the Social Marketing Company (SMC) and its partners. The four-year project (2012 to 2016) involves an integrated social marketing program to provide a comprehensive range of essential health products and services to target populations in Bangladesh. Other partners in this effort include Population Services International (PSI), BRAC, Concerned Women for Family Development (CWFD), Population Services and Training Center (PSTC), Shimantik, and EngenderHealth.
The goal of the Marketing Innovation for Health program is to contribute to sustained improvements in the health status of women and children in Bangladesh by increasing access to and demand for these health products and services. An outcome evaluation will examine changes taking place in key outcomes in terms of utilization of health and family planning products and services. The evaluation measures outcomes “before and after” the intervention in project areas relative to changes in comparison areas. This report provides baseline data that were collected at the beginning of the interventions, in 2013-2014. Endline data will be collected after about two years from the date of the baseline data collection. |
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Mobile Technology for Monitoring and Evaluation and Health Information Systems in Low- to Middle-Income Countries
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Xiong K |
2015 |
English |
|
Monitoring, Evaluation, Health Information Systems, Mobile technology, HIS, LMICs |
In many developing country settings, limited resources constrain the development and expansion of certain technology infrastructures — such as high-speed Internet — that could facilitate more efficient data collection and reporting in the health sector. Mobile technologies may offer an affordable alternative to (or alongside) other electronic health applications in many low-resource settings. In this paper, current uses of such mobile technologies in the developing world are discussed, and how these approaches can be applied to improve national monitoring and evaluation (M&E) systems. Suggested guidelines on the use of mobile technology for M&E purposes are provided. |
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Geospatial Analysis in Global Health M&E: A Process Guide to Monitoring and Evaluation for Informed Decision Making
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Moise IK, Cunningham M, Inglis A. |
2015 |
English |
|
GIS, Geospatial analysis, Geographic Information Systems, Global health, Monitoring, Evaluation |
Download EXERCISE DATA for Appendix 7
Geospatial Analysis in Global Health: A Monitoring and Evaluation Guide for Making Informed Decisions provides monitoring and evaluation (M&E) practitioners an overview of geospatial analysis techniques applicable to their work. This guide shows how geospatial analysis can be used to support public health program decision-making along with routine planning and M&E.The use of geographic information systems (GIS) for M&E of health programs is expanding. As a result of this expansion, a growing number of users are seeking to move beyond basic GIS techniques (such as facility mapping), into more advanced GIS applications that combine various GIS techniques, outputs, and routine M&E datasets to conduct geospatial analysis. However, knowing which advanced analysis approaches are most relevant for M&E can be challenging for M&E professionals with limited formal GIS training.To identify the most appropriate spatial analysis techniques and help M&E professionals understand how to incorporate them into M&E, MEASURE Evaluation convened an experts meeting on Spatial Analytical Methods for M&E in December 2013 in Rosslyn, Virginia.Participating in the meeting were 18 GIS and global health experts with experience in either spatial analysis or M&E. The meeting’s objective was to identify key decision points where M&E practitioners might include spatial analysis techniques in their work. The participants identified several key challenges that M&E practitioners faced when including geospatial analysis in their work:
Mixed skill levels—basic to advanced—among GIS practitioners in many settings.
Limited knowledge of GIS among public health decision makers.
Limited understanding among M&E practitioners about how to use GIS in M&E.
Limitations and incompleteness exist in many of the commonly available routine public health and programmatic datasets.
To address these challenges, meeting participants recommended the development of a guide to give M&E and GIS practitioners an overview of how to select appropriate geospatial analysis techniques to help overcome the drawbacks of commonly used M&E data. This guide provides examples of ways to apply geospatial analysis within the context of M&E, along with resources for additional information if needed. |
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Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs
|
MEASURE Evaluation |
2014-2019 |
English |
|
Orphans and Vulnerable Children, Monitoring, Children, OVC programs, PEPFAR, OVC |
As part of its Monitoring, Evaluation, and Reporting (MER) guidance, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) launched a set of outcome indicators for orphans and vulnerable children (OVC) programs in 2014. These outcome indicators are designated as “Essential Survey Indicators,” which means that PEPFAR considers them critical to tracking progress within PEPFAR-funded projects and has therefore made them a reporting requirement.
The purpose of collecting the MER OVC Essential Survey Indicators (ESI) is to obtain a snapshot of project outcomes at a point in time and to assess changes in outcomes among OVC project beneficiaries over time. Access reports and posters that share findings from surveys in Haiti, Kenya, Mozambique, Namibia, Nigeria, and Tanzania.
MEASURE Evaluation has developed a set of resources to support the collection of the PEPFAR MER Essential Survey Indicators. These resources are intended for all stakeholders involved in the MER OVC Essential Survey Indicators—for example, USAID Mission staff, PEPFAR implementing partner staff, and the organizations responsible for designing and conducting MER surveys.
Access the full online collection at https://www.measureevaluation.org/our-work/ovc/monitoring-outcomes-of-pepfar-orphans-and-vulnerable-children-programs |
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Strengthening Family Planning Programs with Data: Creating a Culture of Data Demand and Use
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MEASURE Evaluation |
2014 (Revised Nov. 2015) |
English |
ETHIOPIA |
|
Significant human and financial resources have been invested worldwide in the collection of health data on populations, services and communities. Unfortunately, this information is often not used by key stakeholders to effectively inform policy and programmatic decision making. The failure to consider empirical evidence before making decisions hinders the health system’s ability to respond to priority needs throughout its many levels. In an effort to address this problem, MEASURE Evaluation partnered with the Family Guidance Association of Ethiopia (FGAE) to apply a comprehensive data demand and use (DDU) intervention within their organization. FGAE was selected as a partner because one of their donors, the Packard Foundation of Ethiopia, solicited help from MEASURE Evaluation to improve the use of data in decision making. The goal of the collaboration was to institutionalize DDU tools, curricula and strategies into FGAE’s official structure and work plans thus diffusing it throughout the organization. This case study explains how MEASURE Evaluation and FGAE adapted a DDU intervention to build a culture of data use within FGAE. |
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A Case Study of Data Quality: Global Action Networks in Health
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James Thomas, Karen Hardee, Andee Parks, David Boone, Win Brown, Sara Pacquée-Margolis, and Ronald Tran Ba Huy |
2014 |
English |
Global |
Health infrastructure, HIV prevention, Data quality, Network analysis, Monitoring, Evaluation, M&E, Global health, HIV/AIDS |
Development in global health is addressed by a complex array of institutions working as “global action networks” (GANs). Network theory suggests a fluidity of connections that is not reflected in most GANs, which are, instead, institutionalized arrangements. We describe the case of a GAN that was ad hoc and temporary. The network successfully produced several now widely used tools for ensuring data quality in systems for monitoring and evaluating programs to reduce the spread of HIV. The ad hoc GAN reflected many of the typical characteristics of GANs, but also exhibited some unique characteristics. Ad hoc GANs focusing on a particular task can be highly adaptive and efficient. We need to learn and foster the circumstances that give rise to them. |
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Integrating Data Demand and Use into a Monitoring and Evaluation Training Course: Training Toolkit
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MEASURE Evaluation |
2014 |
English |
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Data Demand and Use, Monitoring, Evaluation, Training, DDU, Data |
This training tool kit aims to guide monitoring and evaluation (M&E) workshop facilitators on how to integrate data demand and use concepts and tools into existing M&E training workshops by providing training slides, skill-building activities, and facilitator guidance. The overall learning objectives of the tool kit include:
To increase understanding of the basic concepts and practical approaches to improving the use of M&E data in decision making
To build skills in data analysis and interpretation, data presentation, and data feedback
To gain hands-on experience in linking data to the decision-making process by using MEASURE Evaluation tools to facilitate data use
This tool kit provides M&E workshop facilitators with user-friendly, modifiable training components to adapt for different contexts. The modules can be presented as suggested, or separated to supplement existing material of a similar topic. Regardless, this guide will assist facilitators in ways to best incorporate data demand and use concepts into their M&E workshops.
Access the full collection online at https://www.measureevaluation.org/resources/training/capacity-building-resources/integrating-data-demand-use-into-course |
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Introduction to Basic Data Analysis and Interpretation for Health Programs: A Training Toolkit
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MEASURE Evaluation |
2014 |
English |
|
Data, Data Demand and Use, Training |
This training tool kit aims to increase the skills of M&E officers and health program staff to conduct basic data analysis and interpretation for health programs. Specific learning objectives include:
To improve understanding of statistical and M&E concepts in data analysis
To build skills in basis data analysis, including setting targets and calculating program coverage, and service utilization and retention
To enhance skills in data interpretation
The training materials are designed to help trainers conduct effective training of program and M&E officers in the specific area of basic data analysis and interpretation. The tool kit provides trainers with user-friendly, modifiable training components to adapt for use in various contexts. It is recommended that the modules be presented sequentially in a one-day training, but they can also be separated to supplement existing material of a similar topic.
Access the collection online at https://www.measureevaluation.org/resources/training/capacity-building-resources/basic-data-analysis-for-health-programs |
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High Impact Research Training Toolkit
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MEASURE Evaluation |
2014 |
English |
|
Public Health, Training |
his course aims to assist researchers in bridging the research-to-practice gap, providing tips and tools that can be applied to the research process to improve data use. Specific objectives of the course include:
To improve the identification of program- and/or policy-relevant research topics
To improve the involvement of key decision makers in the research process
To facilitate the development of program and/or policy recommendations based on the research findings
To improve the packaging and communication of research results to facilitate their use in decision making
The Tool Kit is designed to help trainers conduct effective training of public health researchers specifically in the area of designing actionable research. The Tool Kit provides trainers with user-friendly, modifiable training components to adapt for use in various contexts. It is recommended that the modules be presented sequentially in a one-day training but they also can be separated to supplement existing material on a similar topic.
The collection is also available online at https://www.measureevaluation.org/resources/training/capacity-building-resources/high-impact-research-training-curricula/ |
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Case Study Series: Community-Based Information Systems
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MEASURE Evaluation |
2014 |
English |
|
Orphans and Vulnerable Children, Community-based health information systems, OVC, CBIS, Community-based |
MEASURE Evaluation, with support from the United States Agency for International Development, conducted case studies in 2014 to understand and document how community-based information systems are designed, implemented, and used by program staff and government counterparts. Case studies in Kenya, Tanzania, and Zambia provide an opportunity to identify key lessons learned – including successes, challenges, and opportunities for improvement – that will inform community-based programs globally.
The case studies focus on OVC programs because such programs rely heavily on community workers and community-based organizations (CBOs) to implement activities and monitor program progress. However, case study findings are relevant to other community-based programs that support prevention efforts and ensure continuity of care through nutrition, home based care (HBC), and general community health programs that are at the forefront of AIDS-free generation efforts.
The case study series includes the case study overview and three separate case studies for each country. Each element of the series can also be downloaded as a stand-alone document:
Case Study Series Overview
Kenya
Tanzania
Zambia
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Addressing Equity in Health
|
Foreit K |
2014 |
English |
Global |
Data, Health |
Health and poverty are intertwined. It is often the poor and other vulnerable groups who experience the burden of disease, which can plunge them deeper into poverty. Recognition of these facts has put health and poverty issues high on the international agenda. Despite the best of intentions, however, health resources and program efforts often fail to reach those in greatest need.
As a result, it is imperative that policymakers and program managers better engage the poor and other excluded groups in the design of policies, programs, and financing mechanisms to make certain that they meet the needs of these groups. This course presents the EQUITY Framework for Health, which provides practical guidance on how to ensure that the voices of the poor are actively engaged in policymaking and that pro‐poor strategies are incorporated throughout the policy‐to‐action process.
At the end of this course, you will be able to:
Define inequality and inequity
Use survey data to identify inequalities and inequities in health utilization indicators
Define the steps involved in the EQUITY Framework for Health
List three ways in which to engage the traditionally excluded
Identify supply‐side and demand‐side barriers that may hinder the achievement of more equitable health outcomes
Name two examples of opportunities for integration
Define targeting and required
Provide an example of an indicator for program design, implementation, service uptake, and equity impacts
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Compendio de Indicadores de igualdad de género y VIH
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Bloom SS, Negroustoueva S. |
2014 |
Spanish |
Global |
HIV/AIDS, HIV |
El compendio de indicadores abarca esferas programáticas esenciales en la intersección de género y VIH. Cada una de estas áreas programáticas incorpora una serie de indicadores que pueden utilizarse a nivel nacional, regional o programático. Los indicadores del compendio forman parte de indicadores existentes utilizados en estudios o por países o bien se han adaptado de indicadores existentes para abordar la intersección de género y VIH. Los indicadores pueden cuantificarse mediante la recopilación de datos existentes y sistemas de información (por ejemplo, seguimiento rutinario de programas, encuestas) en la mayoría de contextos nacionales, aunque es posible que algunos requieran estudios o investigaciones especiales. El propósito de este compendio es ofrecer a los directores de programas, las organizaciones de los encargados de formular políticas una serie de indicadores para “conocer su epidemia del VIH/conocer su respuesta” más adecuadamente desde una perspectiva de género a fin de:
fortalecer la comprensión de las partes interesadas nacionales y subnacionales de su epidemia del VIH y su respuesta desde una perspectiva de igualdad de género,
hacer un seguimiento del progreso hacia la eliminación de las desigualdades de género en las respuestas al VIH, y
vigilar y evaluar programas que aborden tipos específicos de intervenciones relacionadas con la igualdad de género en el contexto del VIH.
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Compêndio de Indicatores de lgualdade de Gênero e HIV/VIH
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Bloom SS, Negroustoueva S. |
2014 |
Portuguese |
Global |
HIV/AIDS, HIV |
O compêndio de indicadores abrange áreas programáticas fundamentais para a interseção entre gênero e HIV/VIH. Cada área programática inclui uma série de indicadores que podem ser utilizados em nível nacional, regional ou programático. Os indicadores do compêndio fazem parte ou são todos indicadores existentes utilizados em estudos, usados por países ou que foram adaptados a partir de indicadores existentes para abordar a interseção entre gênero e HIV/VIH. Os indicadores são mensuráveis por meio dos sistemas existentes de coleta de dados e informa- ção (por exemplo: programa de monitoramento periódico, pesquisas, entre outros) na maioria dos países, embora alguns demandem estudos ou pesquisas especiais. A finalidade deste com- pêndio é disponibilizar um conjunto de indicadores para decisores políticos, organizações e gestores de programa para que “conheçam melhor a epidemia de HIV/VIH e saibam reagir” a partir de uma perspectiva de gênero para:
reforçar o entendimento dos interessados em âmbito nacional e regional sobre a epidemia de HIV/VIH e a resposta a partir de uma perspectiva de igualdade de gênero;
monitorar o progresso no sentido de eliminar as desigualdades baseadas em gênero nas respostas para os programas de HIV/VIH; e
monitorar e avaliar os programas que abordam tipos específicos de intervenções de igual-dade de gênero no âmbito do HIV/VIH.
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Compendium Indicateurs d’égalité des genres et de VIH
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Bloom SS, Negroustoueva S. |
2014 |
French |
Global |
HIV, HIV/AIDS |
Le présent compendium d’indicateurs couvre les domaines programmatiques essentiels à la question du genre dans le contexte du VIH. Chacun de ces domaines programmatiques comprend un nombre d’indicateurs pouvant être utilisés à l’échelle nationale et régionale, ou au niveau programmatique. Tous les indicateurs de ce compendium appartiennent soit à des indicateurs déjà existants et utilisés dans des études ou par les pays, ou ont été adaptés à partir d’indicateurs existants afin d’aborder la question du genre dans le contexte du VIH. Ces indicateurs peuvent être mesurés par l’intermédiaire des systèmes de collecte de données ou d’informations (p. ex. le suivi régulier des programmes, les enquêtes) dans la plupart des contextes nationaux, bien que certains puissent requérir des études ou des recherches spécifiques. Ce compendium a pour objectif de fournir aux responsables de programmes, aux organisations et aux décideurs, une série d’indicateurs leur permettant de mieux « connaître leur épidémie de VIH/leur riposte » du point de vue de la question du genre afin de :
renforcer la manière dont les parties prenantes, aux niveaux national et infranational, appréhendent leur épidémie de VIH et leur riposte du point de vue de l’égalité de genre,
suivre les progrès réalisés en matière d’élimination des inégalités fondées sur le genre au sein des ripostes au VIH, et
suivre et évaluer les programmes qui se concentrent sur des types d’interventions spécifiques relatifs à l’égalité de genre dans le contexte du VIH.
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Making Family Planning Services Relevant to Adolescents: Perspectives from Rural Communities in Central Ghana
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Enuameh Y, Tawiah C, Afari-Asiedu S, Nettey OEA, Sulemana A, Mahama E, Adjei G, Boamah E, Manu A, Gyaase S, Zandoh C, Amanfo N, Asante KP, Letsa T, Owusu-Agyei S |
2014 |
English |
|
Family Planning, Adolescent health, Ghana |
In lower middle-income countries like Ghana, it is common to find low contraceptive use among adolescents and correspondingly high pregnancy rates in young women. The use of contraceptives prevents maternal, neonatal, and infant deaths, but in most lower middle-income countries, socio-cultural practices inhibit their use by adolescents who may want to prevent pregnancy. Increasing access to family planning among adolescents is therefore an important means of reducing maternal, neonatal, and infant mortality.
This article seeks to provide contextually relevant approaches to satisfying the family planning needs of adolescents. With support from MEASURE Evaluation, the study authors employed a qualitative study design from an interpretive paradigm to understand societal attitudes towards family planning delivery to adolescents. This helped reveal contextually appropriate ways of providing family planning. Focused group discussions and in-depth interview techniques were used to collection data and insights from adolescents, relevant community opinion leaders, and family planning and health services providers. Themes that emerged from data analysis on “perspectives on family planning care delivery to adolescents” and “best ways in addressing adolescents’ family planning needs” are presented, followed by discussion of the issues that emerged.
A significant and encouraging finding of the study was that opinion leaders and healthcare providers viewed family planning as a means to protect adolescents against pregnancy and its complications. A key recommendation is for policy makers and political leaders to enact legislation that enables adolescents to access youth-friendly family planning services in appropriate places and times. |
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Strengthening Monitoring and Evaluation Capacity of County Health Management Teams at the Sub-national Level
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|
2014 |
English |
KENYA |
Capacity Building, Monitoring, Evaluation, MEASURE Evaluation PIMA |
In Kenya, the provision of primary health care is now the responsibility of county governments, following the new constitutional dispensation adopted in 2010. County Health Management Teams (CHMTs) are responsible for planning, directing, and overseeing the agenda for health at the subnational level, including monitoring and evaluation (M&E). The CHMTs, however, lack the ability to identify and respond to M&E information needs, due to weak organizational capacity and poor data use practices. This fact sheet summarizes how MEASURE Evaluation PIMA is working with targeted counties to address these challenges, with a focus on the key three areas of developing and strengthening organizational capacity, promoting data demand and use practices, and developing M&E capacity at the organizational and individual level. |
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Strengthening the Monitoring and Evaluation of Referral Systems
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|
2014 |
English |
KENYA |
Monitoring, Evaluation, Referral Systems, MEASURE Evaluation PIMA |
As one of the key programs at MEASURE Evaluation PIMA in Kenya, referral systems strengthening (RSS) focuses on strengthening the Kenya health referral system to ensure continuity and cost-effectiveness of care. This fact sheet describes how MEASURE Evaluation PIMA works with health sector stakeholders to create strategies that address gaps within the referral system. |
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MEASURE Evaluation PIMA
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|
2014 |
English |
KENYA |
Kenya, MEASURE Evaluation PIMA |
MEASURE Evaluation PIMA seeks to strengthen the capacity of Kenya’s Ministry of Health to identify and use quality data for everyday decision making. PIMA is a Swahili word that translates as "measure."
This fact sheet summarizes how MEASURE Evaluation PIMA aims to strengthen the management of health programs and the sustainable delivery of quality services to improve the well-being of targeted communities and populations. Through collaboration and innovation, the program aims to achieve three results: improved monitoring and evaluation capacity of health ministry programs, to identify and respond to information needs at national and sub-national levels; improved availability and use of quality health information at national and sub-national levels; and improved monitoring and evaluation capacity for local training and research institutions. |
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Strengthening Organizational Development Systems to Support M&E Capacity Development
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|
2014 |
English |
KENYA |
Organization Development, Monitoring, Evaluation, MEASURE Evaluation PIMA |
The health sector in Kenya is implementing a wide range of reform initiatives under the new constitution, with increasing citizen demands for better quality health services, accountability, and efficiency in the use of scarce resources. This has intensified the demand for evidence-driven planning and decision making at all levels of health leadership. However, monitoring and evaluation (M&E) systems in the health sector have neither been robust enough, nor adequately resourced, to address this need.
This fact sheet summarizes how MEASURE Evaluation PIMA provides customized technical assistance in organizational development, combining state-of-the art knowledge and extensive experience to strengthen management systems and leadership practices in M&E units in the Ministry of Health, within national health programs, and at county levels.
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Strengthening Malaria Monitoring and Evaluation Systems
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|
2014 |
English |
KENYA |
Malaria, Monitoring, Evaluation, MEASURE Evaluation PIMA |
MEASURE Evaluation PIMA works with the Kenya Malaria Control Unit at the Ministry of Health to strengthen capacity for monitoring and evaluation. This fact sheet outlines the four key areas of this work: capacity building in monitoring and evaluation; strengthening malaria surveillance systems, including epidemic preparedness and response; technical assistance for evaluations; and overall technical assistance in the implementation of the Kenya Malaria Monitoring and Evaluation Plan 2009–2017. |
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Strengthening Data Demand and Use to Guide Decision Making and Planning
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|
2014 |
English |
KENYA |
MEASURE Evaluation PIMA, Data, Data Demand and Use, DDU |
MEASURE Evaluation PIMA has an overarching objective to build sustainable monitoring and evaluation (M&E) capacities to use quality health data for evidence-based decision making and programming. The package of interventions focused on improving capacity for identifying data needs and using information is referred to as data demand and use (DDU). This fact sheet describes seven interventions to improve DDU in Kenya, at both the national and subnational levels.
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Strengthening Civil Registration and Vital Statistics Monitoring and Evaluation Systems
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|
2014 |
English |
KENYA |
CRVS, Monitoring, Evaluation, MEASURE Evaluation PIMA |
Civil registration and vital statistics (CRVS) in Kenya were developed under the Births and Deaths Registration Act enacted in 1928. Throughout the years, registration of births and deaths has evolved and is now managed by the Civil Registration Department (CRD) within the Ministry of Interior and Coordination of National Government. These data are imperative for national-level allocation of resources, along with planning and the targeting of health interventions.
This fact sheet describes how MEASURE Evaluation PIMA works in partnership with stakeholders, at both the national and county levels, to assess how statistics and data are collected, documented, and used.This contributes to establishing a CRVS system that is based on global and national standards, while meeting local data needs for planning and decision making.
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Development of a Nationally Coordinated Evaluation Plan for the Ghana National Strategy for Key Populations
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Reynolds HW, Atuahene K, Sutherland E, Amenyah R, Kwao ID, Larbi ET |
2014 |
English |
GHANA |
Key Populations, Ghana, Evaluation |
Objective: Just as HIV prevention programs need to be tailored to the local epidemic, so should evaluations be country-owned and country-led to ensure use of those results in decision making and policy. The objective of this paper is to describe the process undertaken in Ghana to develop a national evaluation plan for the Ghana national strategy for key populations. Methods: This was a participatory process that involved meetings between the Ghana AIDS Commission (GAC), other partners in Ghana working to prevent HIV among key populations, and MEASURE Evaluation. The process included three two-day, highly structured yet participatory meetings over the course of 12 months during which participants shared information about on-going and planned data and identified research questions and methods. Results: An evaluation plan was prepared to inform stakeholders about which data collection activities need to be prioritized for funding, who would implement the study, the timing of data collection, the research question the data will help answer, and the analysis methods. The plan discusses various methods that can be used including the recommendation for the study design using multiple data sources. It has an evaluation conceptual model, proposed analyses, proposed definition of independent variables, estimated costs for filling data gaps, roles and responsibilities of stakeholders to carry out the plan, and considerations for ethics, data sharing and authorship. Conclusion: The experience demonstrates that it is possible to design an evaluation responsive to national strategies and priorities with country leadership, regardless of stakeholders' experiences with evaluations. This process may be replicable elsewhere, where stakeholders want to plan and implement an evaluation of a large-scale program at the national or subnational level that is responsive to national priorities and part of a comprehensive monitoring and evaluation system. |
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Timeliness of Malaria Treatment in Children Under Five Years of Age in Sub-Saharan Africa: A Multicountry Analysis of National Household Survey Data
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Shah JA, Emina JBO, Ye Y |
2014 |
English |
MADAGASCAR, MALAWI, MALI, MOZAMBIQUE, RWANDA, SENEGAL, TANZANIA, UGANDA, ZAMBIA, ANGOLA, BENIN, ETHIOPIA, GHANA, KENYA, LIBERIA |
Malaria, ACT, Child Health |
Malaria is one of the most severe public health problems worldwide, particularly for children under five years of age. The World Health Organization recommends prompt diagnosis and treatment with effective antimalarial medicines within 24 hours of the onset of fever. Delays in treatment can have fatal consequences, particularly if the infection is severe, but few studies systematically assess these delays among children under five years of age in Sub-Saharan Africa (SSA). This study examined the extent to which children under five years of age across SSA received an antimalarial treatment within 24 hours of the reported onset of fever. The study also investigated children under five years of age who received a first-line artemisinin combination therapy (ACT) within 24 hours of the reported onset of fever. Finally, the study identified predictors of prompt treatment with ACT and describes profiles of children who received this recommended treatment. The study focuses on the following countries prioritized by the United States’ President’s Malaria Initiative (PMI): Angola, Benin, Ethiopia, Ghana, Kenya, Liberia, Madagascar, Malawi, Mali, Mozambique, Rwanda, Senegal, Tanzania mainland, Uganda, Zambia, and Zanzibar. |
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Guidance for Evaluating the Impact of National Malaria Control Programs in Highly Endemic Countries
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Mortality Task Force of the Roll Back Malaria Partnership's Monitoring and Evaluation Reference Group |
2014 |
English |
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Malaria, Evaluation |
In 2007, the Roll Back Malaria Partnership's Monitoring and Evaluation Reference Group (MERG) proposed the use of a plausibility design to measure impact of malaria control programs. Since then, new measurement needs and evidence have emerged, requiring an updated approach. This document reviews and updates the 2007 evaluation framework and provides recommendations for evaluating the scale-up of malaria control interventions in endemic countries. |
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Gender-Based Power and Couples' HIV Risk in Uttar Pradesh and Uttarakhand, North India
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Agrawal A, Bloom SS, Suchindran C, Curtis S, Angeles G |
2014 |
English |
INDIA |
Gender, India, HIV/AIDS |
Context: Gender inequality is a long-recognized driver of the HIV epidemic. However, few studies have investigated the association between gender-based power and HIV risk in India, which has the world's third largest HIV epidemic.
Methods: Population-based data collected in 2003 from 3,385 couples residing in Uttar Pradesh and Uttarakhand, North India, were used to examine associations between gender-based power (wife's autonomy and husband's inequitable gender attitudes) and indicators of couples' HIV risk (whether the husband had had premarital sex with someone other than his eventual spouse, extramarital sex in the past year or STI symptoms in the past year). Structural equation modeling was used to create composite variables for the gender-based power measures and test their associations with HIV risk measures.
Results: Twenty-four percent of husbands had had premarital sex, 7% had had extramarital sex in the past year and 6% had had STI symptoms in the past year. Structural equation models indicated that wives who reported higher levels of autonomy were less likely than other wives to have husbands who had had extramarital sex in the past year (direct association) or STI symptoms in the past year (indirect association). Moreover, husbands who endorsed more inequitable gender attitudes were more likely than others to report having had premarital sex with someone other than their spouse, which in turn was associated with having had extramarital sex and STI symptoms in the past year.
Conclusions: If the associations identified in this study reflect a causal relationship between gender-based power and HIV risk behavior, then HIV prevention programs that successfully address inequitable gender roles may reduce HIV risks in North India. |
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Prioridades para los esfuerzos locales de control de VIH (PLACE) en la República Dominicana
|
|
2014 |
Spanish |
DOMINICAN REPUBLIC |
HIV, PLACE, Dominican Republic |
El objetivo principal del estudio PLACE (prioridades para los esfuerzos locales de control de VIH) en la República Dominicana es proporcionar información útil para la prevención estratégica del VIH y aumentar la capacidad de las organizaciones locales para recolectar tal información. PLACE se llevó acabo en seis regiones durante enero a julio del 2014. Para cada región, los objetivos fueron los siguientes:
Identificar las áreas de prevención prioritarias (APPs), también conocidas como zonas de alta transmisión o de alto riesgo (áreas que carecen de actividades de prevención)
Caracterizar y mapear los lugares y eventos de alto riesgo en cada APP donde se encuentren nuevas parejas sexuales o los usuarios de drogas socialicen, y donde se podrían implementar actividades de alcance comunitario (“outreach”) para personas en riesgo de adquirir y transmitir la infección
Caracterizar a los hombres y las mujeres que frecuentan lugares y eventos de alto riesgo y a personas que trabajan en estos lugares (incluyendo la prevalencia de sífilis y VIH), e identificar las brechas en la oferta de servicios de prevención del VIH (ej., pruebas de VIH y consejería, condones y programas para poblaciones clave)
Estimar el tamaño de las poblaciones clave en sitios, incluyendo las trabajadoras sexuales, hombres que tienen sexo con hombres, y personas transgéneros.
Otros objetivos al nivel nacional:
Describir las características de las poblaciones clave a nivel nacional, incluyendo una estimación de la prevalencia de sífilis y de VIH.
Aumentar la capacidad de las organizaciones locales y los proveedores de servicios para recolectar, analizar e interpretar los datos, y usar la información en el desarrollo de planes de acción regionales.
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Findings from a Multi-Country Assessment of Integrated Health Programs
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|
2014 |
English |
BANGLADESH, HONDURAS, CAMBODIA, GUATEMALA, KENYA, LIBERIA, MALAWI, NEPAL, NICARAGUA, SENEGAL |
Health programs, Integration |
Integration of health interventions is promoted to make better use of resources, meet health needs, and achieve sustained improvements in health. Many definitions of integration exist, and some converge on a concept of integrated health services within the context of a supportive health system that provides clients with a continuum of services according to their needs over time (Waddington & Egger, 2008). Studies of integrated health services have shown integration to be feasible, and that it can improve quality of care, increase service uptake, and improve outcomes such as contraceptive use and HIV testing uptake (Spaulding et al., 2009; Lindegren et al., 2012; Wilcher et al., 2013). Evidence is more limited regarding effects on health impacts and costs.
The United States government (USG) contributes to a worldwide effort to communicate, learn about, and promote integration by funding projects, issuing guidance, developing indicators, convening meetings and working groups, sponsoring literature reviews and publishing. Specifically, a USG inter-agency group on integration published the GHI Principle Paper on Integration in the Health Sector in May 2012, developed a related results framework for integration, defined a list of indicators to measure the outputs and outcomes of integration (document forthcoming), and articulated a learning agenda. This report presents the results of a multi-country assessment of integrated health programs in 10 countries conducted by MEASURE Evaluation to inform this broader learning agenda on integration of health services.
This multi-country assessment was intended to be a first step in gathering information to understand the types of services that are being integrated; rationale for the choice of integration model and interventions; perceived strengths, weaknesses, and gaps of M&E systems; and environment, policies and systems that facilitate service integration. |
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Fact Sheet: Measuring the Strength of National Social Service Systems
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|
2014 |
English |
|
PEPFAR |
New indicators from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) help governments and their partners know where their investments are paying off and where to push harder. The indicators help to answer the following questions:
What is the current status of the national social service system?
Is the system showing signs of improvement over time?
Are investments from donors and other sources making the system stronger?
Is the system being developed sustainably?
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Évaluation de l’aide apportée par l'USAID à la prévention du VIH au Mali de 2000 à 2010
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2014 |
French |
MALI |
Evaluation, HIV, Mali |
La mission de l’USAID au Mali apporte de l’aide au gouvernement malien depuis les années 90 dans ses efforts visant à empêcher la propagation du VIH à travers une variété de programmes allant de la recherche aux interventions ciblées. Ce rapport présente les résultats d’une évaluation des strategies VIH/SIDA de l’USAID et de ses programmes de prévention du VIH au Mali. L’objectif était alors de mener une évaluation de la performance des stratégies et des programmes de prévention du VIH parrainés par l’USAID de 2000 à 2010 au Mali et de documenter les changements en termes de comportements à risque et de prévalence du VIH pendant cette même période. Les résultats de cette évaluation aideront à la conception du programme VIH/SIDA de l’USAID/Mali pour la période 2013-2018. |
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Monitoring and Evaluation at the Community Level: A Strategic Review of MEASURE Evaluation, Phase III Accomplishments and Contributions
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de la Torre C, Unfried K |
2014 |
English |
|
Monitoring, Evaluation, Evaluation, Monitoring |
As a global monitoring and evaluation (M&E) project, MEASURE Evaluation, during its phase III cooperative agreement with the U.S. Agency for International Development (USAID), which ran from September 2008 to August 2014, contributed to various endeavors aimed at strengthening community M&E (i.e. M&E activities that are concerned with the delivery of services at the community level). The project has worked with international agencies, national governments, service delivery organizations, and community workers to improve the collection and use of community data in a variety of contexts. This strategic review catalogues the project’s contributions to community M&E, highlights lessons learned through this work, notes key gaps that require attention, and proposes future work that builds on the project’s achievements.
The primary audience for this review is USAID and other stakeholders who are looking to shape future plans and strategic direction of community M&E systems. This review may also be helpful to anyone interested in strengthening community M&E systems and wants to learn about the various tools and approaches developed or used by the MEASURE Evaluation project for doing so. |
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GIS and Sampling
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Lance P, Spencer J, Hattori A |
2014 |
English |
Global |
GIS, Sampling, Geographic Information Systems |
This manual details how geographic information systems (GIS) can inform the sampling process, opening the door to powerful new possibilities for obtaining samples representative of particular subpopulations of interest, and the considerations surrounding the application of GIS to sampling. In other words, it is concerned with how GIS can serve sampling and what the procedure for applying GIS to the sampling process entails. |
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Fact Sheet: M&E of Malaria Control Programs: Building Capacity through Regional Workshops
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|
2014 |
English |
GHANA |
Monitoring, Evaluation, Malaria |
MEASURE Evaluation and implementing partners, Centre de Recherche en Santé de Nouna (CRSN), Burkina Faso and University of Ghana School of Public Health (UGSPH), Ghana, implemented regional Anglophone and Francophone workshops from 2010 to 2014 to strengthen capacity in the monitoring and evaluation (M&E) of malaria, in response to increased funding for malaria control programs in sub-Saharan Africa and a need for strong information system support to inform malaria program planning. |
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Impact Evaluations of Large-Scale Public Health Interventions: Experiences from the Field
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Skiles MP, Hattori A, Curtis SL |
2014 |
English |
NEPAL, TANZANIA, UKRAINE, BANGLADESH, GHANA, JAMAICA, ETHIOPIA, GUATEMALA, MOZAMBIQUE |
Public Health, Impact Evaluation |
Agencies are articulating the need to causally attribute health outcomes to investments in an era of shrinking resources and increasingly complex development environments. The opportunity to uncover essential information for program planning and resource allocation is a strong motivation for impact evaluations. Findings from large-scale impact evaluations (IEs) can be instrumental for decision making, yet they are not without challenges and costs.
In this paper, we share field experiences from a number of evaluation studies undertaken during MEASURE Evaluation Phases II and III. A series of case studies highlight design and implementation challenges that required creative solutions to move forward; plus analysis across studies revealed common reoccurring themes and valuable lessons. Examples of these cross-cutting themes presented include: challenges with identification and selection of program beneficiaries, random assignment in complex environments, identification of a robust comparison or control group for estimating the counterfactual, heterogeneity of program impacts, timing of baseline data collection, and absence of baseline data and a counterfactual.
Field experiences from MEASURE Evaluation project demonstrate the need for transparency and collaboration among the key partners, the inevitable balancing of technical requirements with programmatic priorities, and the flexibility required to adapt designs in order to answer the most valuable evaluation questions. Interest in accountability of funding of public health interventions continues to grow, promising continued interest in IEs. Evaluators, implementers, and funders can share in these learnings as we move forward with expanding our understanding of the costs and benefits for rigorous evaluations. |
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Development of a Master Health Facility List in Nigeria
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Makinde OA, Azeez A, Bamidele S, Oyemakinde A, Oyediran KA, Adebayo W, Fapohunda B, Abioye A, Mullen S |
2014 |
English |
NIGERIA |
Nigeria, Health Information Systems, Health Facilities |
Routine Health Information Systems (RHIS) are increasingly transitioning to electronic platforms in several developing countries. Establishment of a Master Facility List (MFL) to standardize the allocation of unique identifiers for health facilities can overcome identification issues and support health facility management. The Nigerian Federal Ministry of Health (FMOH) recently developed a MFL, and we present the process and outcome.
The MFL was developed from the ground up, and includes a state code, a local government area (LGA) code, health facility ownership (public or private), the level of care, and an exclusive LGA level health facility serial number, as part of the unique identifier system in Nigeria. To develop the MFL, the LGAs sent the list of all health facilities in their jurisdiction to the state, which in turn collated for all LGAs under them before sending to the FMOH. At the FMOH, a group of RHIS experts verified the list and identifiers for each state.
The national MFL consists of 34,423 health facilities uniquely identified. The list has been published and is available for worldwide access; it is currently used for planning and management of health services in Nigeria.
Unique identifiers are a basic component of any information system. However, poor planning and execution of implementing this key standard can diminish the success of the RHIS. Development and adherence to standards is the hallmark for a national health information infrastructure. Explicit processes and multi-level stakeholder engagement is necessary to ensuring the success of the effort. |
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Rethinking HIV Prevalence Determination in Developing Countries
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Makinde OA, Oyediran KA |
2014 |
English |
|
HIV/AIDS |
The process for HIV prevalence determination using antenatal clinic (ANC) sentinel surveillance data has been plagued by criticisms of its biasness. Exploring other means of HIV prevalence determination is necessary to validate that estimates are near actual values or to replace the current system.
We propose a data collection model that leverages the increasing adoption and penetration of the Internet and mobile technology to collect and archive routine data from HIV counseling and testing (HCT) client intake forms from all HCT centers and prevention of mother-to-child transmission (PMTCT) sites in a country. These data will then be mined to determine prevalence rates and risk factors at the community level. The need to improve the method for the generation of HIV prevalence rates has been repeatedly echoed by researchers though no one has been able to fashion out a better and more reliable way to the current ANC sentinel surveillance method at a reasonable cost. The chance of using routinely generated data during HCT and PMTCT is appealing and needs to be envisioned as the technology to achieve this is increasingly becoming available and affordable in countries worst hit by the pandemic. Triangulating data generated from routine HCT and PMTCT sites with data from sentinel surveillance and where the confidence of its quality is assured, as the sole source of HIV prevalence rate determination and behavioral risk assessment will improve the acceptance by communities and drive evidence-based interventions at the community level. |
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United States Government Global Health Principles Monitoring and Evaluation Resource Guide
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|
2014 |
English |
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Global health, Monitoring, Evaluation |
This guide provides clear monitoring and evaluation definitions, global indicators, and country-level indicators for a variety of U.S. agencies, to enabled them to collaborate more closely on shared objectives in global health. Interagency teams worked together, with MEASURE/Evaluation, to explore existing monitoring approaches, review the evidence, and develop meaningful and specific indicators. |
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Ethnicity and HIV Risk Behaviour, Testing and Knowledge in Guatemala
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Taylor TM, Hembling J, Bertrand JT |
2014 |
English |
GUATEMALA |
Guatemala, HIV/AIDS |
Data on 16,205 women aged 15–49 and 6822 men aged 15–59 from the 2008–2009 Encuesta Nacional de Salud Materno Infantil were used to describe ethnic group differences in sexual behaviour, HIV knowledge and testing. We then controlled for age, education, wealth and other socio-demographic factors in a multivariate logistic regression model to examine the effects of ethnicity on outcomes related to age at sexual debut, number of lifetime sex partners, comprehensive HIV knowledge, HIV testing and lifetime sex worker patronage (men only).
The data show low levels of risky sexual behaviour and low levels of HIV knowledge among indigenous women and men, compared to other respondents. Controlling for demographic factors, indigenous women were more likely than other women never to have been tested for HIV and to lack comprehensive HIV knowledge. They were less likely to report early sexual debut and three or more lifetime sexual partners. Indigenous men were more likely than other men to lack comprehensive HIV knowledge and demonstrated lower odds of early sexual debut, 10 or more lifetime sexual partners and sex worker patronage.
The Mayan indigenous population in Guatemala, while broadly socially vulnerable, does not appear to be at elevated risk for HIV based on this analysis of selected risk factors. Nonetheless, low rates of HIV knowledge and testing may be cause for concern. Programmes working in indigenous communities should focus on HIV education and reducing barriers to testing. Further research into the factors that underlie ethnic self-identity and perceived ethnicity could help clarify the relative significance of these measures for HIV risk and other health outcomes. |
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Improving Estimates of Insecticide-treated Mosquito Net Coverage from Household Surveys: Using geographic coordinates to account for endemicity
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Burgert CR, Bradley SE, Arnold F, Eckert E |
2014 |
English |
|
GIS, Malaria |
Coverage estimates of insecticide-treated nets (ITNs) are often calculated at the national level, but are intended to be a proxy for coverage among the population at risk of malaria. The analysis uses data for surveyed households, linking survey enumeration areas (clusters) with levels of malaria endemicity and adjusting coverage estimates based on the population at risk. This analysis proposes an approach that is not dependent on being able to identify malaria risk in a location during the survey design (since survey samples are typically selected on the basis of census sampling frames that do not include information on malaria zones), but rather being able to assign risk zones after a survey has already been completed.
The analysis uses data from 20 recent nationally representative Demographic and Health Survey (DHS), Malaria Indicator Surveys (MIS), an AIDS Indicator Survey (AIS), and an Anemia and Malaria Prevalence Survey (AMP). The malaria endemicity classification was assigned from the Malaria Atlas Project (MAP) 2010 interpolated data layers, using the Geographic Positioning System (GPS) location of the survey clusters. National ITN coverage estimates were compared with coverage estimates in intermediate/high endemicity zones (i.e., the population at risk of malaria) to determine whether the difference between estimates was statistically different from zero (p-value <0.5).
Endemicity varies substantially in eight of the 20 studied countries. In these countries with heterogeneous transmission of malaria, stratification of households by endemicity zones shows that ITN coverage in intermediate/high endemicity zones is significantly higher than ITN coverage at the national level (Burundi, Kenya, Namibia, Rwanda, Tanzania, Senegal, Zambia, and Zimbabwe.). For example in Zimbabwe, the national ownership of ITNs is 28%, but ownership in the intermediate/high endemicity zone is 46%.
Incorporating this study's basic and easily reproducible approach into estimates of ITN coverage is applicable and even preferable in countries with areas at no/low risk of malaria and will help ensure that the highest-quality data are available to inform programmatic decisions in countries affected by malaria. The extension of this type of analysis to other malaria interventions can provide further valuable information to support evidence-based decision-making. |
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Monitoring and Evaluating Progress towards Universal Health Coverage in Bangladesh
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Huda T, Khan JAM, Ahsan KZ, Jamil K, Arifeen SE |
2014 |
English |
BANGLADESH |
Monitoring, Evaluation, Bangladesh |
In the 42 years since independence, Bangladesh has made some substantial progress in the health sector, which is all the more remarkable when compared with other countries in the region. However, this achievement is not uniform across all health indicators. The coverage of many critical health services is still quite low. The country's health system is struggling to meet basic standards for quality of care because of a shortage of skilled health workers, the large number of unregulated private service providers, irregular supplies of drugs, inadequate public financing, high out-of-pocket expenses, and lack of proper monitoring and supervision mechanisms. Further complicating the situation is the increasing burden of non-communicable diseases, and the absence of any pre-payment risk pooling mechanisms. Bangladesh faces a daunting challenge in achieving the goal of universal health coverage. |
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Moving Data off the Shelf and into Action: An intervention to improve data-informed decision making in Côte d’Ivoire
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Nutley T, Gnassou L, Traore M, Bosso AE, Mullen S |
2014 |
English |
COTE D'IVOIRE |
Cote D’Ivoire, Africa, Data Demand and Use, Data Quality |
Background: Improving a health system requires data, but too often they are unused or under-used by decision makers. Without interventions to improve the use of data in decision making, health systems cannot meet the needs of the populations they serve. In 2008, in Côte d’Ivoire, data were largely unused in health decision-making processes.
Objective: To implement and evaluate an intervention to improve the use of data in decision making in Cote d’Ivoire.
Design: From 2008 to 2012, Cote d’Ivoire sought to improve the use of national health data through an intervention that broadens participation in and builds links between data collection and decision-making processes; identifies information needs; improves data quality; builds capacity to analyze, synthesize, and interpret data; and develops policies to support data use. To assess the results, a Performance of Routine Information System Management Assessment was conducted before and after the intervention using a combination of purposeful and random sampling. In 2008, the sample consisted of the central level, 12 districts, and 119 facilities, and in 2012, the sample consisted of the central level, 20 districts, and 190 health facilities. To assess data use, we developed dichotomous indicators: discussions of analysis findings, decisions taken based on the analysis, and decisions referred to upper management for action. We aggregated the indicators to generate a composite, continuous index of data use.
Results: From 2008 to 2012, the district data-use score increased from 40 to 70%; the facility score remained the same – 38%. The central score is not reported, because of a methodological difference in the two assessments.
Conclusions: The intervention improved the use of data in decision making at the district level in Côte d’Ivoire. This study provides an example of, and guidance for, implementing a large-scale intervention to improve data-informed decision making. |
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County Civil Registration and Vital Statistics Stakeholder Forums: Strengthening Civil Registration Systems at the County Level
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2014 |
English |
KENYA |
CRVS |
In Kenya, the Civil Registration Department (CRD) is responsible for the registration of all births and deaths that occur in the country and is developing a civil registration and vital statistics (CRVS) research agenda to help strengthen Kenya’s civil registration system. To increase the level of stakeholders’ engagement, stakeholders attended one-day meetings in March and April 2014 in 12 counties: Bungoma, Embu, Garissa, Kakamega, Kilifi, Kirinyaga, Machakos, Mombasa, Nairobi, Nakuru, Siaya, and Wajir. This report provides a summary of county action plans developed by participants as a way forward to strengthen the CRVS system at the county level. |
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Know Your HIV-Prevention Response, Southern Province, Zambia. HIV-Prevention Policies and Programs in Government Health and Non-Health Sectors
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Macwan’gi M, Munyima M, Mbozi P, Simwanza T, Gage AJ |
2014 |
English |
ZAMBIA |
HIV/AIDS, Zambia, HIS |
The Know Your HIV-Prevention Response study was a situation analysis of the HIV/AIDS prevention response in Zambia with the goal of identifying principle implementers in Southern Province, programmatic needs, existing policies, and opportunities for the future. The study was implemented jointly by MEASURE Evaluation and the Institute of Economic and Social Research (INESOR) at University of Zambia, in collaboration with the National HIV/AIDS/STI/TB Council, from September to October 2013. The study had three primary objectives:
determine what specific HIV-prevention interventions were being implemented;
determine by which organizations and in which districts the interventions were being implemented; and
assess the extent to which the HIV-prevention response matched current HIV-transmission patterns, were focused on geographic areas where HIV was spreading most rapidly, and covered technical recommendations for populations at higher risk of HIV exposure.
Main findings are described for the government health and non-health sectors, with particular attention to the policy environment, strategic information, geographic gaps in the availability of HIV-prevention interventions in public health facilities, and HIV-prevention services in the government non-health sector. |
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Know Your Response: Country-Level HIV-Prevention Response Census and Mapping Tool Kit. Lessons Learned For Practical Application in Developing Country Settings
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Munyima M, Gage AJ, Sutherland E |
2014 |
English |
GHANA, ZAMBIA |
HIV, HIV/AIDS, Mapping |
The objective of this report is to identify, document and disseminate lessons learned from the pilot test of the Know Your Response: HIV Prevention Tool Kit which was pilot tested in Zambia and Ghana in September-October 2013. The report identifies what worked well, what did not work well, and what needs to done differently in the future. The report also assesses the technical methods and tools, and makes recommendations for future improvements. |
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Trafficking in Persons and Health: A Compendium of Monitoring and Evaluation Indicators
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Cannon AC, Arcara J, Arnoff E, Bloom SS. |
2014 |
English |
|
Trafficking, Monitoring, Evaluation |
This document is designed to assist program managers and decision-makers to plan, monitor, and evaluate their response to trafficking and health. The list of indicators is a result of an international collaboration of multi- and bi-lateral donors, researchers, civil society, NGOs and other experts who came to agreement on these indicators as critical to measuring the intersection of trafficking in persons, gender, and health at the national, regional, or programmatic levels. The compendium is designed to be a menu of options to allow governments and organizations select indicators that are most applicable to their programs and health facilities. The indicators are applicable to labor, sex, and other forms of trafficking.
The programmatic areas in this guide cover health sector preparedness, post-trafficking assistance programs’ response to health, referrals and policies related to health, and the health status and care received by individuals who have been trafficked. Current methods and areas for further development are discussed, as additional research and indicator development will be vital to addressing trafficking and the intersection of gender and health in a wider context. |
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Lessons Learned: Stronger Monitoring and Evaluation Systems to Address Avian Influenza in Vietnam
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2014 |
English |
VIET NAM |
Avian Influenza, Monitoring, Evaluation |
From 2006 through 2014, MEASURE Evaluation, with support from the U.S. Agency for International Development (USAID), collaborated with governments in Southeast Asia, donors, and other implementing partners to establish and strengthen monitoring and evaluation (M&E) systems for avian and human influenza (AHI) programs. In Vietnam, MEASURE Evaluation worked at the national and provincial levels to strengthen local capacity for M&E of integrated human and animal health and other health issues more broadly. MEASURE Evaluation helped develop and implement a national AHI M&E framework and supported USAID portfolio management activities while also ensuring that they aligned with a national framework. This document summarizes some of the lessons learned from these activities. |
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Analyse Situationnelle du Système d’Information Sanitaire du Mali
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2014 |
French |
MALI |
|
Déjà en 1998, le schéma directeur du Système Local d’Information Sanitaire (SLIS) du Mali révélait :
l’irrégularité de la publication et le partage des données sanitaires avec les partenaires,
les insuffisances sur l’utilisation de l’information sanitaire comme instrument de planification et de gestion des services,
l’insuffisance de la participation du secteur privé dans le système,
la méconnaissance de la réglementation de la part de certains partenaires ;
la difficulté de coordination des programmes liée à la disparité des interventions des partenaires
Les résultats des évaluations très récentes (2013) du système d’information communautaires et du PRISM montraient que malgré l’régularité du contrôle de la qualité des données et l’indisponibilité des normes et procédures du système d’information sanitaire, les taux d’exactitude, de complétude et de promptitude des rapports de données étaient acceptables à tous les niveaux du système d’information sanitaire. L’utilisation et la promotion de la culture des données restent également très faibles à tous les niveaux de la pyramide sanitaire.
L’analyse situationnelle du SLIS vient compléter les résultats de ces évaluations afin permettre une bonne documentation des problèmes de coordination du système, d’utilisation et de gestion des données, de l’implication et de l’engagement du gouvernement et des partenaires dans la gestion de l’information sanitaire.
The 2018 version of the PRISM Series, updated and with new modules (Toolkit, User’s Kit, and Training Kit) is available here: https://www.measureevaluation.org/prism |
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MEASURE Evaluation Tanzania: Strengthening M&E Systems and Evidence Base for Health and Social Service Programs
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2014 |
English |
TANZANIA |
|
Building on successes and lessons learned from MEASURE Evaluation’s technical assistance to Tanzania since 2008, USAID/Tanzania approved a new five-year (2014-2019) project phase, known as MEASURE Evaluation Associate Award (MEASURE Evaluation/TZ). This brochure outlines the project's approach, objectives, and geographic areas of focus.
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Applying Geospatial Tools to Rugg’s Staircase Method for Monitoring and Evaluation: MEASURE Evaluation’s Case Studies
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2014 |
English |
|
|
This paper seeks to illustrate the important role geospatial analysis can have on monitoring and evaluation (M&E). It moves beyond the hypothetical scenarios that have been previously used in the literature to discuss specific, real world examples of how geospatial tools, methods, and techniques have been used to support M&E. The examples in this paper are from HIV/AIDS prevention activities associated with the MEASURE Evaluation project and are conceptualized within the Rugg eight-step M&E framework. |
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Patrones de consumo de alcohol, drogas ilícitas y comportamiento sexual de riesgo entre los HSH y mujeres transgénero en San Salvador
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2014 |
Spanish |
EL SALVADOR |
|
El consumo de alcohol y de drogas perjudica el funcionamiento cognitivo y puede afectar los resultados de salud, especialmente en los casos de uso excesivo o abuso. Diferentes estudios han mostrado tasas más altas de consumo excesivo de alcohol y uso de drogas entre hombres que tienen relaciones sexuales con hombres (HSH) en comparación con los hombres heterosexuales. No se cuenta con estudios comparativos sobre el uso de sustancias para mujeres transgénero (MT), aunque hay evidencia de un mayor uso de sustancias vinculado a niveles más altos de trabajo sexual en personas de este grupo. A partir de la vigilancia biológica y conductual integrada en la región de América Central, hay evidencia del uso problemático de sustancias entre los HSH y las MT. Sin embargo, independientemente de las frecuencias presentadas en estos estudios, para los HSH y MT en los países centroamericanos hay muy escasa información descriptiva disponible sobre los patrones de consumo de alcohol y uso de drogas, así como sobre las motivaciones para el uso de sustancias y la asociación potencial del uso de sustancias con el VIH. La información que se presenta en este informe de investigación pretende superar esta brecha. |
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Alcohol consumption patterns, illicit drug use, and sexual risk behavior among MSM and transgender women in San Salvador
|
|
2014 |
English |
EL SALVADOR |
|
Alcohol consumption and drug use impairs cognitive functioning and may affect health outcomes, especially in cases of heavy use or abuse. Studies have shown higher rates of heavy drinking and drug use among men who have sex with men (MSM) compared to heterosexual men. Comparison studies for substance use are not available for transgender women (TW), although there is evidence of increased substance use linked with higher levels of sex work among this group. There is evidence from integrated biological and behavioral surveillance in the Central America region of problematic substance use among MSM and TW. However, apart from the frequencies presented in these studies, there is scant descriptive information available on the patterns of alcohol consumption and drug use, motivations for substance use, and the potential association of substance use with HIV for MSM and TW in Central American countries. The information presented in this research brief aims to address this gap. |
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Determinantes sociales de la salud para los HSH y mujeres transgénero en San Salvador
|
|
2014 |
Spanish |
EL SALVADOR |
|
El análisis de los problemas de salud desde una perspectiva de los determinantes sociales es un enfoque útil para identificar áreas que se superponen a través de los sectores del desarrollo y en el logro de las metas del desarrollo en educación, gobernanza, prosperidad económica y salud. En este resumen de investigación analizamos los determinantes sociales de la salud para los HSH y MT en San Salvador, concentrándonos en el trabajo sexual y la carencia de vivienda como condiciones sociales que pueden influir en la salud de esta población. Análisis previos, realizados con datos de este estudio, identificaron dos vías psicológicas a través de las cuales el estigma afecta el acceso a los servicios de salud, el estrés y el bienestar. En los análisis actuales, exploramos la vía estructural a través de la cual el estigma sexual puede influir en la salud para esta población al limitar las opciones sociales y económicas, así como las consecuencias resultantes para su salud. |
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Social Determinants of Health for Men Who Have Sex with Men and Transgender Women in San Salvador
|
|
2014 |
English |
EL SALVADOR |
|
Analysis of health problems from a social determinants perspective is a useful approach to identify overlapping areas across development sectors and reach development goals in education, governance, economic prosperity, and health. In this research brief we analyze social determinants of health for MSM and TW in San Salvador by focusing on sex work and homelessness as social conditions that may influence the health of this population. Previous analyses of data from this study identified psychological pathways through which sexual stigma affects access to healthcare, stress, and well-being. In the current analyses, we explore the structural pathway through which sexual stigma may influence health for this population by limiting social and economic opportunities, and the resultant consequences for their health. |
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Using Geospatial Analysis to Improve Resource Allocation for HIV Programs in Iringa Region, Tanzania
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Cunningham M, Mapala Y, Patrick J |
2014 |
English |
TANZANIA |
|
Over a two-year period, MEASURE Evaluation worked with local authorities in the Iringa and Njombe regions of Tanzania to illustrate the potential of maps and geographic information systems (GIS) for supporting effective programming of resources and to enhance demand for and use of data for decision making in the health sector. The work started with activities designed to gather data on HIV transmission dynamics and service coverage, and continued with activities aiming to increase the capacity of district council health management teams to use this and other data to improve resource allocation for HIV programs.
This case study describes the capacity building process, summarizing the data used and providing illustrative examples of what worked. We conclude with lessons learned for other organizations interested in using GIS and improving data demand and use in their local HIV response, or in other health interventions. |
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Using Participatory Mapping to Assess Service Catchment and Coverage. Guidance from the Iringa Participatory Mapping Exercise
|
Cunningham M, LaMois P, Mapala Y, Inglis A |
2014 |
English |
TANZANIA |
|
Effective program planning requires matching services with service needs. Program efficiency is enhanced when resources are targeted to or focused on program priorities, including areas of greatest need, underserved locations, or vulnerable populations. Geographic information systems (GIS) can be an effective decision-support tool to provide policy makers, program planners, and other stakeholders with maps of the spatial distributions of needs and service coverage, showing where services are matched to needs and where there are coverage gaps.
While such maps are easy to interpret, they are only as good as the data on which they are based. Some data may be readily available—for example, the locations of fixed facilities such as hospitals or clinics. Other data may need to be collected—for example, the size and location of groups who need specific services and the effective catchment area of program sites.
In Iringa Region, Tanzania, MEASURE Evaluation piloted a novel, low-cost approach using easily replicable methods to identify catchment areas and estimate coverage patterns for facility-based and outreach HIV services. The approach used combination of key informant interviews, printed maps, and open source GIS software to produce computer-generated, district-level maps of catchment and coverage patterns. This working paper details that approach for those seeking evaluate the spatial distribution of their own health programs. |
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Priorities for Local AIDS Control Efforts Uganda, 2013-2014
|
MEASURE Evaluation |
2014 |
English |
East Africa, Africa |
|
Uganda has a long history of successful HIV prevention that saw the decrease of HIV prevalence from its peak in 1990-1992 when HIV prevalence among women attending urban antenatal clinics ranged from 20% -30% to under 6% in the new millennium. However, despite the earlier registered success in the fight against HIV/AIDs and the marked increase in HIV treatment and care programs in Uganda, new HIV infections are on the rise. The 2011 Uganda AIDS Indicator Survey (UAIS) found that HIV prevalence in the general population increased nationally from 6.4% to 7.3% since the previous survey in 2004. Prevalence increased among both men and women and is higher in urban than in rural areas. According to modes of transmission assessments, a high proportion of new infections may be occurring in stable sero-discordant couples, but the “upstream” drivers of the epidemic are not well characterized. Given the wide variation in HIV prevalence across the country, it is likely that drivers of the epidemic are local and not only concentrated in urban and along major highways as previously thought. Consequently, effective district level responses would be most effective if they were tailored to local epidemics. Unfortunately, however, there is little information on most at risk populations outside of Kampala and other major urban areas.
The Priorities for Local AIDS Control Efforts (PLACE) method is a monitoring tool to identify priority prevention areas (PPAs) in a country and the specific venues within these areas where AIDS prevention pro-grams should be focused. The method translates the scientific principles of HIV/STI transmission epidemiology and applies new technologies in spatial analysis and HIV rapid testing into a step-by-step rapid assessment and planning tool for use at the local level. Scientific principles, available data, and information from experts are used to identify districts likely to have high incidence of HIV infection. Within these dis-tricts, a rapid assessment identifies gaps in HIV prevention programs. PLACE maps specific risk sites and provides indicators of the characteristics and behaviors of key populations that are critical to designing effective prevention programs.
Thirty districts in Uganda participated in the PLACE activities, carried out from July 2013 through July 2014. Districts were selected based on criteria determined by national-level stakeholders from the UAC, MOH, and USAID. |
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Know Your HIV/AIDS Response: Southern Province, Zambia. An Examination of Program Implementers in the Nongovernment Sector
|
Gage AJ |
2014 |
English |
ZAMBIA |
|
The Know Your HIV-prevention Response study was a situation analysis of HIV-prevention interventions and was conducted in Southern Province, Zambia, from September to October 2013. The study was implemented jointly by MEASURE Evaluation and the Institute of Economic and Social Research (INESOR) at University of Zambia. The study had five instruments, two of which were the Program Implementer Core Questionnaire and the Program Implementer Modules for Key (and vulnerable) Populations, on which this report is based. The study population included 93 organizations in the nongovernmental organization (NGO) sector and had three primary objectives:
determine what specific HIV-prevention interventions were being implemented;
determine by which organizations and in which districts the interventions were being implemented; and
assess the extent to which the HIV-prevention response matched current HIV-transmission patterns, were focused on geographic areas where HIV was spreading most rapidly, and covered technical recommendations for populations at higher risk of HIV exposure.
Information was collected on six categories of interventions: standard hybrid interventions commonly used; interventions affecting knowledge, attitudes and beliefs and influencing psychological and social risk correlates; harm reduction interventions; biological/biomedical interventions that reduce HIV-infection and transmission risk; interventions for the mitigation of barriers to prevention and negative social outcomes of HIV infection; and interventions for the mitigation of biological outcomes of HIV infection. Data were also collected on interventions targeted at the following key and vulnerable populations: female sex workers; men who have sex with men and transgender; people who inject drugs; young people aged 10-24 years in the general population; emergency settings and refugee/internally displaced population; migrant and mobile populations; pregnant women, infants, and young children; uniformed personnel/services; and incarcerated populations.
The main findings are described for the NGO sector, with particular attention to geographic gaps in the availability of specific interventions. |
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Know Your HIV-Prevention Response: Southern Province, Zambia. Chart Book on Implementation of HIV-prevention Interventions by Nongovernmental Organizations
|
Gage AJ |
2014 |
English |
ZAMBIA |
|
In 2013, MEASURE Evaluation in collaboration with the Zambian National HIV/AIDS/STI/TB Council and the Institute of Economic and Social Statistics of the University of Zambia, implemented the Know Your HIV Response (KYR) study, a situation analysis of HIV-prevention interventions in Southern Province, Zambia. The study had three primary objectives:
determine what specific HIV-prevention interventions were being implemented;
determine by which organizations and in which districts the interventions were being implemented; and
assess the extent to which the HIV-prevention response matched current HIV-transmission patterns, were focused on geographic areas where HIV was spreading most rapidly, and covered technical recommendations for populations at higher risk of HIV exposure.
The purpose of this chart book is to disseminate easily understandable information on gaps in HIV-prevention interventions in the nongovernmental sector in Southern Province. It is hoped that the information presented will guide program implementers as they select and prioritize prevention interventions that are needed to have an impact on HIV incidence and prevalence. |
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Perspectives on Gender-Based Violence and Women’s Economic Empowerment in Sub-Saharan Africa: Challenges and Opportunities
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Mejia C, Cannon A, Zietz S, Arcara J, Abdur-Rahman A |
2014 |
English |
Africa |
|
Economic empowerment has long been considered a key component in structural interventions to reduce gender inequality and the experience of gender-based violence (GBV) among women and girls. However, results from recent studies have yielded inconsistent evidence on the relationship between women’s economic empowerment (WEE) interventions and the risk of GBV. For example, there is evidence to support the theory that WEE increases risk of GBV, possibly because increased empowerment challenges the status quo in the household, which can result in a male partner using violence to maintain his position. Alternatively, there is evidence indicating increased empowerment reduces GBV because educational or financial empowerment offers higher status in the household, which then decreases women’s risk of experiencing violence.
This study includes a systematic review of the literature as well as key informant interviews (KIIs) with program staff and experts from organizations implementing and/or conducting research on economic empowerment interventions targeted to women in sub-Saharan Africa. Findings from the literature review guided the questions for the KIIs. The KIIs added to the findings from the systematic review by focusing on what programs identify as important drivers in the relationship between WEE and GBV and the common M&E practices programs use to document intervention effect on gender outcomes.
Access the recording and slides from a webinar on the study. |
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MEASURE Evaluation Capability Statement: Health Systems Strengthening
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|
2014 |
English |
|
health systems strengthening, capability statement, health systems |
Health information systems (HIS) are the foundation of the health system; quality and timely data are necessary to inform decision making and resource allocation for all health system elements and to support governance and accountability within the health system. MEASURE Evaluation provides HIS technical assistance across all stages of the program cycle including:
advocacy,
assessment,
policy,
planning,
start-up,
scale-up,
capacity building and training,
monitoring and evaluation (M&E),
research,
analysis,
data use, and
contribution to the global learning agenda.
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Assessment of an mHealth Initiative to Improve Patient Retention
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do Nascimento N, Cannon M, Perales N, Chariyeva Z |
2014 |
English |
MOZAMBIQUE |
|
Effective treatment of chronic conditions such as HIV requires clients to return periodically to a treatment center for resupply of medications as well as for check-ups and laboratory tests. Failure to return at scheduled times compromises treatment effectiveness and in the case of HIV, can even lead to antiretroviral treatment (ART) resistance, lower retention in treatment, and increased mortality among patients. This report provides findings from a Mozambique pilot using mobile telephones to follow up on patients who have defaulted on their ART or have missed appointments or lab test dates. The pilot involved sending confidential messages through a Web-based application called CommCare directly to community health workers (activistas) to inform them of a defaulted patient's name, sex, location and contact information, confidant (a person the activista can speak to if the patient is not there), reason for the search and number of days since the patient defaulted (i.e., missed an appointment, missed medication pick-up, or is otherwise non-adherent and in need of a visit to the facility). |
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Les opportunités pour atteindre les femmes qui ont un besoin non satisfait de planification familiale à Madagascar
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Meekers D, Ratovonanahary R, Andrianantoandro T, Randrianarisoa H |
2014 |
French |
MADAGASCAR |
|
Tenant compte du fait que un tiers de la demande globale de planification familiale reste non satisfait, il est important d’explorer d’autres opportunités pour atteindre les femmes dont la demande n’est pas satisfaite. Le présent rapport analyse les données de l’étude 2012-2013 des Objectifs Millénaires pour le Développement afin d’identifier de telles opportunités par le biais de la panoplie des services de santé dont ces femmes bénéficient. |
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Measuring Progress and Progress in Measuring: Strengthening M&E Systems for Avian and Pandemic Influenza Programs in Southeast Asia, 2006-2014
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|
2014 |
English |
VIET NAM |
|
This end-of-activity report summarizes MEASURE Evaluation's work in strengthening monitoring and evaluation (M&E) systems for avian and pandemic influenza programs in Southeast Asia. Between 2006 and 2014, MEASURE Evaluation supported the U.S. Agency for International Development’s Regional Development Mission in Asia in its efforts to develop regional M&E standards, support the establishment of country-level M&E systems, build capacity for avian and pandemic influenza M&E at provincial and district levels, and generated lessons learned to inform similar efforts in other regions. |
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Outils d'enquête sur le bien-être de l'enfant, de la personne qui s'occupe de l'enfant et du ménage pour les programmes destinés aux orphelins et enfants vulnérables. Un manuel
|
Chapman J, Foreit K, Hickmann M, Parker L |
2014 |
French |
|
|
Ces outils de collecte de données sont des questionnaires destinés à une enquête auprès de ménages avec des enfants âgés 0 à 17 ans et les adultes du ménage qui s'occupent des enfants. Les questionnaires sont conçues pour mesurer des changements dans le bien-être des enfants, des personnes qui s'occupent des enfants et des ménages qui peuvent être attribués, dans la mesure du raisonnable, aux interventions du programme. Les outils sont accompagnés par:
Un manuel d'outils (le présent document);
Un modèle de protocole d'enquête;
Un modèle de plan d'analyse et;
Un manuel de formation
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Know Your HIV/AIDS Response: A Pilot Test of a New Service Mapping Tool Kit in Greater Accra, Ghana
|
Sutherland E, Laar A, Ghana KYR Study Group |
2014 |
Bengali |
GHANA |
|
“Knowing” an HIV response in a country is a complex undertaking. This effort requires knowing to the level of a district (or similar local administrative unit) what key implementers in all sectors (government, nongovernment, public, and private) are working against HIV, what populations they serve, what is the reach of these programs, and what specific types of interventions they are implementing. We pilot tested a set of newly developed data collection tools (referred to as the Know Your HIV Response or KYR) in the Greater Accra region of Ghana at the request of the government of Ghana. Data were collected on HIV programming being undertaken in each of the 16 metropolitan, municipal, and district assemblies (MMDAs) in the Greater Accra region of Ghana. As a prevention tool, the KYR tools address three key concepts that are critical for an improved understanding of the HIV-prevention response (location, scale, and needs). Analysis and dissemination of data includes the production of maps of HIV services using geographic information system technology. Overall, the data generated from this pilot exercise allows for mapping and understanding of the scope and scale of the HIV-prevention response at the regional level and identifies challenges and opportunities for scaling the exercise nationally. Ultimately, the study provides information needed to guide prioritization, and/or adjustment of the national HIV-prevention programs and interventions being carried out in the Greater Accra region. |
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Outcome Monitoring for Global Health Programs
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Barden-O’Fallon J, Mandal M |
2014 |
English |
|
|
Outcome monitoring is the periodic measurement of the knowledge, behaviors, or practices that a program or intervention intends to change. While many global health programs are engaged in the practice of outcome monitoring, there are few available resources on the practice of outcome monitoring itself. This paper helps fill the gap by providing a general resource on the practice of outcome monitoring. Additionally, useful references and links to resources specific to different aspects of outcome monitoring are included.
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Evaluation of a Mobile Reporting System for the Collection of Routine Malaria Data in Mali
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De la Torre C, N’Gbichi J-M, Unfried K |
2014 |
English |
MALI, West Africa, Africa |
|
Accurate and timely data from routine health information systems are needed in order to track malaria trends and to monitor health system performance with regards to case management and prevention efforts. This evaluation examines whether the use of improved technologies, including mobile reporting and the use of web-based databases, can help improve the timeliness, quality, and use of routine information. The evaluation used data from a routine reporting system for malaria that was recently established in Mali to examine these issues. |
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The Effect of Women's Property Rights on HIV: A Search for Quantitative Evidence
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Tumlinson K, Thomas JC, Reynolds HW |
2014 |
English |
|
HIV/AIDS |
In recent years, efforts to reduce HIV transmission have begun to incorporate a structural interventions approach, whereby the social, political, and economic environment in which people live is considered an important determinant of individual behaviors. This approach to HIV prevention is reflected in the growing number of programs designed to address insecure or nonexistent property rights for women living in developing countries. Qualitative and anecdotal evidence suggests that property ownership may allow women to mitigate social, economic, and biological effects of HIV for themselves and others through increased food security and income generation. Even so, the relationship between women's property and inheritance rights (WPIR) and HIV transmission behaviors is not well understood. We explored sources of data that could be used to establish quantitative links between WPIR and HIV.
Our search for quantitative evidence included (1) a review of peer-reviewed and "gray" literature reporting on quantitative associations between WPIR and HIV, (2) identification and assessment of existing data-sets for their utility in exploring this relationship, and (3) interviews with organizations addressing women's property rights in Kenya and Uganda about the data they collect. We found no quantitative studies linking insecure WPIR to HIV transmission behaviors. Data-sets with relevant variables were scarce, and those with both WPIR and HIV variables could only provide superficial evidence of associations. Organizations addressing WPIR in Kenya and Uganda did not collect data that could shed light on the connection between WPIR and HIV, but the two had data and community networks that could provide a good foundation for a future study that would include the collection of additional information. Collaboration between groups addressing WPIR and HIV transmission could provide the quantitative evidence needed to determine whether and how a WPIR structural intervention could decrease HIV transmission. |
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Organizational Network Analysis: MEASURE Evaluation's Experience 2010-2014
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Reynolds HW, Curran J, Thomas JC |
2014 |
English |
THAILAND, MALAWI, ETHIOPIA |
|
Health care organizations usually provide a narrow range of services that address a specific health need or the focus of a particular funding source. For many organizations, it is too costly or complex to provide all the health services necessary to address the full range of their clients’ needs. However, when an organization can see that it is part of a network of organizations providing the full range of services, and when it learns to collaborate within that network, it can gain access to and make use of information, skill sets, commodities, materials, and resources better than it can as a solitary organization. From a client’s perspective, the network is better able to meet his or her health needs. Well-coordinated networks can result in more synergies, less duplication, saved expenses, more thorough provision of services, and better health outcomes.
Research on organizational networks in health systems was initially conducted in developed countries. At MEASURE Evaluation, we sought to extend the application by creating a practical organizational network analysis (ONA) approach for resource-poor settings. The purpose of this document is to share that approach, the related tools, and insights from implementing ONA in three countries: Ethiopia, Thailand, and Malawi. |
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Encuesta para la Evaluación de Línea de Base del Programa Integrado del Altiplano Occidental: Un estudio de caso en la práctica de evaluación
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Taylor T |
2014 |
Spanish |
GUATEMALA |
|
La experiencia de la encuesta de línea de base del Programa WHIP brindó importantes lecciones sobre cómo implementar enfoques para las evaluaciones a gran escala. En primer lugar, se necesita una cantidad enorme de recursos para lograr una evaluación de programa de alta calidad. Las evaluaciones de impacto, en particular, no pueden compararse a otros procesos de monitoreo o evaluación, ya que requieren conocimientos o destrezas especializadas por parte del equipo de expertos en todos los casos. La planificación de una evaluación a gran escala debe empezar tan pronto como se inicie la planificación del programa mismo, y su implementación puede tardar un año o más. Si se necesita información que deben brindar los socios de implementación, como listas de beneficiarios, se deben comunicar estos requerimientos con suficiente tiempo. La magnitud del estudio, de hecho, podría limitar las comunicaciones entre las partes interesadas, los socios y aun los miembros del personal. Los efectos resultantes podrían minimizarse identificando y promoviendo las vías de comunicación más esenciales. En el Altiplano Occidental de Guatemala, y sin duda en otros lugares, el componente más importante para alcanzar el éxito en la implementación es quizás lograr un amplio apoyo de la comunidad. Por último, la Política de Evaluación de USAID y de sus programas insignia como Feed the Future (FTF) están promoviendo inversiones considerables en evaluación. Los esfuerzos coordinados que tienen éxito no sólo proporcionan datos de alta calidad con fines de la toma de decisiones, sino que también refuerzan los compromisos para lograr la transparencia y la colaboración. |
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The Western Highlands Integrated Program (WHIP) Evaluation Baseline Survey in Guatemala: A Case Study in Evaluation Practice
|
Taylor T |
2014 |
English |
GUATEMALA |
|
The Western Highlands Integrated Program (WHIP) baseline survey experience in Guatemala yielded important lessons about how to implement effective large-scale evaluation approaches. This case study summarizes the lessons learned.
Access an addendum to this report. |
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Mapping Community-Based Global Health Programs: A Reference Guide for Community-Based Practitioners
|
|
2014 |
English |
|
|
As visual displays, maps showing community resources and health services serve as focal points for communities to discuss program needs and gaps with themselves and with other stakeholders. As such, they can serve as powerful evaluation and advocacy tools supporting improved targeting of services and better health outcomes.
Across the global health community, mapping efforts are incorporating community knowledge, detailing where services are available, outbreaks occurring, and where treatment is been provided. Using maps to visual displays this information can empower communities and program planners with using this information to support the effectively deliver health services to those who need them.
This document serves as a guidance framework for those aiming to use maps to support community-based programs. We identify key questions to ask when planning a mapping effort, review necessary resources, and outline the four main stages of the mapping process:
1. Community engagement 2. Data collection 3. Visualization 4. Analysis and Information use
While each community based project is different, and will require its own tailored approach, this guidance framework is designed to help program managers walk through the process of incorporating maps for M&E of global health programs. |
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A Case Study to Measure National HIV M&E System Strengthening: Nigeria
|
Kemerer V, Salentine S |
2014 |
English |
NIGERIA |
|
Quantitative measurement of monitoring and evaluation (M&E) system strengthening has proven challenging; however, this case study of Nigeria’s efforts to strengthen its M&E systems identified and described several most significant changes. This study used interviews with stakeholders and key informants and other evidence to verify real change in routine health information system strengthening through indicator and data collection tool harmonization, development of an electronic patient record system, and improvement in data quality through the collection, collation, and reporting data cycle. The study also showed that although much has been accomplished, considerations for future M&E system strengthening assessment and implementation should account for a systems thinking approach to strengthen a country-led M&E system. Future interventions also will need to collaboratively and actively identify the work of each national agency and development partner to build partnerships that use substantive, productive feedback on what is and is not working. |
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Case Study Series: Community-Based Information Systems: Zambia
|
|
2014 |
English |
ZAMBIA |
|
Many community-based programs are providing services intended to mitigate the effects of HIV including HIV prevention, HIV care and treatment, and services for orphans and vulnerable children (OVC). These programs vary widely in terms of the data that are collected for monitoring and evaluation (M&E); the job function and skills of data collectors; and how and by whom the data are managed, analyzed, used, and stored. MEASURE Evaluation, with funding from the United States Agency for International Development (USAID) and support and technical input from members of the President’s Emergency Plan for AIDS Relief (PEPFAR) OVC Technical Working Group (TWG), conducted case studies in three countries to unpack the complexity of community-based M&E systems and to make recommendations. This case presents the findings from Zambia. |
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Case Study Series: Community-Based Information Systems: Tanzania
|
|
2014 |
English |
TANZANIA |
|
Many community-based programs provide services to mitigate the effects of the HIV and AIDS epidemic, including HIV prevention, HIV care and treatment, and services for orphans and vulnerable children (OVC). These community-based programs vary widely in terms of the data that are collected for monitoring and evaluation (M&E); the job function and skills of people who collect the data; and how and by whom the data are managed, analyzed, used, and stored. MEASURE Evaluation, with funding from the United States Agency for International Development (USAID) and support and technical input from members of the President’s Emergency Plan for AIDS Relief (PEPFAR) OVC Technical Working Group (TWG), conducted case studies in three countries to understand and document how community-based information systems are designed, implemented, and used to provide information to a broad range of stakeholders. This case presents the findings from Tanzania. |
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Case Study Series: Community-Based Information Systems: Kenya
|
|
2014 |
English |
KENYA |
|
Many community-based programs provide services to mitigate the effects of the HIV and AIDS epidemic, including HIV prevention, HIV care and treatment, and services for orphans and vulnerable children (OVC). These programs vary widely in terms of the data that are collected for monitoring and evaluation (M&E); the job function and skills of data collectors; and how and by whom the data are managed, analyzed, used, and stored. MEASURE Evaluation, with funding from the United States Agency for International Development (USAID) and support and technical input from members of the President’s Emergency Plan for AIDS Relief (PEPFAR) OVC Technical Working Group (TWG), conducted case studies in three countries (Kenya, Tanzania, and Zambia) to understand and document how community-based information systems are designed, implemented, and used to provide information to a broad range of stakeholders. This case presents the findings from Kenya. |
|
Case Study Series: Community-Based Information Systems: Overview
|
|
2014 |
English |
TANZANIA, ZAMBIA, KENYA |
|
Many community-based programs provide services intended to mitigate the effects of HIV and AIDS, including HIV prevention, HIV care and treatment, and services for orphans and vulnerable children (OVC). These programs vary widely in terms of the data that are collected for monitoring and evaluation (M&E); the job function and skills of people who collect the data; and how and by whom the data are managed, analyzed, used, and stored.
MEASURE Evaluation, with support from the United States Agency for International Development (USAID), conducted case studies to understand and document how community-based information systems are designed, implemented, and used by program staff and government counterparts. Case studies in Kenya, Tanzania, and Zambia provide an opportunity to identify key lessons learned—including successes, challenges, and opportunities for improvement—that will inform community-based programs globally.
The case studies focus on OVC programs because such programs rely heavily on community workers and community-based organizations (CBOs) to implement activities and monitor program progress. However, case study findings are relevant to other community-based programs that support prevention efforts and ensure continuity of care through nutrition, home based care (HBC), and general community health programs that are at the forefront of AIDS-free generation efforts. |
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MEASURE Evaluation Orphans and Vulnerable Children Survey Tools: Psychosocial Well-being Measurement Supplement
|
do Nascimento N, Chapman J, Parker L |
2014 |
English |
|
|
This document is intended as a resource for investigators aiming to measure the psychosocial well-being of children and their caregivers. It is part of a set of MEASURE Evaluation tools for measuring quantitative child outcomes and caregiver/household outcomes in programs for orphans and vulnerable children (OVC). Widely-used psychosocial scales and questions that measure social support, self-efficacy, self-esteem, hope, and functional aspects of well-being in adult caregivers and children are discussed. |
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Collecting PEPFAR MER Essential Survey Indicators: A Supplement to the Orphans and Vulnerable Children Survey Tools
|
MEASURE Evaluation |
2014 |
English |
Global |
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This document was prepared by MEASURE Evaluation at the request of the PEPFAR OVC Technical Working Group and reflects a legislative mandate to monitor and evaluate programs funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).
As part of its new monitoring, evaluation, and reporting (MER) guidance, PEPFAR launched a set of outcome indicators for PEPFAR programs serving orphans and vulnerable children (OVC). These outcome indicators reflect internationally-accepted developmental milestones and collectively measure holistic wellbeing for children and their families over time. Indicators track the ways OVC programs gain from and contribute to the broader HIV and child protection response. These outcome indicators are designated as "essential survey indicators", meaning that PEPFAR requires countries to collect these indicators biennially. These indicators are held in country to be used to inform program planning and review, both by country and visiting headquarters staff.
The purpose of this document is to provide U.S. government staff and others with a high-level understanding of outcomes monitoring and approaches to outcomes monitoring to enable effective procurement of data collection services for these new outcome indicators.
Two appropriate methods for outcomes monitoring are briefly described: cluster sample surveys and Lot Quality Assurance Sampling (LQAS) surveys. Like evaluation, outcomes monitoring should be carried out by a group that is independent and external to program delivery. The methodology for outcomes monitoring must be documented in a data collection protocol. Unlike evaluation, outcomes monitoring protocol may be exempt from full ethical review. However, protocols should be submitted to an ethics review board to certify and document exemption. A data collection tool and analysis guidance is provided. |
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Avaliação de um Programa em Moçambique. Cuidados Comunitários para Crianças Vulneráveis num Programa Integrado de Crianças Vulneráveis e Cuidados Domiciliares
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Cannon M, do Nascimento N, Chariyeva Z, Foreit K |
2014 |
Portuguese |
MOZAMBIQUE |
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O Programa de Cuidados Comunitários (PCC) financiado por USAID/Moçambique é um projeto de cinco anos (2010-2015) que visa fortalecer a resposta ao HIV e SIDA, apoiando especificamente órfãos e crianças vulneráveis (COV) e a prestação de serviços de cuidados domiciliares (CD) para as pessoas que vivem com HIV e SIDA (PVHIV), em sete províncias focais através de uma rede de organizações comunitárias de base (OCB). Antes do PCC, o apoio a COV e CD geralmente tinha sido fornecido por diferentes activistas (agentes comunitários) e/ou diferentes organizações de base comunitária, mesmo quando o mesmo agregado familiar tinha COV e clientes de CD. Com o PCC que oferece um apoio integrado a COV com prestação de CD, um único activista daria apoio integrado a todas as pessoas que vivem com o HIV (PVHIV), COV, e mulheres pré/pós parto residentes no agregado familiar através dos CD, bem como apoiaria agregados familiares que têm apenas um tipo de beneficiário (por exemplo, agregados familiares com crianças vulneráveis mas nenhum cliente de CD). A integração dos serviços e dos prestadores de serviços envolveu a elaboração de um cronograma de visitas com base nas pessoas que necessitam de cuidados mais freqüentes e aqueles que necessitam de cuidados menos frequentes (fases dos cuidados "intensivos" vs "manutenção").
Os parceiros esperavam que esta abordagem integrada iria oferecer um modelo mais eficiente de prestação de serviços. USAID/Moçambique pediu a MEASURE Evaluation para avaliar o modelo integrado para entender melhor o que a integração dos serviços de CD e de COV significa para os COV beneficiários.
Encontramos consenso sobre a mais valia de ter um activista prestar serviços a todos os clientes em um agregado familiar para a eficiência dos serviços que oferece, inclusive o apoio integral aos agregados familiares, o potencial de redução de custos e a capacidade integrada do activista para alcançar COV que podem não ter sido alcançadas anteriormente. |
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Technical Brief: Measurement of M&E System Strengthening. Application, Lessons, and Recommendations from a Retrospective Case Study Approach in Côte d’Ivoire and Nigeria
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Salentine S, Kemerer V |
2014 |
English |
COTE D'IVOIRE, NIGERIA |
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A case study to document monitoring and evaluation (M&E) systems strengthening in Côte d’Ivoire and Nigeria sought to (1) document the M&E system strengthening interventions and investment from 2007 to 2012 and (2) identify M&E system strengthening progress and the need for future interventions.
The purpose of this technical brief is to highlight the methods applied to assess M&E system strengthening, share lessons learned, and provide recommendations for improving approaches to measure M&E system strengthening. |
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Technical Brief: Findings from the Case Study to Measure M&E Systems Strengthening in Côte d’Ivoire and Nigeria
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Kemerer V, Salentine S |
2014 |
English |
COTE D'IVOIRE, NIGERIA |
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A case study to document monitoring and evaluation (M&E) systems strengthening in Côte d’Ivoire and Nigeria sought to (1) document the M&E system strengthening interventions and investment from 2007 to 2012 and (2) identify M&E system strengthening progress and the need for future interventions.
Analysis of the qualitative findings focused on providing understanding in four key areas: (1) national commitment to HIV M&E system strengthening, (2) performance of the HIV M&E system, (3) national capacity to strengthen the HIV M&E system, and (4) integration of HIV M&E systems with national health information systems. A summary of conclusions is provided. |
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A Case Study to Measure National HIV Monitoring and Evaluation System Strengthening: Côte d’Ivoire
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Kemerer V, Salentine S |
2014 |
English |
COTE D'IVOIRE |
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This Côte d’Ivoire study uses interviews with stakeholders and key informants and other evidence to verify real change in routine health information system strengthening through indicator and data collection tool harmonization, development of an electronic patient record system, and improvement in data quality through the collection, collation, and reporting data cycle. The study also shows that although much has been accomplished, considerations for future monitoring and evaluation (M&E) system strengthening assessment and implementation should account for a systems thinking approach to strengthen a country-led M&E system. Future interventions also will need to collaboratively and actively identify the work of each national agency and development partner to build partnerships that use substantive, productive feedback on what is and is not working. |
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Mozambique Program Assessment: Community Care for Vulnerable Children in an Integrated Vulnerable Children and Home-Based Care Program
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Cannon M, do Nascimento N, Chariyeva Z, Foreit K |
2014 |
English |
MOZAMBIQUE |
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In Mozambique, the Community Care Program (Programa de Cuidados Comunitários, or PCC in Portuguese) is a five-year project (2010-2015) that seeks to strengthen the response to HIV and AIDS, specifically support to orphans and vulnerable children (OVC) and home-based care (HBC) service provision for people living with HIV and AIDS (PLHIV), in seven focus provinces through a network of community-based organizations (CBOs). Prior to PCC, OVC support and HBC had usually been provided by different activistas (community workers) and/or different CBOs, even when the same household had both HBC clients and OVC.
PCC integrated OVC support with HBC service provision: a single activista would provide integrated support to all people living with HIV (PLHIV), OVC, and pre/post-partum women living in the household through HBC, as well as supporting households that may have only one beneficiary type (e.g., households with vulnerable children and no HBC client). Integration of services and service providers involved devising a schedule of visits based on those needing more frequent care and those needing less frequent care (“intensive” versus “maintenance” stages of care).
Stakeholders expected that this integrated approach would offer a more efficient model of service provision. The U.S. Agency for International Development (USAID) in Mozambique asked MEASURE Evaluation to assess the integrated model to better understand what integration of HBC and OVC services means for OVC beneficiaries.The assessment outlined in this report found consensus regarding the value of having one activista provide services to all clients in one household for the efficiencies it offers, including offering holistic support to households, the potential for cost savings, and the integrated activista’s ability to reach OVC that may not have been previously reached. |
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Institutional Capacity Building in Nigeria Sustainability Assessment Report: Obafemi Awolowo University, Ahmadu Bello University
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Cannon M, Post S, Bamidele S |
2014 |
English |
NIGERIA |
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In 2012, MEASURE Evaluation conducted a sustainability assessment of its two monitoring and evaluation (M&E) training partners in Nigeria, Ahmadu Bello University (ABU) and Obafemi Awolowo University (OAU). The assessment evaluated the capacity at ABU and OAU to offer workshops that meet M&E workforce needs, develop other M&E products including relevant higher education coursework and certification, and generally serve as Nigeria’s key M&E training and resource institutions.
This sustainability assessment was conducted in two phases and focused on the Population and Reproductive Health Programme (PRHP) and Department of Community Health at OAU and the Department of Community Medicine at ABU. Phase I included a literature review on sustainability factors in institutions of higher learning, from small US-based colleges to large international universities. Based on the literature review, a protocol was developed for interviewing key staff from the two Nigerian institutions involved in managing and implementing the workshops.
Phase II included interviews and a document review. Two sets of interviews were conducted at each institution, one related to organizational development factors, and the other related to technical and administrative functions. In addition, a document review (workshop reports, summaries of workshop observations and recommendations, budgets) was conducted that helped inform assessment findings. The findings show that the two universities have achieved significant progress toward institutionalizing both M&E training workshops and their own M&E academic programs. |
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The Future of Long-Acting and Permanent Methods of Contraception in Bangladesh: A Policy Brief
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2014 |
English |
BANGLADESH |
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This policy brief gives a systematic review of the trend of demand for and use of long-acting and permanent methods (LAPM), such as IUDs, implants, and female or male sterilizations, and programmatic and socio-cultural factors associated with the low use of LAPM, and combines the findings from the evaluation of the Mayer Hashi project that provided interventions to increase the use of LAPM in 21 districts of Bangladesh during 2010-2013. Recommendations that will help family planning programs strategize and prioritize the future LAPM program actions in Bangladesh are provided. |
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A Case Study from Ethiopia: Supportive Supervision in Monitoring and Evaluation with Community-Based Health Staff in HIV Programs
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Marshall A, Fehringer J |
2014 |
English |
ETHIOPIA |
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Background – Supportive supervision is a facilitative approach that promotes mentorship, joint problem-solving, and communication between supervisors and supervisees. In Ethiopia, MEASURE Evaluation trained government managers on supportive supervision as part of a project to scale-up the country’s health management information system (HMIS). This report presents a case study of the project that can serve as an example for other programs wishing to use supportive supervision in monitoring and evaluation (M&E).
Methods – A single case study design was used. Data were collected through 12 key informant interviews, four observations of supervision visits, and document review. Participants were sampled purposively from three strata: MEASURE Evaluation staff, government supervisors, and community-level staff. Interview transcripts were coded in NVIVO 10 and compared with direct observation notes and documents using thematic content analysis.
Results – Findings suggest that the project was successful in promoting program ownership, standardizing supervision, and improving data quality. Participants attributed these successes to collaboration among government offices, supervision tools, and feedback and training provided to staff by supervisors. The project was less successful at promoting data use for decision making. While participants had theoretical knowledge, there was little actual use of information at health facilities.
Conclusion – Supportive supervision is a promising approach to improve routine data collection for M&E of community-based programs. Programs that wish to use this approach can adapt best practices and lessons learned from this and other projects. Specifically, programs should work in teams of supervisors, address staff motivation and confidence during visits, promote data demand and use, and create a training plan for M&E staff. |
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A Sense of PLACE: Following Up on the Legacy of PLACE Studies in Seven Countries
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2014 |
English |
GHANA, JAMAICA, RWANDA, ZIMBABWE, KENYA, CHINA, CONGO, THE DEMOCRATIC REPUBLIC OF THE |
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The Priorities for Local AIDS Control Efforts (PLACE) methodology is an innovative set of tools that allow the public health community to identify, track, and describe venues where high-risk populations are meeting new sexual partners. This information can then be used for surveillance or intervention-design purposes. In an effort to understand better what happens to data and information during and after the implementation of PLACE in a country, follow-up interviews were conducted with key informants in seven countries who were involved in PLACE studies since 2003. This case study reports findings from the interviews. |
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Conocimiento comprensivo sobre el VIH en personas jóvenes en Costa Rica
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2014 |
Spanish |
COSTA RICA |
Sexual Behavior, HIV/AIDS, Sexual Behavior, Contraceptive Use, and Reproductive Health |
This brief was developed by an interdisciplinary group of Costa Rican public health professionals who participated in a long-term capacity building process to promote secondary analysis of the 2010 Survey of Sexual and Reproductive Health. With technical assistance provided by MEASURE Evaluation, teams of participants (1) defined a research question that is based on existing literature, (2) drafted a basic analysis proposal, including dummy tables, (3) received a Stata training and software and conducted a basic bivariate analysis of the survey data, (4) presented and interpreted the results in a research brief, and (5) disseminated the findings to national authorities.
The final brief was produced by the Central American Population Center of the University of Costa Rica. |
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Uso correcto y sistemático del condón en Costa Rica
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2014 |
Spanish |
COSTA RICA |
Sexual Behavior, HIV/AIDS, Sexual Behavior, Contraceptive Use, and Reproductive Health |
This brief was developed by an interdisciplinary group of Costa Rican public health professionals who participated in a long-term capacity building process to promote secondary analysis of the 2010 Survey of Sexual and Reproductive Health. With technical assistance provided by MEASURE Evaluation, teams of participants (1) defined a research question that is based on existing literature, (2) drafted a basic analysis proposal, including dummy tables, (3) received a Stata training and software and conducted a basic bivariate analysis of the survey data, (4) presented and interpreted the results in a research brief, and (5) disseminated the findings to national authorities.
The final brief was produced by the Central American Population Center of the University of Costa Rica. |
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Factores vulnerabilidad al VIH/sida en mujeres costarricenses sexualmente activas
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2014 |
Spanish |
COSTA RICA |
Sexual Behavior, Contraceptive Use, and Reproductive Health, Sexual Behavior, HIV/AIDS |
This brief was developed by an interdisciplinary group of Costa Rican public health professionals who participated in a long-term capacity building process to promote secondary analysis of the 2010 Survey of Sexual and Reproductive Health. With technical assistance provided by MEASURE Evaluation, teams of participants (1) defined a research question that is based on existing literature, (2) drafted a basic analysis proposal, including dummy tables, (3) received a Stata training and software and conducted a basic bivariate analysis of the survey data, (4) presented and interpreted the results in a research brief, and (5) disseminated the findings to national authorities.
The final brief was produced by the Central American Population Center of the University of Costa Rica. |
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Adopción del condón masculino como método de planificación y de prevención de la infección por VIH
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2014 |
Spanish |
COSTA RICA |
Sexual Behavior, Contraceptive Use, and Reproductive Health, HIV/AIDS |
This brief was developed by an interdisciplinary group of Costa Rican public health professionals who participated in a long-term capacity building process to promote secondary analysis of the 2010 Survey of Sexual and Reproductive Health. With technical assistance provided by MEASURE Evaluation, teams of participants (1) defined a research question that is based on existing literature, (2) drafted a basic analysis proposal, including dummy tables, (3) received a Stata training and software and conducted a basic bivariate analysis of the survey data, (4) presented and interpreted the results in a research brief, and (5) disseminated the findings to national authorities.
The final brief was produced by the Central American Population Center of the University of Costa Rica. |
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Factores determinantes de la realización de la prueba de VIH en Costa Rica
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2014 |
Spanish |
COSTA RICA |
HIV/AIDS |
This brief was developed by an interdisciplinary group of Costa Rican public health professionals who participated in a long-term capacity building process to promote secondary analysis of the 2010 Survey of Sexual and Reproductive Health. With technical assistance provided by MEASURE Evaluation, teams of participants (1) defined a research question that is based on existing literature, (2) drafted a basic analysis proposal, including dummy tables, (3) received a Stata training and software and conducted a basic bivariate analysis of the survey data, (4) presented and interpreted the results in a research brief, and (5) disseminated the findings to national authorities.
The final brief was produced by the Central American Population Center of the University of Costa Rica.
The final brief was produced by the Central American Population Center of the University of Costa Rica. |
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Efecto de la violencia sexual en el riesgo de infección del VIH
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2014 |
Spanish |
COSTA RICA |
HIV/AIDS |
This brief was developed by an interdisciplinary group of Costa Rican public health professionals who participated in a long-term capacity building process to promote secondary analysis of the 2010 Survey of Sexual and Reproductive Health. With technical assistance provided by MEASURE Evaluation, teams of participants (1) defined a research question that is based on existing literature, (2) drafted a basic analysis proposal, including dummy tables, (3) received a Stata training and software and conducted a basic bivariate analysis of the survey data, (4) presented and interpreted the results in a research brief, and (5) disseminated the findings to national authorities.
The final brief was produced by the Central American Population Center of the University of Costa Rica.
The final brief was produced by the Central American Population Center of the University of Costa Rica. |
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Evaluation du Système Local d'Information Sanitaire (SLIS) avec les Outils PRISM: Rapport
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MEASURE Evaluation |
2014 |
French |
West Africa, Africa |
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Le Mali est un pays enclavé de l’Afrique de l’Ouest, classé 178ème sur 182 pays selon l’Indice de développement humain des nations Unies. Malgré les récents progrès réalisés au Mali des efforts considérables restent à faire sur beaucoup d’indicateurs de santé sur le plan mondial: la mortalité maternelle est de 464 décès pour 100000 naissances vivantes; la mortalité chez les enfants de moins de 5 ans est de 98 décès pour 1000 naissances vivantes; et la mortalité infantile est estimée à 58 décès pour 1000 naissances vivantes. La malnutrition est un facteur majeur contribuant à la mortalité maternelle et infantile, et 38% des enfants souffrent de malnutrition chronique.
L’environnement au Mali, est caractérisé par un faible accès à l’eau potable et aux services d’assainissement de base; les conditions d’hygiène y sont précaires. Selon l’Enquête Mondiale sur la Santé 2006, 39,7% de la population ont accès à l’eau potable de sources aménagées, avec une disparité entre le milieu urbain 51,3%, et le milieu rural 34,5%.
Le recensement général de la population de 2009 avait estimé la population totale du Mali à 14.517.176, presque le double de la population il y a 20 ans (1987: 7.696.348); le taux d’accroissement de la population a augmenté de 2,4% à 3,6% pendant la même période. L’indice synthétique de fécondité est de 6,1 enfants par femme, avec un taux de prévalence contraceptive moderne de 9,9%. L’Enquête démographique et santé (EDSM-V, 2013) estime que 39 % d’enfants de 12-23 mois ont été complètement vaccinés et 12% n’ont reçu aucun vaccin, les autres (49%) ont été partiellement vaccinés.
De manière spécifique, 84% des enfants ont reçu le BCG ; dans 80% des cas, les enfants ont reçu la première dose de DTCoq (ou de Pentavalent) ; dans une proportion encore plus élevée (84 %), ils ont reçu la première dose de polio ; et 72% d’enfants de 12-23 mois ont été vaccinés contre la rougeole. La dose de Polio 0 (à la naissance) a été reçue par près des deux tiers des enfants (64%).
La prévalence de la parasitémie palustre est 52% (EDSM-V, 2013), en hausse comparée à 38% (Enquête d’anémie et de parasitémie, 2010). La prévalence du VIH est basse au Mali, estimée à 1,3%, comparativement aux autres pays au Sud du Sahara. Néanmoins, la prévalence du VIH est très élevée chez les travailleuses du sexe (24,2%) et les hommes ayant des rapports sexuels avec des hommes (MSM) (17%-35%).
The 2018 version of the PRISM Series, updated and with new modules (Toolkit, User’s Kit, and Training Kit) is available here: https://www.measureevaluation.org/prism |
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Evaluation des Niveaux CSREF, CSCOM et Communautaire du SLIS du Mali a l’Aide de l’Outil PRISM
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MEASURE Evaluation |
2014 |
French |
West Africa, Africa |
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L’objectif de cette étude était d’évaluer le niveau de performance de la fonctionnalité, de la qualité des données et de l’utilisation de l’information du système d’information à base communautaire (SIBC) du Mali afin de formuler des recommandations pour l’amélioration des pratiques et de gestion des activités de santé communautaires.
The 2018 version of the PRISM Series, updated and with new modules (Toolkit, User’s Kit, and Training Kit) is available here: https://www.measureevaluation.org/prism |
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Development and Use of a Master Health Facility List: Haiti’s Experience During the 2010 Earthquake Response
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Rose-Wood A, Heard N, Thermidor R, Chan J, Joseph F, Lerebours G, Zugaldia A, Konkel K, Edwards M, Lang B, Rosa-Torresa C |
2014 |
English |
HAITI |
Haiti, Health Facilities |
Master health facility lists (MHFLs) are gaining attention as a standards-based means to uniquely identify health facilities and to link facility-level data. The ability to reliably communicate information about specific health facilities can support an array of health system functions, such as routine reporting and emergency response operations. MHFLs support the alignment of donor-supported health information systems with county-owned systems. Recent World Health Organization draft guidance promotes the utility of MHFLs and outlines a process for list development and governance. Although the potential benefits of MHFLs are numerous and may seem obvious, there are few documented cases of MHFL construction and use.
The international response to the 2010 Haiti earthquake provides an example of how governments, nongovernmental organizations, and others can collaborate within a framework of standards to build a more complete and accurate list of health facilities. Prior to the earthquake, the Haitian Ministry of Health (Ministe`re de la Sante´ Publique et de la Population [MSPP]) maintained a list of public-sector health facilities but lacked information on privately managed facilities. Following the earthquake, the MSPP worked with a multinational group to expand the completeness and accuracy of the list of health facilities, including information on post-quake operational status. This list later proved useful in the response to the cholera epidemic and is now incorporated into the MSPP’s routine health information system. Haiti’s experience demonstrates the utility of MHFL formation and use in crisis as well as in the routine function of the health information system. |
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Monitoring and Evaluation Survey for the Western Highlands Integrated Program, Baseline 2013
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Angeles G, Hidalgo E, Molina-Cruz R, Taylor T, Urquieta-Salomón J, Calderón C, Fernández JC, Hidalgo M, Brugh K, Romero M |
2014 |
English |
GUATEMALA |
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Since 2012, the U.S. Agency for International Development mission in Guatemala has been engaged in an effort to implement 18 different programs in 30 municipalities located in the Guatemalan Western Highlands. This group of inter-related programs is known as WHIP, the Western Highlands Integrated Program. WHIP’s main objectives are to reduce poverty and chronic malnutrition, improve health and nutrition, and increase health service utilization in the region. This baseline survey deals directly with two of those 18 programs: the Rural Value Chain Project (RVCP), which seeks to increase agricultural productivity and improve market access, and the health and nutrition program, which includes several partners implementing community-level activities designed to improve the health of women and children under age five and to expand and strengthen available health services. In order to evaluate these programs’ performance, changes over time in key population and program performance indicators will be examined. Specifically, changes occurring from 2013 to 2015 (the program’s midpoint) and from 2013 to 2017 (the end of the program) will be analyzed. A difference-in-differences, quasi-experimental design with a matched control group and fixed effects will be applied, with the aim of evaluating program impact. EMEPAO 2013 (Encuesta de Monitoreo y Evaluación del Programa del Altiplano Occidentalis or Western Highlands Integrated Program Monitoring and Evaluation Survey) is thus the first of three surveys that will provide representative and longitudinal data to evaluate the WHIP. |
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Organizational Network Analysis of Organizations that Serve Men Who Have Sex with Men and Transgender People in Chiang Mai, Thailand
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Curran J, Berry S, Sangsuk K |
2014 |
English |
THAILAND |
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This study seeks to facilitate the improvement of voluntary counseling and testing (VCT) and other services for men who have sex with men (MSM) and transgender (TG) people through more efficient delivery of services, reducing duplication of efforts, and comprehensively addressing clients’ needs. The study aims to understand the extent to which organizations and actors providing VCT and other support and services to MSM and TG people in Chiang Mai, Thailand are aware of each other and the services they provide; and how these organizations coordinate, collaborate and/or share information, resources, and clients. |
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Gender Inequality and the Risk of HIV among Married Couples in North India
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Bloom SS, Agrawal A, Singh KK, Suchindran CM |
2014 |
English |
INDIA |
India, HIV/AIDS |
This study investigated the distribution and determinants of HIV risks among married couples in North India. Gender inequality emerged as a potential driver of HIV risks in this region. Data collection took place in 2003 in a probability survey of 3385 couples living in India's most populous state – Uttar Pradesh – and Uttaranchal.
Couples' analyses utilizing generalized estimating equations showed that compared with husbands, wives were less knowledgeable about HIV (OR = 0.31, 95% CI = 0.27–0.36), more likely to consider themselves at risk for infection (OR = 6.86, 95% CI = 4.65–10.13), and less likely to feel that a wife had the right to refuse sex with her husband (OR = 0.50, 95% CI = 0.44–0.58). The proportion of husbands reporting non-marital sex in the past year was 7.1% and transactional sex in the past year, 2.2%. Among their wives, 73.4% were unaware of their husbands' non-marital sexual behaviors and only 28.9% of husbands reported condom use during their last non-marital sexual encounter.
Logistic regression analyses showed that husbands' alcohol use, husbands' mobility, and urban residence were positively associated with husbands' non-marital sexual behaviors adjusting for other covariates. The data demonstrate that HIV prevention programs among couples in North India should consider both sexual risks and gender inequalities which potentially fuel HIV spread in this region. |
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Impact Evaluation of the Mayer Hashi Program of Long-Acting and Permanent Methods of Contraception in Bangladesh
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Rahman M, Curtis SL, Haider MM |
2014 |
English |
BANGLADESH |
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The Mayer Hashi (MH) project covered 21 low-performing districts of Bangladesh to improve access, quality, and use of long-acting and permanent methods (LAPM) of contraception and selective maternal health services. This evaluation report focuses on the LAPM activities.
Under a “before-after and intervention-comparison” evaluation framework, six districts from the MH program districts and three otherwise comparable districts from non-program districts were selected. The evaluation design permits a difference-in-difference (DID) analysis of the project impact. Endline surveys were conducted among 5,864 currently married women of reproductive ages (CMWRA) and 627 service providers during February-May 2013. Baseline data on 32,018 CMWRA were taken from the 2010 Bangladesh Maternal Mortality Survey (BMMS) (conducted during January-August 2010) for the nine selected districts: Barisal, Patuakhali, Cox’s Bazar, Comilla, Moulovibazar, and Sunamganj are program districts; and Kishoreganj, Mymensingh, and Narsingdi are non-program districts.
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Child, Caregiver & Household Well-being Survey Tools for Orphans & Vulnerable Children Programs: Data Management Guidance
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2014 |
English |
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This guide is part of a set of tools for measuring quantitative child outcomes and caregiver/household outcomes in programs for orphans and vulnerable children (OVC). The purpose of the guide is to standardize data management procedures; outline the steps for database design; describe best practices in data entry and data cleaning; identify where data-related missteps can occur; and highlight the importance of proactive data management. |
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Explaining Inequity in the Use of Institutional Delivery Services in Selected Countries
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Do M, Soelaeman R, Hotchkiss DR |
2014 |
English |
GHANA, PHILIPPINES, RWANDA |
Health Services, Rwanda, Ghana |
Wealth-related disparities in the use of reproductive health services remain a substantial problem in many low- and middle-income countries. Very few studies have attempted to explain such inequalities through decomposition of the contributions made by various individual- and household-level factors. This study aims to: (1) assess the degree of wealth-related inequality and inequity in the use of institutional delivery services in selected low- and middle-income countries, and (2) to explain wealth-related inequity through decomposition by the contributions made by various components, including health insurance coverage. Data come from Demographic and Health Surveys in three countries: Ghana, Rwanda, and the Philippines. Concentration indices are used to calculate inequality and horizontal inequity in service utilization. Multivariate methods are used to decompose inequity. Findings indicate a moderate to high degree of inequity in institutional delivery service use in all study countries. The study provides some evidence of the contribution of health insurance to increased wealth-related inequity in the use of institutional delivery services, although having health insurance was also associated with increased utilization of services. Results suggest that increased health insurance coverage does not automatically translate to lower wealth-related inequity in service utilization. Inequities in service utilization exist if there are still inequities in the health insurance status. The study advocates for expanding health insurance coverage, particularly among the poor to reduce inequity in insurance coverage and increase service utilization. |
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Child, Caregiver & Household Well-being Survey Tools for Orphans & Vulnerable Children Programs: Results and Lessons Learned from the 2013 Pilot Tests in Zambia & Nigeria
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2014 |
English |
NIGERIA, ZAMBIA |
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MEASURE Evaluation has produced a set of questionnaires for measuring quantitative child outcomes and caregiver/household outcomes, developed with the support of the PEPFAR Orphans and Vulnerable Children Technical Working Group.
The questionnaires include a number of verifiable questions (e.g., weight, documented immunizations). However, some questions may be open to interpretation for both the respondent and the data collector. Furthermore, some of the sections include questions that may be duplicative (e.g., income and expenditure, or items of a psychosocial well-being assessment scale). Others contain questions that ask respondents to recall their state of well-being up to one month prior to survey.
To finalize the questionnaires for public use, we pilot-tested them in Zambia and Nigeria in 2013. Findings from the pilot test informed revisions of the questionnaires. This report presents the methodology and findings of the pilot test, as well as the nature of the revisions to questions and procedures after pilot testing. |
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Acknowledging HIV and Malaria as Major Causes of Maternal Mortality in Mozambique
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Singh K, Moran A, Story W, Bailey P, Chavane L |
2014 |
English |
MOZAMBIQUE |
HIV/AIDS, Malaria, Mozambique |
Objective: To review national data on HIV and malaria as causes of maternal death and to determine the importance of looking at maternal mortality at a subnational level in Mozambique.
Methods: Three national data surveys were used to document HIV and malaria as causes of maternal mortality and to assess HIV and malaria prevention services for pregnant women. Data were collected between 2007 and 2011, and included population-level verbal autopsy data and household survey data.
Results: Verbal autopsy data indicated that 18.2% of maternal deaths were due to HIV and 23.1% were due to malaria. Only 19.6% of recently pregnant women received at least two doses of sulfadoxine-pyrimethamine for intermittent preventive treatment, and only 42.3% of pregnant women were sleeping under an insecticide-treated net. Only 37.5% of recently pregnant women had been counseled, tested, and received an HIV test result. Coverage of prevention services varied substantially by province.
Conclusion: Triangulation of information on cause of death and coverage of interventions can enable appropriate targeting of maternal health interventions. Such information could also help countries in Sub-Saharan Africa to recognize and take action against malaria and HIV in an effort to decrease maternal mortality. |
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Maternal Mortality in Bangladesh: A countdown to 2015 country case study
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Arifeen SE, Hill K, Ahsan KZ, Jamil K, Nahar Q, Streatfield PK |
2014 |
English |
BANGLADESH |
Bangladesh, Monitoring, Evaluation, Maternal Mortality |
Bangladesh is one of the only nine Countdown countries that are on track to achieve the primary target of Millennium Development Goal (MDG) 5 by 2015. It is also the only low-income or middle-income country with two large, nationally-representative, high-quality household surveys focused on the measurement of maternal mortality and service use.
We use data from the 2001 and 2010 Bangladesh Maternal Mortality Surveys to measure change in the maternal mortality ratio (MMR) and from these and six Bangladesh Demographic and Health Surveys to measure changes in factors potentially related to such change. We estimate the changes in risk of maternal death between the two surveys using Poisson regression.
The MMR fell from 322 deaths per 100 000 livebirths (95% CI 253—391) in 1998—2001 to 194 deaths per 100 000 livebirths (149—238) in 2007—10, an annual rate of decrease of 5·6%. This decrease rate is slightly higher than that required (5·5%) to achieve the MDG target between 1990 and 2015. The key contribution to this decrease was a drop in mortality risk mainly due to improved access to and use of health facilities. Additionally, a number of favourable changes occurred during this period: fertility decreased and the proportion of births associated with high risk to the mother fell; income per head increased sharply and the poverty rate fell; and the education levels of women of reproductive age improved substantially. We estimate that 52% of maternal deaths that would have occurred in 2010 in view of 2001 rates were averted because of decreases in fertility and risk of maternal death.
The decrease in MMR in Bangladesh seems to have been the result of factors both within and outside the health sector. This finding holds important lessons for other countries as the world discusses and decides on the post-MDG goals and strategies. For Bangladesh, this case study provides a strong rationale for the pursuit of a broader developmental agenda alongside increased and accelerated investments in improving access to and quality of public and private health-care facilities providing maternal health in Bangladesh. |
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A Performance Evaluation of the National HIV Prevention Program for FSW and MSM in Ghana
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|
2014 |
English |
GHANA |
|
This evaluation was conducted as a mid-point assessment by MEASURE Evaluation and the University of Ghana School of Public Health, in collaboration with the Ghana AIDS Commission, in order to describe the achievements and challenges of the ongoing implementation of the National HIV Prevention Program for female sex workers (FSW) and men whohave sex with men (MSM) in Ghana.
This performance evaluation employed a mixed-methods approach in order to assess the following key study aims:
describe how services are being delivered;
document barriers and facilitators to accessing health services for MSM and FSW as well as the larger structural influences on sexual and health seeking behaviors such as stigma and discrimination;
assess whether organizations directly providing services to FSW and MSM have standard operating procedures, functional supervision mechanisms, monitoring and reporting systems, and administrative, management, and planning capacity; and
document efforts to increase stakeholder and organizational coordination and to address social, cultural, religious, political, and legal barriers to HIV prevention efforts among FSW and MSM.
Study findings suggest that while some greater capacity building and standardization could improve data collection and reporting and standardize service availability, organizations are striving to adhere to the service package and to provide a high quality product. This effort has resulted in high demand for services and a positive reputation for respectful treatment and confidentiality among FSW and MSM. Overall, recommendations focus on the ways in which the program can continue to be strengthened and expanded to better meet demand for services without sacrificing the reputation for service quality upon which that demand is predicated. |
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Strengthening Orphan and Vulnerable Children Programs with Data: Creating a Culture of Data Demand and Use
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2014 |
English |
LESOTHO |
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Significant human and financial resources have been invested worldwide in the collection of health data on populations, services and communities. Unfortunately, this information is often not used by key stakeholders to effectively inform policy and programmatic decision making. The failure to consider empirical evidence before making decisions hinders the health system’s ability to respond to priority needs throughout its many levels. In an effort to address this problem, MEASURE Evaluation partnered with Pact Worldwide to apply a comprehensive data demand and use (DDU) intervention within their organization. Pact was targeted as a partner because of their interest in and commitment to improving DDU and because of their global program reach. The goal of the collaboration was to institutionalize DDU tools, curricula, and strategies in Pact’s institutional guidance and official structure in order to create a culture of data use that could be diffused to their programs worldwide. An organization that has adopted data use strategies to intentionally support the use of data will be better positioned to sustain the use of data in decision-making processes.
This case study explains how MEASURE Evaluation and Pact Worldwide adapted a DDU intervention to build a culture of data use within their organization and their partner organizations in Lesotho. |
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Fact Sheet: Desbloqueo de los servicios de salud para HSH y mujeres transgénero en San Salvador
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Andrinopoulos K, Hembling J. |
2014 |
Spanish |
EL SALVADOR |
|
Increasing health service utilization is an important first step towards reducing health disparities for men who have sex with men (MSM) and transgender women (TW). This research brief provides descriptive information on health seeking behavior for MSM and TW in San Salvador. Data on disclosure of sexual orientation to a healthcare provider is also presented since this has been shown to increase quality of care in other contexts. A sample of 670 participants (506 MSM and 164 TW) was recruited using respondent driven sampling (RDS) and completed a survey. Statistical analysis included frequency calculations, chi-squared tests of association, and multivariate logistic regression with the application of appropriate weighting techniques for RDS. Results show that health service utilization was more common among participants who had health insurance and a regular facility or provider. Concerns related to confidentiality, judgment, and comfort with the provider, were important factors influencing the decision to seek healthcare. Most participants used MINSAL (public) facilities when they need healthcare. This is particularly true for TW. However, slightly more than half report a preference for private services. Disclosure of sexual orientation to a healthcare provider was more common among TW compared to MSM. It was also more common among participants with access to a healthcare provider supportive of MSM and TW, and participants who used MINSAL (public) versus private services. Alarmingly, disclosure of sexual orientation to a healthcare provider was associated with a higher level of perceived provider discrimination by the participant, suggesting that disclosure in this context may lead to a worse rather than better experience when seeking health services. There was also no difference in HIV service use (measured by HIV testing history), among participants who had disclosed their sexual orientation to a healthcare provider. Based on the findings, it is recommended that additional activities be implemented to mitigate the stigma and discrimination experienced by MSM and TW in the wider society and the health system. Given the level of service use and preference across types of health facilities, it is necessary to address barriers in the public sector (MINSAL/ISSS) while concurrently supporting access to private health services. |
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Fact Sheet: Unlocking Health Services for MSM and Transgender Women in San Salvador
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Andrinopoulos K, Hembling J. |
2014 |
English |
EL SALVADOR |
|
Increasing health service utilization is an important first step towards reducing health disparities for men who have sex with men (MSM) and transgender women (TW). This research brief provides descriptive information on health seeking behavior for MSM and TW in San Salvador. Data on disclosure of sexual orientation to a healthcare provider is also presented since this has been shown to increase quality of care in other contexts. A sample of 670 participants (506 MSM and 164 TW) was recruited using respondent driven sampling (RDS) and completed a survey. Statistical analysis included frequency calculations, chi-squared tests of association, and multivariate logistic regression with the application of appropriate weighting techniques for RDS. Results show that health service utilization was more common among participants who had health insurance and a regular facility or provider. Concerns related to confidentiality, judgment, and comfort with the provider, were important factors influencing the decision to seek healthcare. Most participants used MINSAL (public) facilities when they need healthcare. This is particularly true for TW. However, slightly more than half report a preference for private services. Disclosure of sexual orientation to a healthcare provider was more common among TW compared to MSM. It was also more common among participants with access to a healthcare provider supportive of MSM and TW, and participants who used MINSAL (public) versus private services. Alarmingly, disclosure of sexual orientation to a healthcare provider was associated with a higher level of perceived provider discrimination by the participant, suggesting that disclosure in this context may lead to a worse rather than better experience when seeking health services. There was also no difference in HIV service use (measured by HIV testing history), among participants who had disclosed their sexual orientation to a healthcare provider. Based on the findings, it is recommended that additional activities be implemented to mitigate the stigma and discrimination experienced by MSM and TW in the wider society and the health system. Given the level of service use and preference across types of health facilities, it is necessary to address barriers in the public sector (MINSAL/ISSS) while concurrently supporting access to private health services. |
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Information Needs for OVC Program Management and Evaluation: A framework
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Chapman J, Cannon M |
2014 |
English |
|
Monitoring, Evaluation, Orphans and Vulnerable Children |
Programs serving orphans and vulnerable children (OVC) have become increasingly complex over the last decade, necessitating programs to collect more information to ensure adequate management. Programs are also facing greater pressure to demonstrate an interest in understanding impact and value for money, which is similarly leading to changes in the ways programs collect information and the types of information collected. In order to gather such information and contain costs, governments and programs are collecting increasing amounts of information at every interaction with program beneficiaries. This has led to a high burden on those providing, gathering, and inputting information and low data quality overall.
In this paper, we present a framework for categorizing different information needs for OVC program management and evaluation. The purpose of this framework is to support OVC program staff and donors to more clearly define information-collection strategies based on the information needed, why it is needed, and by whom it is needed. This will improve the efficiency of data-collection efforts, and improve the availability of the right (high-quality) data for various decision-making processes. |
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Using Geospatial Analysis to Inform Decision Making in Targeting Health Facility-Based Programs: A Guidance Document
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Colston JM, Burgert CR |
2014 |
English |
NAMIBIA |
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Geospatial analysis and geographic information system (GIS) software are useful tools for decision-making. This is because, to maximize health service coverage and access, it is important to assess whether the locations of health facilities are appropriately distributed throughout populated areas. This guide describes the questions that need to be answered and the data required to make a decision about resource allocation, using GIS tools.The guide also presents an illustrative scenario in which geospatial techniques were used to target investments in improving antenatal care coverage in Namibia |
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Uganda Vulnerability Index Assessment Results
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2014 |
English |
UGANDA |
Orphans and Vulnerable Children, Uganda |
In 2011-2012, Uganda’s Ministry of Gender, Labour, and Social Development approved use of the Vulnerability Index (VI), a tool to identify vulnerable households and the extent of their vulnerability. Five U.S government-funded implementing partners started using the VI in 2012-2013. USAID/Uganda asked MEASURE Evaluation to conduct an assessment of the VI tool’s usefulness, feasibility, and data quality. This assessment concluded that while the VI provides a comprehensive, standardized tool for OVC programs, the tool may not identify the most critically vulnerable children. While one possible remedy would be to adjust the criteria used to capture children who fall in the “critically vulnerable” category, secondary data analysis illustrates that the tool design (e.g., number of questions per CPA, scoring rubric) should be reviewed more broadly. |
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VAT Reliability Assessment Results
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2014 |
English |
UGANDA |
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MEASURE Evaluation conducted a reliability assessment of over 12,000 Round 1 VAT and Round 2 VAT records to determine if select indicators that were not supposed to change over time (e.g., sex of respondent, child disability status), remained the same in Round 2. These data helped determine the tool’s reliability for variables that should remain constant. |
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Training for PEPFAR OVC Survey Data Collectors: Facilitator's Guide
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2014 |
English |
|
|
Data collectors implementing the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) orphans and vulnerable children (OVC) survey tools must be trained to a high standard. To enable this, MEASURE Evaluation has developed a training manual and materials for data collectors. Groups wanting to implement the OVC survey tools will need to adapt this training manual and materials to reflect the aims and design of the specific study. However, the structure of the training for data collectors should be similar, regardless of study objectives or design, and there are topic areas such as interviewing children that are relevant to all types of OVC studies and OVC research questions. This training manual aims to provide as much guidance as possible for prospective data collectors to implement these tools.
This training manual has three key objectives:
1. to familiarize participants with PEPFAR’s expectations around how these tools should be implemented;
2. to ensure standard and routine application of child protection and research ethics safeguards; and
3. to reduce the burden on local and international researchers who want to implement the OVC program evaluation tools. |
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Fact Sheet: Routine Health Outcome Monitoring Using Lot Quality Assurance Sampling
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2014 |
English |
LIBERIA |
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Lot Quality Assurance Sampling (LQAS) is a relatively rapid and inexpensive approach to data collection for monitoring and evaluation purposes. It can be used to empower program managers to assess program performance, enabling them to determine whether program objectives and targets have been achieved within a specific unit of interest. Data was collected in Lofa County, Liberia in March of 2013 on five health indicators as part of a capacity building exercise with the Ministry of Health. Results are calculated for each indicator at both the Supervision Area level (Supervision Areas are associated with Health Districts) to determine whether the Supervision Area met or did not meet the county target, and at the county level to determine the weighted average coverage. |
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Una colaboración binacional contra el VIH: El legado de USAID en México
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2014 |
Spanish |
MEXICO |
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La Agencia de los Estados Unidos para el Desarrollo Internacional (USAID) trabajaba con el gobierno de México en la mejora de los servicios de planificación familiar y salud reproductiva, al momento en que el primer caso de SIDA en México se registró en 1983. El VIH emergió como una amenaza a la salud mundial que no reconoce fronteras. Dados los fuertes lazos entre México y los Estados Unidos basados en el intercambio comercial, educativo y científico, así como en las relaciones familiares, fue del interés de ambos gobiernos impulsar conjuntamente la respuesta a la amenaza a la salud pública. La asistencia de USAID para mejorar la atención y prevención del VIH y otras infecciones de transmisión sexual (ITS) comenzó en México en 1987; y la implementación de programas de VIH y SIDA significativamente más grandes comenzó en 1997. En 1999, USAID también empezó a apoyar un programa de tuberculosis (TB), encabezando un exitoso proyecto de coinfección TB/VIH. |
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A Bi-national Partnership against HIV: USAID Legacy in Mexico
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2014 |
English |
MEXICO |
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When the first AIDS case in Mexico was recorded in 1983, the U.S. Agency for International Development (USAID) was working with the Government of Mexico (GOM) to improve family planning and reproductive health services. HIV emerged as a global health threat that did not recognize borders. With strong ties between Mexico and the U.S. based on commerce, scientific exchange, and family relationships, it was in the interest of both governments to address the public health threat together. USAID assistance to improve the surveillance and prevention of HIV and other sexually transmitted infections in Mexico began in 1987, and significantly larger HIV and AIDS programs began in 1997. In 1999, USAID also began to support a tuberculosis (TB) program, spear-heading successful TB/HIV co-infection activities.
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Fact Sheet: Violencia contra la mujer y diferencias étnicas en Panamá
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2014 |
Spanish |
PANAMA |
|
This fact sheet was developed by teams of Panamanian public health professionals who participated long-term capacity building process to promote secondary analysis of the National Sexual and Reproductive Health Survey-2009 (Encuesta Nacional de Salud Sexual y Reproductiva --- ENASSER 2009). Through in-person and long-distance technical assistance provided by MEASURE Evaluation, teams of participants (1) defined a research question that is based on existing literature, (2) drafted a basic analysis proposal, including dummy tables, (3) received a Stata training and software and conducted a basic bivariate analysis of the ENASSER, (4) presented and interpreted the results in a research brief, and (5) disseminated the findings to national authorities. |
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Fact Sheet: Características y factores de riesgo de hombres panameños que pagan por tener sexo
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2014 |
Spanish |
PANAMA |
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This fact sheet was developed by teams of Panamanian public health professionals who participated long-term capacity building process to promote secondary analysis of the National Sexual and Reproductive Health Survey-2009 (Encuesta Nacional de Salud Sexual y Reproductiva --- ENASSER 2009). Through in-person and long-distance technical assistance provided by MEASURE Evaluation, teams of participants (1) defined a research question that is based on existing literature, (2) drafted a basic analysis proposal, including dummy tables, (3) received a Stata training and software and conducted a basic bivariate analysis of the ENASSER, (4) presented and interpreted the results in a research brief, and (5) disseminated the findings to national authorities. |
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Fact Sheet:Características demográficas de hombres panameños de 15 a 59 años con conductas sexuales de riesgo y la asociación con el no uso del condón y no realización de la prueba del VIH
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2014 |
Spanish |
PANAMA |
|
This fact sheet was developed by teams of Panamanian public health professionals who participated long-term capacity building process to promote secondary analysis of the National Sexual and Reproductive Health Survey-2009 (Encuesta Nacional de Salud Sexual y Reproductiva --- ENASSER 2009). Through in-person and long-distance technical assistance provided by MEASURE Evaluation, teams of participants (1) defined a research question that is based on existing literature, (2) drafted a basic analysis proposal, including dummy tables, (3) received a Stata training and software and conducted a basic bivariate analysis of the ENASSER, (4) presented and interpreted the results in a research brief, and (5) disseminated the findings to national authorities. |
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Fact Sheet: Empoderamiento de la mujer y factores de riesgo asociados al género para la infección por VIH
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2014 |
Spanish |
PANAMA |
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This fact sheet was developed by teams of Panamanian public health professionals who participated long-term capacity building process to promote secondary analysis of the National Sexual and Reproductive Health Survey-2009 (Encuesta Nacional de Salud Sexual y Reproductiva --- ENASSER 2009). Through in-person and long-distance technical assistance provided by MEASURE Evaluation, teams of participants (1) defined a research question that is based on existing literature, (2) drafted a basic analysis proposal, including dummy tables, (3) received a Stata training and software and conducted a basic bivariate analysis of the ENASSER, (4) presented and interpreted the results in a research brief, and (5) disseminated the findings to national authorities. |
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Fact Sheet: Grupos étnicos y el VIH/SIDA en Panamá
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2014 |
Spanish |
PANAMA |
|
This fact sheet was developed by teams of Panamanian public health professionals who participated long-term capacity building process to promote secondary analysis of the National Sexual and Reproductive Health Survey-2009 (Encuesta Nacional de Salud Sexual y Reproductiva --- ENASSER 2009). Through in-person and long-distance technical assistance provided by MEASURE Evaluation, teams of participants (1) defined a research question that is based on existing literature, (2) drafted a basic analysis proposal, including dummy tables, (3) received a Stata training and software and conducted a basic bivariate analysis of the ENASSER, (4) presented and interpreted the results in a research brief, and (5) disseminated the findings to national authorities. |
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Fact Sheet: Edad temprana de la primera relación sexual en hombres y mujeres de 18–34 años y factores asociados
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2014 |
Spanish |
PANAMA |
|
This fact sheet was developed by teams of Panamanian public health professionals who participated long-term capacity building process to promote secondary analysis of the National Sexual and Reproductive Health Survey-2009 (Encuesta Nacional de Salud Sexual y Reproductiva --- ENASSER 2009). Through in-person and long-distance technical assistance provided by MEASURE Evaluation, teams of participants (1) defined a research question that is based on existing literature, (2) drafted a basic analysis proposal, including dummy tables, (3) received a Stata training and software and conducted a basic bivariate analysis of the ENASSER, (4) presented and interpreted the results in a research brief, and (5) disseminated the findings to national authorities. |
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Evidence of the Negative Effect of Sexual Minority Stigma on HIV Testing Among MSM and Transgender Women in San Salvador, El Salvador
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Andrinopoulos K, Hembling J, Guardado ME, de Maria Hernández F, Nieto AI, Melendez G |
2014 |
English |
EL SALVADOR |
HIV/AIDS, At-Risk Populations |
A cross sectional survey was administered to 670 men who have sex with men (MSM) and transgender women (TW) in San Salvador through respondent driven sampling to identify determinants of ever testing for HIV using a minority stress framework. A positive association was found between ever testing and older age [adjusted odds ratio (aOR) 2.10], past experience of sexual assault (aOR 2.92), perceiving that most social acquaintances had tested (aOR 1.81), and knowing a PLHIV (aOR 1.94). A negative association was found between homelessness and ever testing (aOR 0.43). Among the MSM sub-sample (n = 506), similar results were found for older age (aOR 2.63), and past experience of sexual assault (aOR 2.56). Internalized homonegativity was negatively associated with ever testing for HIV among MSM (aOR 0.46), and HIV testing stigma and experienced provider discrimination further strengthened this relationship. It is important to mitigate sexual minority stigma in order to increase HIV testing among MSM. Future research should explore this construct among TW. |
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How Do We Know if a Program Made a Difference? A Guide to Statistical Methods for Program Impact Evaluation
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Lance P, Guilkey D, Hattori A, Angeles G |
2014 |
English |
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This manual provides an overview of core statistical and econometric methods for program impact evaluation (and, more generally, causal modelling). More detailed and advanced than typical brief reviews of the subject, it also strives to be more approachable to a wider range of readers than the advanced theoretical literature on program impact evaluation estimators. It thus forms a bridge between more basic treatments of the essentials of impact evaluation methods and the more advanced discussions. It seeks to discuss impact evaluation estimators in a thorough manner that does justice to their complexity, but in a fashion that is approachable.
The manual is targeted to: public health professionals at programs, government agencies, and NGOs who are the consumers of the information generated by program impact evaluations; professionals serving the aforementioned role in any area of programming that influences human welfare; graduate students in public health, public policy and the social sciences; technical staff at evaluation projects; journalists looking for a more nuanced understanding of the steady stream of impact (and, more broadly, causal) studies on which they are asked to report; analysts at health analytics organizations; and so on.
Download STATA do files for the programs behind the numerical examples in the manual. The first number of each do file indicates its associated chapter, and the second number indicates order within the chapter.
The current version of this manual is a revision posted on September 22, 2014. This manual was heavily edited before initial release, but inevitably for such a detailed, equation-intense piece, some typographical errors have been found since that time. We expect that some errors remain, and therefore anticipate periodic future revisions. We apologize for any inconvenience this causes.
Please submit comments, questions, and corrections using this feedback form. |
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Burundi PLACE Report. Priorities for Local AIDS Control Efforts
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2014 |
English |
BURUNDI |
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The Priorities for Local AIDS Control Efforts (PLACE) method is a monitoring tool to identify areas likely to have a higher incidence of HIV infection. In Burundi, a total of 66 municipalities (13 from Bujumbura, 21 other urban areas including 16 provincial capitals and 32 rural municipalities) were selected for this study. Key informants from the community were identified within each of the priority prevention areas to identify sites where new relationships and sexual partnerships occur. Then, each site was visited and a person familiar with the site was interviewed on its characteristics. Finally, the sites were sampled and interviews were conducted with sites patrons and workers to characterize sexual behavior and HIV seroprevalence.
Based on the findings from this PLACE assessment, the study recommends improved condom availability at venues were people meet new partners, offering HIV testing and linkage to care, voluntary male circumcision, and studies to test the acceptability of new HIV prevention interventions such as pre-exposure prophylaxis, redesigned female condoms, and anti-retroviral-releasing vaginal rings. |
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Know Your HIV/AIDS Epidemic from a Gender Perspective: Rwanda Report
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Bloom SS, Cannon A, Negroustoueva S |
2014 |
English |
|
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In Rwanda, women and girls are disproportionately infected with HIV, comprising approximately 59% of all infections. For this study, MEASURE Evaluation conducted a gender-based analysis in Rwanda, using HIV-related routine and non-routine data. Sex-disaggregated variables from routine sources examined the difference, or the gender gap, between the number or proportion of men/boys and women/girls using services and reached by programs. Data from special surveys conducted during the past five years were used to explore structural factors related to gender and HIV. Working with a multisectoral national-level collaborative team in Rwanda, the activity was designed to enable program managers at the national level to understand how to use their data for a gender-sensitive and effective HIV response. |
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Holding a National Summit to Improve Health Outcomes through Health and Mapping Sector Collaboration in the Development of National Geospatial Data Infrastructure: The Nigerian Strategy
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Agbaje G, Azeez A, Oyediran KA, Stewart J |
2014 |
English |
NIGERIA |
Nigeria, GIS |
The use of geographic approaches in improving health outcomes, including the fight against Human immunodeficiency virus infection / acquired immunodeficiency syndrome (HIV/AIDS), is increasing; however, health ministries, AIDS coordinating agencies, and other social service ministries often lack the capacity to use geospatial data and tools such as geographic information systems (GIS). Health organizations would benefit from building collaborative relationships with national mapping agencies (NMAs), national geospatial data infrastructure (NGDI) coordinating bodies and in-country stakeholders with GIS capacity to enhance decision making for health sector programmes and to create an action plan to help address identified challenges.
One approach for strengthening the NGDI within the nation’s health sector was the two-day Nigeria Health and Mapping Summit of 2011. The summit provided opportunities for stakeholders in the NGDI and health sectors to discuss strategies for sharing geospatial data and building capacity to support national health endeavours.
This paper provides a description of the summit and offers lessons learned on key aspects of the event, including the post-summit communiqué presented to both executive and legislative arms of the government with the intent of improving the NGDI. This paper also discusses progress on health and mapping sector collaboration and coordination since the summit. |
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The Annotated Bibliography of Health Science Literature for the Eastern Caribbean 2005-2012 MEASURE Evaluation Project
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Hembling J, Freyder M |
2014 |
English |
Latin America and the Caribbean |
Barbados and Eastern Caribbean |
This review offers an annotated bibliography of peer reviewed and grey health science literature relevant to the Eastern Caribbean region published between 2005 and 2012. |
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A Review of Diabetes Treatment Adherence Interventions for the Eastern Caribbean
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McGuire M, Freyder M, Ricketts P |
2014 |
English |
Latin America and the Caribbean |
Barbados and Eastern Caribbean |
This paper systematically analyzes previous research pertaining to the monitoring of adherence to diabetes medication, identifies barriers to patient compliance, and examines possible intervention models dealing with this public health burden in the Eastern Caribbean. |
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Strategic HIV Testing and Counseling Models for the Eastern Caribbean
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Andrinopoulos K, Freyder M, Dlugosz A, Bunde E |
2014 |
English |
Latin America and the Caribbean |
Barbados and Eastern Caribbean |
This paper presents a review of available grey and published literature to summarize the current situation in the Organization of Eastern Caribbean States in relation to the HIV epidemic and testing services. The summary includes an assessment of World Health Organization recommendations as well as recent innovations in HIV testing and counseling service provision. |
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Evaluation of the USAID Support for HIV Prevention in Mali from 2000 to 2010
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2014 |
English |
MALI |
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The U.S. Agency for International Development (USAID) in Mali has been supporting the Malian government since the 1990s in its efforts to prevent HIV transmission through a variety of programs that include research and targeted interventions. This report presents the findings from an evaluation of USAID’s HIV/AIDS strategies and programs around HIV prevention in Mali. The purpose was to conduct a performance evaluation of HIV prevention strategies and programs sponsored by USAID from 2000 to 2010 in Mali and to document changes in risk behaviors and HIV prevalence over this same period. The results of this evaluation will help inform USAID/Mali’s HIV/AIDS program design for 2013–2018. |
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"Do You Think Your Main Partner Has Other Sex Partners?" A Simple Question Provides Insight into Sexual Risk in Jamaica
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Weir SS, Figueroa JP, Byfield LL, Scott MA, Hobbs MM, Edwards JE, Duncan JP |
2014 |
English |
JAMAICA |
|
Objective: To estimate the association between a simple measure of sexual partner concurrency and sexually transmitted infection (STI).
Design: Cross-sectional surveys, STI testing.
Methods: A population-based household survey (n = 1795) and targeted surveys of people at venues where people meet sexual partners (n = 1580) asked about sexual behavior. Persons interviewed at venues were tested for HIV, gonorrhea, chlamydia, gonorrhea, and trichomoniasis. We compared the association between STI and reporting a partner had other partners.
Results: More women than men reported their main partner had other partners. Thirteen percent of all women in the population-based survey and 14.4% in the targeted survey reported having one partner in the past 12 months and that partner had additional partners. STI prevalence was significantly associated with reporting a partner had other partners (36.8% vs. 30.2%; prevalence ratio [PR] 1.2; 95% confidence interval [CI] 1.1, 1.4).
Discussion: Construction of complete sexual networks is costly and not routinely feasible. We recommend adding a question to cross-sectional surveys used to monitor sexual behavior about whether the respondent believes his or her partner has other sexual partners. Although subject to bias, the question was useful in Jamaica to identify a group of women with only one sexual partner at increased risk of infection.
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Connecting People to Improve Monitoring and Evaluation of Global Health Programs: Experiences from MEASURE Evaluation-Supported Communities of Practice
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Wyatt LD, Nicholson JL, Isenhower W |
2014 |
English |
Latin America and the Caribbean, KENYA |
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As of 2014, the MEASURE Evaluation project had provided technical assistance and other support to a dozen communities of practice focusing on various aspects of monitoring and evaluation (M&E) of health programs, including those addressing HIV, malaria, health information systems, and data demand and use. These networks have connected nearly 8,000 members from over 100 countries and provided platforms to exchange both tacit and explicit knowledge to improve the practice of M&E for global health. Community members have represented implementing partner organizations, multi- and bi-lateral organizations, local government health agencies, nongovernmental organizations (NGOs), community-based organizations, and faith-based organizations.
This document examines ways in which three of these communities of practice supported by MEASURE Evaluation have worked to close knowledge gaps and increase engagement among M&E practitioners. These case studies provide an opportunity to examine networks operating to improve health information systems at the national, regional, and global levels. |
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A Qualitative Study of the Acceptability of and Barriers to Routine Screening for Intimate Partner Violence in Health Care Settings in Artibonite, Haiti: Implications for Training, Practice, and Research
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Gage AJ, Balan JG, Deleon J, Honoré JG |
2014 |
English |
HAITI |
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Recognizing the critical role that health care providers can play in addressing intimate partner violence (IPV), this study examined the acceptability of and barriers to routine screening for IPV in health care settings in the Department of Artibonite, Haiti. Semi-structured, face-to-face in-depth interviewers were conducted in May to July 2013 among 41 health care providers and 43 female clients of reproductive health services who were recruited in six health facilities, and among 21 community members, 12 of whom were male. Interviews were conducted in Haitian Creole and transcribed for analysis using a grounded theory approach. |
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Fact Sheet: Las conductas de riesgo para hombres indígenas que residen en las zonas de alto y bajo reporte de casos de VIH
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2014 |
Spanish |
GUATEMALA |
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This fact sheet was developed by teams of Guatemalan public health professionals who participated long-term capacity building process to promote secondary analysis of the National Maternal and Child Health Survey 2008-2009 (Encuesta Nacional de Salud Materno Infantil – ENSMI 2008-2009). Through in-person and long-distance technical assistance provided by MEASURE Evaluation, teams of participants (1) defined a research question that is based on existing literature, (2) drafted a basic analysis proposal, including dummy tables, (3) received a Stata training and software and conducted a basic bivariate analysis of the ENSMI, (4) presented and interpreted the results in a research brief, and (5) disseminated the findings to national authorities. |
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Assessment of Health Management Information System (HMIS) Performance in SNNPR, Ethiopia
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Belay H, Azim T, Kassahun H |
2014 |
English |
ETHIOPIA |
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As part of an ongoing effort to scale up health management information system (HMIS) reform in Ethiopia, the Regional Bureau of Health (RHB) of Southern Nations, Nationalities and People’s Region (SNNPR) of Ethiopia, in collaboration with the MEASURE Evaluation HMIS scale-up team, planned to enhance efforts for strengthening HMIS performance in four phases: (1) zonal HMIS performance assessment; (2) developing a HMIS strengthening action plan; (3) implement HMIS strengthening interventions, and (4) routine monitoring of the HMIS performance to measure the effect of the interventions.
In August 2011, the first round of the zonal HMIS performance assessment was conducted in a cluster of zones (viz. Hadiya and Kambata Tembaro) and special woreda (Halaba) who were implementing the reformed HMIS since mid or late 2010. The assessment was based on the Performance of Routine Information System Management (PRISM) framework. This framework promotes strengthening of the HMIS performance, i.e. better data quality and improved information use by addressing technical, organizational and behavioral factors affecting HMIS data quality and use for health service performance improvement.
This document reports on the assessment findings that serve as a basis for formulating interventions to improve the HMIS performance and as a baseline for future monitoring of HMIS performance improvement in the zones. Additionally, lessons learned from this assessment will further inform needed modifications and/or adaptations of the HMIS performance assessment tools to be used for assessments in the remaining zones of SNNPR. |
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Child Status Index Training Manual
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Cannon M |
2014 |
English |
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This manual provides guidance for community care workers and other wardens of orphans and other vulnerable children who intend to use the Child Status Index tool. It provides:
an overview of the Child Status Index, its purpose, development, and application;
an overview of the recommended approach for training care workers in the use of this tool;
Instructions for workshop facilitators on how to offer the most effective and engaging training workshops; and
supplemental materials, such as class handouts, frequently asked questions, and a workshop evaluation form.
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Здоровье женщин России: Российский мониторинг экономического положения и здоровья населения НИУ«Высшая школа экономики», 2012
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Reynolds Z, Barden-O'Fallon J, Speizer IS |
2014 |
Russian |
RUSSIAN FEDERATION |
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Данные о планировании семьи и репродуктивном здоровье (СП/РЗ) регулярно собирались на ранних стадиях проведения Российского мониторинга экономического положения и здоровья населения (RLMS-HSE) до 2003 года. Затем после некоторого перерыва этот модуль был включен в опросы 2010 и 2012 годов. В настоящем докладе используются данные 2012 года. |
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Pilot Test of a Violence-Prevention Curriculum among High School Students in Port-au-Prince, Haiti: Baseline Evaluation Survey Report
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Gage AJ, Honoré JG, Deleon J |
2014 |
English |
HAITI |
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The objectives of this baseline evaluation study were to establish baseline levels of knowledge and skills among high school students in Port-au-Prince, Haiti, that are relevant to dating violence prevention, anger management, conflict resolution and help seeking, prior to the implementation of a violence prevention project based on the SAFE Dates Program. |
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Adapting a Violence-Prevention Curriculum to the Haitian Setting: Insights from Focus Group Discussions
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Gage AJ, Honoré JG, Deleon J |
2014 |
English |
HAITI |
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This report presents qualitative data from focus group discussions held with 10th-12th grade students and teachers in a private high school in Port-au-Prince about how to adapt a violence-prevention curriculum to the Haitian context. The study pointed to some needed changes in order to improve the usefulness of the curriculum in the Haitian setting. Participants pointed out that the social context of adolescent relationships in Haiti is differerent from that in the United States. Adolescent dating relationships based on economic considerations, transactional sex and security concerns and those involving children and adults, some of whom are employers, are increasingly common in Haiti but are not covered by the Curriculum. In particular, same-sex relationships were not addressed inspite of their increased visibility in society. Participants were unamimous in their preference for administering the curriculum to boys and girls separately, using teachers of the same sex as the students. Students suggested that the curriculum should integrate information on abstinence, sexual and reproductive health and HIV/AIDS while the teachers felt that the curriculum could be improved by incorporating information on drugs, alcohol, and acculturation. Teachers expressed a need for parent education on violence prevention and for schools to work hand-in-hand with churches and the community to help parents talk to their children about safe and healthy relationships. There was consensus among teachers that the violence-prevention intervention began too late for 10th to 12th graders and that the curriculum should be administered to earlier grades as well. It was also felt that the use of audiovisual and media technology would improve the reach of the Curriculum and enhance students’ understanding. Some teachers suggested that schools should assign a specific course on and appoint a designated instructor for violence prevention while others proposed that teachers should take the opportunity to educate students on violence prevention before teaching existing courses. The study revealed few perceived implementation challenges, the most notable being teachers’ own need for training, the availability of an adequate number of copies of the Curriculum for teachers and handouts for students, safety and security concerns due to possible retaliation from adult perpetrators, student application of violence-prevention principles in their daily lives, and follow-up to find out the extent to which students were applying knowledge and skills learned. Finally, participants considered the focus on high school students to be too narrow and expressed a need for all segments of Haitian society to be educated on relationship violence prevention. |
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Short-Term Effects of a Violence Prevention Curriculum on Knowledge of Dating Violence among High School Students in Port-au-Prince, Haiti
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Gage AJ, Honoré JG, Deleon J |
2014 |
English |
HAITI |
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This study was carried out to determine whether a violence-prevention curriculum taught to students in grades 10-12 in one public and one private high schools in Port-au-Prince, Haiti would increased knowledge about dating violence. A one-group pretest-posttest study was carried out in November to December 2013. Students who took the exam prior to curriculum implementation and after the program was completed were assessed for knowledge of dating violence. The curriculum was an adaptation of the SAFE Dates Program and consisted of ten 50-minutes sessions that were taught over a period of five weekends. The curriculum consisted of interactive activities, games and role plays addressing the definition of dating violence, dating violence norms, gender stereotyping, conflict management skills and forms of support that may be provided to friends in abusive relationships. Bivariable analysis was conducted to determine whether the curriculum was associated with increased knowledge of dating violence. A total of 221 students completed both the pretest and posttest exams, of whom 32 were from the private school. Pretest levels of knowledge of dating violence were low. All eight measures of knowledge increased singificantly between the pretest and posttest in both schools. The mean score for knowledge of dating violence facts and myths increased from 5.2 at pretest to 8.4 at posttest out of a maximum of 10. Gains in knowledge of dating violence were higher among public school students than among private school students for some outcomes. Exposure to the curriculum increased knowledge of dating violence in the short-term. |
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Fact Sheet: Homonegatividad Internalizada y sus Consecuencias Relacionadas con la Salud para los HSH en San Salvador
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Andrinopoulos K, Hembling J. |
2014 |
Spanish |
EL SALVADOR |
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La homonegatividad internalizada (HI) se refiere a las actitudes negativas que los hombres gay pueden tener hacia la homosexualidad en general y hacia su propia orientación sexual (Mayfield 2001). Esta condición está influenciada por el nivel de acuerdo o desacuerdo de un hombre con las creencias sociales negativas acerca de la homosexualidad masculina y el grado en que esas creencias afectan su capacidad de desarrollar una identidad sexual positiva (Fassinger 1996). Las actitudes sociales sobre la orientación sexual son definidas por la cultura en la cual vive una persona. Esas actitudes pueden también influir en los propios sentimientos sobre su atracción hacia personas del mismo sexo a través de la “internalización” de las creencias de la sociedad acerca de la homosexualidad (Shidlo 1994; Mayfield 2001). El análisis de la HI es una manera de aumentar nuestra comprensión acerca de la forma en que la salud de un hombre puede verse afectada; esto, como consecuencia de la aflicción que puede experimentar debido a la atracción que siente hacia otros hombres o mujeres trans, en lugares en donde esa atracción está estigmatizada. |
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GIS and HIV: Linking HIV Databases in Rwanda. A Case Study
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2014 |
English |
RWANDA |
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This case study describes the process of developing, implementing, and evaluating a geographic information system (GIS) project in Rwanda. The document describes Rwanda’s HIV epidemic; gives an overview of GIS and its relevance to Rwanda, HIV monitoring and evaluation, and international goals and guidance; and details the process of implementing a GIS workshop for tracking Rwanda's HIV epidemic. The project description includes both the capacity-building process, which enabled stakeholders to create maps and share data, and the development of a logic framework to track program outcomes; and suggests lessons learned for other countries and organizations that wish to use GIS to link and monitor HIV data. |
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Women’s Health in the Russian Federation: The Russia Longitudinal Monitoring Survey of the National Research University Higher School of Economics, 2012
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Reynolds Z, Barden-O’Fallon J, Speizer IS |
2014 |
English |
RUSSIAN FEDERATION |
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Modern contraceptive methods are widely available in the Russian Federation, but uptake has been hampered by limited provider knowledge of family planning and the lack of integration with primary care. While contraceptive use has increased in recent years, prevalence remains modest in comparison to other European countries. Traditional methods are used widely despite their limited effectiveness. Understanding patterns of contraceptive use and changing sexual behaviors of young women remains important in the Russian context where programs and policies are continually evolving. This paper examines these patterns using 2012 data from the Russia Longitudinal Monitoring Survey. |
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Compendium of Gender Equality and HIV Indicators
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Bloom SS, Negroustoueva S. |
2014 |
English |
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The compendium of indicators is the result of an international collaboration of multi and bilateral donors (including UNWomen, UNAIDS, WHO, USAID, PEPFAR, GFATM), civil society, NGOs, researchers and other experts who came to agreement on a set of standardized indicators to measure programmatic areas vital to the intersection of gender and HIV that may be used at national, regional or programmatic levels.
The indicators in the compendium are all either part of existing indicators used in studies or by countries or have been adapted from existing indicators to address the intersection of gender and HIV. The indicators can be measured through existing data collection and information systems (e.g. routine program monitoring, surveys) in most country contexts, though some may require special studies or research. The intended purpose of this compendium is to provide program managers, organizations, and policy makers with a menu of indicators to better “know their HIV epidemic/know their response” from a gender perspective in order to:
strengthen national and subnational stakeholders’ understanding of their HIV epidemic and response from a gender equality perspective,
monitor progress towards eliminating gender-based inequities in HIV responses, and
monitor and evaluate programs that address specific types of gender equality interventions in the context of HIV.
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Spatial Patterns in Domestic Violence and HIV Prevalence in Nigeria
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Oyediran K, Cunningham M |
2014 |
English |
NIGERIA |
Nigeria, HIV/AIDS, Gender |
We explore the spatial patterns of domestic violence and HIV prevalence in Nigeria using the 2008 Demographic and Health Survey and the 2010 ANC sentinel Surveillance survey. The analysis revealed a sizeable number of women in Nigeria suffers physical and sexual violence which occurs across the social strata and ethnic groups in Nigeria. Based on the previous studies that have already established a link between gender based violence and declining in health status of women, the paper examines the linkage between domestic violence and HIV prevalence in Nigeria. We found spatial linkage between the two concepts or variables though we did not establish a causal relationship. We found women in states with a high HIV prevalence rate had either experienced physical and/or sexual violence from their spouses. Based on the results, it shows that there is a need to further explore the causal relationships between domestic violence and health outcomes especially HIV infections. Thus, the spatial linkage between domestic violence and HIV prevalence in Nigeria will be highly context-specific. The study demonstrated a spatial interrelationship between domestic violence and HIV prevalence, thus, planning HIV prevention programming should also design activities or intervention to concurrently address the domestic violent aspects. Since it has been documented and current attempts reveal a connection between domestic violence and HIV infection in Nigeria, there is a need for further research to investigate the relationship between domestic violence and HIV in Nigeria to increase the evidence. |
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The Provision of Intermittent Preventive Treatment for Malaria in Antenatal Care Clinics in Malawi: Views of Health Care Providers
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Yoder PS, Nsabagasani X |
2014 |
English |
MALAWI |
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This study focused on providers of antenatal health care in Malawi and their understanding and actions in the routine administration of intermittent preventive treatment in pregnancy (IPTp) for malaria. Since the recognition of the benefits of IPTp in preventing malaria transmission from mother to child, many countries in Africa have sought to provide at least two doses of the antimalarial drug sulfadoxine-pyrimethamine (SP) as an integral part of antenatal care. Malawi adopted IPTp as an official policy in 1993; and yet, after 20 years, the coverage of pregnant women who receive at least two doses of SP (IPTp2) is at 55%, according to the 2010 Malawi Demographic and Health Survey. The Malawi Ministry of Health has a target of 80% coverage for at least two doses of SP during antenatal care by 2015. The research explored the viewpoint of service providers: guidelines they use, challenges they face, problems they solve, and the rationale for giving SP pills. Study results show that the lack of clear, detailed guidelines for providing antimalarial drugs is the weakest aspect of Malawi antenatal services. Researchers also found a need for a system of supervision of antenatal services to focus attention on IPTp services. |
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Integration Opportunities for HIV and Family Planning Services in Addis Ababa, Ethiopia: An Organizational Network Analysis
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Thomas J, Reynolds H, Bevc C, Tsegaye A |
2014 |
English |
ETHIOPIA |
HIV/AIDS, Ethiopia, Family Planning |
Background
Public health resources are often deployed in developing countries by foreign governments, national governments, civil society and the private health clinics, but seldom in ways that are coordinated within a particular community or population. The lack of coordination results in inefficiencies and suboptimal results. Organizational network analysis can reveal how organizations interact with each other and provide insights into means of realizing better public health results from the resources already deployed. Our objective in this study was to identify the missed opportunities for the integration of HIV care and family planning services and to inform future network strengthening.
Methods
In two sub-cities of Addis Ababa, we identified each organization providing either HIV care or family planning services. We interviewed representatives of each of them about exchanges of clients with each of the others. With network analysis, we identified network characteristics in each sub-city network, such as referral density and centrality; and gaps in the referral patterns. The results were shared with representatives from the organizations.
Results
The two networks were of similar size (25 and 26 organizations) and had referral densities of 0.115 and 0.155 out of a possible range from 0 (none) to 1.0 (all possible connections). Two organizations in one sub-city did not refer HIV clients to a family planning organization. One organization in one sub-city and seven in the other offered few HIV services and did not refer clients to any other HIV service provider. Representatives from the networks confirmed the results reflected their experience and expressed an interest in establishing more links between organizations.
Conclusions
Because of organizations not working together, women in the two sub-cities were at risk of not receiving needed family planning or HIV care services. Facilitating referrals among a few organizations that are most often working in isolation could remediate the problem, but the overall referral densities suggests that improved connections throughout might benefit conditions in addition to HIV and family planning that need service integration. |
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Child, Caregiver and Household Well-being Survey Tools for Orphan and Vulnerable Children Programs: Analysis Guidance
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2014 |
English |
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This data analysis guidance is a part of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) orphans and other vulnerable children (OVC) program evaluation tool kit developed by MEASURE Evaluation. The purpose of this guidance is to:
familiarize investigators with PEPFAR’s expectations of how to analyze data gathered from these tools;
enable the production of comparative analyses of child and caregiver well-being and household economic status data across a diverse set of interventions and geographical regions; and
reduce the burden on local and international researchers who want to implement the OVC program evaluation tools. We hope that this guidance will reduce the level of effort needed to develop study-specific analysis plans.
As indicated in the tools’ manual, the PEPFAR OVC program evaluation tools were developed specifically to support program evaluation but may be adapted for use in intervention evaluations and situation analyses. The purpose for which you have used the tools (program evaluation, intervention evaluation, or situation analysis), your study design (cross-sectional or cohort, with or without a comparison group), whether you are collecting data at one or more points in time (and where you are in your study timeline), and, of course, your study objectives, will determine how you should analyze your data. In this document we give broad guidance focused on areas of interest for program evaluation. In most cases, we demonstrate analyses for data collected at a single point of time without a comparison group. We provide examples of how to present data collected at two or more points of time, with and without a comparison group in an appendix. The guidance has been written for use by masters-level research and monitoring and evaluation staff who have some training or experience in using statistical software such as Microsoft Excel, STATA, or IBM’s SPSS. |
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Internalized Homonegativity and Its Health-Related Consequences for MSM in San Salvador
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Andrinopoulos K, Hembling J. |
2014 |
English |
EL SALVADOR |
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Internalized homonegativity (IH) refers to negative attitudes that gay men may have towards homosexuality in general, and towards their own sexual orientation (Mayfield, 2001). It is influenced by a man’s level of agreement or disagreement with negative social beliefs about male homosexuality, and the degree to which those beliefs affect his development of a positive sexual identity (Fassinger & Miller, 1996). In this research brief, we examine IH and its relationship to health among men who have sex with men (MSM) in San Salvador, El Salvador. The first objective is to assess the influence of IH on health for MSM. The health-related outcomes examined include suicide, overall mental well-being, health seeking behavior, and sexual risk behavior. The second objective is to identify factors that influence IH and ways to prevent it among MSM. |
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Existing Gap between Preferred and Actual Birth Intervals in Bangladesh: Relation to Fertility and Child Health. Analysis from the Bangladesh Demographic and Health Survey 2011
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Fuad MH, Khan SH, Jahan FA, Talukder SH, Shakhider MAH |
2014 |
English |
BANGLADESH |
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This paper looks into the existing gap between actual and preferred birth intervals in Bangladesh. The paper also examines the degree to which the interval varies in different geographical locations – namely urban and rural. For this the respondents who already had a live birth and observed the time interval to the second birth were considered. The survival probability of the preceding birth interval (time) and different explanatory variables were examined in this process. The 2011 Bangladesh Demographic and Health Survey dataset was utilized for this paper.
A secondary analysis found that the overall length for actual birth intervals in urban and rural areas are 64.87 months and 57.57 months, respectively. These lengths are significantly higher than the mean lengths of the previous intervals (41.54 in urban areas and 39.53 in rural areas). However, for intervals less than 24 months the difference between actual and preferred birth interval is not significant. That means there is a group of people in both urban and rural areas who prefer to have more children within a short interval. Based on the secondary analysis, the interval of the preceding birth to conception is strongly associated with neonatal mortality as well as under-five mortality, even after controlling for a host of potentially confounding factors. |
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Fact Sheet: The Evolution of Community-Based Distribution of Family Planning in Kenya
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2014 |
English |
KENYA |
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Family planning (FP) has been increasingly acknowledged for its health, economic and environmental benefits. However, about a quarter of married Kenyan women (mostly poor and residing in rural areas) would like to delay the next birth or stop childbearing altogether but are not using any form of contraception. Task-shifting specific services to trained volunteers (community health workers or CHWs) was initiated in Kenya in the early 1980s as a solution to the health workforce crisis and insufficient number of health facilities. The community-based distribution (CBD) program stalled in the late 1990s, affecting FP uptake, but was rejuvenated in the 2000s. The African Institute for Development Policy (AFIDEP) was awarded a small grant from the MEASURE Evaluation PRH project to evaluate these policy and program changes. To read the full report, see: http://www.measureevaluation.org/publications/wp-14-144 |
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An Assessment of the Policy and Programmatic Evolution of the Community-Based Distribution of Family Planning Program in Kenya and Prospects for its Sustainability
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Musila RN, Mueni E |
2014 |
English |
KENYA |
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In order to gain insights into the evolution of policies that govern the community health worker (CHW) program in Kenya, this study explores several research questions that are grouped under five thematic areas: policies, policy implications, outcomes, sustainability, and external lessons/knowledge sharing. The study uses a triangulation of methods to address these questions, namely, (1) literature review and review of policy and program documents, (2) key informant interviews, and (3) analysis of Kenya Demographic Health Survey data. |
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An Association Between Neighbourhood Wealth Inequality and HIV Prevalence in Sub-Saharan Africa
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Brodish P |
2014 |
English |
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HIV/AIDS, Africa |
This paper investigates whether community-level wealth inequality predicts HIV serostatus using DHS household survey and HIV biomarker data for men and women ages 15-59 pooled from six sub-Saharan African countries with HIV prevalence rates exceeding 5%.
The analysis relates the binary dependent variable HIV-positive serostatus and two weighted aggregate predictors generated from the DHS Wealth Index: the Gini coefficient, and the ratio of the wealth of households in the top 20% wealth quintile to that of those in the bottom 20%. In separate multilevel logistic regression models, wealth inequality is used to predict HIV prevalence within each statistical enumeration area, controlling for known individual-level demographic predictors of HIV serostatus. Potential individual-level sexual behaviour mediating variables are added to assess attenuation, and ordered logit models investigate whether the effect is mediated through extramarital sexual partnerships. Both the cluster-level wealth Gini coefficient and wealth ratio significantly predict positive HIV serostatus: a 1 point increase in the cluster-level Gini coefficient and in the cluster-level wealth ratio is associated with a 2.35 and 1.3 times increased likelihood of being HIV positive, respectively, controlling for individual-level demographic predictors, and associations are stronger in models including only males. Adding sexual behaviour variables attenuates the effects of both inequality measures. Reporting eleven plus lifetime sexual partners increases the odds of being HIV positive over five-fold. The likelihood of having more extramarital partners is significantly higher in clusters with greater wealth inequality measured by the wealth ratio. Disaggregating logit models by sex indicates important risk behaviour differences. Household wealth inequality within DHS clusters predicts HIV serostatus, and the relationship is partially mediated by more extramarital partners.
These results emphasize the importance of incorporating higher-level contextual factors, investigating behavioural mediators, and disaggregating by sex in assessing HIV risk in order to uncover potential mechanisms of action and points of preventive intervention. |
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International Planned Parenthood Federation Routine Data Quality Assessment Tool User's Guide
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2014 |
English |
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This user’s guide is a reference document designed to complement the International Planned Parenthood Federation (IPPF) Routine Data Quality Assessment (RDQA) tool. The RDQA approach to evaluating data quality was selected and adapted for use by IPPF’s member associations due to its flexible nature and its usefulness in identifying weaknesses in data quality flow. This user’s guide includes an overview of the IPPF RDQA tool and detailed guidance on the implementation and use of the tool. Instructions on using the tool can also be found within the tool itself. |
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Assessment of Integration of Family Planning into HIV/AIDS Care and Treatment Services in Health Facilities in Dire Dawa City Administration, Eastern Ethiopia
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Kassa M, Abera G, Bekele D, Girma B, Adamou B |
2014 |
English |
ETHIOPIA |
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Background: In Ethiopia, approximately 38,401 pregnant women are living with HIV. Despite significant efforts to prevent mother to child transmission, there were an estimated 13,008 new pediatric infections in 2011. What proportion of these pregnancies were planned and what proportion were unplanned and could have been prevented with properly met family planning (FP) services is unknown. Making FP services accessible to people living with HIV (PLHIV) is one of the four key strategies that the World Health Organization (WHO) promotes in its comprehensive approach to prevent HIV infections in infants and young children.
Method: A cross-section study design was employed to assess the unmet need for FP and barriers to use among PLHIV in Dire Dawa Administration, Eastern Ethiopia. HIV-positive women of reproductive age (15-49 years) who were attending HIV/AIDS care and treatment services at three hospitals and eight health centers providing HIV/AIDS care and treatment services in Dire Dawa were interviewed as well as health care providers and program managers from those facilities, as well as two others. An inventory of services provided at the facilities was also conducted.
Result: A total of 438 PLHIV were interviewed. Among the 83% of the study subjects who had been pregnant at least once, only 32% desired more children. Nearly 89% of the participants had heard of at least one FP method. Seventy-nine percent had ever used an FP method in the past. Nearly 69% of the PLHIV were using an FP method during the data collection period, with male condoms being the most widely used. Seventy-two percent of the study subjects were counseled on FP methods. The unmet need for FP method was found to be 36%. A weak integration of FP services to chronic HIV care was noted.
Conclusion: There is high unmet need for FP among women living with HIV in Dire Dawa, Ethiopia. Addressing the unmet will improve the reproductive health of PLHIV and reduce the transmission of HIV to their babies. Integrating FP services into the HIV chronic care service is of paramount importance. |
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Orphans and Vulnerable Children Survey Toolkit
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MEASURE Evaluation |
2013-2019 |
English |
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OVC programs, PEPFAR, Toolkit, Orphans and Vulnerable Children, OVC |
The U.S. government and other investors in programs to improve the well-being of orphans and vulnerable children (OVC) want to know the impact of their funding.
Meaningful evaluation requires measurable results. But existing surveys used to collect internationally comparable data on children—the Demographic and Health Survey, for example—don’t capture information at the OVC program level, nor do they capture all of the core indicators of an OVC program’s success.
New indicators and tools developed by MEASURE Evaluation, with support from the OVC technical working group of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), simplify and standardize the data needed to set measurable goals for an OVC intervention. Using them, program designers and administrators can now answer questions fundamental to the planning and evaluation of OVC programs worldwide. Learn more in a fact sheet on evaluating orphans and vulnerable children outcomes and listen to a webinar recording on the resources.
Access the full collection online at https://www.measureevaluation.org/our-work/ovc/ovc-program-evaluation-tool-kit |
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Child, Caregiver & Household Well-being Survey Tools for Orphans & Vulnerable Children Programs: Manual
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Chapman J, Foreit K, Hickmann M, Parker L |
2013 (Revised 2019) |
English |
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This manual describes the purpose of the orphans and vulnerable children (OVC) program evaluation tools, including when to use these tools, and how to use the tools. The manual also includes information on how the tools have been used to date, and how data generated from them can be used to support program planning and management. In the appendices, a question-by-question breakdown of all three survey tools is provided.
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Malaria Surveillance and Response: A Comprehensive Curriculum and Implementation Guide – Participant’s Manual
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2013 |
English |
KENYA |
Health Workers, MEASURE Evaluation PIMA, Kenya, Malaria |
The Division of Malaria Control (DOMC) in Kenya has been in the process of operationalizing the WHO Manual for Surveillance in endemic settings. The DOMC has so far realized the adoption of common indicators and dashboards for malaria program monitoring. With the aim of determining whether the data required for malaria surveillance indicators exists at the national, sub-national (district and health facility) level a series of international and national consultative workshops were held, a gap analysis of the existing systems carried out and a pilot of malaria surveillance data collection tool conducted in selected districts.
In this regard, the DOMC has developed the curriculum to train health workers on how to carry out an effective malaria surveillance at all service levels in the awareness that surveillance systems consists of tools procedures, people and structures which are required to generate information for planning, monitoring and evaluating malaria programs.
This participant's manual presents PowerPoint presentations used for all modules of the course. Access a related curriculum and implementation guide and trainer's manual. |
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Malaria Surveillance and Response: A Comprehensive Curriculum and Implementation Guide – Trainer’s Manual
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2013 |
English |
KENYA |
Kenya, Malaria, Health Workers, MEASURE Evaluation PIMA |
The Division of Malaria Control (DOMC) in Kenya has been in the process of operationalizing the WHO Manual for Surveillance in endemic settings. The DOMC has so far realized the adoption of common indicators and dashboards for malaria program monitoring. With the aim of determining whether the data required for malaria surveillance indicators exists at the national, sub-national (district and health facility) level a series of international and national consultative workshops were held, a gap analysis of the existing systems carried out and a pilot of malaria surveillance data collection tool conducted in selected districts.
In this regard, the DOMC has developed the curriculum to train health workers on how to carry out an effective malaria surveillance at all service levels in the awareness that surveillance systems consists of tools procedures, people and structures which are required to generate information for planning, monitoring and evaluating malaria programs.
This trainer's manual presents the sample pretest and post test questions for the course. Access the related curriculum and implementation guide and participant's manual. |
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Malaria Surveillance and Response: A Comprehensive Curriculum and Implementation Guide
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2013 |
English |
KENYA |
Health Workers, Kenya, Malaria, MEASURE Evaluation PIMA |
The Division of Malaria Control (DOMC) in Kenya has been in the process of operationalizing the WHO Manual for Surveillance in endemic settings. The DOMC has so far realized the adoption of common indicators and dashboards for malaria program monitoring. With the aim of determining whether the data required for malaria surveillance indicators exists at the national, sub-national (district and health facility) level a series of international and national consultative workshops were held, a gap analysis of the existing systems carried out and a pilot of malaria surveillance data collection tool conducted in selected districts.
In this regard, the DOMC has developed the curriculum to train health workers on how to carry out an effective malaria surveillance at all service levels in the awareness that surveillance systems consists of tools procedures, people and structures which are required to generate information for planning, monitoring and evaluating malaria programs.
This resource presents the foundation of the curriculum and implementation guide, showing detailed front matter, the module titles, objectives, and content. Access a related trainer's manual and participant's manual. |
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Assessment of Primary Health Care Facilities for Decentralization of HIV/AIDS Services in Nigeria
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2013 |
English |
NIGERIA |
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This report presents findings from an assessment of 268 primary health facilities selected from 17 States and the Federal Capital Territory (FCT) by the U. S. Agency for International Development (USAID), U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Defense (DoD) implementing HIV/AIDS programs as part of the scale-up plan for universal access to services for those infected or affected by HIV. Nigeria is one of the few countries in the developing world to decentralize systematically the delivery of basic health and education services to locally elected governments. Its health policy has also been guided by the Bamako Initiative to encourage and sustain community participation in primary health care services. This assessment data provide systematic evidence on how these decentralized institutions are ready to deliver HIV services, especially antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT).
Download the State Profiles
Akwa Ibom
Anambra
Bauchi
Benue
Borno
Cross River
Edo
Federal Capital Territory
Gombe
Kaduna
Kano
Kogi
Lagos
Nasarawa
Plateau
Rivers
Taraba
Yobe
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Data Demand and Use Coaching Guide
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2013 |
English |
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Data, Data Demand and Use |
National efforts to strengthen health systems involve building the capacity of staff, through training, to produce quality and timely data that informs decisions about health service performance, financing, access to medical products, or strategic planning (WHO, 2007). However when health professionals return to their place of work, they face many challenges implementing their new skills such as competing priorities, lack of motivation or initiative, or other professional stresses. Coaching has been identified as a successful approach to supporting newly trained staff as they apply their new skills in work settings. The goal of individual coaching for health professionals implementing a data demand and use (DDU) intervention is to continue to grow their problem-solving skills to achieve their objectives. The DDU coach can provide a team of health service providers the individual technical guidance to strategically adapt their DDU skills to their specific work environment and health goals. This on-going capacity building is as important as getting the job done. |
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The Influence of Family Dynamics on Contraceptive Use in Madagascar and the Ensuing Impact on Family Well-Being
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Hajason JZ, Piña K, Raveloharimisy JL |
2013 |
English |
MADAGASCAR |
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While studies have shown a relationship between family dynamics and contraceptive use and between contraceptive use and family well-being, no empirical study has been conducted to test whether a relationship exists between family influence on contraceptive use and family well-being. The objective of this study is to explore whether there is such a relationship between family influence on contraceptive use and family well-being.
Methods
A survey was administered in the Vatovavy Fitovinany region of Madagascar, which has one of the lowest contraceptive prevalence rates in the country. The survey collected data on demographics, access to social services, socio-economic status, family dynamics, and knowledge and practice of family planning. Data were retained for 768 Malagasy couples in a binding relationship, such as marriage and civil union. Multiple regression was used to determine (1) the relationships between contraceptive use and two levels of family dynamics: spousal dynamics (communication and agreement within a couple) and extended family influence (communication and agreement between a couple and their parents) and (2) whether the two levels of family dynamics and contraceptive use were associated with four types of well-being: psychological, physical, intellectual, and economic.
Results
Fifty-seven percent of couples talk to, discuss with, and agree with each other on family planning decisions; 20.8% of couples talk to, discuss with, and agree with extended family on family planning decisions. Fifty-one percent of women use at least one method of contraception. About 96% of couples who have discussions do so with their spouse before others. There is evidence that while both spousal dynamics and extended family influence were associated with contraceptive use, spousal dynamics showed a stronger relationship. Analyses regarding well-being were inconclusive overall but suggest that spousal dynamics may also have a greater association with well-being than extended family influence.
Conclusion
We recommend increased support for family planning promotion and training that includes couples as a unit rather than women only. Also, family planning can be promoted during community outreach in order to increase understanding and acceptance within the community, which includes extended family members. |
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Fact Sheet: Quality of FP Programs in HIV/AIDS Care and Treatment Clinics
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2013 |
English |
TANZANIA |
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Mounting evidence shows that many people with HIV have an unmet need for family planning (FP). Providing FP services in HIV care and treatment clinics (CTCs) can increase access to FP among women and couples living with HIV. However, the potential health benefits of integrated services remain largely undocumented.
There are two models of FP/HIV integration in Tanzanian health facilities. The facilitated referral model screens clients at risk for unintended pregnancies, educates clients on FP methods, records referrals to an FP clinic, and accompanies clients to the FP clinic. The expanded facilitated referral model provides all the above services in addition to providing short-acting FP methods.
The National Institute for Medical Research (NIMR)-Muhimbili was awarded a small grant from the MEASURE Evaluation PRH project to evaluate the quality of FP services provided in the two models and assess the extent to which provision of FP services in CTCs meets established national standards for FP service delivery.
The study involved eight health facilities offering FP in CTCs in Morogoro and Iringa, Tanzania. The study included 200 HIV-positive clients ages 18–49 attending the CTCs and 16 providers from the health facilities.
To read the full study see: http://www.measureevaluation.org/publications/wp-13-136 |
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The Women’s Justice and Empowerment Initiative: Lessons Learned and Implications for Gender-Based Violence Programming in Sub-Saharan Africa
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Arnoff E, Hill L, Bloom SS, Maman S |
2013 |
English |
BENIN, KENYA, SOUTH AFRICA, ZAMBIA |
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The Women’s Justice and Empowerment Initiative (WJEI) was a three-year, 55-million-dollar program to bolster women’s justice and empowerment in four sub-Saharan African countries from 2008–2011: South Africa, Zambia, Benin and Kenya. The four countries were selected because they had already demonstrated governmental commitment to combat gender-based violence (GBV) within their respective settings. The program was designed to raise awareness, improve the capacity in these countries to investigate and prosecute perpetrators, and assist female survivors of rape and abuse. The program was implemented slightly differently in each of the four contexts, but the three major components were:
Raise the awareness of GBV: This component sought to increase the awareness of the prevalence of GBV, care and support resources available to survivors; enhance public policy and laws regarding women’s rights; assist communities to overcome the barriers to recognizing GBV as a problem and ultimately contribute to changing peoples’ behavior related to GBV incidents, care and support, and accepting attitudes towards GBV.
Improve the ability to investigate, prosecute, and adjudicate GBV cases: This component sought to strengthen the capacity of legal systems to protect women from violence and to punish violators. Activities in this component were focused on increasing the capacity of the police, prosecutors, and judges to understand and combat criminal conduct associated with GBV. Efforts were also directed towards teaching how to conduct effective investigations and use forensic techniques.
Provide victims with medical, psychosocial, and legal support to enhance their reintegration into their respective societies: This component sought to strengthen the capacity of health, legal, and social organizations that provide assistance to GBV survivors.
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Supportive Supervision in Monitoring and Evaluation with Community-based Health Staff in HIV Programs: A Case Study from Haiti
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Marshall A, Fehringer J |
2013 |
English |
HAITI |
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Background
Supportive supervision is a facilitative approach to supervision that promotes mentorship, joint problem-solving and communication between supervisors and supervisees. In recent years, supportive supervision has been implemented to improve routine program monitoring and evaluation (M&E). However, there is a lack of documentation on how supportive supervision has been applied to M&E at the community-level. The purpose of this research was to develop a case study that could be used as an example for other community-based programs wishing to use supportive supervision in M&E.
Methods
MEASURE Evaluation’s supportive supervision project in Haiti was selected as the case under study. Data were collected through 11 key informant interviews and four direct observations with governmental, nongovernmental, and MEASURE Evaluation staff involved in the supportive supervision project. Participants were sampled purposively. Interview topics included the project background, description of supportive supervision visits and supervision tools, outcomes of the project, and recommendations. Interview transcripts, direct observation notes, and documents were coded and analyzed using a descriptive case study framework.
Results
Findings from interviews and direct observations suggest that the supportive supervision project was successful in improving data quality and data collection at the community-level, achieving a consistent use of tools to facilitate supervision, and providing feedback on staff performance. Participants attributed these successes to standardized data collection tools, ongoing supervision, and training. Emphasis on data use strategies and collaboration and mentoring during supportive supervision visits emerged as aspects of the project that needed improvement.
Conclusion
Supportive supervision is a promising approach to improve routine data collection for M&E of community-based programs. It can increase staff capacity to collect, manage, and use data and improve leadership capacity to make decisions based on collected data. By enhancing a program’s capacity to synthesize and disseminate information, it also contributes to the larger goal of health systems strengthening. |
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A Case Study of the Integrated Patient Monitoring System in Cote d'Ivoire
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2013 |
English |
COTE D'IVOIRE |
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Cote d’Ivoire has a three percent adult HIV prevalence rate, one of the highest in West Africa. In 2001 the country launched a national care and treatment program with the goal of improving the quality of life for people living with HIV and AIDS. The Ministry of Health (MoH) of Cote d’Ivoire has sought strategies to address the epidemic in a comprehensive way, in alignment with global guidance provided by the World Health Organization (WHO), other international agencies, and bilateral donors. As part of this effort, in 2008 the MoH adapted and implemented the WHO’s system of standardized patient monitoring tools, known as the Patient Monitoring System (PMS) for the country’s national HIV care and treatment program.
Beginning in 2010, to support and strengthen the integration of HIV services, the MoH worked with MEASURE Evaluation to revise the PMS, producing the Interlinked Patient Monitoring System (IPMS). The IPMS system includes a set of paper-based data collection forms for collecting and recording information from individual patient consultations, registers for recording information on clinical services rendered to all patients seen at the various service delivery points (i.e., the care and treatment clinic, antenatal care clinic, counseling and testing center, among others), and two types of summary documents that produce aggregate reports from the patient-level data. The objective of the IPMS is to set up a national system through which comprehensive, longitudinal patient data can be collected and used for decision-making by service providers at different service delivery units at the facility level, by program managers working at the regional and national levels; and for reporting data to external donors.
This case study was conducted immediately following the field test of the tools in order to gather information that would be informative for the national scale-up of the tools. The case study examines tool users' perceptions of the tools and whether they believe the IPMS improves service integration, patient monitoring, program management and health information system performance. |
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Facilitating Data Use for Gender-Aware Health Programming: Guidance for Workshop Facilitators
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2013 |
English |
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This document provides guidance for designing and implementing a two-and-a-half-day workshop on gender analysis of routine health data to inform evidence-based decision making. Through lectures and group activities the workshop introduces and defines gender concepts, provides tips to interpret gender-disaggregated data, applies the Gender Analysis Framework tool to understand underlying causes of gender gaps, and facilitates gender integration planning into ongoing health services. The guidance document can be used to expand efforts to mainstream gender into the analysis and interpretation of monitoring and evaluation (M&E) data for health services throughout a health system. Specific learning objectives for the workshop include the following:
interpret routine data to identify gender-related service disparities;
assess and prioritize potential reasons for gender disparities;
identify actions to address prioritized causal factors; and
identify indicators and a plan to monitor changes over time.
Handouts and Slides
Introduction and Agenda Review
Session 1
Group Exercise 1
Session 2
Group Exercise 2
Session 3
Session 4
Group Exercise 3
Session 5
Session 6
Other Documents |
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Fact Sheet: Involving Men in Family Planning Programs and Services
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2013 |
English |
RWANDA |
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Several studies have shown that male engagement can improve access to and use of family planning (FP). But despite the Rwandan Ministry of Health’s expanded focus on couple counseling in FP, male involvement in FP is still poor in both the household and healthcare settings.
The Medical Students’ Association of Rwanda (MEDSAR) was awarded a small grant from the MEASURE Evaluation PRH project to investigate the barriers to integrating men into FP programs in Rwanda. The research team conducted one-on-one interviews with 96 community health workers (CHWs) and 24 nurses in 24 healthcare facilities in Rwanda’s Southern and Kigali City Provinces. Focus group discussions were conducted with men and women, all parents either married or not, at each of the healthcare facilities. To read the full study see: http://www.measureevaluation.org/publications/wp-13-132. |
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Fact Sheet: Factors Influencing the Adoption of Postpartum Family Planning
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2013 |
English |
GHANA |
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Pregnancy and the immediate postpartum period are considered opportunistic times for counseling women on adopting a modern family planning method. In spite of various interventions to promote postpartum family planning (PPFP), uptake in sub-Saharan Africa has remained very low, particularly in rural areas. The Centre for Health Research and Implementation Support (CHRIS) was awarded a small grant from the MEASURE Evaluation PRH project to study women attending antenatal care in Ghana to explore factors that influence their willingness to adopt PPFP. The research team interviewed 1,914 pregnant women in rural and semi-rural health facilities in the Central Region of Ghana, a region with some of the most adverse FP indicators in the nation. To read the full study see: http://www.measureevaluation.org/publications/wp-10-117. |
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Fact Sheet: Measuring Outcomes of Orphan and Vulnerable Children Programs
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2013 |
English |
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MEASURE Evaluation has produced a set of tools for measuring quantitative child outcomes and caregiver/household outcomes in programs for orphans and vulnerable children (OVC). This tool kit was developed with the support of the PEPFAR OVC technical working group to:
standardize the production of population-level child and caregiver well-being data beyond what is available from routine surveys,
produce actionable data to inform programs and enable mid-course corrections, and
enable comparative assessments of child and caregiver well-being and household economic status across a diverse set of interventions and geographical regions.
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Brief Non-Commercial Sexual Encounters Among Patrons of Entertainment Venues in Liuzhou, China
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Weir SS, Pan S, Huang Y, Zhang N, Gandhi AD, Chen XS |
2013 |
English |
CHINA |
HIV/AIDS, China |
Brief non-commercial sexual encounters among patrons of social venues are increasing in China, but whether these encounters increase syphilis risk is unknown. We surveyed and tested 797 men and women at randomly selected social venues in urban Liuzhou and three surrounding counties. The percent reporting recent non-commercial one-time sex ranged from 14.5 % of county women to 24.8 % of urban men. 2.4 % of men and 3.7 % of women had a positive rapid syphilis test. Men reporting non-commercial one-time sex were significantly more likely to have a positive rapid syphilis test than other men (7.4 vs. 0.9 %). Among women, commercial sex was more strongly associated with syphilis than non-commercial one-time sex (6.0 vs. 0.7 %). Recent one-time sex was common and associated with syphilis among men. Venue-based HIV/STI prevention methods may be warranted among persons who do not engage in commercial sex, but frequently engage in one-time sex. |
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Prioridades de Esforços para o Controle Local da SIDA: PLACE, Luanda, Angola, 2010-11
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2013 |
Portuguese |
ANGOLA |
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Uma vez que os recursos destinados a programas de prevenção do VIH são limitados, existe uma necessidade urgente de se concentrar intervenções onde elas ofereçam o melhor perfil de custo-eficácia. Para prevenir novas infecções de modo mais custo-eficaz, os programas de prevenção do VIH devem se concentrar em áreas com probabilidade de apresentar uma incidência maior da infecção. O método de Prioridades de Esforços para o Controle Local da SIDA (em inglês PLACE) é uma ferramenta de monitoria para identificar áreas com probabilidade de apresentar uma incidência mais elevada da infecção.
Dentro dessas áreas, o método PLACE identifica locais públicos específicos onde os programas de prevenção da SIDA devem ser concentrados, de modo a atingir pessoas com um maior risco de adquirir e transmitir o VIH. Os resultados deste método também produzem indicadores para monitorar a cobertura de programas de prevenção de VIH/SIDA e identificar lacunas nos respectivos programas; fornecendo, além disso, informações comportamentais relevantes para o entendimento da epidemia local, como por exemplo a existência de múltiplos parceiros sexuais concorrentes e o sexo transaccional entre pessoas que frequentam os locais públicos de convivência social. Estudos prévios utilizando a metodologia de PLACE produziram resultados que efectivamente mobilizaram populações locais a realizar progressos no sentido de resolver as lacunas existentes nos programas de prevenção. |
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Geographic Tools for Global Public Health: An Assessment of Available Software
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2013 |
English |
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There is a growing list of software options for those wishing to map data. Users in global public health often have little time or money to invest in developing the technical expertise and data required for mapping, and are therefore confronted with capacity and data constraints that can make mapping difficult to implement. This makes the process for selecting the most appropriate software especially challenging. In this guide, the MEASURE GIS Working Group evaluates the features and ease of use of five commonly used mapping applications: ArcGIS, Quantum GIS (QGIS), Epi Info, Google mapping tools (including Google Maps, Google Earth, and the related MEASURE E2G tool), and DevInfo. |
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Fact Sheet: Factores asociados a conductas sexuales de riesgo entre agricultores entre 18–59 años
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2013 |
Spanish |
GUATEMALA |
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This fact sheet was developed by teams of Guatemalan public health professionals who participated long-term capacity building process to promote secondary analysis of the National Maternal and Child Health Survey 2008-2009 (Encuesta Nacional de Salud Materno Infantil – ENSMI 2008-2009). Through in-person and long-distance technical assistance provided by MEASURE Evaluation, teams of participants (1) defined a research question that is based on existing literature, (2) drafted a basic analysis proposal, including dummy tables, (3) received a Stata training and software and conducted a basic bivariate analysis of the ENSMI, (4) presented and interpreted the results in a research brief, and (5) disseminated the findings to national authorities. |
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Fact Sheet: Hombres que pagaron por tener relaciones sexuales con una mujer y factores asociados
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2013 |
Spanish |
GUATEMALA |
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This fact sheet was developed by teams of Guatemalan public health professionals who participated long-term capacity building process to promote secondary analysis of the National Maternal and Child Health Survey 2008-2009 (Encuesta Nacional de Salud Materno Infantil – ENSMI 2008-2009). Through in-person and long-distance technical assistance provided by MEASURE Evaluation, teams of participants (1) defined a research question that is based on existing literature, (2) drafted a basic analysis proposal, including dummy tables, (3) received a Stata training and software and conducted a basic bivariate analysis of the ENSMI, (4) presented and interpreted the results in a research brief, and (5) disseminated the findings to national authorities. |
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Fact Sheet: Análisis de hombres y mujeres que han tenido relaciones sexuales antes de los quince años y factores de riesgo asociados
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2013 |
Spanish |
GUATEMALA |
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This fact sheet was developed by teams of Guatemalan public health professionals who participated long-term capacity building process to promote secondary analysis of the National Maternal and Child Health Survey 2008-2009 (Encuesta Nacional de Salud Materno Infantil – ENSMI 2008-2009). Through in-person and long-distance technical assistance provided by MEASURE Evaluation, teams of participants (1) defined a research question that is based on existing literature, (2) drafted a basic analysis proposal, including dummy tables, (3) received a Stata training and software and conducted a basic bivariate analysis of the ENSMI, (4) presented and interpreted the results in a research brief, and (5) disseminated the findings to national authorities. |
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Fact Sheet: Factores de riesgo asociados al padecimiento de las infecciones de transmisión sexual (ITS) entre hombres Guatemaltecos
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2013 |
Spanish |
GUATEMALA |
|
This fact sheet was developed by teams of Guatemalan public health professionals who participated long-term capacity building process to promote secondary analysis of the National Maternal and Child Health Survey 2008-2009 (Encuesta Nacional de Salud Materno Infantil – ENSMI 2008-2009). Through in-person and long-distance technical assistance provided by MEASURE Evaluation, teams of participants (1) defined a research question that is based on existing literature, (2) drafted a basic analysis proposal, including dummy tables, (3) received a Stata training and software and conducted a basic bivariate analysis of the ENSMI, (4) presented and interpreted the results in a research brief, and (5) disseminated the findings to national authorities. |
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Fact Sheet: Jóvenes que han pagado por tener relaciones sexuales con una mujer y factores de riesgo asociados
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2013 |
Spanish |
GUATEMALA |
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This fact sheet was developed by teams of Guatemalan public health professionals who participated long-term capacity building process to promote secondary analysis of the National Maternal and Child Health Survey 2008-2009 (Encuesta Nacional de Salud Materno Infantil – ENSMI 2008-2009). Through in-person and long-distance technical assistance provided by MEASURE Evaluation, teams of participants (1) defined a research question that is based on existing literature, (2) drafted a basic analysis proposal, including dummy tables, (3) received a Stata training and software and conducted a basic bivariate analysis of the ENSMI, (4) presented and interpreted the results in a research brief, and (5) disseminated the findings to national authorities. |
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The Presence of CD4 Counts for the Management of HIV Patients in East Africa: A Multicentred Study
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Harding R, Simms V, Penfold S, Downing J, Powell RA, Mwangi-Powell F, Namisango E, Moreland S, Gikaara N, Atieno M, Kataike J, Nsubuga C, Munene G, Banga G, Higginson IJ |
2013 |
English |
East Africa |
Africa, HIV/AIDS |
New WHO guidance stipulates six-monthly CD4 testing and treatment initiation at CD4 less than 350. This study aimed to determine the presence of CD4 results in patient records across five care facilities in Kenya, and to identify factors associated with the presence of CD4 count. This is a cross-sectional study of consecutive outpatients. Participants completed self-reported outcomes of demographics, and both physical and mental health dimensions of quality of life and function; charts were reviewed for a CD4 count in the previous 13 months; 548 patients participated. For those diagnosed during the 13-month study period, 7.1% of the sample had no CD4 result on record. For those diagnosed prior to the study, 8.7% had no result. Multivariate logistic regression revealed that 30 days post-HIV diagnosis, facility and antiretroviral therapy use were associated with the odds of having a CD4 result on file. At six months, poverty and prevalence of multidimensional problems were associated with lack of CD4 result. For those diagnosed prior to the observation period, education level was associated with more infrequent CD4 counts, and facility and number of dependants were associated with odds of a CD4 result within six months. Our data suggest inconsistencies in CD4 results availability within and between facilities. Implementation of new guidance will require a shift in practice. |
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'My Dreams are Shuttered Down and It Hurts Lots’– A Qualitative Study of Palliative Care Needs and Their Management by HIV Outpatient Services in Kenya and Uganda
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Selman L, Simms V, Penfold S, Powell RA, Mwangi-Powell F, Downing J, Gikaara N, Munene G, Higginson IJ, Harding R. |
2013 |
English |
KENYA, UGANDA |
Kenya, HIV/AIDS, Uganda |
Background: Despite the huge burden of HIV in sub-Saharan Africa, there is little evidence of the multidimensional needs of patients with HIV infection to inform the person-centred care across physical, psychological, social and spiritual domains stipulated in policy guidance. We aimed to describe the problems experienced by people with HIV in Kenya and Uganda and the management of these problems by HIV outpatient services.
Methods: Local researchers conducted in depth qualitative interviews with HIV patients, caregivers and service staff at 12 HIV outpatient facilities (6 in Kenya, 6 in Uganda). Interview data were analysed thematically.
Results: 189 people were interviewed (83 patients, 47 caregivers, 59 staff). The impact of pain and symptoms and their causes (HIV, comorbidities, treatment side-effects) were described. Staff reported that effective pain relief was not always available, particularly in Kenya. Psychosocial distress (isolation, loneliness, worry) was exacerbated by stigma and poverty, and detrimentally affected adherence. Illness led to despair and hopelessness. Provision of counselling was reported, but spiritual support appeared to be less common. Neither pain nor psychosocial problems were routinely reported to service staff. Collaboration with local hospices and income-generation activities for patients were highlighted as useful.
Conclusions: The findings demonstrate the multiple and interrelated problems associated with living with HIV and how psychosocial and spiritual distress can contribute to 'total pain’ in this population. In line with the palliative care approach, HIV care requires holistic care and assessment that take into account psychological, socioeconomic and spiritual distress alongside improved access to pain-relieving drugs, including opioids. |
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Geographically Linking Population and Facility Surveys: Methodological Considerations
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Skiles MP, Burget CR, Curtis SL, Spencer J |
2013 |
English |
RWANDA |
Population, Rwanda, GIS |
Background: The relationship between health services and population outcomes is an important area of public health research that requires bringing together data on outcomes and the relevant service environment. Linking independent, existing datasets geographically is potentially an efficient approach; however, it raises a number of methodological issues which have not been extensively explored. This sensitivity analysis explores the potential misclassification error introduced when a sample rather than a census of health facilities is used and when household survey clusters are geographically displaced for confidentiality.
Methods: Using the 2007 Rwanda Service Provision Assessment (RSPA) of all public health facilities and the 2007–2008 Rwanda Interim Demographic and Health Survey (RIDHS), five health facility samples and five household cluster displacements were created to simulate typical SPA samples and household cluster datasets. Facility datasets were matched with cluster datasets to create 36 paired datasets. Four geographic techniques were employed to link clusters with facilities in each paired dataset. The links between clusters and facilities were operationalized by creating health service variables from the RSPA and attaching them to linked RIDHS clusters. Comparisons between the original facility census and undisplaced clusters dataset with the multiple samples and displaced clusters datasets enabled measurement of error due to sampling and displacement.
Results: Facility sampling produced larger misclassification errors than cluster displacement, underestimating access to services. Distance to the nearest facility was misclassified for over 50% of the clusters when directly linked, while linking to all facilities within an administrative boundary produced the lowest misclassification error. Measuring relative service environment produced equally poor results with over half of the clusters assigned to the incorrect quintile when linked with a sample of facilities and more than one-third misclassified due to displacement.
Conclusions: At low levels of geographic disaggregation, linking independent facility samples and household clusters is not recommended. Linking facility census data with population data at the cluster level is possible, but misclassification errors associated with geographic displacement of clusters will bias estimates of relationships between service environment and health outcomes. The potential need to link facility and population-based data requires consideration when designing a facility survey. |
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When Women Deliver with No One Present in Nigeria: Who, What, Where and So What?
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Fapohunda BM, Orobaton NG |
2013 |
English |
NIGERIA |
Nigeria, Maternal Mortality |
With the current maternal mortality ratio (MMR) of 630/100,000 live births, Nigeria ranks among the nations with the highest mortality rates in the world. The use of skilled assistants during delivery has been identified a key predictor in the reduction of mortality rates in the world over. Not only are Nigerian women predominantly using unskilled attendants, one in five births are delivered with No One Present (NOP).
We assessed who, what, where and the so what of this practice using 2008 Nigeria DHS (NDHS) data. The study revealed that the prevalence of NOP is highest in the northern part of Nigeria with 94% of all observed cases. Socio-demographic factors, including, women’s age at birth, birth order, being Muslim, and region of residence, were positively associated with NOP deliveries. Mother’s education, higher wealth quintiles, urban residence, decision-making autonomy, and a supportive environment for women’s social and economic security were inversely associated with NOP deliveries. Women’s autonomy and social standing were critical to choosing to deliver with skilled attendance, which were further amplified by economic prosperity. Women’s’ economic wellbeing is entwined with their feelings of independence and freedom. Programs that seek to improve the autonomy of women and their strategic participation in sound health seeking decisions will, most likely, yield better results with improvements in women’s education, income, jobs, and property ownership.
As a short term measure, the use of conditional cash transfer, proven to work in several countries, including 18 in sub-Saharan Africa, is recommended. Its use has the potential to reduce household budget constraint by lowering cost-related barriers associated with women’s ability to demand and use life-saving services. Given the preponderance of NOP in the Northern region, the study suggests that interventions to eradicate NOP deliveries must initially focus this region as priority. |
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Repositioning Family Planning: Decision Support Tool Manual
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Snyder E, Judice NR |
2013 |
English |
|
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The MEASURE Evaluation Population and Reproductive Health project developed a results framework to assess efforts to reposition family planning services. The Framework for Monitoring and Evaluating Efforts to Reposition Family Planning can be used by international donors, governments, and health programs to evaluate their efforts; identify gaps in strategies to reposition family planning in countries; and inform funding decisions, program design, policy and advocacy, and program planning and improvement. The project also developed a simple decision support tool to accompany the framework and indicators. This tool provides a way for stakeholders to gather information about the indicators and to receive progress feedback to support decision making. Repositioning Family Planning: Decision Support Tool Manual provides background about the framework, as well as guidance about applying the framework and the decision support tool. |
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Child Marriage Prevention in Amhara Region, Ethiopia: Association of Communication Exposure and Social Influence with Parents/guardians' Knowledge and Attitudes
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Gage, A |
2013 |
English |
ETHIOPIA |
Ethiopia, Reproductive Health, Child Health |
Despite increasing international attention to child marriage and its negative health and social consequences, little is known about the knowledge and beliefs of individuals who are in control of negotiating children's marriages and of the social context in which these individuals function. Using data from a 2007 cross-sectional household survey and multilevel logistic regression models, this paper examined the associations of communication exposure and measures of social influence with knowledge of marriage legislation, perceptions that marriage before age 18 was “too early”, and beliefs in daughters' rights to individual marriage choice among parents/guardians in Amhara Region, Ethiopia. The study found that mass media and interpersonal communication exposure were positively associated with all outcomes. The influence of communication exposure on knowledge of the legal minimum age at marriage and the perception that marriage before 18 was “too early” varied significantly across communities. Community pressure to stop child marriages and awareness of marriage law enforcement were positively associated with endorsing daughters' rights to choose their marriage age and partner. Perceived social norms regarding early marriage, normative beliefs and perceived benefits of delayed marriage were at least as important as communication exposure for endorsing daughters' rights to marriage choice. Gender and education differences were detected. The findings imply that child marriage-prevention programs should diversify information channels, reinforce perceived advantages of delayed marriage, and adopt a social influence perspective. |
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Impact of a Decision-support Tool on Decision Making at the District Level in Kenya
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Nutley T, McNabb S, Salentine S |
2013 |
English |
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Evaluation, Monitoring, Kenya, Data Demand and Use |
Background: In many countries, the responsibility for planning and delivery of health services is devolved to the subnational level. Health programs, however, often fall short of efficient use of data to inform decisions. As a result, programs are not as effective as they can be at meeting the health needs of the populations they serve. In Kenya, a decision-support tool, the District Health Profile (DHP) tool was developed to integrate data from health programs, primarily HIV, at the district level and to enable district health management teams to review and monitor program progress for specific health issues to make informed service delivery decisions.
Methods: Thirteen in-depth interviews were conducted with ten tool users and three non-users in six districts to qualitatively assess the process of implementing the tool and its effect on data-informed decision making at the district level. The factors that affected use or non-use of the tool were also investigated. Respondents were selected via convenience sample from among those that had been trained to use the DHP tool except for one user who was self-taught to use the tool. Selection criteria also included respondents from urban districts with significant resources as well as respondents from more remote, under-resourced districts.
Results: Findings from the in-depth interviews suggest that among those who used it, the DHP tool had a positive effect on data analysis, review, interpretation, and sharing at the district level. The automated function of the tool allowed for faster data sharing and immediate observation of trends that facilitated data-informed decision making. All respondents stated that the DHP tool assisted them to better target existing services in need of improvement and to plan future services, thus positively influencing program improvement.
Conclusions: This paper stresses the central role that a targeted decision-support tool can play in making data aggregation, analysis, and presentation easier and faster. The visual synthesis of data facilitates the use of information in health decision making at the district level of a health system and promotes program improvement. The experience in Kenya can be applied to other countries that face challenges making district-level, data-informed decisions with data from fragmented information systems. |
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Gender Equality as a Means to Improve Maternal and Child Health in Africa
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Singh K, Bloom S, Brodish P |
2013 |
English |
Africa |
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In this article we examine whether measures of gender equality, household decision making, and attitudes toward gender-based violence are associated with maternal and child health outcomes in Africa. We pooled Demographic and Health Surveys data from eight African countries and used multilevel logistic regression on two maternal health outcomes (low body mass index and facility delivery) and two child health outcomes (immunization status and treatment for an acute respiratory infection). We found protective associations between the gender equality measures and the outcomes studied, indicating that gender equality is a potential strategy to improve maternal and child health in Africa. |
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Child, Caregiver & Household Well-being Survey Tools for Orphans & Vulnerable Children Programs: Protocol Template
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2013 |
English |
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This template protocol has been developed for use by local and international investigators and other research stakeholders, such as program managers, donors, and government, that are implementing research involving orphans and vulnerable children. The process of protocol development enables discussion and agreement on the implementation strategy and child protection issues, among other concerns. This process improves the study design, enables matching of resources to objectives, and ultimately improves the usability of the data generated from the study. A protocol is a guidance document for all stakeholders throughout the study period, serving as a reminder to all stakeholders of the agreed strategy and timeline. |
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Common Types of Coordinates Collected with a GPS Receiver
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2013 |
English |
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This fact sheet discusses types of coordinates collected by global positioning system receivers. |
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Household Survey Indicators for Malaria Control
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2013 |
English |
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The purpose of this manual is to provide detailed specifications for malaria control indicators that can be measured through household surveys and the data that are required for their construction, as well as the issues related to their interpretation. Details of the data collection methods required for estimating these indicators through national level household surveys are also provided. This manual is intended to maximize internal consistency and comparability of the indicators and the types of data collection methods used across countries and over time. |
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Fact Sheet: Dos naciones hacen frente a la Tuberculosis: Legado de USAID en México
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2013 |
Spanish |
MEXICO |
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Durante la última década, ha habido un fuerte compromiso político de México y los Estados Unidos (EE.UU) en relación con la tuberculosis. La colaboración entre los EE.UU. y México comenzó en 1999, cuando la incidencia estimada de tuberculosis en México era cuatro veces más alta que la incidencia en los Estados Unidos. En febrero de 1999, el Presidente mexicano Ernesto Zedillo y el Presidente de los EE.UU., William Clinton, establecieron en un Memorando de Entendimiento (MdE) las bases de un acuerdo de Cooperación para la Prevención y Control de la Tuberculosis, poniendo énfasis en las preocupaciones compartidas por ambas naciones y ratificando la cooperación internacional para el control de la TB. El MdE condujo a un acuerdo formal entre la Agencia de los Estados Unidos para el Desarrollo Internacional (USAID) y la Secretaría de Salud de México. USAID convino en proveer asistencia técnica y financiera al Programa Nacional de TB (PNTB) de México, con el objeto de mejorar el diagnóstico, control y monitoreo de la TB. |
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Fact Sheet: Two Nations Tackle Tuberculosis: USAID Legacy in Mexico
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2013 |
English |
MEXICO |
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Over the last decade, political commitment from Mexico and the United States (U.S.) regarding tuberculosis has been strong. U.S.-Mexico collaboration began in 1999, when Mexico’s estimated tuberculosis incidence was over four times higher than the incidence of the U.S. In February 1999, Mexican President Ernesto Zedillo and U.S. President William Clinton entered into a Memorandum of Understanding (MOU) on the Cooperation in Prevention and Control of Tuberculosis, emphasizing both nations’ joint concerns and affirming international cooperation for TB control. The MOU led to a formal agreement between the U.S. Agency for International Development (USAID) and Mexico’s Secretariat of Health. USAID agreed to provide Mexico’s National TB Program (NTP) with technical and financial assistance intended to improve the diagnosis, control and monitoring of TB. |
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Evaluation Plan for the Ghana National Strategy for Key Populations
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2013 |
English |
GHANA |
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The Ghana AIDS Commission (GAC), as part of its strategic information and monitoring and evaluation efforts, is planning for an evaluation of its national HIV prevention programme for key populations, also known as most-at-risk populations (MARP), as outlined in the National MARP Strategic Plan 2011-2015 and MARP Operational Plan Framework 2011-2013. This document is the national evaluation plan developed by the GAC and the members of the national MARP Technical Working Group (TWG). MEASURE Evaluation collaborated by facilitating the process to develop the evaluation plan. The process was informed by guidance provided in a 2010 United Nations Joint Programme on HIV/AIDS document titled Strategic Guidance for the Evaluation of HIV Prevention Programmes and input from the U.S. Centers for Disease Control and Prevention.The purpose of this document (the evaluation plan) is to provide GAC and the MARP TWG with the information necessary to inform activities to answer the evaluation questions. The evaluation plan describes the process, data collection, analytic approach, and process to determine needed resources necessary to carry out an evaluation to answer those questions. This evaluation plan complements and expands on the M&E strategy and operational plan already developed for the national MARP strategy. |
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Availability of essential drugs for managing HIV-related pain and symptoms within 120 PEPFAR-funded health facilities in East Africa: A cross-sectional survey with onsite verification
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Harding R, Simms V, Penfold S, Downing J, Powell RA, Mwangi-Powell F, Namisango E, Moreland S, Gikaara N, Atieno M, Kataike J, Nsubuga C, Munene G, Banga G, Higginson IJ |
2013 |
English |
East Africa |
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Background: World Health Organization's essential drugs list can control the highly prevalent HIV-related pain and symptoms. Availability of essential medicines directly influences clinicians' ability to effectively manage distressing manifestations of HIV.
Aim: To determine the availability of pain and symptom controlling drugs in East Africa within President's Emergency Plan for AIDS Relief (PEPFAR)-funded HIV health care facilities.
Design: Directly observed quantitative health facilities' pharmacy stock review. We measured availability, expiration and stock-outs of specified drugs required for routine HIV management, including the World Health Organization pain ladder.
Setting: A stratified random sample in 120 PEPFAR-funded HIV care facilities (referral and district hospitals, health posts/centres and home-based care providers) in Kenya and Uganda.
Results: Non-opioid analgesics (73%) and co-trimoxazole (64%) were the most commonly available drugs and morphine (7%) the least. Drug availability was higher in hospitals and lower in health centres, health posts and home-based care facilities. Facilities generally did not use minimum stock levels, and stock-outs were frequently reported. The most common drugs had each been out of stock in the past 6 months in 47% of facilities stocking them. When a minimum stock level was defined, probability of a stock-out in the previous 6 months was 32.6%, compared to 45.5% when there was no defined minimum stock level (χ2 = 5.07, p = 0.024).
Conclusion: The data demonstrate poor essential drug availability, particularly analgesia, limited by facility type. The lack of strong opioids, isoniazid and paediatric formulations is concerning. Inadequate drug availability prevents implementation of simple clinical pain and symptom control protocols, causing unnecessary distress. Research is needed to identify supply chain mechanisms that lead to these problems.
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Fact Sheet: Data Sources for Investigating the Relationship Between WPIR and HIV Transmission Behaviors
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2013 |
English |
KENYA, UGANDA |
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Efforts to reduce transmission of HIV have traditionally focused on interventions designed to change the behavior of individuals. Many believe, however, that changing the social, political, and economic environment in which people live is an essential component of individual behavior change. One example of this approach to HIV prevention can be found in the numerous groups working to secure the right of women to own and control property. In many developing countries, a lack of property and inheritance rights places women in a position of economic dependence on male relatives and may increase susceptibility of women to HIV.
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Directory of Women’s Property and Inheritance Rights Organizations and Services
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2013 |
English |
KENYA, UGANDA |
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This directory, compiled by MEASURE Evaluation in collaboration with the International Center for Research on Women, contains information on select organizations working at the intersection of HIV and women’s property and inheritance rights (WPIR) in Kenya and Uganda and was compiled to facilitate access to, communication with, and collaboration between programmatic organizations working on these issues. Organizations included in this directory were initially identified via a systematic internet search and through references to programs in published reports, evaluations, and peer-reviewed and grey literature. Experts in WPIR and HIV in the USAID missions in Kenya and Uganda were also consulted for program recommendations. Inclusion criteria focused on programs operating in Kenya and/or Uganda, addressing both property rights and HIV, and having some level of data collection and/or program evaluation. A total of 43 programs were identified and were requested to complete a survey to provide more in-depth program information. Out of the 43 programs contacted, 11 completed the surveys, representing a 26 percent response rate. More extensive information on the programmatic and monitoring and evaluation efforts of these organizations can be found in the compendium entitled, Protecting the Land and Inheritance Rights of HIV-Affected Women in Kenya and Uganda; A Compendium of Current Programmatic and Monitoring and Evaluation Approaches. http://www.cpc.unc.edu/measure/publications/sr-13-80
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Protecting the Land and Inheritance Rights of HIV-Affected Women in Kenya and Uganda: A Compendium of Current Programmatic and Monitoring and Evaluation Approaches
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2013 |
English |
KENYA, UGANDA |
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Many in the field of the public health and international development hypothesize that strengthening women’s property and inheritance rights (WPIR) may reduce susceptibility to HIV and enable households to better mitigate the economic, physical, and emotional consequences of HIV, particularly in high prevalence countries. A growing body of qualitative and programmatic evidence suggests that programs addressing both WPIR and HIV are more effective at helping women and families alleviate the consequences of HIV compared with programs that address WPIR or HIV alone. However, there is a lack of quantitative evidence to support this assumption.
To better understand the effectiveness of combination programming at this intersection, more investment is needed in data collection and monitoring to document and evaluate the impact of programs that address both WPIR and HIV. A critical first step is having a clear understanding of current programmatic and monitoring and evaluation (M&E) efforts. This compendium aims to fill this gap by reviewing programs working at the intersection of HIV and WPIR in Kenya and Uganda, countries that have been heavily affected by the HIV epidemic and subsequently are experiencing a high occurrence of property grabbing and disinheritance from widows and orphans.
The compendium includes descriptions and analysis of the 11 identified organizations and two in-depth case studies. Though not meant to be exhaustive, the compendium represents the depth and breadth of current programming in Kenya and Uganda that includes both WPIR and HIV. We summarize current programmatic and M&E approaches, discuss strengths and challenges of each, and provide recommendations for next steps.
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Bangladesh Smiling Sun Franchise Program Endline Survey Report 2011
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Lance P, Angeles G, Kamal N |
2013 |
English |
BANGLADESH, South Asia |
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The Bangladesh Smiling Sun Franchise Program (BSSFP), running from 2007 to 2012, was a USAID-funded health service delivery program that aimed to deliver family planning and a broad package of maternal and child health-focused essential services through a network of clinics administered by 23 local NGOs. It was the most recent phase of an evolving series of interventions that began with separate urban and rural components, called, respectively, the Urban Family Health Partnership (UFHP) and Rural Service Delivery Partnership (RSDP), before being consolidated into the successor NGO Service Delivery Program (NSDP).
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Formative Assessment of a Future mHealth Site in Nhamatanda, Mozambique
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do Nascimento N, de Jesús João F |
2013 |
English |
MOZAMBIQUE |
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Background: Effective treatment of chronic conditions such as HIV, diabetes, and hypertension requires clients to return periodically to the treatment center for resupply of medications as well as for check-ups and laboratory tests. Failure to return at scheduled times compromises treatment effectiveness and, in the case of HIV, can even lead to antiretroviral therapy (ART) resistance, lower retention in treatment, and increased mortality among patients. In Mozambique, busca activa complements facility care processes. It consists of community outreach done by community workers (known as activistas) to locate treatment patients who are overdue for pharmacy pickups or needed consultations. MEASURE Evaluation – in collaboration with the Community Care Program (PCC) and the Clinical HIV/AIDS Services Strengthening in Sofala, Manica and Tete project (CHASS SMT) – is assessing the feasibility of using mobile telephone technology to facilitate communications between the treatment facility and the community workers who carry out busca active.
This paper discusses a document review and in-depth interviews/discussions with key stakeholders and staff from both PCC and CHASS SMT, which was complemented by a self-administered questionnaire completed by activistas of the Nhamatanda PCC CBO. Interviews and discussions with stakeholders with another organization based in Munhava, Beira City, are included.
Conclusions: The current busca activa system implemented in Nhamatanda district is in need of significant improvements before it will be operating at a level that will enable the introduction of mobile phone technology. Training on usage of mobile phones for busca activa will be important given activistas’ limited experience with mobile technology.
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Community Health Information System for Family-centered Health Care: Scale-up in Southern Nations, Nationalities and People's Region
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Chewicha K, Azim T |
2013 |
English |
ETHIOPIA |
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The Community Health Information System (CHIS) is a family-centered health information system designed for the health extension worker (HEW) to manage and monitor her work in educating households and delivering an integrated package of promotive, preventive, and basic curative health service to families. Initiated in October 2010, the roll-out of CHIS was completed in the Southern Nations, Nationalities and People’s Region (SNNPR) of Ethiopia within 2 years. SNNPR's strong leadership coupled with community mobilization and involvement of partners ensured smooth implementation of CHIS, bringing about a positive change in the management of health services at community level. SNNPR is now starting to harvest the benefits of CHIS. The HEWs are using the system to target pregnant women and children for services, and with the tickler file system they are better equipped to identify defaulters. The managers at woreda, zonal and regional levels are able to access the health post data and using it for planning and monitoring.
The scale-up of CHIS has not been without challenges, including remoteness of some health posts with subsequent difficulty in ensuring regular supervisory visits and continuous support, and persisting parallel reporting systems with subsequent over-burden on HEWs. CHIS has a lot of potential; however, it needs to be properly scaled-up, owned and used for realizing its potential and ensuring its sustainability. This article aims at describing the scale-up of CHIS in SNNPR and documenting achievements and challenges, sharing lessons learned that can be useful in CHIS implementation in other regions. |
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Health Management Information System: Participants' Handouts & Instruments
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2013 |
English |
ETHIOPIA |
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The Health Management Information System (HMIS) in Ethiopia is designed to capture and provide essential core data for planning and monitoring the health system’s performance. This document provides handout materials and other instruments to be used in HMIS training for health providers.
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Health Management Information System: Facilitator's Guide for Training of Trainers
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2013 |
English |
ETHIOPIA |
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Health Management information System (HMIS) is one of the six building blocks essential for health system strengthening; and Ministry of Health (MOH) Government of Ethiopia gives due recognition to HMIS as a management support system for improving the health system in Ethiopia by providing continuous information support to decision making process at each decision-making level – federal MOH, Regional Health Bureau (RHB), Zonal Health Department (ZHD), Woreda Health Office (WorHO), and health facility.
Training health staff and health managers in Nations, Nationalities and Population Region (SNNPR) is one of the essential elements of scaling up HMIS. Health staff are targeted because they are the one who collect, aggregate, and report data, and who must also understand the utility and benefits of the data that they collect. Health managers are targeted so that, on one hand, they can have a thorough knowledge of the HMIS and, thereby, can provide technical support/mentoring to health staff to properly collect, compile and report HMIS data and ensure data quality. On the other hand, these managers are the users of the reported data and need to have the necessary capacity to understand, interpret and utilize HMIS data for management decisions.
The HMIS Procedures and Management Training for the hospitals is organized in two tiers. The first tier is the training of the trainers (TOT) from among the hospital management and case teams. The second tier is the training of hospital staff. This manual is intended as a TOT manual for the first and second tier training.
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eHMIS User Guide
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2013 |
English |
ETHIOPIA |
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eHMIS is a facility based data aggregation system that is used for public health related decision making. Its main users are public policy makers, health officers, researchers, planning departments of health offices, HMIS focal persons, data entry clerks and many others ranging from health facility to federal management levels.
Moreover, eHMIS is best referred as a system that is designed to fulfill the need of automated national health information management system. It helps to accurately and timely collect, aggregate, store, analyze and evaluate health related data from health facility to federal level. The system also has decision support tools mainly used by decision makers at the federal, regional, zonal and woreda levels.
eHMIS, therefore, is composed of a set of interrelated components and procedures organized with the objective of generating health information and intelligence to monitor the health status and health services of the nation to improve public health care leadership and management decisions at all levels.
This user guide document is developed for users from regional to woreda levels in Ethiopia working on eHMIS.
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Health Management Information System: Facilitator's Guide for Training Hospital Staff
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2013 |
English |
ETHIOPIA |
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Health Management information System (HMIS) is one of the six building blocks essential for health system strengthening; and Ministry of Health (MOH) Government of Ethiopia gives due recognition to HMIS as a management support system for improving the health system in Ethiopia by providing continuous information support to decision making process at each decision-making level – federal MOH, Regional Health Bureau (RHB), Zonal Health Department (ZHD), Woreda Health Office (WorHO), and health facility.
Training health staff and health managers in Nations, Nationalities and Population Region (SNNPR) is one of the essential elements of scaling up HMIS. Health staff are targeted because they are the one who collect, aggregate, and report data, and who must also understand the utility and benefits of the data that they collect. Health managers are targeted so that, on one hand, they can have a thorough knowledge of the HMIS and, thereby, can provide technical support/mentoring to health staff to properly collect, compile and report HMIS data and ensure data quality. On the other hand, these managers are the users of the reported data and need to have the necessary capacity to understand, interpret and utilize HMIS data for management decisions.
The HMIS Procedures and Management Training for the hospitals is organized in two tiers. The first tier is the training of the trainers (TOT) from among the hospital management and case teams. The second tier is the training of hospital staff.
This manual is intended as a TOT manual. It has been designed so that the trainers, who belong primarily to the government’s health system, develop appropriate skills to become good trainers/facilitators during the training period, but also acquire mentoring skills for providing technical support to their health staff. Thus, in addition to focus on HMIS instruments, emphasis has been put on overall concept of HMIS, HMIS indicators and their use in performance improvement, and data quality improvement.
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HMIS Information Use Training Manual
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2013 |
English |
ETHIOPIA |
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The ultimate goal of the Health Management Information System (HMIS) is to generate quality data and use that data for management decisions to improve health service provision. The Regional Health Bureau of Southern Nations Nationalities and People’s Region (SNNPR) puts utmost attention to scale up culture of HMIS information use at each level of the health system across the region. Among these, establishing the Performance Review Teams at every health administrative unit and at health facilities level is one of the initiatives taken by the RHB.
In SNNPR, HMIS data are readily available and accessible thanks to the electronic HMIS (eHMIS) developed and rolled out throughout the region with the technical assistance of the MEASURE Evaluation HMIS Scale-up Project. To further build the skills of the health managers and professionals in using the information generated by HMIS and linking it to program planning and performance monitoring, the RHB jointly with partners have developed the HMIS Information Use Training Manual. The manual is based on the HMIS Information Use Guide Technical Area 4, Version 2 published by the FMOH and follows the experiential training methodology recommended by FMOH for in-service trainings. This manual is intended for workshop-based trainings and trainings organized through health science colleges in the region.
Access the accompanying presentation slides. |
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HMIS Information Use Guide: Technical Standards Area 4: Version 2
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2013 |
English |
ETHIOPIA |
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The Health Management Information System (HMIS) in Ethiopia is designed to capture and provide essential core data for planning and monitoring health system’s performance. With the view to enhance the use of HMIS for planning and management purposes at each level of the health system, this guide on HMIS use by the Regional Health Bureaus (RHB), Zonal Health Departments (ZHD), Woreda Health Offices (WorHO) and Primary Health Care Units (PHCU) is produced.
This version of the HMIS Information Use guidelines is the latest version of the HMIS/M&E Redesign Technical Standards Area 4 (May 2007) that was redesigned based on the three overarching principles of HMIS redesign – i.e., standardization, integration, and simplification. In that version, guidelines for self-assessment by individual and health institutions, as well as externally assisted performance monitoring, dissemination and visual presentation of information were laid down. The current guide attempts to fit in the HMIS use in the bigger health system picture by linking it to the various program frameworks and to the overall planning and monitoring processes already existing in the country. It also takes account of the recent changes in how the health system in Ethiopia is organized, especially the establishment of primary health care units (PHCU) and the reporting needs to the councils/cabinets at every administrative level.
Thus, the flow of this guide has been arranged to familiarize the target audience, in this case the health managers at regional, zonal, woreda and PHCU levels, first with the HMIS indicators and how they relate to different program frameworks.
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Community Health Information System Data Recording and Reporting: User's Manual
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2013 |
English |
ETHIOPIA |
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In the context of the health sector reform and decentralization in Ethiopia, generating health information and intelligence that is standardized, integrated and well linked at all levels is well recognized to monitor the health services and health status of the population. The organization of the family based services in Ethiopia, the Health Extension Programme, has called for the reorganization of information systems to collect and use information for action at local levels using a family folder. This in turn drives a need for the careful assessment of what is required for local (community level) data collection, processing, analysis and dissemination, as well as linking to the national health management and information systems.
This guidance document is therefore, prepared by the Policy, Planning & Finance (PPF) Directorate of Federal Ministry of Health, Ethiopia (FMOH), with the support of USAID-funded MEASURE Evaluation HMIS Project, Tulane University Technical Assistance Project, Ethiopia (TUTAPE), the World Health Organization (WHO) country office in Ethiopia and Italian Development Cooperation, Ethiopia for use principally by the district experts, heath extension supervisors and health extension workers all over the country as well as experts at the M&E unit of the FMOH and Regional Health Bureaus. This document was prepared considering the lessons learned from the pilot implementation of Family Folder and HMIS procedures in Amhara and SNNPR in 2010.
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Training of Health Extension Workers on Family Folder and HMIS Procedures: Facilitators' Guide
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2013 |
English |
ETHIOPIA |
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In the context of the health sector reform and decentralization in Ethiopia, generating health information and intelligence that is standardized, integrated and well linked at all levels is well recognized to monitor the health services and health status of the population. The organization of the family based services in Ethiopia, the Health Extension Programme, has called for the reorganization of information systems to collect and use information for action at local levels using a family folder. This in turn drives a need for the careful assessment of what is required for local (community level) data collection, processing, analysis and dissemination, as well as linking to the national health management and information systems.
This guidance document is prepared by the Policy, Planning & Finance (PPF) Directorate of Ethiopian Federal Ministry of Health, Ethiopia (FMOH), with the support of USAID-funded MEASURE Evaluation HMIS Project, Tulane University Technical Assistance Project, the World Health Organization country office in Ethiopia, and Italian Development Cooperation, Ethiopia, for use principally by the district experts, heath extension supervisors and health extension workers all over the country as well as experts at the M&E unit of the FMOH and Regional Health Bureaus.
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Summary of Methodologies to Measure Prevention of HIV/AIDS among Young People
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2013 |
English |
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This document provides a summary table of the major tools that have been commonly used to measure prevention of HIV/AIDS among youth. This table has been designed to help program planners, policy makers, and others interested in understanding the status of youth HIV risk and youth HIV prevention programs at the national, regional, or local level. For each methodology, this document lists the most commonly used data collection tools to evaluate youth programs. Information is provided on the significance of the tool, how it is administered, what it can measure, the strengths and weaknesses of the tool, applications and examples of data use, and resources for where to find more information on each of the tools. Technical reviews and inputs were provided by the members of the Strategic Information Working Group of the Inter-Agency Task Team on HIV/AIDS and Young People.
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A Systematic Approach to the Planning, Implementation, Monitoring, and Evaluation of Integrated Health Services
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Reynolds HW, Sutherland EG |
2013 |
English |
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This paper focuses on integrated health services but takes into account how health services are influenced by the health system, managed by programs, and made up of interventions. We apply the principles in existing comprehensive monitoring and evaluation (M&E) frameworks in order to outline a systematic approach to the M&E of integration for the country level. The approach is grounded by first defining the country-specific health challenges that integration is intended to affect. Priority points of contact for care can directly influence health, and essential packages of integration for all major client presentations need to be defined. Logic models are necessary to outline the plausible causal pathways and define the inputs, roles and responsibilities, indicators, and data sources across the health system. Finally, we recommend improvements to the health information system and in data use to ensure that data are available to inform decisions, because changes in the M&E function to make it more integrated will also facilitate integration in the service delivery, planning, and governance components. |
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Climate Change, Food Security, and Population in Sub-Saharan Africa: Modeling the Linkages
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Moreland S, Smith E |
2013 |
English |
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A computer simulation model was developed to help clarify the dynamic relationships between climate change, food security, and population growth. The aim was to develop a model that would be simple enough to adapt to a country and that could be used at the policy level to introduce population issues into the dialogue on adaptation to climate change in the context of food security. The resulting model links a population projection, a sophisticated economic model that takes account of the effects of climate change on agriculture, and a food requirements model that uses Food and Agricultural Organization formulas.
The model was tested and piloted in Ethiopia. The Ethiopia pilot demonstrated the usefulness of this model in quantifying the contribution of family planning in adapting to potential climate change-induced food security challenges. |
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Association of Child Marriage With Suicidal Thoughts and Attempts Among Adolescent Girls in Ethiopia
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Gage AJ. |
2013 |
English |
ETHIOPIA |
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Purpose: Little information exists on the mental health implications of child marriage in Africa. This study examined the association between child marriage and suicidal ideation and suicide attempt among girls aged 10–17 years.
Methods: Data were drawn from a 2007 cross-sectional survey conducted in the Amhara region, Ethiopia. Multilevel logistic regression was used to analyze risk factors for suicidality.
Results: Approximately 5.2% of girls reported ever being married, 5.4% were promised in marriage, and 9.3% reported receiving marriage requests. Girls who were ever married (odds ratio [OR] = 1.81; 95% confidence interval [CI] = 1.03–3.18), were promised in marriage (OR = 2.35; 95% CI = 1.38–4.01) or had received marriage requests (OR = 2.29; 95% CI = 1.46–3.59) were significantly more likely than girls who were never in the marriage process to have had suicidal thoughts in the past 3 months. Residence in communities with high involvement in stopping child marriage was protective of suicidal ideation. The odds of suicide attempt were twice as high among girls with marriage requests as among those with none.
Conclusions: Child marriage was associated with increased odds of suicidality. Findings call for stronger community engagement in child marriage prevention and mental health support for child brides. |
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Association Between Child Marriage and Reproductive Health Outcomes and Service Utilization: A Multi-Country Study From South Asia
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Godha D, Hotchkiss DR, Gage AJ. |
2013 |
English |
|
|
Purpose: Despite the pervasiveness of child marriage and its potentially adverse consequences on reproductive health outcomes, there is relatively little empirical evidence available on this issue, which has hindered efforts to improve the targeting of adolescent health programs. The purpose of this study was to assess the association of child marriage with fertility, fertility control, and maternal health care use outcomes in four South Asian countries: India, Bangladesh, Nepal, and Pakistan.
Methods: Data for the study come from the most recent Demographic and Health Surveys conducted in the study countries; we used a subsample of women aged 20–24 years. Child marriage, defined as first marriage before 18 years of age, is categorized into two groups: first married at ages 15–17 years and first married at age ≤14 years. We used multivariate logistic regression models.
Results: The results of the study suggest that child marriage is significantly associated with a history of rapid repeat childbirth, current modern contraceptive use, female sterilization, not using contraception before first childbirth, pregnancy termination, unintended pregnancy, and inadequate use of maternal health services, although the associations are not always consistent across countries. Furthermore, women who married in early adolescence or childhood show a higher propensity toward most of the negative outcomes, compared with women who married in middle adolescence.
Conclusions: Child marriage adds a layer of vulnerability to women that leads to poor fertility control and fertility-related outcomes, and low maternal health care use. |
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Relationships Between Antenatal and Postnatal Care and Post-partum Modern Contraceptive Use: Evidence from Population Surveys in Kenya and Zambia
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Do M, Hotchkiss D |
2013 |
English |
KENYA, ZAMBIA |
|
Background: It is often assumed, with little supportive, empirical evidence, that women who use maternal health care are more likely than those who do not to use modern contraceptives. This study aims to add to the existing literature on associations between the use of ante-natal (ANC) and post-natal care (PNC) and post-partum modern contraceptives.
Methods: Data come from the most recent Demographic and Health Surveys (DHS) in Kenya (2008–09) and Zambia (2007). Study samples include women who had a live birth within five years before the survey (3,667 in Kenya and 3,587 in Zambia). Multivariate proportional hazard models were used to examine the associations between the intensity of ANC and PNC service use and a woman’s adoption of modern contraceptives after a recent live birth.
Results: Tests of exogeneity confirmed that the intensity of ANC and PNC service use and post-partum modern contraceptive practice were not influenced by common unobserved factors. Cox proportional hazard models showed significant associations between the service intensity of ANC and PNC and post-partum modern contraceptive use in both countries. This relationship is largely due to ANC services; no significant associations were observed between PNC service intensity and post-partum FP practice.
Conclusions: While the lack of associations between PNC and post-partum FP use may be due to the limited measure of PNC service intensity, the study highlights a window of opportunity to promote the use of modern contraceptives after childbirth through ANC service delivery. Depending on the availability of data, further research should take into account community- and facility-level factors that may influence modern contraceptive use in examining associations between ANC and PNC use and post-partum FP practice.
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Using a Patient-Held Record System to Examine Family Planning Uptake, Continuation of Use, and Method/Provider-Switching in Rural Karonga
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Dasgupta ANZ, Dube A, Gondwe L, Ngwalo R, Ngwira B, Taulo F, Branson K, Zaba B, Crampin AC |
2013 |
English |
MALAWI |
|
This study in northern rural Malawi used an innovative method for collecting family planning (FP) data using patient-held records capturing provider data to build a prospective longitudinal data set that allows exploration of continuity of use and provider/method-switching, and can be linked to a health and demographic surveillance site (HDSS) database. To outline the method briefly: all 8,176 women aged 15-49 living in the Karonga HDSS were offered an FP card. When a woman accessed a FP service, the health provider recorded on her FP card the date, method received (or advice given), and provider type. After one year, the FP cards were collected by KPS for data entry, linkage to the HDSS database, and analysis.
Although 42% of married women report using FP in Malawi as a whole, this study found that 62% of women in the study had used some method of FP at some stage over the study year. However, this figure does not reflect the fact that many of these women might be using FP haphazardly and inconsistently. Our findings demonstrate the importance of community-based distribution of FP.
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Inventory of PRISM Framework and Tools: Application of PRISM Tools and Interventions for Strengthening Routine Health Information System Performance
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Belay H, Lippeveld T |
2013 |
English |
|
|
The Performance of Routine Information System Management (PRISM) framework defines routine health information system (RHIS) performance as both the production of quality data and documented use of information for health services decision making. This framework is accompanied by a set of tools to measure RHIS performance. This paper describes the conceptual framework on the determinants of RHIS performances and effectiveness of strategies to improve the system. The examples addressed in this paper highlight the RHIS permanence in various countries at different administrative levels, efforts made to address identified gaps, and some observed progresses. Preliminary findings of PRISM assessments after intervention show encouraging results.
The 2018 version of the PRISM Series, updated and with new modules (Toolkit, User’s Kit, and Training Kit) is available here: https://www.measureevaluation.org/prism |
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Household Air Pollution in Low- and Middle-income Countries: Health Risks and Research Priorities
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Martin WJ II, Glass RI, Araj H, Balbus J, Collins FS, Curtis, S, et al. |
2013 |
English |
|
|
Household air pollution (HAP) from solid fuel (biomass or coal) combustion is the leading environmental cause of death and disability in the world.
Many governments, multinational companies and nongovernmental organizations are developing programs to promote access to improved stoves and clean fuels, but there is little demonstrated evidence of health benefits from most of these programs or technologies.
A stakeholder meeting hosted by U.S. government sponsors identified research gaps and priorities related to the health effects of HAP and unsafe stoves in seven areas (cancer; infections; cardiovascular disease; maternal, neonatal, and child health; respiratory disease; burns; and ocular disorders) and gaps in four cross-cutting areas that are relevant to research on HAP (exposure and biomarker assessment, women's empowerment, behavioral approaches, and program evaluation).
It is vital that researchers partner with implementing organizations and governments to evaluate the impacts of improved stove and fuel programs to identify and share evidence regarding the outcomes of the many implementation programs underway, including the socio-behavioral aspects of household energy use.
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Effectiveness of the PHE Approach for Achieving Family Planning and Fertility Outcomes in Ethiopia: A Comparative Study in the Gurage Zone
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Belachew T, Sinaga M, Mohammed A, Teklu N, Stelljes K |
2013 |
English |
ETHIOPIA |
|
Background: A high population growth rate increases
demand for resources as well as the rate at which these resources are
exploited. Population, health and environment (PHE) are inextricably connected.
Population growth unbalanced with economic development creates food insecurity
which leads households to consume food with reduced quality and quantity
leading to increased risk of malnutrition and poor health. Food insecurity
obliges people to encroach into the natural environment leading to a spiraling
path to destitution.
Although the PHE
approach has been implemented in Gurage Zone of South Ethiopia, its outcomes
have not been evaluated. The objective of this study was to evaluate the
effectiveness of the PHE approach for achieving family planning (FP) and
fertility outcomes in Gurage Zone. A comparative correctional study involving
both quantitative and qualitative data was conducted from October 2 to 8, 2012.
A total of 960 married women of reproductive age (15-49) were included in the
study.
Results: There was
no significant difference in the contraceptive prevalence rate (CPR) in both
types of woredas, which we suspect to be due to the confounding effect of the
Meskel holiday, during which a large-scale campaign promoted FP that resulted
in a culture of FP use by the community. A subgroup analysis of CPR excluding
recent new acceptors showed that PHE woredas had a significantly higher CPR as
compared to non-PHE woredas. Within this sub-group, women in the PHE
woredas were over four times more likely to use an FP method during the study
period compared with women in the non-PHE woredas. (Women whose husbands
support their use of FP were 17 times as likely to use an FP method.) This was
increased to 20 times more likely when conducting a sub-group analysis for
women who were not new acceptors.
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Botswana’s Integration of Data Quality Assurance Into Standard Operating Procedures: Adaptation of the Routine Data Quality Assessment Tool
|
Boone D, Cloutier S, Lins S, Makulec A |
2013 |
English |
BOTSWANA |
|
The ability of health system stewards to make strategic decisions is impacted by the quality of their health data. At the national level in Botswana, data ultimately inform budget and policy decisions. At the District Health Management Teams (DHMTs) and service delivery sites, data enable providers and Monitoring and Evaluation (M&E) Officers to understand the broader health activities and priorities in their respective areas.
To support improved data quality throughout the health system, the Botswana Ministry of Health (MoH) collaborated with experts from MEASURE Evaluation to develop a national procedure for routine monitoring of data quality and providing specific guidance on developing action plans to address challenges, using a bottom-up approach.
This case study documents the collaborative process between MEASURE Evaluation and the Botswana MoH for writing the standard operating procedures (SOPs) related to data quality, adapting the global Routine Data Quality Assessment (RDQA) tool, and developing and implementing a training curriculum to support the roll out of the new SOPs and tool, highlighting resources required to support the activities and lessons learned for future country adaptations.
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Quality of Family Planning Services in HIV/AIDS Care and Treatment Clinics in Tanzania
|
Murashani J, Godfather K, Byashalira K, Diarz E |
2013 |
English |
TANZANIA |
|
This study seeks a better understanding of the quality of family planning services as provided in two integration models in Tanzania and further to inform national efforts to scale up the facilitated model throughout other regions in Tanzania, while ensuring that quality of services is not compromised as a result. It builds upon information already gathered by FHI 360 as part of an evaluation of the program and adds key information on quality. Knowledge generated from this study also contributes to the global evidence and quality of family planning services in integrated settings.
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Guide for Monitoring Scale-up of Health Practices and Interventions
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Adamou B, Curran J, Wilson L, Apenem Dagadu N, Jennings V, Lundgren R, Kiesel R, Hardee K |
2013 |
English |
|
|
Several resources have been developed to assist program implementers with the process of scaling up. However, once scale-up is underway, few resources exist to help ensure continuous and systematic monitoring of the process to track progress toward sustainability of these innovations. This guide is intended to provide governments, donors, country organizations, and implementing partners with a low cost and replicable approach to monitoring the process of scaling up innovations in health. |
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Defining the Innovation: Appendix A to Guide for Monitoring Scale-up of Health Practices and Interventions
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Adamou B, Curran J, Wilson L, Apenem Dagadu N, Jennings V, Lundgren R, Kiesel R, Hardee K |
2013 |
English |
|
|
Several resources have been developed to assist program implementers with the process of scaling up. However, once scale-up is underway, few resources exist to help ensure continuous and systematic monitoring of the process to track progress toward sustainability of these innovations. This appenidix is part of a guide intended to provide governments, donors, country organizations, and implementing partners with a low cost and replicable approach to monitoring the process of scaling up innovations in health. Appendix A provides a work sheet of basic principles and guiding questions to help define an innovation being considered for scale-up. |
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Selected Frameworks and Approaches for Scaling Up Health Interventions: Appendix B to Guide for Monitoring Scale-up of Health Practices and Interventions
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Adamou B, Curran J, Wilson L, Apenem Dagadu N, Jennings V, Lundgren R, Kiesel R, Hardee K |
2013 |
English |
|
|
Several resources have been developed to assist program implementers with the process of scaling up. However, once scale-up is underway, few resources exist to help ensure continuous and systematic monitoring of the process to track progress toward sustainability of these innovations. This appenidix is part of a guide intended to provide governments, donors, country organizations, and implementing partners with a low cost and replicable approach to monitoring the process of scaling up innovations in health. Appendix B provides a summary of selected frameworks and approaches for scaling up health interventions. |
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Monitoring Scale-up Case Studies: Appendix C to Guide for Monitoring Scale-up of Health Practices and Interventions
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Adamou B, Curran J, Wilson L, Apenem Dagadu N, Jennings V, Lundgren R, Kiesel R, Hardee K |
2013 |
English |
|
|
Several resources have been developed to assist program implementers with the process of scaling up. However, once scale-up is underway, few resources exist to help ensure continuous and systematic monitoring of the process to track progress toward sustainability of these innovations. This appenidix is part of a guide intended to provide governments, donors, country organizations, and implementing partners with a low cost and replicable approach to monitoring the process of scaling up innovations in health. Appendix C provides case studies highlighting different aspects of the monitoring scale-up experience. |
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GIS for Monitoring Scale-up: Appendix D to Guide for Monitoring Scale-up of Health Practices and Interventions
|
Adamou B, Curran J, Wilson L, Apenem Dagadu N, Jennings V, Lundgren R, Kiesel R, Hardee K |
2013 |
English |
|
|
Several resources have been developed to assist program implementers with the process of scaling up. However, once scale-up is underway, few resources exist to help ensure continuous and systematic monitoring of the process to track progress toward sustainability of these innovations. This appenidix is part of a guide intended to provide governments, donors, country organizations, and implementing partners with a low cost and replicable approach to monitoring the process of scaling up innovations in health. Appendix D provides a guide for using geographic information systems (GIS) to monitor scale-up. |
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Building Leadership for Data Demand and Use: A Facilitator's Guide
|
|
2013 |
English |
|
Data Demand and Use, Data |
This guide aims to provide the conceptual basis for leading data use within an organization or program, or at the national, state, or district level of government. It includes a variety of leadership, management, and data demand and use (DDU) tools created by MEASURE Evaluation partners to facilitate the sustainable use of data in decision making. The specific learning objectives are to:
raise awareness of the importance of data in decision making
define the role of leadership in promoting sustainable data use
build individual and team capacity to apply DDU concepts, approaches, and tools
promote and sustain them through strong leadership
develop and implement specific plans to overcome barriers to data use
The guide is for both experienced and novice workshop facilitators to use and learn from. It presents them with the foundations of a workshop, explains how to conduct all the necessary activities, and is designed to be easy to use and adaptable to suit the specific needs of various audiences.
Handouts and Slides
Welcome and Introduction
Session 1: The Case for Leadership and DDU
Session 2: Your Role as Leaders in Promoting Data Use
Session 3: Context of Decision Making
Session 4: Linking Data with Action
Session 5: Identifying Opportunities and Barriers for Improving Data Use
Session 6: Culture Change and Change Management |
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The Costs of HIV Treatment, Care, and Support Services in Uganda
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Moreland S, Namisango E, Paxton A, Powell RA. |
2013 |
English |
UGANDA |
|
MEASURE Evaluation and The African Palliative Care Association (APCA) conducted a follow-up study to the HIV care services costing study component of the public health evaluation (PHE) that was completed in 2009 with King’s College London in association with APCA and MEASURE Evaluation [1]. This new study took place in selected public and private not-for-profit health facilities across Uganda. The study sought to provide a broader, more comprehensive insight into the costs of providing HIV care at differing levels of service delivery in Uganda. The specific objectives included:
To determine the average annual unit cost per patient (adult and child) for specific HIV treatment, care and support services; To establish the key cost components or “drivers” of such HIV treatment, care and support services;To determine what costs are borne by patients (“out-of-pocket costs”) that are not incurred in a clinical facility, and;To compare cost variation by level of service delivery facility.
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|
Community Trace and Verify Tool
|
|
2013 |
English |
TANZANIA |
Orphans and Vulnerable Children, Child Health |
The Community Trace and Verify (CTV) Tool was developed to provide programs with a way to verify that orphans and vulnerable children (OVC) who are reported as being provided with services by community-based organizations (CBOs) actually receive services. The tool is designed to be used as part of supervision. The questionnaire is fairly short so that its application will not be burdensome. It is not designed to be an inventory of all services received by OVC, but of selected services that can let a program know if children on their list are being served by the program. The tool consists of a questionnaire, tabulation plan, and implementation protocol. |
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Gender Differences in the Use of Insecticide-Treated Nets After a Universal Free Distribution Campaign in Kano State, Nigeria: Post-Campaign Survey Results
|
Garley AE, Ivanovich E, Eckert E, Negroustoueva S, Ye Y. |
2013 |
English |
NIGERIA |
|
Background
Recent expansion in insecticide-treated net (ITN) distribution strategies range from targeting pregnant women and children under five and distributing ITN at antenatal care and immunization programmes, to providing free distribution campaigns to cover an entire population. These changes in strategy raise issues of disparities, such as equity of access and equality in ITN use among different groups, including females and males. Analysis is needed to assess the effects of gender on uptake of key malaria control interventions. A recent post-universal free ITN distribution campaign survey in Kano State, Nigeria offered an opportunity to look at gender effects on ITN use.
Methods
A post-campaign survey was conducted three to five months after the campaign in Kano State, Nigeria from 19 October to 4 November, 2009, on a random sample of 4,602 individuals. The survey was carried out using a questionnaire adapted from the Malaria Indicator Survey. Using binary logistic regression, controlling for several covariates, the authors assessed gender effects on ITN use among individuals living in households with at least one ITN.
Results
The survey showed that household ITN ownership increased more than 10-fold, from 6% before to 71% after the campaign. There was no significant difference between the proportion of females and males living in households with at least one ITN. However, a higher percentage of females used ITNs compared to males (57.2% vs 48.8%). After controlling for several covariates, females remained more likely to use ITNs compared to males (OR: 1.5, 95% CI: 1.3-1.7). Adolescent boys remained the least likely group to use an ITN.
Conclusions
This study reveals gender disparity in ITN use, with males less likely to use ITNs particularly among ages 15–25 years. The uptake of the intervention among the most at-risk group (females) is higher than males, which may be reflective of earlier strategies for malaria interventions. Further research is needed to identify whether gender disparities in ITN use are related to traditional targeting of pregnant women and children with malaria interventions; however, results provide evidence to design gender-sensitive messaging for universal ITN distribution campaigns to ensure that males benefit equally from such communications and activities. |
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PRH Summaries: Strategies for Addressing Intimate Partner Violence in Haiti: Perspectives of Female Clients
|
|
2013 |
English |
HAITI |
|
This concise summary discusses strategies for addressing intimate partner violence in health care settings in Haiti from the perspective of female clients.
|
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PRH Summaries: Strategies for Addressing Intimate Partner Violence in Health Care Settings in Haiti: Provider Perspectives
|
|
2013 |
English |
HAITI |
|
This concise summary discusses strategies for addressing intimate partner violence in health care settings in Haiti from the perspective of providers. |
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Overview of Child Status Index Studies
|
|
2013 |
English |
KENYA, MALAWI, ZAMBIA, COTE D'IVOIRE |
|
In 2009, MEASURE Evaluation published the Child Status Index, A Tool for Assessing the Well-Being of Orphans and Vulnerable Children, a manual designed to capture vulnerable children’s status across the six domains of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Based on anecdotal reports of widespread use, MEASURE Evaluation conducted the Child Status Index Usage Assessment (phase 1) in 2011-2012 to understand how large programs were using the Child Status Index (CSI) to meet a range of information needs. Findings from that study were helpful in understanding the benefits and challenges of using the CSI at the implementing partner level, but did not obtain the perspective of community-based workers who use the CSI on a routine basis. In 2012, MEASURE Evaluation conducted a second study, Decision Making Among Community-Based Volunteers Working in Vulnerable Children Programs (phase 2), designed to complement the first study. This document provides an overview of the studies.
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A Regional Multilevel Analysis: Can Skilled Birth Attendants Uniformly Decrease Neonatal Mortality?
|
Singh K, Brodish P, Suchindran C |
2013 |
English |
|
|
Globally 40% of deaths to children under-five occur in the very first month of life with three-quarters of these deaths occurring during the first week of life. The promotion of delivery with a skilled birth attendant (SBA) is being promoted as a strategy to reduce neonatal mortality. This study explored whether SBAs had a protective effect against neonatal mortality in three different regions of the world. The analysis pooled data from nine diverse countries for which recent Demographic and Health Survey data were available. Multilevel logistic regression was used to understand the influence of skilled delivery on two outcomes—neonatal mortality during the first week of life and during the first day of life. Control variables included age, parity, education, wealth, residence (urban/rural), geographic region (Africa, Asia and Latin America/Caribbean), antenatal care and tetanus immunization. The direction of the effect of skilled delivery on neonatal mortality was dependent on geographic region. While having a SBA at delivery was protective against neonatal mortality in Latin America/Caribbean, in Asia there was only a protective effect for births in the first week of life. In Africa SBAs were associated with higher neonatal mortality for both outcomes, and the same was true for deaths on the first day of life in Asia. Many women in Africa and Asia deliver at home unless a complication occurs, and thus skilled birth attendants may be seeing more women with complications than their unskilled counterparts. In addition there are issues with the definition of a SBA with many attendants in both Africa and Asia not actually having the needed training and equipment to prevent neonatal mortality. Considerable investment is needed in terms of training and health infrastructure to enable these providers to save the youngest lives. |
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Men and Family Planning in Rwanda: What Affects the Integration of Men in Family Planning?
|
Rusatira JC, Kyamanywa P |
2013 |
English |
RWANDA |
|
Objective: This study was undertaken to understand what affects the integration of men in family planning (FP) in Rwanda, mainly in villages of Southern Province and Kigali City Province. A secondary objective of the study was to identify the factors that facilitate the integration of men in FP services through other services at healthcare facilities such as voluntary counseling and testing (VCT), antiretroviral therapy (ART), prevention of mother-to-child transmission (PMTCT), and antenatal care (ANC); and the public’s awareness on this issue.
Methods: This qualitative, community-based, participatory research was conducted in 24 healthcare facilities in Kigali City Province and Southern Province of Rwanda. Focus group interviews were conducted with 24 healthcare providers, 96 community health workers (CHWs), and 366 women and men.
Conclusion: The factors that facilitated the integration of men in FP include radio talks, Rwanda Ministry of Health (MOH) trainings at healthcare facilities and the community level, CHW teachings and visits to families, and FP counseling in health centers integrated with different services, namely FP, VCT and ANC, though the lack of a defined calendar for FP services to men in these services impended service delivery. Other factors that facilitated the integration of men in FP through other services included: 1) the selection of counselors and their training level in FP methods, 2) the decentralization of the healthcare system through CHWs, and 3) basic trainings offered to healthcare providers and CHWs. The main factor encouraging men to take a role in FP issues is concern over the financial status of their families; however, they face barriers to use such as misconception about side effects of FP methods, religious beliefs, wives willing to continue having children, and few methods available for them.
The MOH’s interest in integrating men into FP services is an attempt to make services more accessible and efficient. Through discussions with healthcare providers in the two regions, the research team identified several suggestions for improving the process of integration in the future. Those suggestions generally fall into two main groups: 1) improving the content and follow-up of trainings in FP at different levels including healthcare providers, CHWs, and couples; and 2) taking into account the local context of service delivery to improve FP services, especially for men, and setting up permanent FP services involving men from the healthcare facility to the village. If FP services are to be offered in a more effective and sustainable manner, awareness programs need to be strengthened to prevent and address rumors about FP that are circulating in communities. Local leaders need to be the first examples; more trainings need to be offered to healthcare providers and CHWs, taking into consideration cultural and religious values; more FP methods, especially pills, need to be found for men; and FP services should be offered with other reproductive health services at facilities such as VCT, ANC, PMTCT, and ART.
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Résumés PRH: Stratégies pour lutter contre la violence conjugale dans les établissements de soins de santé en Haiti: Perspectives du prestataire
|
|
2013 |
French |
HAITI |
|
En 2012, Tulane University a conduit une étude qualitative sur l’acceptabilité et les obstacles au dépistage de routine de la violence conjugale dans les structures sanitaires du département de l’Artibonite. L'objectif global de l'étude était d'élargir les connaissances actuelles en comparant les attitudes, les obstacles perçus et les facteurs favorisant le dépistage universel de la VPI chez les médecins, les infirmières, et les agents de santé communautaires. L'étude a été menée dans six établissements de santé du département de l'Artibonite. Les résultats de l'étude peuvent être utilisés pour améliorer la formation des prestataires sur les soins et traitement des victimes de violence, et pour améliorer la réponse du secteur santé à la violence contre les femmes et les filles. |
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Résumés PRH: Stratégies pour lutter contre la violence conjugale dans les établissements de soins de santé en Haiti: Perspectives de la clientèle féminine
|
|
2013 |
French |
HAITI |
|
En 2012, Tulane University a conduit une étude qualitative sur l’acceptabilité et les obstacles au dépistage de routine de la violence conjugale dans les établissements sanitaires du département de l’Artibonite parmi les clientes des services de planification familiale et de santé reproductive. L’objectif global de ce volet de l’étude était d’élargir les connaissances actuelles en: (a) determinant les services à base communautaires et les sources de soutien pour les survivants de la VPI; (b) determinant la façon dont les clientes appréhendent le fait de discuter de la VPI avec les prestataires de soins de santé; et (c) determinant les points de vue des clientes sur ce que les prestataires de soins devraient faire pour aider les victimes de la VPI. L'étude a été menée dans six établissements de santé du département de l'Artibonite. Les résultats de l'étude peuvent être utilisés pour améliorer les services institutionnels et à base communautaire en vue de prévenir et de diminuer la VPI et améliorer la réponse nationale à la violence contre les femmes et les filles.
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Core OVC Program Impact Indicators
|
Chapman J |
2013 |
English |
|
|
This set of 12 child and three household well-being indicators/suggested survey questions is recommended for use in evaluations of programs for orphans and other vulnerable children (OVC). These questions do not form a composite indicator of child well-being, and this set of questions is not a stand-alone data collection tool. It is recommended that this minimum set of indicators/questions be integrated into a comprehensive data collection tool in upcoming OVC program evaluations and other related surveys. |
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Referral Systems Assessment and Monitoring Toolkit
|
|
2013 |
English |
|
|
The Referral Systems Assessment and Monitoring (RSAM) tool was developed to assist health and program managers in obtaining and using information regarding the performance of referral systems. These systems play an increasingly important role in the health systems of developing countries as result of the recent impetus toward service integration. Regular assessment and monitoring of referral systems should aim to assure that the underlying processes are functioning properly, that providers are linking clients to the services they need, and that clients are able to access a comprehensive package of health and related services. RSAM was developed to provide program managers with guidance and skills needed to assess and monitor referral systems effectively.
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Decision Making Among Community-Based Volunteers Working in Vulnerable Children Programs: Child Status Index Usage Assessment Phase 2
|
Cannon M, Snyder E |
2013 |
English |
COTE D'IVOIRE, KENYA, MALAWI, ZAMBIA |
|
In 2009, MEASURE Evaluation published the Child Status Index (CSI), a tool designed to be implemented periodically by low-literate community caregivers to capture children’s status across the six domains of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) programming for children who are orphaned and made vulnerable by HIV/AIDS. Based on anecdotal reports of widespread use, MEASURE Evaluation conducted the CSI usage assessment in 2011-2012 to understand how large programs were using CSI to meet a range of information needs. Findings from that study, along with other studies previously conducted regarding CSI, have been useful, but did not get the perspective of community-based caregivers. This study was designed to complement the first study and others by collecting data from caregivers who work directly with vulnerable children to explore how care decisions are made by community-based volunteers, and the utility of CSI at the community level as a job aid. Seventy-nine caregivers participated in 12 focus groups in urban and rural settings in Côte d’Ivoire, Kenya, Malawi, and Zambia. In addition, nine representatives from community-based committees were interviewed.
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Health Service Utilization among Men Who Have Sex with Men and Transgender Women, San Salvador, El Salvador 2011–2012
|
Andrinopoulos K, Hembling J |
2013 |
English |
EL SALVADOR |
|
Introduction: Men
who have sex with men (MSM) and transgender women (TW) in El Salvador are
disproportionately affected by HIV and other sexually transmitted infections
(STI), and may experience unique health service needs and access barriers due
to their social marginalization. The
purpose of this study was to provide descriptive information on health service
utilization for MSM/TW, including HIV/STI services, and factors influencing
service use. It is intended that this
information will be used to support programs aimed at improving the quality of
life and wellbeing of MSM and TW in El Salvador.
Methods: A
structured survey was administered to a representative sample of 670 MSM and TW
in San Salvador between November-February of 2012. Research participants were recruited using
respondent driven sampling (RDS). The
eligibility criteria included: being a man or transgender woman 18 years of age
or older, who had anal sex with a man or transgender woman in the previous 12
months, and who had lived, studied or worked in the department of San Salvador
for a minimum of three months prior to the interview. Univariate and bivariate analysis were
conducted using RDSAT to facilitate appropriate weighting of the data.
Findings: One
third of participants (30%) received healthcare services from a medical
provider in the last 12 months.
Participants with income, health insurance, and a regular provider of
healthcare were more likely to use health services. Participants who had disclosed their sexual
orientation to a family member or healthcare provider, as well as those with
access to a provider accepting towards MSM/TW, were also more likely to use
services. Those who reported
experiencing discrimination from a healthcare provider were less likely to use
services.
Most
participants had tested for HIV at least once in their life (75%) and in the
last 12 months (61%). Participants who
had ever tested for HIV were more likely to be older, have had 16 or more
lifetime sexual partners, to know a PLHIV, to have many social acquaintances
that had tested, and to be a survivor of sexual assault. Among MSM, participants with a high level of
internalized homonegativity were less likely to have tested.
Discussion: In
addition to traditional access barriers to health services, MSM and TW face
unique barriers and health problems due to their sexual identity and
orientation and related stigma.
Increasing health service use and HIV testing will require programs to
address more distal social factors influencing disclosure to family and
healthcare providers, provider aptitude in caring for MSM/TW clients, and
internalized feelings of shame related to sexual orientation and identity.
|
|
An Association between Ethnic Diversity and HIV Prevalence in Sub-Saharan Africa
|
Brodish P |
2013 |
English |
MALAWI, ZAMBIA, KENYA |
|
This paper investigates whether ethnic diversity at the Demographic and Health Surveys (DHS) cluster level predicts HIV serostatus in three sub-Saharan African countries (Kenya, Malawi and Zambia), using DHS household survey and HIV biomarker data for men and women aged 15–59 collected since 2006. The analysis relates a binary dependent variable (HIV positive serostatus) and a weighted aggregate predictor variable representing the number of different ethnic groups within a DHS Statistical Enumeration Area (SEA) or cluster, which roughly corresponds to a neighbourhood. Multilevel logistic regression is used to predict HIV prevalence within each SEA, controlling for known demographic, social and behavioural predictors of HIV serostatus. The key finding was that the cluster-level ethnic diversity measure was a significant predictor of HIV serostatus in Malawi and Zambia but not in Kenya. Additional results reflected the heterogeneity of the epidemics: male gender, marriage (Kenya), number of extramarital partners in the past year (Kenya and Malawi, but probably confounded with younger age) and Muslim religion (Zambia) were associated with lower odds of positive HIV serostatus. Condom use at last intercourse (a spurious result probably reflecting endogeneity), STD in the past year, number of lifetime sexual partners, age (Malawi and Zambia), education (Zambia), urban residence (Malawi and Zambia) and employment (Kenya and Malawi) were associated with higher odds of positive serostatus. Future studies might continue to employ multilevel models and incorporate additional, more robust, controls for individual behavioural risk factors and for higher-level social and economic factors, in order to verify and further clarify the association between neighbourhood ethnic diversity and HIV serostatus.
|
|
Pain Among HIV Outpatients Attending HIV Care and Support Facilities in Two East African Countries
|
Harding R, Simms V, Selman L |
2013 |
English |
KENYA, UGANDA, East Africa |
|
Pain is a common and distressing symptom among people with HIV disease, yet despite cheap and effective availability of pain relief, it remains under-reported and poorly controlled. The overall purpose of this study was to identify and characterize the prevalence and management of pain among HIV outpatients in PEPFAR sites in Kenya and Uganda. The study aimed to facilitate the development of enhanced pain management programmes in East Africa.
|
|
Can Mobile Phone Text Messaging Increase Uptake of Family Planning Services in Uganda?
|
Walakira B, Lubaale YAM, Balidawa F, Nalule S, Githinji F |
2013 |
English |
UGANDA |
|
The study objective was
to determine if mobile telephone text messages on family planning influence uptake of modern contraceptive
methods and services, how the support information messages impact contraceptive
services uptake, the effect of the language in which the message is sent on
services uptake, and the effect of mobile phone ownership on services uptake.
The study was conducted
in Jinja District in the Eastern region of Uganda. The study was a longitudinal
comparison group study that included 679 women (375 women in the experimental group
and 304 in the control group).
There
was a significant relationship between the language in which a message was sent
and acceptance of a modern contraceptive method. The majority of the women in
the implementation group who were using modern contraceptive methods (65.6
percent) felt that the messages they had received where helpful in
contraceptive adherence/continuation decisions. They reported that the messages
had helped them understand how to manage the side effects (52 percent), or use
the method more correctly and effectively (66 percent). Furthermore, the majority
of the women (75 percent) who received text messages mobilizing them to turn up
at the health facility for family planning sensitization meetings honored the invitation.
|
|
Utilización de los servicios de salud entre los hombres que tienen sexo con hombres y mujeres transgénero, San Salvador 2011–2012
|
Andrinopoulos K, Hembling J |
2013 |
Spanish |
EL SALVADOR |
|
Introducción: Los hombres que tienen sexo con hombres (HSH) y las
mujeres transgéneros (MT) en El Salvador se ven desproporcionadamente
infectados por el VIH y otras ITS, además de que experimentan barreras en los
servicios de salud debido a la marginación social.
Métodos: Se administró una encuesta estructurada a una muestra
representativa de 670 HSH y MT en San Salvador, entre noviembre de 2011 y
febrero de 2012. Los participantes fueron reclutados mediante Muestreo Dirigido
por el Entrevistado (RDS por sus siglas en ingles). Los datos se analizaron
utilizando RDSAT 6.0 para facilitar la aplicación apropiada de pesos.
Resultados: Un tercio (30%) de la muestra visitó un proveedor de
salud en los últimos 12 meses.
Participantes con algún ingreso, seguro médico, o un proveedor regular
de salud mostraron mayor propensión al uso de los servicios de salud. Los
participantes que habían divulgado su orientación sexual a los miembros de su
familia o a un proveedor de salud o los que contaban con acceso a un proveedor
de servicios de salud con características que apoyan a los HSH y a las MT
mostraron una mayor tendencia a la utilización de los servicios de salud. Aquellos que señalaron haber experimentado un
alto grado de discriminación por parte de un proveedor de salud mostraron una
tendencia menor al uso de los servicios de salud.
La gran mayoría de los participantes se había hecho la
prueba de VIH al menos una vez un su vida (75%), y en los 12 meses previos a la encuesta (61%). Los participantes que dijeron haberse
sometido a una prueba de VIH alguna vez fueron las personas mayores de 24 años
de edad; los que habían tenido 16+ parejas sexuales en su vida; los que
sobrevivieron a una agresión sexual; los que informan que la mayoría de sus
conocidos se hicieron una prueba de VIH; los que ya divulgaron su orientación
sexual a un miembro de su familia, y los
que dijeron conocer a una persona con VIH.
Entre los HSH, los participantes con una mayor homonegatividad
internalizada mostraron menos probabilidad de haberse sometido a una prueba de
VIH.
Discusión: Además de las barreras tradicionales en acceso a los
servicios de salud, los HSH y las MT experimentan problemas de salud y acceso a
los servicios debido a su orientación e identidad sexual y el estigma. Para mejorar la utilización de servicios de
salud es importante implementar intervenciones que toman en cuenta factores
sociales que influyen en la autoaceptación y divulgación de orientación sexual,
las habilidades de los proveedores de salud de atender a los HSH y a las MT, y en
los sentimientos de vergüenza relacionados con su orientación e identidad
sexual.
|
|
A Review of Diabetes Treatment Adherence Interventions for the Eastern Caribbean
|
McGuire M, Freyder M, Ricketts P |
2013 |
English |
TRINIDAD AND TOBAGO, TURKS AND CAICOS ISLANDS, VIRGIN ISLANDS, BRITISH, VIRGIN ISLANDS, U.S., ANTIGUA AND BARBUDA, ARUBA, BAHAMAS, BARBADOS, CAYMAN ISLANDS, HAITI, JAMAICA, Latin America and the Caribbean, MARTINIQUE, NETHERLANDS ANTILLES, SAINT VINCENT AND THE GRENADINES |
|
Objective: Systematically
analyze previous research pertaining to the monitoring of adherence to diabetes
medication, identify barriers to patient compliance, and examine possible
intervention models dealing with this public health burden in the Eastern
Caribbean.
Search Methods:
Literature was reviewed for meta-analysis using PubMed and Google Scholar searches.
Information was included from Web site searches on the American Diabetes
Association, the World Health Organization, the Pan-American Health
Organization, and the Caribbean Health Research Council Web pages in March 2012.
Article inclusion was restricted to English language articles published in or
after 2004; many articles were included due to lack of academic coverage of the
subject. Major contributing journals included Diabetes Care, the West
Indian Medical Journal, Diabetic
Medicine, Quality in Primary Care,
and Primary Care Diabetes.
Main Conclusions: While
good work has been published on the barriers to treatment and intervention
models to support diabetes compliance in the Caribbean, there are many efficacious
non-Caribbean models that could be culturally tailored and applied in the Eastern
Caribbean for better diabetes outcomes.
|
|
Improving the Use of Health Data for Health System Strengthening
|
Nutley T, Reynolds H |
2013 |
English |
|
|
Background: Good quality and timely data from health information systems are the foundation of all health systems. However, too often data sit in reports, on shelves or in databases and are not sufficiently utilised in policy and program development, improvement, strategic planning and advocacy. Without specific interventions aimed at improving the use of data produced by information systems, health systems will never fully be able to meet the needs of the populations they serve.
Objective: To employ a logic model to describe a pathway of how specific activities and interventions can strengthen the use of health data in decision making to ultimately strengthen the health system.
Design: A logic model was developed to provide a practical strategy for developing, monitoring and evaluating interventions to strengthen the use of data in decision making. The model draws on the collective strengths and similarities of previous work and adds to those previous works by making specific recommendations about interventions and activities that are most proximate to affect the use of data in decision making. The model provides an organizing framework for how interventions and activities work to strengthen the systematic demand, synthesis, review, and use of data.
Results: The logic model and guidance are presented to facilitate its widespread use and to enable improved data-informed decision making in program review and planning, advocacy, policy development. Real world examples from the literature support the feasible application of the activities outlined in the model.
Conclusions: The logic model provides specific and comprehensive guidance to improve data demand and use. It can be used to design, monitor and evaluate interventions, and to improve demand for, and use of, data in decision making. As more interventions are implemented to improve use of health data, those efforts need to be evaluated.
|
|
Technical Report on Electronic Health Management Information System
|
Wannaw F, Azim T |
2013 |
English |
ETHIOPIA |
|
The Health Management Information System and Monitoring and Evaluation (HMIS/M&E) strategy is one of the pivotal components of the Health Sector Development Program (HSDP) of the Ethiopian Federal Ministry of Health (FMOH). The FMOH adopted a “One Plan, One & Budget One Report” policy with the aim of improving management and optimum use of resources for making timely decisions and considers HMIS/M&E as the core information component of effective health care delivery. At the request of the FMOH, USAID/Ethiopia asked JSI, through MEASURE Evaluation, to assist in the scale-up of the reformed HMIS/M&E in Southern Nations and Nationalities People’s Region (SNNPR) in particular, and to work with FMOH on strategies for a national Health Information System (HIS) in general. In this regard, this report involves the Electronic Health Management Information System (eHMIS). |
|
Geographic Approaches to Global Health: A Self-Directed Mini-Course [EPUB edition]
|
Spencer S, Stewart J, Wilkes B |
2012 (rev. 2015) |
English |
Global |
Geospatial analysis, Geographic Information Systems, GIS, Spatial data |
It is important to harness geography to manage, analyze, and leverage spatial data effectively when planning, monitoring, and evaluating health sector programs. Through this course, learners will gain an understanding of how to use spatial data to enhance the decision-making process for health program implementation in limited resource settings.
By the end of this course, the learner will—within a public health context—be able to:
Understand the basics of spatial data and its role in decision making
Explain why geographic data and tools are important for decision makers
Understand geography as a unifying framework and GIS as a tool to collect, link, analyze, visualize, manage, and share data and information
Address the challenges and explore the opportunities of working with spatial data to produce geographic information and geographically based knowledge
Distinguish between the different tools used to collect, analyze, and manipulate geographic data
Communicate with technical specialists to develop program-specific geographic products
This course is appropriate for public health program planners, managers, and professional staff who are interested in learning how geography and spatial data and tools can benefit their programs. The course is designed for individuals without a background in geographic information system(s) (GIS) or who are not specialists in medical geography.
Note: This is an EPUB e-book and is intended for reading on non-Kindle devices. To read it on your iPad, iPhone, or Mac OS device, please open it in iBooks. To read it on your Android device, you may upload the ebook to Google Play Books by following the instructions at https://support.google.com/googleplay/answer/3097151. To read it on a Windows PC, try the Calibre software from http://calibre-ebook.com or consider the Simple EPUB Reader extension for the Google Chrome web browser or the EPUBReader add-on for the FireFox web browser. This publication is also available in PDF and Kindle formats. |
|
Geographic Approaches to Global Health: A Self-Directed Mini-Course [Kindle edition]
|
Spencer S, Stewart J, Wilkes B |
2012 (rev. 2015) |
English |
Global |
Spatial data, Geographic Information Systems, GIS, Geospatial analysis |
It is important to harness geography to manage, analyze, and leverage spatial data effectively when planning, monitoring, and evaluating health sector programs. Through this course, learners will gain an understanding of how to use spatial data to enhance the decision-making process for health program implementation in limited resource settings.
By the end of this course, the learner will—within a public health context—be able to:
Understand the basics of spatial data and its role in decision making
Explain why geographic data and tools are important for decision makers
Understand geography as a unifying framework and GIS as a tool to collect, link, analyze, visualize, manage, and share data and information
Address the challenges and explore the opportunities of working with spatial data to produce geographic information and geographically based knowledge
Distinguish between the different tools used to collect, analyze, and manipulate geographic data
Communicate with technical specialists to develop program-specific geographic products
This course is appropriate for public health program planners, managers, and professional staff who are interested in learning how geography and spatial data and tools can benefit their programs. The course is designed for individuals without a background in geographic information system(s) (GIS) or who are not specialists in medical geography.
Note: This is a Kindle format e-book and is intended for reading on Kindle devices. To read this MOBI file on your Kindle device, please follow the instructions at http://www.amazon.com/gp/sendtokindle/email. This publication is also available in PDF and EPUB formats. |
|
Fundamentals of Implementation Research [Kindle edition]
|
MEASURE Evaluation Implementation Research Technical Working Group |
2012 (rev. 2015) |
English |
Global |
Implementation research |
This module, Fundamentals of Implementation Research, is an introduction to the language, concepts, tools, and strategies used in implementation research (IR). The information is intended to be practical and useful for researchers and program implementers as an orientation to IR.
After successfully completing this course, learners will be able to understand key implementation research (IR) terminology, identify IR core concepts, research frameworks, program components, and appropriate IR questions. Specific objectives include:
Identify characteristics of IR
Describe implementation/scale-up and relate implementation research to these processes
Classify research questions and associated research that falls under the umbrella of IR
Summarize framework characteristics and identify strategies for applying them to IR
Recognize how IR is applied to different implementation problems
Classify IR priorities for grant applications
List the roles of various stakeholders in IR and identify appropriate means for integrating stakeholders in the planning of IR and in communicating and disseminating results
Access a media-rich, interactive version of the Fundamentals of Implementation Research non-certificate course designed for high bandwidth settings.
Note: This is a Kindle format e-book and is intended for reading on Kindle devices. To read this MOBI file on your Kindle device, please follow the instructions at http://www.amazon.com/gp/sendtokindle/email. This publication is also available in PDF and EPUB formats. |
|
Fundamentals of Implementation Research [EPUB edition]
|
MEASURE Evaluation Implementation Research Technical Working Group |
2012 (rev. 2015) |
English |
Global |
Implementation research |
This module, Fundamentals of Implementation Research, is an introduction to the language, concepts, tools, and strategies used in implementation research (IR). The information is intended to be practical and useful for researchers and program implementers as an orientation to IR.
After successfully completing this course, learners will be able to understand key implementation research (IR) terminology, identify IR core concepts, research frameworks, program components, and appropriate IR questions. Specific objectives include:
Identify characteristics of IR
Describe implementation/scale-up and relate implementation research to these processes
Classify research questions and associated research that falls under the umbrella of IR
Summarize framework characteristics and identify strategies for applying them to IR
Recognize how IR is applied to different implementation problems
Classify IR priorities for grant applications
List the roles of various stakeholders in IR and identify appropriate means for integrating stakeholders in the planning of IR and in communicating and disseminating results
Access a media-rich, interactive version of the Fundamentals of Implementation Research non-certificate course designed for high bandwidth settings.
Note: This is an EPUB e-book and is intended for reading on non-Kindle devices. To read it on your iPad, iPhone, or Mac OS device, please open it in iBooks. To read it on your Android device, you may upload the ebook to Google Play Books by following the instructions at https://support.google.com/googleplay/answer/3097151. To read it on a Windows PC, try the Calibre software from http://calibre-ebook.com or consider the Simple EPUB Reader extension for the Google Chrome web browser or the EPUBReader add-on for the FireFox web browser. This publication is also available in PDF and Kindle formats. |
|
Fundamentals of Implementation Research
|
MEASURE Evaluation Implementation Research Technical Working Group |
2012 (rev. 2015) |
English |
Global |
|
This module, Fundamentals of Implementation Research, is an introduction to the language, concepts, tools, and strategies used in implementation research (IR). The information is intended to be practical and useful for researchers and program implementers as an orientation to IR.
After successfully completing this course, learners will be able to understand key implementation research (IR) terminology, identify IR core concepts, research frameworks, program components, and appropriate IR questions. Specific objectives include:
Identify characteristics of IR
Describe implementation/scale-up and relate implementation research to these processes
Classify research questions and associated research that falls under the umbrella of IR
Summarize framework characteristics and identify strategies for applying them to IR
Recognize how IR is applied to different implementation problems
Classify IR priorities for grant applications
List the roles of various stakeholders in IR and identify appropriate means for integrating stakeholders in the planning of IR and in communicating and disseminating results
Access a media-rich, interactive version of the Fundamentals of Implementation Research non-certificate course designed for high bandwidth settings.
Access the EPUB and Kindle editions. |
|
Data Demand and Use: An Introduction to Concepts and Tools
|
Nutley T, Snyder E, Judice N |
2012 (rev. 2015) |
English |
Global |
|
Significant human and financial resources have been invested worldwide in the collection of population, facility, and community-based data. However, this information often is not used by key stakeholders to effectively inform policy and programmatic decision making. As a result, many health programs fail to fully link evidence to decisions and suffer from a decreased ability to respond to the priority needs of the populations they serve.
Many possible factors undermine evidence-based decision making. Some relate to how information flows to decision makers, and how they make their decisions; others to the context in which information is collected and decisions are made; and yet others to the organizational infrastructure and technical capacity of those that generate and use data.This course aims to provide the conceptual basis for data-informed decision making within an organization or program, or at the national, state, or district levels of government. Also included in the course are introductions to several tools created by MEASURE Evaluation to facilitate the use of data in decision making.
The specific learning objective of the course is to improve the understanding of:
the role of data in decision making
the context of decision makingthe determinants of data use
the importance of data sharing and feedback
|
|
Geographic Approaches to Global Health: A Self-Directed Mini-Course
|
Spencer S, Stewart J, Wilkes B |
2012 (rev. 2015) |
English |
Global |
GIS, Geographic Information Systems |
It is important to harness geography to manage, analyze, and leverage spatial data effectively when planning, monitoring, and evaluating health sector programs. Through this course, learners will gain an understanding of how to use spatial data to enhance the decision-making process for health program implementation in limited resource settings.
By the end of this course, the learner will—within a public health context—be able to:
Understand the basics of spatial data and its role in decision making
Explain why geographic data and tools are important for decision makers
Understand geography as a unifying framework and GIS as a tool to collect, link, analyze, visualize, manage, and share data and information
Address the challenges and explore the opportunities of working with spatial data to produce geographic information and geographically based knowledge
Distinguish between the different tools used to collect, analyze, and manipulate geographic data
Communicate with technical specialists to develop program-specific geographic products
This course is appropriate for public health program planners, managers, and professional staff who are interested in learning how geography and spatial data and tools can benefit their programs. The course is designed for individuals without a background in geographic information system(s) (GIS) or who are not specialists in medical geography.
Also available in EPUB and Kindle editions and as an online certificate course. |
|
MEASURE Evaluation OVC Portfolio Brief
|
|
2012 (Updated 2015) |
English |
|
|
MEASURE Evaluation works to improve programs for orphans and vulnerable children (OVC) by providing much-needed data about programs and populations. MEASURE Evaluation is building OVC monitoring and evaluation (M&E) capacity globally through indicator and tool development, program evaluation, data triangulation, and technical assistance and mentoring both directly and via our online community of practice: Child Status Net (http://childstatus.net/). |
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Using Data to Improve Service Delivery: Training Tool Kit for Pre-service Nursing Education
|
MEASURE Evaluation |
2012 |
English |
|
Data, Data use, Training, Service delivery |
This training tool kit aims to increase the skills and knowledge of pre-service nurses to use data in the monitoring and improvement of health services. Specific learning objectives include:
To improve understanding of the links between data collection, analysis, reporting and use of data for program improvement
To improve understanding of the nurse’s role in data collection, production and use
Build skills to use data to monitor and improve health services
The training materials are designed to help nurse educators conduct effective training of pre-service nurses in the concepts of data demand and use, data analysis, data presentation and interpretation, data communication and data-informed decision making. The training materials also highlight the nurse’s role in data collection and data quality. The tool kit provides nurse educators with user-friendly, modifiable training components to adapt for specific university, college or nursing school contexts. The modules can be presented sequentially over two days or they can be separated to supplement existing material of a similar topic.
Access the full collection at https://www.measureevaluation.org/resources/training/capacity-building-resources/using-data-to-improve-service-delivery |
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Assessing HIV Care Networks to Improve Integration and Health Outcomes in Ethiopia
|
MEASURE Evaluation |
2012 |
English |
Africa, ETHIOPIA, Global |
Ethiopia, HIV care, Health outcomes, HIV |
People living with HIV have many needs. They may need care and treatment for their HIV disease, counseling on skills to protect their partners, prevention or treatment for tuberculosis or other diseases, to prevent unintended pregnancies, training for jobs, or support for housing. Services, and thus organizations, must be coordinated and be able to link clients with the care, support, and treatment services in order to meet clients’ care needs.
Service delivery in Ethiopia and elsewhere is largely siloed. People living with HIV receive antiretrovirals from one organization, family planning from another, nutritional services from a third, and so on. The current structure results in duplication of effort and inefficiencies because people, organizations, and donors are not coordinating resources and services.
To make care more comprehensive and to gain efficiencies, the U.S. Global Health Initiative (GHI) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) promote integration as a key strategy. Ethiopian health strategies feature bi-directional referral linkages between facilities and community-based organizations (CBOs). But integration is a complex task and requires cooperation among donors, partners, and organizations. Cooperation and collaboration are often stymied by competition for resources and a lack of understanding about how to collaborate and with whom to collaborate.
A potential tool to guide improvements in service integration is organizational network analysis. Organizational network analysis is an innovative and accessible approach to understanding relationships among actors in health care provision. The approach can provide information about the extent to which organizations share information and resources or refer clients. Results can help actors make better use of available resources to benefit clients. |
|
The Power of Networks – A New Opportunity for Improving Global Health
|
MEASURE Evaluation |
2012 |
English |
|
Network analysis, Global health |
A network perspective offers a new opportunity for improving global health. As we use monitoring and evaluation to guide the allocation of global health resources, social network analysis (SNA) is the tool that will unlock these new opportunities. SNA provides information that can’t be obtained by traditional evaluation methods in which people or organizations (such as government agencies and nongovernmental organizations, or NGOs) are considered in isolation of each other. SNA, on the other hand, examines the relationships between organizations. And because people with chronic conditions such as HIV infection or diabetes require many services over time, the quality of their care and health can be affected by coordination among the organizations providing their services.
In MEASURE Evaluation, we apply a network perspective to evaluating the complex task of providing health services to populations. We see that in some populations, there is an overabundance of programs providing services, with many of them working in isolation of the others; or even worse, in competition with them. In other communities the services are scarce, but still the organizations are not working together. Whether in places of program abundance or scarcity, there are opportunities to reap benefits for the population served by enabling organizations to communicate and coordinate with each other. This is especially important as international investments in health decline or shift to other priorities.
To harness the power of networks to improve health outcomes, MEASURE Evaluation can develop tools and approaches for assessing interactions between healthcare agencies and organizations. |
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Bangladesh Smiling Sun Franchise Program Impact Evaluation Report
|
Lance P, Angeles G, Kamal N |
2012 |
English |
BANGLADESH, South Asia |
|
The Bangladesh Smiling Sun Franchise Program (BSSFP) is a United States Agency for International Development (USAID)/Bangladesh funded health care delivery program providing a package of essential health services through a network of local non-governmental organizations (NGOs). It is a continuation of the NGO Service Delivery Program (NSDP), which had been in place in various forms since the late 1990s. BSSFP operated in areas that had been identified by the Government of Bangladesh (GOB) to have inadequate public health service delivery systems where the government sought assistance from partners to fill the service gap (henceforth referred to as ‘project’ areas). USAID committed US$46 million for BSSFP over a four-year period (2007-2011). The program was later extended for another year with additional funding of around US$11 million.
The program’s overall objectives were to increase the use of family planning, maternal, child, and other basic health services in areas served by BSSFP, with an emphasis on serving the poor and on improving the sustainability of local NGOs in continuing to provide these services. The program was developed at a time when funding for USAID/Bangladesh was expected to decline drastically. Thus, improving financial sustainability of local NGOs within a four-year period was a major emphasis of the program. To meet the desired outcomes, BSSFP had four objectives: (1) to develop a franchise model; (2) to recover 70 percent of operational costs by the end of the project; (3) to increase and expand quality service volume; and (4) to ensure that 30 percent of all health services provided are service contacts targeted towards the poor who are unable or only partially able to pay.
In 2010, three changes were made to the BSSFP program based on a mid-term program assessment conducted in April 2010 and USAID’s periodic program reviews. First, the program was extended for an additional year beyond its fourth year. Second, the program’s cost recovery target was revised downwards to 45 percent of its operational costs. The initial target of 70 percent cost recovery was abandoned since it would have involved further increases in user fees, in addition to the two price hikes introduced in the first three years of the project. Third, further efforts to establish a “franchise” were ceased.
The BSSFP was implemented under a contract between USAID and Chemonics International through 26 local NGOs operating a network of 323 static clinics, around 8,800 satellite (outreach) clinics, and over 6,000 community volunteers known as Community Service Providers (CSPs)/depotholders. The BSSFP served a catchment population of roughly 20 million through 193 clinics in urban areas and 130 clinics in rural areas. The urban and rural components of the BSSFP program varied slightly in design and implementation owing to differences in urban and rural settings. The rural component of the BSSFP had a CSP/depotholder component for community mobilization but the urban one did not. |
|
Implementation of Maternal and Child Health Outcome Surveys Using LQAS
|
|
2012 |
English |
KENYA, LIBERIA |
|
Lot Quality Assurance Sampling (LQAS) is a sampling and analysis methodology for rapid population-based surveys. It requires a small sample size and provides information on whether sub-areas or “lots” are performing at an “acceptable” or “not acceptable” level according to pre-determined targets. Samples from each lot can be aggregated to provide coverage estimates for the entire study area. LQAS can thus be a useful monitoring tool to assess service coverage and health outcomes and behaviors at the district and sub-district level.
Though LQAS is touted as a rapid and inexpensive data collection tool, this does not necessarily translate into implementations that are “quick” and “cheap”, especially when technical assistance is provided by an outside organization. From 2010–2012 MEASURE Evaluation supported three rounds of maternal and child health outcome monitoring surveys in Kenya and two rounds in Liberia.
|
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Bangladesh Maternal Mortality and Health Care Survey 2010
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2012 |
English |
BANGLADESH, Asia |
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The Government of Bangladesh has invested in a maternal health program with support from a number of development partners. Committed to achieving the Millennium Development Goal (MDG) 5, Bangladesh’s targets are to reduce the maternal mortality ratio (MMR) to 143 per 100,000 live births by 2015, and to increase skilled attendance at birth to 50 percent by 2016. In the last decade, the health, nutrition, and population sector program of Bangladesh has adopted a national strategy for maternal health focusing on Emergency Obstetric Care (EmOC) for reducing maternal mortality, focusing especially on early detection and appropriate referral of complications, and improvement of quality of care. Since 2001, the government embarked on program to retrain existing government community health care workers as Community Skilled Birth Attendants (CSBA) as the primary operational strategy for achieving the 2015 target of 50 percent skilled attendance at birth.
The second Bangladesh Maternal Mortality and Health Care Survey was conducted in 2010 (BMMS 2010) with the major objectives being to provide a maternal mortality estimate for the period 2008-2010, to determine whether MMR has significantly declined from 1998-2001, and to ascertain the causes of maternal death. The first such national level survey was conducted in 2001 (BMMS 2001).
The survey was carried out in a national sample of 175,000 households, interviewing ever-married women 13 to 49, as well as investigating any deaths to women of reproductive ages, especially maternal and pregnancy-related deaths. Data collection for the survey was conducted from 18 January to 6 August, 2010.
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2012 Liberia Health Outcome Monitoring Report
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2012 |
English |
LIBERIA |
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The Ministry of Health and Social Welfare (MOHSW) in Liberia is developing an annual health behavior and health outcome monitoring system using Lot Quality Assurance Sampling (LQAS).
LQAS is a relatively rapid and inexpensive approach to data collection for monitoring and evaluation purposes. It can be used to empower program managers to assess program performance, enabling them to determine whether program objectives and targets have been achieved within a specific unit of interest (a geographical area, a facility, an organization, or any other catchment area). The LQAS data collection method and simplified data analysis provides a viable alternative to traditional surveys. It allows for smaller sample sizes than standard probability surveys, and the lower associated costs allow for more frequent sampling. Thus, the speedy collection and ready availability of data from LQAS can help program managers use data as evidence to inform decisions, help in the planning and budgeting process and in formulating targeted interventions.
With LQAS, the entire program area (or catchment area) is divided into meaningful sub-divisions or “lots.” The lot is usually defined as a program supervision area, and the measure is binary (e.g., yes/no, or acceptable/not acceptable) for each indicator included in the study. For example, to determine the status of immunization coverage, “acceptability” is determined by whether the “lot” (supervision area) meets the target for immunization coverage—yes/no. Information from each lot can then be aggregated to provide a coverage estimate for the entire catchment area.
LQAS provides three key pieces of information. It identifies 1) what the problem is because of indicators selected and their coverage estimates, 2) how big the problem is because of the comparison of responses to target levels set for selected indicators, and 3) where the problem is because of the results available by geographic sub-division. However, LQAS does not offer information on why there is problem. Other sources of information are needed to explain the underlying reasons for quantitative results from an LQAS survey, and to identify strategies for improvement.
It is important to clarify that the LQAS approach is not intended to measure incremental change over time. It is designed to assess whether a target has been “met” or “not met” in a designated program supervision area. The small sample size that is required for providing binary (met/not met, acceptable/unacceptable) estimates is a key feature of an LQAS. However, the small sample size at the lot level means that confidence intervals around point estimates at the aggregate level will be wide, such that changes in these point estimates do not register as statistically significant—unless they are very large (e.g., 40–50% increase or decrease).
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GIS Data Linking to Enhance Multi-sectoral Decision Making for Family Planning and Reproductive Health: A Case Study in Rwanda
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2012 |
English |
RWANDA |
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Family planning and reproductive health (FP/RH) services help provide the foundation of a stable, healthy, and economically viable society. Past global strategies, however, have often led to a vertical implementation of FP/RH programs and policies, despite the value for integrated approaches to meeting health needs.
As a result, decision making for FP/RH can be hindered by a lack of information from other sectors, including other health areas, such as maternal and child health (MCH) or HIV/AIDS. Likewise, sectors outside the realm of public health, such as food security, education, physical infrastructure, and poverty, among others, are not routinely taken into account. Additionally, these other sectors do not typically have access to FP/RH data to contextualize their policies and programs.
Linking multi-sectoral data sources is often deterred by information systems that are developed and maintained independently of other information systems, leading to datasets that are unconnected or ‘stovepiped.’ Through its ability to link data using common geographic identifiers, a geographic information system (GIS) can help overcome this stovepiping of data. Once multi-sectoral data links have been established, a GIS can also be used to enhance the visualization and analysis of FP/RH program data. Enhanced data visualization and analysis can make program data much easier to understand and to use for evidence-based decision making.
The benefits of linking multi-sectoral data using a GIS include the following:provides useful ways to visualize and communicate program data;establishes a foundation for data analysis within a geographic context;increases access, use, and value of data from multiple sectors;supplies a point of reference for discussion among stakeholders; andfacilitates better targeting of resources.
To explore these benefits, the MEASURE Evaluation Population and Reproductive Health (PRH) Associate Award, which is funded by the United States Agency for International Development (USAID), sponsored an activity to investigate and document the process of using a GIS to link FP/RH data with data from multiple sectors. Rwanda was selected as a case study, and an assessment of available data and possible opportunities for linkages took place in the fall of 2011.
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Programa de comunicación para el cambio de comportamiento relacionado con el VIH para sitios de alta prevalencia en México
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Gayet C, Freyder M, Roman R, Faura P, Ospina A, Angel Cruz J, Hembling J |
2012 |
Spanish |
MEXICO |
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Por más de 10 años, la Agencia de los Estados Unidos para el Desarrollo Internacional (USAID) ha implementado un programa para responder a la epidemia de VIH y SIDA en México, en apoyo a los intereses comunes de los gobiernos de los Estados Unidos y México. Los objetivos de este estudio son presentar los factores básicos que impulsan la epidemia mexicana, analizar los objetivos del programa de prevención del VIH/SIDA de USAID y las actividades de implementación puestas en práctica durante el período 2005-2009, así como proponer recomendaciones para futuras prioridades de prevención.
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HIV Behavior Change Communications Program for High Prevalence Sites in Mexico
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Gayet C, Freyder M, Roman R, Faura P, Ospina A, Angel Cruz J, Hembling J |
2012 |
English |
MEXICO |
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For over 10 years, the U.S. Agency for International Development (USAID) has implemented a program to address Mexico’s HIV/AIDS epidemic, in support of the common interests of the governments of the United States and Mexico. The objectives ofthis study are to present the basic factors driving the Mexican epidemic, to analyze the USAID HIV/AIDS prevention program objectives and implementation practices during the period 2005-2009, and to provide recommendations for future prevention priorities. |
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MEASURE Evaluation M&E Learning Center
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2012 |
English |
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MEASURE Evaluation makes free online courses on monitoring and evaluation (M&E) topics available for researchers, program managers, trainers, policy makers, students, and other public health professionals. These courses have been developed by global experts to provide state-of-the-art information on M&E.
Certificate courses, related online courses through USAID’s Global Health e-Learning Center, and non-certificate courses can be accessed by visiting http://training.measureevaluation.org.
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Outils PRISM: Guide de l'Utilisateur
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Anwer A, Lippeveld T, Moussa T, Barry A |
2012 |
French |
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Le cadre du PRISM et ses outils ont été utilisés dans plus de dix pays dans différentes parties du Monde, de l'Asie à l'Afrique et du des Caraïbes en Amérique Latine. Le manuel de l'utilisateur répond à un urgent besoin, qui a été identifié dans le domaine, pour l e renforcement des capacités des systèmes d'information sanitaire de routine (SISR) pour aider des professionnels à utiliser plus efficacement le SISR.
The 2018 version of the PRISM Series, updated and with new modules (Toolkit, User’s Kit, and Training Kit) is available here: https://www.measureevaluation.org/prism |
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Consistent condom use among men with non-marital partners in four sub-Saharan African countries
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Reynolds HW, Luseno WK, Speizer IS |
2012 |
English |
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Data from the Demographic and Health Surveys for Namibia, Swaziland, and Zambia and the AIDS Indicator Survey from Tanzania were used to examine the influence of marital status and number of partners on consistent condom use among men with casual sexual partnerships in four generalized HIV epidemic settings. We restrict the sample to the 26% (Zambia), 29% (Tanzania), 35% (Swaziland), and 42% (Namibia) of men, who, in the last 12 months before the survey, had any non-marital/non-cohabiting (i.e., casual) sexual partners. We use “condom always used with any partner in the last 12 months” as a dichotomous-dependent measure of consistent condom use. Analyses were stratified by country. Of men with casual partners, 41% (Zambia) to 70% (Namibia) used a condom every time with at least one partner. The majority of men were unmarried/non-cohabiting with one casual partner in the last year. In Swaziland and Zambia, multivariate results suggest that unmarried/non-cohabiting men with one casual partner had significantly lower odds than married/cohabiting men with casual partners to use condoms consistently (odds ratio [OR] = 0.56, p=0.01 and OR = 0.41, p<0.001, respectively). In Namibia, unmarried/non-cohabiting men with two or more casual partners had significantly greater odds than married/cohabiting men with casual partners to use condoms consistently (OR = 2.80, p<0.01). With some exceptions by country, higher education, religious group, wealth, having no children, knowing HIV results, having an STI, having one lifetime partner, and positive condom knowledge and beliefs also were significantly associated with using a condom every time with any partner. We conclude that consistent condom use remains an elusive goal even among men with casual sexual relationships. Condom use messages should be refined and targeted to men based on their number and types of relationships and combined with other messages to decrease concurrent relationships.
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Improving Family Planning Service Delivery to Adolescents in Ghana: Evidence from Rural Communities in Central Ghana
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Enuameh Y, Boamah E, Nettey OE, Tawiah C, Manu A, Sulemana A, Zandoh C, Adjei G, Mahama E, Gyaase S, Afari-Asiedu S, Owusu-Agyei S |
2012 |
English |
GHANA |
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In a previous study (the Obaapa Vitamin A study), female adolescents were recruited at age 10 to receive vitamin A supplements and were followed until the age of 15. Outcomes monitored in the course of the study were pregnancies, births, and birth outcomes (maternal and neonatal mortality). The current study conducted focus group discussions and in-depth interviews in the same administrative districts as the previous study, and combined these quantitative and qualitative data to help guide family planning service delivery to adolescents in the districts. Research questions focused on the family planning needs of adolescents, whether adolescents view family planning as important to their health and well-being, and the views of adolescents, society, and healthcare providers on how best to address adolescents’ family planning needs.
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Health Articles and Reports for Barbados, Jamaica, Trinidad, and the Organization of Eastern Caribbean States: An Annotated Bibliography
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Hembling J, Freyder M |
2012 |
English |
BARBADOS, JAMAICA, TRINIDAD AND TOBAGO, Latin America and the Caribbean |
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This review offers an annotated bibliography of peer-reviewed and gray health science literature relevant to the Eastern Caribbean published between 2005 and 2012. The review includes articles on HIV/AIDS and other chronic diseases, such as hypertension, diabetes, and cancer. The review also includes articles on obesity, oral health, interpersonal violence, and migration.
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PLACE Mapping and Size Estimation Module
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2012 |
English |
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PLACE is a rapid assessment tool to monitor and improve AIDS prevention program coverage in areas where HIV transmission is most likely to occur. An important aspect of the PLACE method is the creation of maps. This paper discusses the mapping of priority prevention areas that can inform HIV/AIDS prevention activities. Seeing the geographic distribution of sexual network sites over the assessment area can show how and where sites are grouped.
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Making Good Use of HMIS Information in Ethiopia
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2012 |
English |
ETHIOPIA |
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Dilla is a Gadeo zonal town in the Southern Nations, Nationalities and People’s Region (SNNPR) of Ethiopia. Located 375 kilometers from the capital city of Addis Ababa, the Gadeo Zonal Health Department (ZHD) in Dilla town is structured like any other zonal health department in Ethiopia. There is a planning process office that is responsible for health sector planning, performance monitoring and evaluation (M&E), managing health budgets and supporting other business processes within the ZHD. The Planning Coordinator and Health Management information System (HMIS) Officer at the Gadeo ZHD is Meron Umer. With the support of the Gadeo ZHD Head, Ato Buzuneh Negussie, Meron has played a pivotal role in making Gadeo stand out.
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7 Pasos para utilizar información rutinaria para mejorar programas de VIH/SIDA
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Judice, NR |
2012 |
Spanish |
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Este documento presenta los pasos concretos y ejemplos ilustrativos que pueden usarse para facilitar el uso de información como parte de los procesos de toma de decisiones que guían el diseño y gestión de programas y la provisión de servicios en el sector salud. De manera específica, el documento delinea siete pasos para el uso de información que ayudaran a enfocarse en los obstáculos que se presentan al usar los datos que regularmente son recopilados, y lo hará mediante orientación en cómo:
Vincular las preguntas que son de interés para gerentes de programas y proveedores con los datos existentes;Analizar, gráficar e interpretar los datos, yContinuar monitoreando los indicadores claves para informar las mejoras.
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Framework for Monitoring and Evaluating Efforts to Reposition Family Planning
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Judice NR, Snyder E |
2012 |
English |
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Family Planning |
The U.S. Agency for International Development's Office of Population and Reproductive Health, in collaboration with the World Health Organization and other partners, has engaged in an initiative to reposition family planning (FP) in sub-Saharan Africa. Three key approaches for achieving this goal are advocating for policy change, strengthening leadership, and improving capacity to deliver services. As a result, there is a need for a framework by which countries and programs can monitor and evaluate their progress toward repositioning FP. The results framework described in this report includes illustrative indicators that can maximize the use of existing information. This framework for monitoring and evaluating the repositioning of FP services can ultimately be used by international donors, governments, and programs to assess their efforts, identify gaps in strategies to reposition FP in countries, and to inform funding, program design, policy and advocacy, and program planning and improvement. |
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Assessing the process of designing and implementing electronic health records in a statewide public health system: the case of Colima, Mexico
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Hernández-Ávila JE, Palacio-Mejía LS, Lara-Esqueda A, Silvestre E, Agudelo-Botero M, Diana ML, Hotchkiss DR, Plaza B, Parbul AS |
2012 |
English |
MEXICO |
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The findings of a case study assessing the design and implementation of an electronic health record (EHR) in the public health system of Colima, Mexico, its perceived benefits and limitations, and recommendations for improving the implementation process are presented. In-depth interviews and focus group discussions were used to examine the experience of the actors and stakeholders participating in the design and implementation of EHRs. Results indicate that the main driving force behind the use of EHRs was to improve reporting to the two of the main government health and social development programs. Significant challenges to the success of the EHR include resistance by physicians to use the ICD-10 to code diagnoses, insufficient attention to recurrent resources needed to maintain the system, and pressure from federal programs to establish parallel information systems. Operating funds and more importantly political commitment are required to ensure sustainability of the EHRs in Colima.
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Clarification Regarding Usage of the Child Status Index (CSI)
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2012 |
English |
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The Child Status Index (CSI) is a widely used information collection tool among programs for children who are orphaned or made vulnerable by HIV/AIDS. The last several years of CSI implementation have enabled MEASURE Evaluation and others to learn about how the CSI fits into the overall package of M&E tools and when, and in which, circumstances the tool is best used. This document briefly describes the tool, its purposes, and the lessons learned about best usages.
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Performance Management Plans: A Checklist for Quality Assessment
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2012 |
English |
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A performance management plan (PMP) establishes guidelines for the
collection of specific information that will be used to assess program or
project progress and guide decision making. U.S. Agency for International
Development (USAID) operating units must prepare a PMP for each direct objective for which they are responsible. Projects may develop their own PMPs using guidance
from USAID’s Automated Directives System (ADS). While the scope and scale of projects can differ substantially, quality standards for performance management planning are essentially universal. A 14-item checklist provide in this guide is designed to help managers decide whether or not a document has the basic characteristics of a good PMP.
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Gender equality and childbirth in a health facility: Nigeria and MDG5
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Singh K, Bloom S, Haney E, Olorunsaiye C, Brodish P |
2012 |
English |
NIGERIA |
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This paper examined how addressing gender equality can lead to reductions in maternal mortality in Nigeria through an increased use of facility delivery. Because the majority of maternal complications cannot be predicted and often arise suddenly during labor, delivery and the immediate postpartum period, childbirth in a health facility is key to reducing maternal mortality. This paper used data from the 2008 Nigeria Demographic and Health Survey to examine associations of gender measures on the utilization of facility delivery after controlling for sociodemographic factors. Four gender equality measures were studied: household decision making, financial decision making, attitudes towards wife beating, and attitudes regarding a wife’s ability to refuse sex. Results found older, more educated, wealthier, urban, and working women were more likely to have a facility delivery than their counterparts. In addition ethnicity was a significant variable indicating the importance of cultural and regional diversity. Notably, after controlling for the socioeconomic variables, two of the gender equality variables were significant: household decision making and attitudes regarding a wife’s ability to refuse sex. In resource-poor settings such as Nigeria, women with more decision-making autonomy are likely better able to advocate for and access a health facility for childbirth. Thus programs and policies that focus on gender in addition to focusing on education and poverty have the potential to reduce maternal mortality even further.
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Using UNAIDS’s organizing framework to assess Nigeria’s national HIV monitoring and evaluation system
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Ogungbemi K, Oyediran KA, Mullen S, LaFond A, Azeez A, Boone D, Mharadze TN, Kanagat N, Atobatele A |
2012 |
English |
NIGERIA |
|
The Nigeria National Response Management Information System (NNRIMS), developed in 2004 as a framework for monitoring and evaluating the country’s response to HIV, does not function at an optimum level due to several challenges, including a confusing proliferation of vertical reporting systems, competition among sectors, and the nascent nature of the monitoring and evaluation (M&E) sub-systems within many institutions. An assessment of the existing M&E system was conducted to verify whether the system has the capacities to provide essential data for monitoring the epidemic and identifying critical programming gaps. Nigeria’s National Agency for the Control of AIDS (NACA) used an organizing framework for a national HIV M&E system developed by UNAIDS, to assess the strengths and weaknesses of the NNRIMS to generate data for evidence-based decision making. The participatory approach used during an assessment workshop ensured that the process was country-led and -owned to build consensus and local capacity, and that it encouraged adoption of a single national-level multisectoral HIV M&E system. The assessment found an operable M&E system at the national level but a much weaker system at the state and local levels and across seven other sectors. There are multiple data collection and reporting tools at the facility level that lead to vertical reporting systems, which increases the burden of reporting at lower levels, especially by service providers. Human resources are being developed, but problems remain with the quantity and quality of staff. Data use, though evident at the national level, is still very weak among five of the seven sectors assessed. The assessment results have been used to develop a national costed M&E workplan to which all stakeholders contributed in a coordinated response to strengthen the system.
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Holding a National Health and Mapping Summit to Build Partnerships for Improving Health Outcomes: Lessons Learned from the Nigeria Health and Mapping Summit of 2011
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2012 |
English |
NIGERIA |
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In order to help organize a similar event in other countries, this document outlines the key steps for planning and holding the Nigeria Health and Mapping Summit of 2011, held in Abuja, Nigeria. MEASURE Evaluation collaborated with the Federal Republic of Nigeria to hold the summit between the health sector and mapping sector in that country. How to ensure that a health and mapping summit is planned and executed by local stakeholders, whose leadership roles will provide a strong incentive to participate, and how to work together for the success of the effort are covered.
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Beyond indicators: advances in global HIV monitoring and evaluation during the PEPFAR era
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Porter LE, Bouey PD, Curtis S, Hochgesang M, Idele P, Jefferson B, Lemma W, Myrick R, Nuwagaba-Biribonwoha H, Prybylski D, Souteyrand Y, Tulli T |
2012 |
English |
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Monitoring and evaluation (M&E) is fundamental to global HIV program implementation and has been a cornerstone of the President's Emergency Plan for AIDS Relief (PEPFAR). Rapid results were crucial to demonstrating feasibility and scalability of HIV care and treatment services early in PEPFAR. When national HIV M&E systems were nascent, the rapid influx of funds and the emergency expansion of HIV services contributed to the development of uncoordinated “parallel” information systems to serve donor demands for information. Close collaboration of PEPFAR with multilateral and national partners improved harmonization of indicators, standards, methods, tools, and reports. Concurrent PEPFAR investments in surveillance, surveys, program monitoring, health information systems, and human capacity development began to show signs of progress toward sustainable country-owned systems. Awareness of the need for and usefulness of data increased, far beyond discussions of indicators and reporting. Emphasis has turned toward ensuring the quality of data and using available data to improve the quality of care. Assessing progress toward an AIDS-free generation requires that the global community can measure the reduction of new HIV infections in children and adults and monitor the coverage, quality, and outcomes of highly efficacious interventions in combination. Building national M&E systems requires sustained efforts over long periods of time with effective leadership and coordination. PEPFAR, in close collaboration with its global and national partners, is well positioned to transform the successes and challenges associated with early rapid scale-up into future opportunities for sustainable, cost-effective, country-owned programs and systems.
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Improving Data Use in Decision Making: An Intervention to Strengthen Health Systems
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Nutley T |
2012 |
English |
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The
World Health Organization’s framework for health systems strengthening identifies
six attributes of a health system: a health workforce; health services; health financing;
governance and leadership; medical products, vaccines, and technologies; and health
information. While each building block of the WHO framework is important, quality and timely
data from health information systems are the foundation of the health system
and inform decision making in each of the other five building blocks of the
health system. Health systems
require quality data from health information systems to plan for and ensure
that the workforce is fully funded and equipped with the necessary commodities,
infrastructure, resources, and policies to deliver services. Health data are, in
and of themselves, prerequisites to improving each of the other five building
blocks. This
paper discusses the unique role of health data in strengthening the other five
building blocks of health systems and defines specific interventions to strengthen the
use of data in decision making. It also provides a framework for developing,
monitoring, and evaluating interventions to improve the use of and demand for data. The overall aim of the paper is to articulate specific
interventions that can improve the demand for and use of data in decision
making so that improvements in the other health building blocks can be
realized.
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Women’s empowerment and choice of contraceptive methods in selected African countries
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Do M, Kurimoto N |
2012 |
English |
UGANDA, ZAMBIA, GHANA, NAMIBIA |
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CONTEXT: It is generally believed that women's lack of decision-making power may restrict their use of modern contraceptives. However, few studies have examined the different dimensions of women's empowerment and contraceptive use in African countries.
METHODS: Data came from the latest round of Demographic and Health Surveys conducted between 2006 and 2008 in Namibia, Zambia, Ghana and Uganda. Responses from married or cohabiting women aged 15-49 were analyzed for six dimensions of empowerment and the current use of female-only methods or couple methods. Bivariate and multivariate multinomial regressions were used to identify associations between the empowerment dimensions and method use.
RESULTS: Positive associations were found between the overall empowerment score and method use in all countries (relative risk ratios, 1.1-1.3). In multivariate analysis, household economic decision making was associated with the use of either female-only or couple methods (1.1 for all), as was agreement on fertility preferences (1.3-1.6) and the ability to negotiate sexual activity (1.1-1.2). In Namibia, women's negative attitudes toward domestic violence were correlated with the use of couple methods (1.1).
CONCLUSIONS: Intervention programs aimed at increasing contraceptive use may need to involve different approaches, including promoting couples' discussion of fertility preferences and family planning, improving women's self-efficacy in negotiating sexual activity and increasing their economic independence.
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Child Status Index validation study by Sabin et al. misses the mark
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Foreit K, Chapman J, O'Donnell K, Cannon M, Moreland S |
2012 |
English |
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Letter to the Editor
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Review of the Evidence: Linkages between Livelihood, Food Security, Economic Strengthening, and HIV-Related Outcomes
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Xiong K |
2012 |
English |
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This paper assesses the linkages between poverty, livelihood, food security, economic strengthening, and HIV/AIDS-related outcomes through a literature review. It is intended to inform a logic model for FHI 360’s Livelihood and Food Security Technical Assistance (LIFT) project by determining the extent to which household food security and livelihood status are associated with HIV/AIDS-related outcomes; examining the evidence related to the impact of a variety of food security, livelihoods and economic strengthening interventions on HIV/AIDS-related outcomes; and identifying gaps in the evidence. This review of the state of the evidence and identification of gaps will feed into the development of LIFT’s research agenda to explore these issues in greater depth.
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Maternal autonomy and attitudes towards gender norms: associations with childhood immunization in Nigeria
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Singh K, Haney E, Olorunsaiye C |
2012 |
English |
NIGERIA |
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Globally 2.5 million children under-five die from vaccine preventable diseases, and in Nigeria only 23 % of children ages 12-23 months are fully immunized. The international community is promoting gender equality as a means to improve the health and well-being of women and their children. This paper looks at whether measures of gender equality, autonomy and individual attitudes towards gender norms, are associated with a child being fully immunized in Nigeria. Data from currently married women with a child 12-23 months from the 2008 Nigeria Demographic and Health Survey were used to study the influence of autonomy and gender attitudes on whether or not a child is fully immunized. Multivariate logistic regression was used and several key socioeconomic variables were controlled for including wealth and education, which are considered key inputs into gender equality. Findings indicated that household decision making and attitudes towards wife beating were significantly associated with a child being fully immunized after controlling for socioeconomic variables. Ethnicity, wealth and education were also significant factors. Programmatic and policy implications indicate the potential for the promotion of gender equality as a means to improve child health. Gender equality can be seen as a means to enable women to access life-saving services for their children.
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Ethnicity and HIV Risk in Guatemala
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Taylor TM, Hembling J, Bertrand JT |
2012 |
English |
GUATEMALA |
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Mayans and other indigenous groups make up approximately half of the population in Guatemala, and previous research shows them to be highly disadvantaged on nearly every indicator of health and well-being (Gragnolati and Marini, 2003). Little is known, however, about the HIV risk profile of these groups, or how it may differ from that of the non-indigenous population. Evidence of these differences could inform resource allocation and be used to improve HIV prevention intervention strategies in the country.
Data on 16,205 women aged 15–49 and 6,822 men aged 15–59 who participated in the 2008–2009 Encuesta Nacional de Salud Materno Infantil (ENSMI) were used to describe differences between ethnic groups on a variety of demographic and HIV variables. We then controlled for age, education, wealth and other background factors in a logistic regression model investigating the association between ethnicity and respondents’ odds of early sexual debut, higher numbers of sexual partners, condom use, HIV testing, comprehensive HIV knowledge, and accepting attitudes towards people living with HIV (PLHIV).
The data show low reported levels of risky sexual behavior among indigenous women and men, compared to other respondents. However, the indigenous group also exhibited markedly less HIV awareness, more limited understanding of HIV transmission, lower prevention knowledge, and more negative attitudes toward PLHIV. When controlling for other socio-demographic factors, ethnicity was associated with women’s early sexual debut, 3+ lifetime sexual partners, comprehensive HIV knowledge, accepting attitudes, and HIV testing. It was not associated with women’s condom use at last sex. Among men, ethnicity was associated with early sexual debut, 10+ lifetime sexual partners, lifetime history of sex worker patronage, and comprehensive HIV knowledge. It was marginally associated with men’s odds of having 3+ sexual partners in the past 12 months, using a condom during most recent sexual encounter, and HIV testing. Among men ethnicity was not associated with condom use at last sex with a sex worker, or with accepting attitudes towards PLHIV.
We conclude that the indigenous population in Guatemala, while broadly socially vulnerable, does not appear to be at elevated risk for HIV. We recommend that prevention efforts continue to focus on key populations at higher risk. Nonetheless, low rates of HIV testing coupled with limited prevention knowledge, particularly among the indigenous, are cause for concern. Programs working in indigenous communities may wish to focus on basic HIV education and address barriers to testing. Finally, while our analysis of risk factors strongly suggests that the epidemic in Guatemala remains concentrated in traditional key populations, the addition of HIV biomarker data to the next national health survey would provide definitive evidence. Researchers working with other health datasets from Guatemala should also be encouraged to present their results by ethnic group, so that programs and policies can be designed with indigenous communities’ unique needs in mind.
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Using Health Facility Assessment Data to Address Programmatic Questions: Illustrative Examples for Program Managers
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Fapohunda B |
2012 |
English |
KENYA |
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This paper illustrates how health facility assessment data can be
applied to answer questions currently facing many health program
managers.The MEASURE Evaluation data demand and use conceptual framework
is used as an organizing construct, which depicts data demand and use
as a cycle that connects data demand, data collection/analysis, and information availability to data use.
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Effect of injectable contraceptive use on response to antiretroviral therapy among women in Rakai, Uganda
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Polisa CB, Nakigozib G, Ssempijjab V, Makumbic FE, Boazb I, Reynolds SJ, Ndyanabob A, Lutalob T, Wawera MJ, Graya RH |
2012 |
English |
UGANDA |
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Background: There is limited evidence on the effect of injectable contraception on response to antiretroviral therapy (ART). Design: Using modified Poisson regression, we assessed data from 418 female Ugandan ART initiators to examine the effect of injectable contraceptive use on a composite virologic failure outcome (defined as failure to achieve virologic suppression, switch to second line therapy, or death within 12 months of ART initiation) and also assessed ART adherence.Results: About 12% of women reported using injectable contraceptives at ART initiation, and their composite virologic failure rates 12 months later were similar to women not using injectable contraceptives at ART initiation (11% vs. 12%, p=0.99). Multivariable Poisson regression suggested no significant differences in virologic failure by injectable contraceptive use at baseline (prevalence risk ratio: 0.85, p=0.71), but power was limited. Adherence to ART increased with time since ART initiation, and did not appear to differ between injectable contraceptive users and non-users.Conclusions: Consistent with current World Health Organization guidelines, our results suggest no deleterious effect of injectablecontraceptive use on response to ART, but power was limited, injectable contraceptive use patterns over time were inconsistent and additional evidence is needed.
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Can universal insecticide-treated net campaigns achieve equity in coverage and use? The case of northern Nigeria
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Ye Y, Patton E, Kilian A, Dovey S, Eckert E. |
2012 |
English |
NIGERIA |
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Insecticide-treated nets (ITNs) are effective tools for malaria prevention and can significantly reduce severe disease and mortality due to malaria, especially among children under five in endemic areas. However, ITN coverage and use remain low and inequitable among different socio-economic groups in sub-Saharan Africa, particularly in Nigeria. Several strategies have been proposed to increase coverage and use and reduce inequity in Nigeria, including free distribution campaigns recently conducted by the Nigerian federal government. Using data from the first post-campaign survey, the authors investigated the effect of the mass free distribution campaigns in achieving equity in household ownership and use of ITNs.
Methods
A post-campaign survey was undertaken in November 2009 in northern Nigeria to assess the effect of the campaigns in addressing equity across different socio-economic groups. The survey included 987 households randomly selected from 60 clusters in Kano state. Using logistic regression and the Lorenz concentration curve and index, the authors assessed equity in ITN coverage and use.
Results
ITN ownership coverage increased from 10% before the campaigns to 70%-a more than fivefold increase. The campaigns reduced the ownership coverage gap by 75%, effectively reaching parity among wealth quintiles (Concentration index 0.02, 95% CI (-0.02 ; 0.05) versus 0.21 95%CI (0.08 ; 0.34) before the campaigns). ITN use (individuals reporting having slept under an ITN the night before the survey visit) among individuals from households owning at least one ITN, was 53.1% with no statistically significant difference between the lowest, second, third and fourth wealth quintiles and the highest wealth quintile (lowest: odds ratio (OR) 0.87, 95% confidence interval (CI) (0.67 ; 1.13); second: OR 0.85, 95% CI (0.66 ; 1.24); third: OR 1.10 95% CI (0.86 ; 1.4) and fourth OR 0.91 95% CI (0.72 ; 1.15).
Conclusion
The campaign had a significant impact by increasing ITN coverage and reducing inequity in ownership and use. Free ITN distribution campaigns should be sustained to increase equitable coverage. These campaigns should be supplemented with other ITN distribution strategies to cover newborns and replace aging nets.
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Etnicidad y Riesgo de VIH en Guatemala
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Taylor T, Hembling J, Bertrand J. |
2012 |
Spanish |
GUATEMALA |
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Los mayas y otros grupos indígenas constituyen cerca de la mitad de la población de Guatemala y las investigaciones que se han realizado anteriormente arrojan resultados evidentes sobre su alto grado de marginación con respecto a casi todos los indicadores de salud y bienestar (Gragnolati and Marini, 2003). Sin embargo, se sabe muy poco sobre el perfil de riesgo de estos grupos en cuanto al VIH y tampoco se sabe la diferencia entre dicho perfil y el de la población no indígena. La determinación de estas diferencias podría servir de base para la asignación de recursos y para mejorar las estrategias de intervención tendientes prevenir el VIH en el país.
Con el fin de describir las diferencias en una serie de variables demográficas y relativas al VIH entre grupos étnicos, se utilizaron los datos sobre 16,205 mujeres de 15 a 49 años y sobre 6,822 hombres de 15 a 59 años que participaron en la Encuesta Nacional de Salud Materno Infantil (ENSMI) de 2008-2009. Luego se controlaron factores como la edad, la educación, la riqueza y otros, usando para ello un modelo de regresión logística con el fin de investigar la conexión entre la etnicidad y las probabilidades de una iniciación sexual temprana, un mayor número de parejas sexuales, el uso del condón, las pruebas de VIH, un conocimiento a fondo sobre el VIH y las actitudes de aceptación hacia las personas que viven con VIH (PVV) entre los encuestados.
Los datos demostraron que existe un nivel bajo de comportamientos sexuales de riesgo entre las mujeres y los hombres indígenas en relación con los que prevalecen entre otros encuestados. Sin embargo, entre el grupo indígena también se pudo constatar que existe una marcada falta de concienciación sobre el VIH, una comprensión más limitada de cómo se transmite el VIH, menos conocimientos sobre su prevención y más actitudes negativas hacia las PVV. Al controlar otros factores sociodemográficos, se logró establecer una relación entre la etnicidad y la iniciación sexual temprana, 3 o más parejas sexuales a lo largo de su vida, un conocimiento comprensivo sobre el VIH, las actitudes de aceptación y las pruebas de VIH entre las mujeres. No se logró establecer una relación con el uso de un condón durante el último coito. Entre los hombres, se estableció una relación entre la etnicidad y la iniciación sexual temprana, 10 o más parejas sexuales a lo largo de su vida, un historial de ser cliente de las trabajadoras del sexo a lo largo de su vida y un conocimiento a fondo sobre el VIH. Se constató una conexión menos marcada con las probabilidades de que los hombres hayan tenido 3 o más parejas sexuales durante los últimos 12 meses, hayan utilizado un condón durante su coito más reciente y se hayan sometido a pruebas para el VIH. Entre los hombres, no se detectó ninguna relación entre la etnicidad y el uso de un condón durante su último coito con una trabajadora sexual o con su aceptación hacia las PVV.
Se llegó a la conclusión de que la población indígena en Guatemala, aunque es muy vulnerable socialmente, no parece estar en alto riesgo de contraer VIH. Se recomienda que las iniciativas de prevención se sigan centrando en las poblaciones claves que se encuentran en algo riesgo. Sin embargo, son motivo de preocupación los bajos porcentajes de pruebas para el VIH, aunados a los limitados conocimientos que existen sobre la prevención, especialmente entre los indígenas. Los programas que se llevan a cabo en las comunidades indígenas también debieran concentrarse en brindar una educación básica sobre el VIH y abordar las barreras que existen para la realización de pruebas de laboratorio. Por último, a pesar de que nuestro análisis de los factores de riesgo arroja pruebas contundentes de que la epidemia en Guatemala permanece concentrada en las poblaciones claves tradicionales, sería conveniente incorporar datos sobre biomarcadores del VIH en la próxima encuesta de salud a nivel nacional con el fin de lograr una evidencia definitiva. También se anima a aquellos investigadores que trabajan con otros conjuntos de datos sobre la salud en Guatemala para que presenten sus resultados por grupo étnico, con el fin de que los programas y las políticas puedan diseñarse tomando en cuenta las necesidades particulares de las comunidades indígenas.
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Gender and Health Data and Statistics: An Annotated Resource Guide
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Bloom SS, Arnoff E |
2012 |
English |
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Gender-responsive health data are critical for generating evidence on best practices and for advancing and informing health policies, which will improve the health of women and families. Global donors and bilateral agencies have recently expressed an urgent need for interventions, programs, and policies to address gender equality and other structural factors that influence health outcomes, particularly with the aim of improving women’s health. The demand for gender-related information in monitoring and evaluation of health programs and policies has been clearly articulated, yet several challenges related to the collection, analysis and utilization of such data persist.
The minimum requirement for a gender-based analysis is the availability of sex disaggregated health data. These data are collected in surveys and some routine health systems, such as those developed in response to the HIV pandemic. However, many routine systems do not collect sex disaggregated data, or when they are collected, they are not analyzed and reported. Even when these data are available, there is a lack of guidance and tools pertaining to conducting gender-based analysis. These analyses aim to illustrate the effects of gender-related factors on the performance of health programs and resulting effects on health status. Standardized, gender-sensitive health indicators exist in some areas, such as gender-based violence, but are lacking in general. The success of health advocates, policy-makers and other stakeholders attempting to reduce gender-based health inequities depends on ready access to quality gender-related health information.
An expert consultation, “A policy dialogue to strengthen evidence to improve women’s health through gender and health statistics,” was held in Washington DC, October 25–27 2010 to discuss these issues. The need for more gender-related health data and statistics was recognized, along with better access to existing resources. This guide is an annotated compilation of these resources, developed by MEASURE Evaluation at the request of USAID’s IGWG and the Department of Gender, Women and Health of the WHO).
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Expediente Clínico Electrónico en Colima: Estudio de Caso Sobre su Implementación
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Hernandez-Ávila JE, Palacio-Mejia LS, Lara-Esqueda A, et.al. |
2012 |
Spanish |
MEXICO |
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Este documento es el resultado del trabajo mancomunado de instituciones binacionales, de México y de Estados Unidos. El financiamiento estuvo a cargo de La Agencia para el Desarrollo Internacional de los Estados Unidos (USAID, por sus siglas en inglés) a través de MEASURE Evaluation. El diseño y el análisis fueron desarrollados por la Universidad de Tulane (Estados Unidos) y el Instituto Nacional de Salud Pública (INSP de México). El documento contiene información sobre las principales averiguaciones del proyecto: “Expediente Clínico Electrónico en Colima: Estudio de Caso Sobre su Implementación”. El objetivo principal fue proporcionar información relacionada con el diseño e implementación del Sistema de Administración del Expediente Clínico de Colima (SAECCOL). Se busca que los resultados sirvan de guía a otros estados de México y países de América Latina y El Caribe en el desarrollo o en el fortalecimiento de sus Expedientes Clínicos Electrónicos (ECE). El estudio se llevó a cabo entre agosto y noviembre de 2011.
La estrategia metodológica fue de corte cuantitativo y cualitativo. El primer componente sirvió para enmarcar el perfil sociodemográfico y epidemiológico del estado. Con el fin de conocer las percepciones de los involucrados sobre la implementación y los beneficios del ECE, se utilizó el análisis cualitativo por medio de entrevistas a profundidad y de grupos focales con directivos, técnicos operativos y usuarios del SAECCOL, en el ámbito local y federal.
EL SAECCOL es un instrumento de diseño consensuado entre diversos actores estatales (médicos, expertos en informática, directivos del sistema de salud del estado y asesores de distintos perfiles profesionales), ajustado a las necesidades particulares del estado y a los lineamientos nacionales e internacionales en la materia. El ECE se encuentra actualmente en proceso de implementación y actualización; está contemplado en el Plan Estatal de Desarrollo 2009-20154, lo que garantiza el presupuesto y continuidad del proyecto. Poco más de 70% de las unidades de salud han implementado el instrumento por lo que se espera que al final de 2011 alcance una cobertura de 99%.
Uno de los mayores beneficios del ECE es que ha sido una herramienta “hecha en casa” que se ha ido amoldando a los nuevos requerimientos y a las necesidades de los usuarios. Los participantes en el proyecto consideraron que aún existen múltiples retos por abordar como por ejemplo: ajustarlo a la normatividad vigente; lograr la interoperabilidad entre unidades de salud y niveles de atención; garantizar su infraestructura y apoyo para el mantenimiento, y mejoramiento de la información; estandarización de los procesos, la calidad y la eficiencia de los servicios de salud en general, así como el uso de la información para beneficio de todos los usuarios.
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Electronic Health Records in Colima, Mexico: Case Study on Design and Implementation
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Hernandez-Ávila JE, Palacio-Mejia LS, Lara-Esqueda A, et.al. |
2012 |
English |
MEXICO |
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This document is the result of the joint efforts of bi-national institutions of the United States and Mexico. The U.S. Agency for International Development (USAID) provided funding for the project through the MEASURE Evaluation project. Tulane University (United States) and the National Public Health Institute (INSP, in Mexico) developed the design and analysis. The document contains information on the main findings of the project, Electronic Health Records Management System in Colima: Case Study on Implementation. The main objective was to provide information related to the design and implementation of the Management of the Electronic Health Record in Colima (SAECCOL, in Spanish). The results are intended to serve as a guide for other states in Mexico, and other countries in Latin America and the Caribbean, to develop and strengthen their Electronic Health Records (EHR). The study was conducted between August and November 2011.
The methodology used was both quantitative and qualitative in nature. The quantitative aspect was used to define the state’s socio-economic and epidemiological profile. To learn about stakeholders’ perceptions of implementation and benefits, qualitative analysis was conducted, using in-depth interviews and focus groups of SAECCOL’s managers, technicians, operators and users, at a local and federal level.
The SAECCOL is a system agreed upon among various state actors (doctors, information technology experts, managers and consultants of the state’s health department, and other area professionals), adjusted to the needs of the state through national and international guidelines. The EHR is currently being updated and expanded according to the State Development Plan 2009–2015, which guarantees the budget and the continuity of the project. The use of the tool has fluctuated since it was implemented but it was expected that 99% coverage would be reached by the end of 2011.
One of the greatest benefits of the EHR is that it is a “homemade” tool molded to the requirements and demands of users. Project participants felt that were are still many challenges to address including a need to: adapt the system to current regulations, achieve interoperability among health units at different levels of care, ensure proper availability of infrastructure and support to improve data quality, to standardize processes, ensure the quality and efficiency of health services in general, and promote the use of information for the benefit of all users.
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Fact Sheet: Community Health Information System in Action in SNNPR
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2012 |
English |
ETHIOPIA |
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Aragash Worku has been a Health Extension Worker (HEW) at Dobena-Bati Health Post in Ethiopia for the last seven years. Zulfah Jemal is the other HEW working with her in the same Health Post. This fact sheet describes the success they have had using the Family Folder, a robust, simplified, and standardized health management information system.
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The Child Status Index Usage Assessment
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Cannon M, Snyder E |
2012 |
English |
CAMBODIA, COTE D'IVOIRE, ETHIOPIA, HONDURAS, INDIA, KENYA, MALAWI, NIGERIA, RWANDA, TANZANIA, UGANDA, ZAMBIA, ZIMBABWE, Africa, Asia |
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The Child Status Index (CSI), created in 2008, is a tool used by community caregivers to capture children’s status across the six domains of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) programs for children who are orphaned and made vulnerable by HIV/AIDS: food and nutrition; shelter and care; child protection; health; psychosocial; and education and skills training. In 2011, MEASURE Evaluation conducted in-depth telephone interviews with program technical leads among large programs implementing the CSI. A total of 25 organizations in 13 countries were represented in these interviews. Participants were asked about materials created to complement the CSI, such as presentations, manuals, training materials, new or additional tools linked to child well-being measurement, and other language translations of the CSI. In light of the findings from this qualitative study, recommendations are provided.
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Modeling Climate Change, Food Security, and Population
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Moreland S, Smith E |
2012 |
English |
ETHIOPIA |
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We developed a computer simulation model to help clarify the dynamic relationships between climate change, food security, and population growth. The aim was to develop a model that would be simple enough to adapt to a country and that could be used at the policy level to introduce population issues into the dialogue on adaptation to climate change in the context of food security. The resulting model links a population projection, a sophisticated economic model that takes account of the effects of climate change on agriculture, and a food requirements model that uses Food and Agricultural Organization formulas. The model was tested and piloted in Ethiopia. The Ethiopia pilot demonstrated the usefulness of this model in quantifying the contribution of family planning in adapting to potential climate change-induced food security challenges. The model shows that the food security gap in Ethiopia is expected to be greater with climate change than the food security gap without climate change. The model also shows the potential of family planning to address this gap; the food security gap under an assumption of low population growth and climate change is lower compared to the gap with climate change and high population growth. In fact, by the year 2050 the model estimates that slower population growth will compensate completely for the effects of climate change on food insecurity. We conclude that the model can serve as a starting point for a dialogue about the importance of taking into account population factors when adapting to climate change with regard to food security. While technological interventions on the supply side will surely be vital in adapting to climate change and achieving food security, addressing the demand side via population can also contribute to efforts to enhance food security in the face of climate change.
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Caring for the caregiver: evaluation of support groups for guardians of orphans and vulnerable children in Kenya
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Thurman TR, Jarabi B, Rice J |
2012 |
English |
Africa, KENYA |
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HIV and AIDS have altered the context in which millions of children in sub-Saharan Africa are raised. Many are under the care of a widowed or ill parent, and others are residing with their extended family. Caregivers of orphans and other vulnerable children (OVC) face a variety of stressors that may adversely affect children. This study explores potential benefits of caregivers' membership in support groups on their own psychosocial well-being, and on the treatment and psychosocial well-being of OVC aged 8-14 under their care. A post-test study design comparing members and non-members was applied, drawing upon random samples of current and prospective beneficiaries from a rural community in Kenya. With up to two children per caregiver eligible for study inclusion, the sample comprised 766 caregivers and 1028 children. Three-quarters of children had lost at least one parent. Nearly 90% were cared for by a female, often their natural mother or grandmother. Half of the caregivers were widowed and one-fifth had a chronic illness. Over one-third of caregivers were members of support groups, more commonly female caregivers. Regression analyses assessed the effect of support group membership after controlling for household, caregiver and child characteristics. Members reported less social marginalization, better family functioning and more positive feelings towards the children in their care than non-members. Children with caregivers in support groups exhibited fewer behavioral problems, higher rates of pro-social behavior and reported lower incidence of abuse from adults in their household. The psychological state of caregivers, however, was not associated with support group membership. Results underscore that quality care of vulnerable children hinges on interventions that address the psychosocial challenges facing their caregivers.
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Service delivery characteristics associated with contraceptive use among youth clients in integrated voluntary counseling and HIV testing clinics in Kenya
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Baumgartner JN, Otieno-Masaba R, Weaver MA, Grey TW, Reynolds HW |
2012 |
English |
KENYA, Africa |
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Youth attending voluntary counseling and HIV testing (VCT) services often have unmet need for contraception. Integrated family planning (FP) and HIV services can address dual HIV and unintended pregnancy prevention needs. However, little is known about which VCT service characteristics, such as quality of care, strength of FP-HIV service integration, and youth-friendliness, affect contraceptive behavior. This study explores the facility- and provider-level characteristics that may be associated with same day uptake or intention to use contraception after a VCT visit, and contraceptive use three months later among youth clients, controlling for client characteristics. This was a descriptive study conducted in 20 integrated VCT clinics across Kenya. Data collection included 20 structured clinic observations, 349 baseline interviews with male and female clients aged 15–24 after their VCT visit plus 277 follow-up interviews with clients three months later, and interviews with 46 providers who served the clients at the study clinics. Client, provider, and structured observation data were linked and multi-level logistic path models were used for analyses. Results revealed little evidence of specific service characteristics being associated with contraceptive behavior. However, VCT providers were not routinely screening for risk of unintended pregnancy or counseling on contraception. Results are likely a reflection of suboptimal integrated services. The clinics were serving youth with unmet contraceptive need and therefore integrated services should be strengthened overall to ensure no missed opportunities.
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Mortality in Mozambique: Results from a 2007–2008 Post-Census Mortality Survey
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2012 |
English |
MOZAMBIQUE |
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As it entered the second millennium, Mozambique lacked comprehensive estimates of mortality as well as its causes. Although several potential sources of such information existed, each had limitations and weaknesses. Given the lack of comprehensive information, Mozambique was unable to determine levels of mortality, its causes, or the regions and demographic characteristics exhibiting the highest mortality. In response to this critical data gap, the government of Mozambique decided to implement a post-census mortality survey—the Inquérito Sobre Causas de Mortalidade (INCAM)—in conjunction with the 2007 population census. The National Institute of Statistics, in collaboration with the Ministry of Health, implemented INCAM between 2007 and 2008. The INCAM sample was designed to be representative at the national, provincial, as well as urban and rural levels and to yield cause-of-death estimates consistent with the international classification system (ICD-10) developed by the World Health Organization (WHO).
This report presents key findings from INCAM regarding leading causes of death by basic demographic characteristics, including area of residence, age group, sex and other characteristics, such as the use of health services prior to death.
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Improving Access to Family Planning Can Promote Food Security in a Changing Climate
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2012 |
English |
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A growing body of evidence indicates that climate change is decreasing the productivity of many crops around the world, thus exacerbating existing food security challenges. Ensuring sufficient food for a growing world population in the context of climate change will require innovative technologies and strategies to boost agricultural yields and improve access to nutritious foods for the world’s poorest people. New research in Ethiopia demonstrates that slower population growth, achievable by addressing women’s existing needs for family planning, can also play a significant role in promoting future food security in a climate-altered world. Researchers combined three models to demonstrate that the lower fertility rates that would result from greater use of family planning can help to promote food security in two important ways: by slowing population growth, thereby easing demand on strained agricultural systems; and by altering population composition in ways that can enable improved nutritional outcomes among children under five—a group that is highly vulnerable to food insecurity.
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PRISM Tools User Guide
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Aqil A, Lippeveld T, Moussa T, Barry A |
2012 |
English |
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Performance of Routine Information System Management (PRISM) is a conceptual framework for strengthening routine health information systems (RHIS) through better data quality and improved information use. PRISM broadens the analysis of RHIS performance to include three key categories of determinants that affect performance: behavioral (the knowledge, skills, attitudes, values, and motivation of the people who collect and use data); technical (the data collection forms, processes, systems, and methods); and organizational (the information culture, structure, resources, and roles and responsibilities of key contributors at each level of the health system). This guide is intended for professionals who want to design, assess, strengthen, and evaluate RHIS performance at the national and sub‐national levels.
The 2018 version of the PRISM Series, updated and with new modules (Toolkit, User’s Kit, and Training Kit) is available here: https://www.measureevaluation.org/prism |
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FACT SHEET: HIV Care Networks: Integration and Health Outcomes in Ethiopia
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2012 |
English |
ETHIOPIA |
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A potential tool to guide improvements in service integration is organizational network analysis. Organizational network analysis is an innovative and accessible approach to understanding relationships among actors in health care provision. The approach can provide information about the extent to which organizations share information and resources or refer clients. Results can help actors make better use of available resources to benefit clients.
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The measurement of condom use in four countries in east and southern Africa
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Reynolds HW, Luseno WK, Speizer IS |
2012 |
English |
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Measurement of condom use is important to assess progress in increasing use. Since 2003, the Demographic and Health Surveys (DHS) and AIDS Indicator Surveys (AIS) have included new measures of self-reported condom use. We use data from Namibia, Swaziland, Tanzania, and Zambia to compare measures of condom use accounting for type of sexual partner. Condom use at last sex ranged from 20% in Tanzania to 57% in Namibia for men, and from 12% in Tanzania to 41% in Namibia for women. Reported condom use was lower in response to questions about condom use every time with last partner (from 13 to 47% for men and from 8 to 33% for women). Condom use was highest among people with two or more partners in the last year and lowest with marital partners. Overall, the prevalence of condom use was low, and there was wide variability across the various measures, countries, sexes, and types of partner. Promotion of condom use in all partnerships, but especially in non-marital relationships and among individuals with multiple partners, remains a critical strategy. New condom use questions in the DHS and AIS expand options for measuring and studying condom use.
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How Can Routine Health Information Systems Improve Health Systems Functioning in Low-Resource Settings? Assessing the Evidence Base
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Hotchkiss D, Diana M, and Foreit K |
2012 |
English |
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Health system strengthening depends on production and use of quality health data and information at all levels of the health system. Routine health information systems (RHIS) are receiving increasing attention as a sustainable strategy towards country-owned, integrated national systems that reduce reliance on parallel, vertical systems. To guide investment decisions on RHIS strengthening, evidence is needed on which types of strategies work and which do not. This paper reviews the literature on the evaluation of RHIS interventions in low- and middle-income countries, on the premise that investments in RHIS could produce greater benefits than they currently do. The paper describes the conceptual literature on the determinants of RHIS performance and its role in improving health systems functioning and performance at the local level, discusses the evidence base on the effectiveness of strategies to improve RHIS performance, provides an overview of RHIS evaluation challenges, and makes suggestions to improve the evidence base that can be used to help ensure that (a) RHIS interventions are appropriately designed and implemented to improve health systems functioning and (b) resulting RHIS information is used more effectively.
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The importance of HIV prevention messaging for orphaned youth in Zimbabwe
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Haney E, Singh K |
2012 |
English |
ZIMBABWE |
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The AIDS epidemic has contributed to a drastic increase in the number of orphans in Zimbabwe. Female adolescent orphans are particularly in jeopardy of contracting HIV due to disadvantages including extreme poverty, low education, and the absent of parental oversight which can lead to higher risk-taking sexual behaviors. By understanding where girls receive education about HIV and who they rely on for information, organizations can effectively modify existing programs to better target this at-risk population. For this study a household survey was conducted which included 216 orphans and 324 non-orphans (n=540), aged 12–17 years, in the resource-poor setting of Hwange District, Zimbabwe. The aims of this article were to examine the differences between orphans and non-orphans in HIV prevention message exposure, level of motivation for learning about HIV, and communication with caregivers about safe sex. The household survey revealed that younger orphans, aged 12–15 years, were more motivated to learn about HIV and had greater HIV messaging exposure in school than non-orphans. These exposure and differences in the levels of motivation between groups dissipated at older ages. Our research also discovered less caregiver communication among orphans than non-orphans. Our findings suggest that HIV programs targeting orphans need to do a better job at keeping older orphans interested in HIV prevention at a time when it matters most. Furthermore, intervention strategies that provide caregiver support are instrumental in effectively delivering prevention messages to girls at home.
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Fact Sheet: Program Implementation Brief: Jamaica
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2012 |
English |
JAMAICA |
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In 2010, the USAID Mission in Jamaica requested that MEASURE Evaluation provide technical assistance to the National HIV/STI Program (NHP) to support the goals of the National HIV M&E; Plan (2007–2012). Specifically, MEASURE Evaluation was tasked with strengthening the monitoring and evaluation (M&E;) of most-at-risk populations (MARPs); building the M&E; capacity of program implementers to monitor the implementation of their activities; evaluate processes, outputs and outcomes; and use existing data for program decisions; and strengthening the existing M&E; systems, specifically the analysis of treatment data and facilitate the prioritization of research questions. |
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Improving Demand for and Use of Data Strengthens HIV/AIDS Programs in Rwanda
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2012 |
English |
RWANDA |
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In an effort to develop a multi-sectoral approach to reducing the spread of HIV in Rwanda, the government committed to strengthening systems to ensure data-informed decision making. This case study describes the approach used to strengthen data demand and use (DDU or DDIU) and outlines the best practices for promoting and institutionalizing data-informed decision making. The government worked through national agencies and various development partners ‑ the National AIDS Control Commission (CNLS); the Ministry of Health; the Center for Treatment and Research on AIDS, Malaria, Tuberculosis, and Other Epidemics (TRAC Plus); and with development partners, including MEASURE Evaluation and the Joint United Nations Programme on HIV/AIDS (UNAIDS).
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Nigeria Health and Mapping Summit 2011: Enlisting National Mapping Agencies in Improving Health Outcomes
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2012 |
English |
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The Federal Government of Nigeria collaborated with MEASURE Evaluation, which is funded by the U.S. Agency for International Development, to organize the Nigeria Health and Mapping Summit 2011: Enlisting National Mapping Agencies in Improving Health Outcomes. This report is a summary of the conference, which took place at the Reiz Continental Hotel in Abuja October 18-19, 2011. The conference was the first of its kind at the country level in Africa, as it marked the first time government representatives from the health and mapping sectors had met on such inter-ministerial or agency levels to harmonize national efforts to improve health outcomes through more effective leveraging of the National Geospatial Data Infrastructure (NGDI), also known as National Spatial Data Infrastructure or NSDI. The conference also represents a continuation of health and mapping sector collaboration that was launched in April 2009 at the Committee on Development Information, Science and Technology (CODIST) I pre-conference workshop in Addis Ababa, Ethiopia.
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Operational Guidelines for Monitoring and Evaluation of HIV Programmes for Sex Workers, Men Who Have Sex with Men, and Transgender People - Volume I National and Sub-National Levels
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Weir S, et al |
2012 |
English |
Africa, Asia, Latin America and the Caribbean |
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These Guidelines address the unique monitoring and evaluation needs of settings where HIV affects men who have sex with men, sex workers, and transgender people. They apply to countries with low-level, concentrated, and generalized HIV epidemics. The Guidelines assume three levels of monitoring and evaluation that require coordination – at national, sub-national and service delivery levels.
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Regional Initiative Health Information Systems Strengthening: Latin America and Caribbean: 2005-2010
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Plaza B, Giusti A, Palacio LS, Torres N, Reyes N |
2012 |
English |
Latin America and the Caribbean |
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The original Spanish version is available at http://www.relacsis.org
Latin America and the Caribbean (LAC) is a large and diverse region, ranging from tropical to polar climates, which includes over 20 countries with 560 million people, speaking mostly Spanish and Portuguese.
Within this spectrum, Health Information Systems have performed inadequately because, among other things, there is less emphasis on improving data quality and continuous use of information; too little use of performance improvement tools, more emphasis on use of information technology for improving performance rather than looking at why staff cannot remain motivated or retain the skills learned; and less emphasis on empowerment and decision-making.
There is also insufficient promotion of a culture of information by senior management, lack of dissemination of success stories on data use and a lack of role models or champions of data use. Coupled with the issues mentioned above, the traditionally disjointed and unstructured activities among donor agencies to strengthen HIS in the LAC Region have contributed to poor performance.
MEASURE Evaluation has been strategically collaborating with the Pan-American Health Organization (PAHO) with financial support from the USAID–LAC Bureau since 2004. This partnership has yielded precise and tangible results including the documentation and dissemination of best practices, provision of technical assistance to use Health Metrics Network (HMN) Framework and Tools and technical support in the use of Performance of Routine Information System Management (PRISM) framework and tools. The objective of the regional health information systems activity is (broadly) to encourage “low tech” improvements to routine health information systems in LAC. For example – rather than focusing on expensive high tech solutions to health information needs – we want countries to focus first on how information flows, how it is coordinated etc. so that policy makers at all levels of the health system can make use of that information.
Furthermore, the collaboration between MEASURE Evaluation and PAHO and the associated results has attracted new partners which have widened the scope of technical expertise available to countries of focus and also extended the technical assistance for HIS assessment and strengthening provided under the previous collaboration with new countries. |
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Addressing Poverty: A Guide for Considering Poverty-Related and Other Inequities in Health
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Foreit K |
2012 |
English |
Global |
Public Health, Poverty |
Taken as a whole, this guide covers the spectrum from priority-setting to monitoring and evaluation (M&E). Each chapter can also be used as a self-contained module, depending where a particular Mission is in its planning cycle. For example, Missions that are mid-course in priority programs may wish to refine their M&E plans to include inequity issues (Chapter 4). Missions that are planning new initiatives with NGO partners may find it useful to deepen their understanding of the local situation before selecting one or another intervention to pilot test (Chapters 2 & 3). Missions that are undertaking a portfolio review may wish to explore linkages and synergies between Health/Investing in People and other program areas (Chapters 1 & 2). Depending on the local situation, Missions may benefit from specific technical assistance for analysis, program design, and/or M&E. |
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Compilation CD: MEASURE Evaluation Publications Phase I-III
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|
2012 |
English |
Global |
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A digital collection of MEASURE Evaluation Publications Phase I-III on dvd. Most are in PDF format; some are HTML files. For the most current publications available please visit the publications page on the MEASURE Evaluation website: http://www.cpc.unc.edu/measure/resources/publications |
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MEASURE Evaluation Excel to Google Earth (E2G) 3.0 Tutorial
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|
2011, revised 2014 |
English |
|
GIS |
This document contains the tutorial for the MEASURE Evaluation Microsoft Excel to Google Earth (E2G) mapping tool. |
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Estimating Expenditure-Based Poverty from the Bangladesh Demographic and Health Survey
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Schreiner, M |
2011 |
English |
BANGLADESH |
|
It is widely believed that inequalities in health are related with poverty but formal analysis of the health-poverty nexus is hampered by data constraints. In particular, the most common measure of poverty compares expenditure with poverty lines, but expenditure surveys usually do not collect detailed health data. Conversely, the large repository of internationally comparable Demographic and Health Surveys has detailed health data but no expenditure data. This has led DHS researchers to control socio-economic status using an asset index defined in terms of housing characteristics and ownership of durable goods. While this may be a valid conception of poverty, it is difficult to compare the asset-based measure with the more common consumption based measure. This paper presents a simple poverty scorecard for Bangladesh that allows researchers to estimate the likelihood that expenditure is below a given poverty line using ten verifiable, inexpensive-to-collect indicators found in both Bangladesh’s 2004 DHS and also in the 2005 Household Income and Expenditure Survey. The estimates of poverty from the scorecard are then compared with those of the DHS asset index. |
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Barriers to Adoption of Family Planning among Women in Eastern Democratic Republic of Congo
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Mathe JK, Kasonia KK, Maliro AK |
2011 |
English |
CONGO, THE DEMOCRATIC REPUBLIC OF THE |
|
The objectives of this survey were to identify women's level of knowledge, attitudes and practices (KAP) toward family planning (FP); identify possible barriers to using FP; determine pregnancy spacing pattern; and ascertain the level of FP promotion by health workers. This was a 2-weeks cross-sectional survey at all maternity units in Butembo of postpartum women. 572 women were interviewed. FP knowledge was high (76%), perception good (80%). Majority used traditional methods (65%), mostly Calendar method (72%). Barriers to using modern FP included lack of knowledge, fear of side effects, religious considerations and husband opposition. Unmet need for spacing and limiting was high (21 & 31%). For majority (56%), pregnancy spacing met WHO's Healthy Timing and Spacing of Pregnancy recommendations. Promotion of FP was poor (42%). Training of health workers, advocating modern contraception, improving FP services in all public health facilities and promoting FP on each contact of women is highly recommended in this city. |
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Barriers to referral in Swaziland: perceptions from providers and clients of a system under stress
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Macintyre K, Littrell M, Hotchkiss D, Mndzebele S, Nkambule R, Malima B, Gumbi S, Dhlamini T, Brown L, and Kemerer V |
2011 |
English |
SWAZILAND |
|
In Swaziland, where one in four adults is HIV positive, identifying and addressing barriers to a strong referral system is critical to ensure continuity of care for HIV-positive individuals. This study examines the referral system from the perspectives of health providers, community health workers, traditional healers, clients seeking facility-based care, and managers of private health organizations. Structured and semi-structured questionnaires were administered to 52 senior providers, 161 providers, and 307 clients in 52 health facilities. In 82 randomly selected communities, 81 traditional healers and 247 community health workers also participated. Staff from private health agencies providing HIV-related care were also interviewed.
Referral is commonly understood as sending clients to seek care at higher-level facilities and is an individualized process dependent on various factors. Providers sending clients rarely hear back on any regular basis about those clients. Referrals and linkages for certain services, including nutrition support, psychosocial support, palliative care and home-based care, are particularly weak. Many providers recommended that referral protocols with improved communication tools are needed and said referred clients should be given priority at referral-receiving sites. Policy recommendations include: referral form redesign; formalizing or reforming the referral protocol; strengthening communication and linkages between community- and facility-based providers; and improving patient flow at referral sites.
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Fact Sheet: HMIS Scale-Up in Ethiopia
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|
2011 |
English |
ETHIOPIA |
|
The Health Management Information System and Monitoring and Evaluation (HMIS/M&E) strategy is one of the pivotal components of the Health Sector Development Program (HSDP) of the Federal Ministry of Health (FMOH). The FMOH adopted a “One Plan, One Report & One Budget” policy with the aim of improving management and optimum use of resources for making timely decisions as HMIS/M&E is a core component of effective health care delivery.
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Bangladesh District Level Socio-demographic and Health Care Utilization Indicators
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MEASURE Evaluation, ICDDR,B |
2011 |
English |
BANGLADESH |
|
|
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Operational Guidelines for Monitoring and Evaluation of HIV Programmes for Sex Workers, Men who have Sex with Men, and Transgender People - Volume II for Service Delivery Providers
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Weir S, et al |
2011 |
English |
Africa, Asia, Latin America and the Caribbean |
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These Guidelines address the unique monitoring and evaluation needs of settings where HIV affects men who have sex with men, sex workers, and transgender people. They apply to countries with low-level, concentrated, and generalized HIV epidemics. The Guidelines assume three levels of monitoring and evaluation that require coordination – at national, sub-national and service delivery levels. |
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Evaluation Externe du Plan Decennal de Developpment Sanitaire et Social 1998-2007
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2011 |
French |
MALI |
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Le Plan Décennal de Développement Sanitaire et Social (PDDSS) pour la période 1998–2007 est issu des politiques de santé et de population (1990) et de solidarité pour la lutte contre l’exclusion et la marginalisation (1993). Le PDDSS a été mis en oeuvre à travers le Programme de Développement Sanitaire et Social (PRODESS) au cours de trois phases distinctes: le PRODESS I (1998–2002), le PRODESS II (2005–2009) et le PRODESS Prolongé (2009–2011). L‘évaluation du PRODESS avait les objectifs suivants:
–2007 est issu des politiques de santé et de population (1990) et de solidarité pour la lutte contre l’exclusion et la marginalisation (1993). Le PDDSS a été mis en oeuvre à travers le Programme de Développement Sanitaire et Social (PRODESS) au cours de trois phases distinctes: le PRODESS I (1998–2002), le PRODESS II (2005–2009) et le PRODESS Prolongé (2009–2011). L‘évaluation du PRODESS avait les objectifs suivants:
Décrire et analyser les résultats obtenus au regard des cibles des indicateurs de suivi, de manière globale et pour chacune des composantes de santé et de développement social;
Poser un diagnostic du système de santé, selon les six piliers définis par l’OMS;
Evaluer la mise en oeuvre des réformes institutionnelles effectuées analyser leur influence sur les résultats produits par le PDDSS;
Identifier les principaux goulots d’étranglement, les difficultés et contraintes rencontrés aux différents niveaux de la pyramide sanitaire et social dans la mise en oeuvre des composantes du PDDSS;
Evaluer la cohérence des différents volets du PRODESS et des plans stratégiques qui ont été conçus pour l’accompagner;
Analyser l’impact de l´interaction entre les deux départements en charge du PRODESS selon les effets observés.
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Здоровье женщин России: Российский мониторинг экономического положения и здоровья населения НИУ«Высшая школа экономики», 2010
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Barden-O’Fallon J, Reynolds Z, Speizer IS |
2011 |
Russian |
RUSSIAN FEDERATION |
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Российский мониторинг экономического положения и здоровья населения Национального исследовательского университета «Высшая школа экономики» (RLMS-HSE), представляет собой серию общенациональных репрезентативных обследований. Целью мониторинга является изучение влияния российских реформ на здоровье и благосостояние домохозяйств и отдельных жителей Российской Федерации. При подготовке данного отчѐта использовались данные дополнительного модуля «Планирование семьи и репродуктивное здоровье» (СП/РЗ) 19-й волны RLMS-HSE, полученные в октябре-ноябре 2010 г. Включение модуля СП/РЗ в 19-ую волну обследования RLMS-HSE стало возможным благодаря финансовой поддержке Агентства США по международному развитию. Для того, чтобы обеспечить сопоставимость представленных результатов, данные всех волн были взвешены.
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Methods for Estimating the Costs of Family Planning: Report of the Expert Group Meeting on Family Planning Costing
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Moreland S |
2011 |
English |
|
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This report is a summary of an expert meeting held in June 2011 to discuss issues related to methods of estimating family planning program costs. Such estimates have been used by government officials to plan national and subnational budgets, by nongovernmental organizations and donors to determine levels of donor support at all levels, and for advocacy purposes at all levels to highlight shortfalls in funding or to put family planning program costs into perspective for various audiences. The report examines a variety of models and studies that represent this range of audiences and purposes.
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An Overview of Spatial Data Protocols for HIV/AIDS Activities: Why and How to Include the “Where” in Your Data
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|
2011 |
English |
|
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This guide focuses on data and how to use geography to facilitate linkages among data. It presents an overview of the ways to structure HIV activities data to take maximum advantage of existing geographic data, or to facilitate future inclusion of the geographic context of data being gathered. Data with a geographic component are particularly well-suited to support monitoring and evaluation efforts and evidence-based decision making within HIV prevention, treatment, and care activities. The use of geospatial technologies in the health care context has been hampered by limitations that often exist with the data. This document seeks to address some of these limitations by presenting key concepts involved in the collection and use of spatially referenced data.
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The Influence of Child Marriage on Fertility, Fertility-Control, and Maternal Health Care Utilization: A Multi-country Study from South Asia
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Godha D, Hotchkiss D, Gage A |
2011 |
English |
NEPAL, PAKISTAN, BANGLADESH, INDIA |
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Although substantial progress has been made in reducing the prevalence of child marriage (marriage before the age of 18 years), it remains a pervasive problem in South Asia and sub-Saharan Africa, with female children being disproportionately at risk. Despite the pervasiveness of child marriage and its potentially adverse consequences on reproductive health outcomes, there is relatively little empirical evidence available on this issue, which has hindered efforts to improve the targeting of adolescent health programs. The purpose of this study is to assess the influence of child marriage on fertility, fertility-control, and maternal health care utilization in four South Asian countries ― India, Bangladesh, Nepal, and Pakistan ― after controlling for other individual-, household-, and community-level factors. Data for the study come from the most recent Demographic and Health Surveys conducted in the study countries. Descriptive and multivariate methods are used to assess whether child marriage is associated with fertility, fertility control, and maternal health outcomes among women 20-24 years of age and whether these associations are statistically significant across countries. The results of this study provide strong evidence that, in the South Asian context, child marriage is significantly associated with many negative outcomes of fertility and fertility control, as well as maternal health care utilization. Furthermore, women who married in early adolescence and childhood show a higher propensity towards most of the negative health outcomes as compared to women who married in middle adolescence. The study concludes that child marriage adds a layer of vulnerability to women that leads to poor fertility control and fertility related outcomes, and maternal care utilization. It is imperative that laws against child marriage be strictly reinforced and that reproductive health programs be developed to reach these women better.
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Influence of the Service Delivery Environment on Family Planning Outcomes in Nigeria
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Gage AJ, Zomahoun D |
2011 |
English |
NIGERIA |
|
Using linked data from the 2009 Community Participation for Action in the Social Sectors project health facility and household surveys, this paper examined the association of the family planning service delivery environment with contraceptive outcomes among males and females in five states of Nigeria. Multilevel logit models were used to assess the association with contraceptive outcomes of method choice, health worker training, equipment availability, quality of provider-client interaction, use of quality assurance methods, and perceived needs in local family planning health facilities. The findings showed a strong positive association of the availability of an increased range of contraceptive methods and the use of quality assurance systems by family planning health facilities in the local government area (LGA) with odds of knowing three or more modern methods of contraception. The breadth of health worker training to provide family planning services had a positive association while a perceived need for staff by family planning providers in the LGA had a negative association with the odds of both lifetime use and current use of a modern method. The quality of family planning provider-client interaction in the LGA was positively associated with current use of a modern method. In LGAs with higher quality family planning provider-client interaction, the odds of ever using and the odds of currently using a modern method were significantly higher for women than for men. To increase knowledge of modern contraception, programs should target LGAs that provide a limited range of contraceptive methods and that use few quality assurance mechanisms. Efforts to increase modern contraceptive use should reach LGAs with staff shortages, low quality of provider-client interaction, and a limited scope of in-service training on the delivery of family planning and reproductive health services.
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Effect of Hormonal Contraceptive Use on Virologic Response to Antiretroviral Therapy among Women in Rakai, Uganda
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Polis CB, Nakigozi G, Ssempijja V, Makumbi FE, Boaz I, Reynolds SJ, Ndyanabo A, Lutalo T, Wawer MJ, Gray RH |
2011 |
English |
UGANDA |
|
An updated version of this paper is available online at the international reproductive health journal Contraception at the link provided below.
Objective: Effective contraceptive counseling for HIV-infected women on antiretroviral therapy (ART) is complicated by the fact that little is known about potential interactions between hormonal contraception (HC) and ART, which share common hepatic metabolic pathways. In theory, these drugs may interact to decrease ART efficacy, decrease HC efficacy, or increase side effects. Decreased ARV drug levels could lead to drug resistance, treatment failure, and potentially increased mortality. In addition, regimen complexity or pill burden may contribute to non-adherence of either ART or HC regimens, and could thus lower efficacy of either regimen. Our objective was to strengthen the evidence base regarding the effect of HC on virologic response to ART among HIV+ women in Rakai, Uganda.
Design: Retrospective analysis of clinical and questionnaire data from 433 Ugandan women initiating ART.
Methods: Using a modified Poisson regression model, we assessed the effect of HC on failure to suppress viral load at 12 months after ART initiation or ART regimen change or death within one year of ART initiation among sexually active women in Rakai, Uganda. We also assessed whether HC use was associated with poorer adherence to ART.
Results: We did not find that HC use was associated with increased risk of failure, nor did we find that HC use was associated with poorer adherence to ART.
Conclusions: Our results are consistent with current WHO recommendations for HC use among HIV+ women on ART.
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What differentiates method stoppers from switchers? Contraceptive discontinuation and switching among Honduran women
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Barden-O’Fallon J, Speizer I |
2011 |
English |
HONDURAS |
|
CONTEXT: Contraceptive discontinuation contributes to unplanned pregnancy and unwanted births, as well as increased maternal, neonatal and infant morbidity and mortality. Information on differences between women who stop using contraceptives and those who switch to another method would be useful for programs aimed at preventing unplanned pregnancies and their consequences.
METHODS: Data come from two rounds of interviews with women aged 15–44 (800 interviewed at baseline and 671 reinterviewed one year later) who were new or continuing users of injectable or oral contraceptives or an IUD. Bivariate analysis examined associations between attitudes and behaviors of women who discontinued their baseline method and side effects they experienced. Multivariate logistic regression assessed differences between women who switched methods immediately or within one month of discontinuation and those who stopped contraceptive use for one month or more.
RESULTS: Of the 671 women who were reinterviewed, 41% (273) discontinued use of their baseline contraceptive method within the one-year follow-up; of those, 43% (117) switched to a new method, and 57% (156) stopped for one month or more. Seeking help with side effects from a health worker, urban residence, talking to a partner about the decision to discontinue, and new and recent method adoption were associated with increased odds of switching methods (odds ratios, 2.0–3.5).
CONCLUSION: Access to high-quality family planning services and encouraging discussion with partners and families before stopping contraceptive use is important for women who experience side effects from contraceptive methods and are at risk of discontinuation.
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Evidence of high-risk sexual behaviors among injection drug users in the Kenya PLACE study
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Brodish P, Singh K, Rinyuri A, Njeru C, Kingola N, Mureithi P, Sambisa W, Weir S |
2011 |
English |
East Africa, Africa, KENYA |
|
BACKGROUND:
Injection drug users (IDUs) in resource poor settings are at high risk for HIV transmission through unsafe needle-sharing and sexual practices. We report on the injecting and sexual behavior of a sample of IDUs from Malindi, Kenya.
METHODS:
A Priority for Local AIDS Control Efforts (PLACE) study was conducted from April to May 2010 to identify areas where HIV transmission is most likely to occur and specific venues where people meet new sexual partners. Community informants (n=202) listed 157 unique venues from which 29 were randomly selected using a systematic fixed interval sampling strategy with probability of selection proportional to venue size. Twenty patrons and four workers were interviewed at each venue. Drug use practices were elicited in a staff-administered interview.
RESULTS:
Between 40% and 50% of IDUs reported needle-sharing, taking drugs from a common reservoir, using a ready-made solution without boiling, and not exchanging a used for a new syringe in the past month. Most could inconsistently or never get new syringes. In multivariate logistic regression models controlling for age, education, residence, and poverty status, IDUs were twice as likely as non-IDUs to report multiple partners in the past year (OR 1.94, 95% CI 1.26-3.00, p<.01) and multiple new partners in the past year (OR 2.11, 95% CI 1.30-3.42, p<.01).
CONCLUSIONS:
High prevalence of multiple sexual partnerships and risky injecting behaviors among IDUs and unavailability of new injecting needles are likely facilitating HIV transmission in Malindi, Kenya.
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A new approach to large-scale effectiveness evaluation
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Spencer J, Pill C, Curtis S, Kunyanga E |
2011 |
English |
Global |
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We endorse the view of Cesar Victora and colleagues (Jan 1, 2011, p 85, The Lancet) that traditional evaluation designs are limited in today's complex global health environment. The national evaluation platform approach proposed will require the linking of multiple data sources at the district level to permit analysis of programme effectiveness. Geographic identifiers are a key to linking data sources from both vertical programme and more integrated information systems.
In Kenya, work is underway to develop a two-pronged approach that addresses both the organisational and technical facets of linking data sources by use of geography in the context of programmes for orphans and vulnerable children. Organisationally, the Government's Department of Children's Services will work with their primary programme supporters (including donors) to develop a consensus on the sharing of information that will empower child welfare officers and service providers at the district and subdistrict levels. Technically, stakeholders will develop a spatial data model that will allow data sharing across programmes. The data model will not require changes within the vertical reporting structures, but will enable interoperability between systems and allow the Department of Children's Services to know who is doing what where.
Geographic identifiers also provide the opportunity for production of maps and our experience in other countries suggests that maps can be a powerful motivation for strengthening data quality to support such mapping for decision making. We believe that such efforts compliment the proposed national evaluation platform approach and advocate for explicit attention to the spatial data infrastructure as the concept evolves.
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Contraceptive discontinuation among Honduran women who use reversible methods
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Barden-O’Fallon J, Speizer I, Cálix J, Rodriguez F |
2011 |
English |
HONDURAS |
|
A panel study examining the effects of women's individual
characteristics, side effects experienced, and service quality on their
contraceptive discontinuation was undertaken in four urban areas of Honduras.
Data were collected from October 2006 to December 2007. The baseline sample
consisted of 800 women aged 15–44 who were new or continuing users of an
injectable contraceptive, the IUD, or an oral contraceptive. A total of 671
women (84 percent) were reinterviewed after one year. Life tables and Cox
proportional hazards models were used to present discontinuation rates and
factors associated with contraceptive discontinuation. Among new users,
discontinuation of the baseline method at 12 months was high (45 percent),
especially for users of an injectable method (50 percent). In the hazards
model, service quality had little effect on discontinuation, whereas individual
characteristics and the experience of specific side effects showed significant
effects. The results suggest that programs should emphasize continuous
contraceptive coverage rather than continuous use of a particular method.
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Contraceptive discontinuation and unintended pregnancy: an imperfect relationship
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Curtis S, Evens E, Sambisa W |
2011 |
English |
BANGLADESH, DOMINICAN REPUBLIC, KAZAKHSTAN, KENYA, PHILIPPINES, ZIMBABWE, Africa |
|
CONTEXT:
Contraceptive discontinuation is a common event that may be associated with low
motivation to avoid pregnancy. If this is the case, a substantial proportion of
pregnancies that follow discontinuation will be reported as intended.
METHODS:
Demographic and Health Survey data from six countries (Bangladesh, the
Dominican Republic, Kazakhstan, Kenya, the Philippines and Zimbabwe) over the
period 1999–2003 were used to explore the proportions of pregnancies women
reported as intended or unintended following various contraceptive behaviors.
Multivariate logistic regression analysis was used to examine the
characteristics of women who reported births as intended when they followed
contraceptive failure or discontinuation for reasons other than a desire for
pregnancy.
RESULTS: The
proportion of births reported as intended following contraceptive failure
ranged from 16% in Bangladesh to 54% in Kazakhstan, and the proportion reported
as intended following discontinuation for reasons other than a desire for
pregnancy ranged from 37% in Kenya to 51% in Kazakhstan. In at least half the
countries, associations were found between selected women’s characteristics and
their reports that births following either contraceptive failure or discontinuation
were intended: Factors that were positively associated were women’s age and the
time elapsed between contraceptive discontinuation and the index conception;
factors that were negatively - associated were increasing number of living
children and reporting method failure as opposed to method discontinuation.
CONCLUSION: These
findings suggest that underlying variation in the motivation to avoid pregnancy
is an important factor in contraceptive discontinuation.
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Age, poverty and alcohol use as HIV risk factors for women in Mongu, Zambia
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Singh K, Buckner B, Tate J, Ndubani P, Kamwanga J |
2011 |
English |
ZAMBIA, Africa |
|
Background: Age,
poverty and alcohol use are seen as risk factors for HIV among women in
sub-Saharan Africa.
Objective: The
objective of this study was to understand the influence of socioeconomic
factors (including age and poverty) as well as alcohol use on risky sexual
behaviors among women in Mongu, Zambia.
Methods: This
study examines these factors in the local context of Mongu, Zambia using the
Priorities for Local AIDS Control Efforts (PLACE) methodology. This methodology
allows for the study of risky behaviors while taking into consideration local
factors. The two outcome variable studied were transactional sex in the past
year and having two or more sexual partners in the past year.
Results: In this
study age was not a significant factor, but alcohol use and poverty/desire for
economic advancement were significant factors.
Conclusion:
Programs and policies need to address the influence of alcohol on risky sexual
behaviors and also the important but complex influence of poverty.
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Feasibility of using a World Health Organization-standard methodology for Sample Vital Registration with Verbal Autopsy (SAVVY) to report leading causes of death in Zambia: results of a pilot in four provinces, 2010
|
Mudenda S, Kamocha S, Mswia R, Conkling M, Sikanyiti P, Potter D, Mayaka W, Marx M |
2011 |
English |
Africa, ZAMBIA |
|
Verbal autopsy (VA) can be used to describe leading causes of death in
countries like Zambia where vital events registration does not produce usable
data. The objectives of this study were to assess the feasibility of using
verbal autopsy to determine age-, sex-, and cause-specific mortality in a
community-based setting in Zambia and to estimate overall age-, sex-, and
cause-specific mortality in the four provinces sampled. Methods: A
dedicated census was conducted in regions of four provinces chosen by
cluster-sampling methods in January 2010. Deaths in the 12-month period prior
to the census were identified during the census. Subsequently, trained field staff
conducted verbal autopsy interviews with caregivers or close relatives of the
deceased using structured and unstructured questionnaires. Additional deaths
were identified and respondents were interviewed during 12 months of fieldwork.
After the interviews, two physicians independently reviewed each VA
questionnaire to determine a probable cause of death. Results: Among
the four provinces (1,056 total deaths) assessed, all-cause mortality rate was
17.2 per 1,000 personyears (95% confidence interval [CI]: 12.4, 22). The seven
leading causes of death were HIV/AIDS (287, 27%), malaria (111, 10%), injuries
and accidents (81, 8%), diseases of the circulatory system (75, 7%),
malnutrition (58, 6%), pneumonia (56, 5%), and tuberculosis (50, 5%). Those who
died were more likely to be male, have less than or equal to a primary
education, and be unmarried, widowed, or divorced compared to the baseline
population. Nearly half (49%) of all reported deaths occurred at home. Conclusions: The 17.2 per 1,000 all-cause mortality rate is somewhat similar to modeled country
estimates. The leading causes of death – HIV/AIDS, malaria, injuries,
circulatory diseases, and malnutrition – reflected causes similar to those
reported for the African region and by other countries in the region. Results
can enable the targeting of interventions by region, disease, and population to
reduce preventable death. Collecting vital statistics using standardized Sample
Vital Registration with Verbal Autopsy (SAVVY) methods appears feasible in
Zambia. If conducted regularly, these data can be used to evaluate trends in
estimated causes of death over time. |
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Predictors of condom-use among young never-married males in Nigeria
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Oyediran KA, Feyisetan OI, Akpan T |
2011 |
English |
Africa, NIGERIA, West Africa |
|
This study examined the factors that influence condom-use
among young never-married males in Nigeria. Such information can help improve
the design of a prevention programme for young never-married, especially, males
to reduce their vulnerability to sexually transmitted infections (STIs) and
HIV/AIDS transmission. Data were derived from the 2003 Nigeria Demographic and
Health Survey (NDHS). Analysis of data was restricted to 827 males aged 15-24
years, who had never married or lived together with a woman. Both descriptive
and analytical methods were used for assessing the net effects of socioeconomic
factors on condom-use. The analysis used logistic regression models for
determining the predictors of sexual behavior and condom-use among young
never-married males in Nigeria. About 43% of the study population was sexually
experienced, and the use of a condom remained low. One in five reported the use
of a condom at sexual debut. Level of education, place of residence in
childhood, urban/rural region, religious affiliation, economic status index,
and exposure to mass media were associated with sexual experience and use of
protective measures. Economic status index and mass-media exposure were
associated with the use of a condom by the respondents during their last sex
encounter. About two-fifths (43%) of the young unmarried Nigerian men were
sexually experienced but the condom-use remained low, thus making this sub-group
of Nigerian population highly vulnerable to STIs, including HIV/AIDS.
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Comparing Alternative Measures of Poverty: Assets-Based Wealth Index vs. Expenditures-Based Poverty Score
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Foreit KGF, Schreiner M |
2011 |
English |
BANGLADESH, MALAWI, ETHIOPIA |
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How comparable are different measures of poverty? In the economic literature, poverty is often measured by income or expenditures. National health surveys, such as a Demographic and Health Survey (DHS), do not routinely collect data on household expenditures but rather estimate relative wealth by analyzing household assets and housing characteristics. This paper assesses the predictive validity of using DHS data to assign expenditures-based poverty rankings to households and individuals, using countries for which there are contemporaneous expenditures surveys and a DHS. The estimates come from a three-step method. First, potential poverty indicators are matched between the expenditures survey and the DHS. Second, a poverty scorecard is constructed based on data from the expenditures survey, using only indicators that appear in both that survey and the DHS. Third, the scorecard is applied to the DHS to produce estimates of expenditures-based poverty.
Three countries were analyzed: Bangladesh, Ethiopia, and Malawi. After matching items between DHS and expenditures surveys, the estimated proportions of people living below the poverty line of $1.25 a day purchasing power parity (PPP) were comparable between the DHS and the expenditures surveys. When we compared individuals’ assets-based wealth quintile with their expenditure-based poverty scorecard quintile, the assets-based wealth quintiles correlated positively with expenditures-based poverty scores. Marked differences between countries were also found. Appreciable mismatch between the two poverty measures could be seen, most notably in the case of Ethiopia where more than a third of the individuals in each assets-based wealth index quintile were ranked two or more quintiles above or below that quintile on the expenditures-based poverty scorecard.
We conclude that assets-based wealth indices do not consistently track well against expenditure-based measures of poverty and should not be used to identify individuals or households living below consumption- or expenditures-based poverty thresholds. We also recommend that future DHS country surveys harmonize the selection, wording and response categories of questions on household assets and dwelling characteristics with national expenditure surveys, and vice-versa.
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2011 Lot Quality Assurance Sampling Survey in Liberia
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2011 |
English |
LIBERIA |
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LQAS is a relatively rapid and inexpensive approach to data collection, and is primarily used for M&E purposes. Used to empower program managers to evaluate program performance, the LQAS method enables these managers to assess whether program objectives and targets have been achieved within a specific unit of interest (a geographical area, a facility, an organization, or any other catchment area). The LQAS data collection method provides a viable alternative to traditional surveys. The method allows for smaller sample sizes than standard probability surveys, and the lower associated costs allow for more frequent sampling. This report describes effective use of LQAS in Liberia.
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Relationships between Maternal Health Care and Postpartum Modern Contraceptive Use in Kenya and Zambia
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Do M, Hotchkiss D |
2011 |
English |
ZAMBIA, KENYA |
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This study examines the associations between the use of maternal health care (antenatal and postnatal care [ANC and PNC]) and postpartum modern contraceptives. Data come from the most recent Demographic and Health Surveys (DHS) in Kenya (2008-09 DHS) and Zambia (2007 DHS). The study sample includes women who were currently married or cohabiting with their partners and had a live birth within five years before the survey (3,667 in Kenya and 3,587 in Zambia). Tests of exogeneity confirmed that the intensity of ANC and PNC service use and postpartum modern contraceptive practice were not influenced by common unobserved factors. Cox proportional hazard models showed significant associations between the service intensity of ANC and PNC combined, as well as ANC only, and postpartum modern contraceptive use in both countries. No significant associations were observed between PNC service intensity and postpartum family planning (FP) practice. The study adds to the body of evidence of the associations between maternal health care and postpartum modern FP use. It highlights a window of opportunity to promote the use of modern contraceptives after childbirth through ANC service delivery.
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An Overview of Spatial Data Protocols for Family Planning Activities: Why and How to Include the “Where” in Your Data
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2011 |
English |
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GIS |
This guide focuses on data and how to use geography to facilitate linkages among data. It presents an overview of the ways to structure family planning data to take maximum advantage of existing geographic data, or to facilitate future inclusion of the geographic context of data being gathered. Data with a geographic component are particularly well-suited to support monitoring and evaluation (M&E) efforts and evidence-based decision making within family planning activities. The use of geospatial technologies in the family planning context has been hampered by limitations that often exist with the data. This document seeks to address some of these limitations by presenting key concepts involved in the collection and use of spatially referenced family planning data. |
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Women's Health in the Russian Federation: The Russia Longitudinal Monitoring Survey 2010
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Barden-O’Fallon J, Reynolds Z, Speizer IS |
2011 |
English |
RUSSIAN FEDERATION |
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The Russia Longitudinal Monitoring Survey (RLMS) of the National Research University Higher School of Economics (HSE) is a series of nationally representative surveys designed to monitor the effects of Russian reforms on the health and economic welfare of households and individuals in the Russian Federation. RLMS data have been collected annually since 1992. This report uses data from the family planning and reproductive health module of the RLMS round 19 survey, with fieldwork conducted in 2010. Findings provide a snapshot of the current reproductive health of women in the Russian Federation, highlighting some of the successes of the Russian health system to provide comprehensive reproductive health care, but also demonstrating certain changes in behavior that have the potential to produce negative health outcomes for women. For instance, Russian women are initiating sex at younger ages and are increasingly putting off childbearing, thereby increasing the potential exposure to adolescent and unwanted pregnancy.
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Fact Sheet: MEASURE Evaluation in Vietnam
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2011 |
English |
VIET NAM |
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Fact Sheet: MEASURE Evaluation in Tanzania
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2011 |
English |
TANZANIA |
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Fact Sheet: MEASURE Evaluation in Rwanda
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2011 |
English |
RWANDA |
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Fact Sheet: MEASURE Evaluation in Russia
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2011 |
English |
RUSSIAN FEDERATION |
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Fact Sheet: MEASURE Evaluation in Nigeria
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2011 |
English |
NIGERIA |
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Fact Sheet: MEASURE Evaluation in Mozambique
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2011 |
English |
MOZAMBIQUE |
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Fact Sheet: MEASURE Evaluation in Liberia
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2011 |
English |
LIBERIA |
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Fact Sheet: MEASURE Evaluation in Kenya
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2011 |
English |
KENYA |
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Fact Sheet: MEASURE Evaluation in Jamaica
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2011 |
English |
JAMAICA |
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Fact Sheet: MEASURE Evaluation in Haiti
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2011 |
English |
HAITI |
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Fact Sheet: MEASURE Evaluation in Ethiopia
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2011 |
English |
ETHIOPIA |
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Fact Sheet: MEASURE Evaluation in The Democratic Republic of the Congo
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2011 |
English |
CONGO, THE DEMOCRATIC REPUBLIC OF THE |
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Fact Sheet: MEASURE Evaluation in China
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2011 |
English |
CHINA |
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Fact Sheet: MEASURE Evaluation in Barbados and the Eastern Caribbean
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2011 |
English |
VIRGIN ISLANDS, BRITISH, BARBADOS, ANTIGUA AND BARBUDA, DOMINICA, GRENADA, SAINT KITTS AND NEVIS, SAINT LUCIA, MONTSERRAT, SAINT VINCENT AND THE GRENADINES, ANGUILLA |
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Fact Sheet: MEASURE Evaluation in Bangladesh
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2011 |
English |
BANGLADESH |
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Fact Sheet: MEASURE Evaluation in Angola
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2011 |
English |
ANGOLA |
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Influence of Gender Measures on Maternal and Child Health in Africa
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Singh K, Bloom S, Brodish P |
2011 |
English |
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Despite progress maternal mortality remains high in developing countries. The WHO estimated 358,000 maternal deaths in 2008, while the Institute of Health Metrics and Evaluation had a similar estimate at 342,900 (WHO, 2010; Hogan et al., 2010). Millennium Development Goal (MDG) 5a is to reduce by 2/3 the maternal mortality ratio (MMR) from 1990 to 2015. The decrease from the 542,424 deaths in 1990 to WHO’s estimate of 358,000 in 2008 represents only a 34% decline. The majority of maternal deaths can be prevented if women had access to emergency obstetric care (EmOC)1. UNICEF (2010) estimates that about 8.1 million children under the age of five died in the year 2009, while the Institute of Health Metrics and Evaluation (Rajaratnam et al., 2010) estimated the number of deaths to be 7.7 million in 2010. MDG 4a is to reduce by 2/3 the under-five mortality rate. The decline from 12.4 million deaths in 1990 to UNICEF’s estimate of 8.1 million deaths in 2009 represents only a 1/3 reduction. It is estimated that about 2/3 of under-five deaths can be easily prevented. Though the treatment and preventative measures to save these children are largely known, access to such services is an obstacle for many around the world.
This report explores the associations between gender measures and several health outcomes which include (1) low BMI, an indicator of overall maternal health; (2) birth in a facility, an indicator of the utilization of maternal health services and a proxy measure for maternal mortality; (3) having a child who is fully immunized, an indicator of the utilization of a preventive child health service; and (4) treatment seeking for a child with an acute respiratory infection (ARI), an indicator of the utilization of a curative child health service.
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Nigeria Reproductive Health, Child Health, and Education End-of-Project Household Survey, 2009
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Koram N, Gage AJ (eds.) |
2011 |
English |
NIGERIA |
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This report presents findings from the 2009 Nigeria end-of-project
household survey. The survey serves as the endline for the Community
Participation for Action in the Social Sector Project (COMPASS). The survey was
implemented in local government areas (LGAs) in the states of Bauchi, Federal
Capital Territory (FCT), Kano, Lagos, and Nasarawa where COMPASS was
implemented. The purpose of COMPASS was to enhance reproductive health and
family planning services, as well as to promote child survival and improved
literacy. The core idea behind COMPASS was to integrate the health, child
survival, and education sectors through the promotion of community coalitions. Survey findings are presented on initiation of sexual
activity and childbearing; a number of aspects of
contraception, including knowledge, current use, approval, and discussion of
family planning methods; care during pregnancy and
breastfeeding; several areas of importance to
child survival, such as vitamin A supplementation, use of
insecticide treated bednets, home-based treatment of common childhood
illnesses, and child immunization; mass media exposure; primary school
education; and changes in household-level indicators
between the baseline and end-of-project surveys. |
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Evaluation of the Performance of Routine Information System Management (PRISM) framework: evidence from Uganda
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Hotchkiss D, Aqil A, Lippeveld T, Mukooyo E |
2011 |
English |
UGANDA, Africa |
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The 2018 version of the PRISM Series, updated and with new modules (Toolkit, User’s Kit, and Training Kit) is available here: https://www.measureevaluation.org/prism
Background
Sound policy, resource allocation and day-to-day management decisions in the health sector require timely information from routine health information systems (RHIS). In most low- and middle-income countries, the RHIS is viewed as being inadequate in providing quality data and continuous information that can be used to help improve health system performance. In addition, there is limited evidence on the effectiveness of RHIS strengthening interventions in improving data quality and use. The purpose of this study is to evaluate the usefulness of the newly developed Performance of Routine Information System Management (PRISM) framework, which consists of a conceptual framework and associated data collection and analysis tools to assess, design, strengthen and evaluate RHIS. The specific objectives of the study are: a) to assess the reliability and validity of the PRISM instruments and b) to assess the validity of the PRISM conceptual framework.
Methods
Facility- and worker-level data were collected from 110 health care facilities in twelve districts in Uganda in 2004 and 2007 using records reviews, structured interviews and self-administered questionnaires. The analysis procedures include Cronbach's alpha to assess internal consistency of selected instruments, test-retest analysis to assess the reliability and sensitivity of the instruments, and bivariate and multivariate statistical techniques to assess validity of the PRISM instruments and conceptual framework.
Results
Cronbach's alpha analysis suggests high reliability (0.7 or greater) for the indices measuring a promotion of a culture of information, RHIS tasks self-efficacy and motivation. The study results also suggest that a promotion of a culture of information influences RHIS tasks self-efficacy, RHIS tasks competence and motivation, and that self-efficacy and the presence of RHIS staff have a direct influence on the use of RHIS information, a key aspect of RHIS performance.
Conclusions
The study results provide some empirical support for the reliability and validity of the PRISM instruments and the validity of the PRISM conceptual framework, suggesting that the PRISM approach can be effectively used by RHIS policy makers and practitioners to assess the RHIS and evaluate RHIS strengthening interventions. However, additional studies with larger sample sizes are needed to further investigate the value of the PRISM instruments in exploring the linkages between RHIS data quality and use, and health systems performance. |
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Fact Sheet: Monitoring Health Outcomes in Liberia Using Lot Quality Assurance Sampling
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2011 |
English |
LIBERIA |
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Lot Quality Assurance Sampling (LQAS) is a relatively rapid approach to data collection that provides a viable alternative to traditional surveys. The method allows for smaller sample sizes than standard probability surveys, and the lower associated costs allow for more frequent sampling. LQAS data can also be used in conjunction with other sources of health information, such as service statistics, to obtain information on coverage and quality of care at the population level. In Liberia, LQAS has provided county-level estimates of coverage of selected indicators and information whether supervision areas within the county meet performance targets. LQAS is designed to assess whether a target has been “met” or “not met” in a designated program supervisory area. The small sample size required to provide the binary estimates is a key feature of an LQAS. While this can provide important information for program managers, point estimates will not be available for the supervisory areas.
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Fact Sheet: Building a Neighbor's Capacity
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2011 |
English |
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MEASURE Evaluation provides technical leadership through collaboration at local, national, and global levels to advance the field of health monitoring and evaluation. We build sustainable capacity of individuals and organizations to identify data needs, collect and analyze technically sound data, and use that data for health decision-making.
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Guía del Usuario de las Herramientas de PRISM
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Aqil A, Lippeveld T |
2011 |
Spanish |
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The Performance of Routine Information System Management (PRISM) framework and its tools of application have expanded since 2004. Version 3.0, Spanish language version, produced in March 2010, is provided in this document.
The 2018 version of the PRISM Series, updated and with new modules (Toolkit, User’s Kit, and Training Kit) is available here: https://www.measureevaluation.org/prism |
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PRISM : Performance de la Gestion des Systèmes d’Information de Routine
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Aqil A, Lippeveld T |
2011 |
French |
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The Performance of Routine Information System Management (PRISM) framework and its tools of application have expanded since 2004. Version 3.0, French language version, produced in March 2010, is provided in this document.
The 2018 version of the PRISM Series, updated and with new modules (Toolkit, User’s Kit, and Training Kit) is available here: https://www.measureevaluation.org/prism |
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Tools for Data Demand and Use in the Health Sector: Quick Guide
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2011 |
English |
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This pocket manual serves as a cursory reference to the tools used to improve the data demand for and use of information (DDU or DDIU) in health decision making. Each of the tools presented in this tool kit can be modified and adapted to fit the needs, timeline, and budget of the context in which they are being used. |
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Stakeholder Engagement Tool
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2011 |
English |
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Since such large amounts of money and effort are being devoted to collecting data from health facilities, communities and populations, maximizing the impact of that data for real-world benefit is essential. This is where the Stakeholder Engagement tool is so valuable.Data is only valuable if it is seen as relevant and useful by prospective users. When data is seen as useful, it is more likely to be ‘owned’ by those who need it to inform decision making.For data ownership to be built, the appropriate set of stakeholders needs to be identified and involved when proposing, designing, implementing, and reporting on research and monitoring and evaluation (M&E) initiatives.
Who needs to use the data, and what questions are they seeking to answer?Who has influence and resources that can be brought to bear to aid this project?Who will be directly or indirectly affected by the outcome of this initiative?Who will support our plan? Who will oppose it? Why? How do we deal with it?What each of these individuals contribute to the process?
Effective stakeholder analysis answers these questions in a way that significantly improves a project’s design and outcomes.
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Performance of Routine Information Systems Management (PRISM) Tools
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2011 |
English |
Global |
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The ministry of health was concerned that district and facility staff rarely used routine data to identify performance gaps, make plans, and monitor progress. Information was available; why was it being used only to populate reports and not to drive decisions and program improvements? PRISM Tools provided a structured way for the ministry to assess the quality of data and use of information in its routine health information system. The findings were revealing. Data errors were very high, due in part to overly complex data collection forms, inaccurate transfer of data from patient records, and calculation errors. The PRISM assessment led to the design of easy-to-use forms, a refresher training course in data collection and processing for health workers, and a series of meetings and publications to share performance results and successes.
The 2018 version of the PRISM Series, updated and with new modules (Toolkit, User’s Kit, and Training Kit) is available here: https://www.measureevaluation.org/prism |
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Information Use Map
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2011 |
English |
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Existing monitoring and evaluation (M&E) systems typically focus on data collection and reporting to higher levels, while little attention is paid to how the data can be used locally for program improvements. As a result, there are many missed opportunities for feedback mechanisms and the identification of specific ways in which the data can be analyzed to make mid-course corrections. Since such large amounts of money and effort are being devoted to collecting data and reporting in health information systems, maximizing the impact of that data for real-world benefit is essential. This is where the Information Use Mapping tool is so valuable.
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Framework for Linking Data with Action
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2011 |
English |
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In areas of the world where the need for health services is great and resources are limited, policy and program decisions must produce the best possible outcomes. The urgency and expense associated with major health issues, such as disease mitigation, require that decisions be based on more than “gut feel” or past experience. The Framework for Linking Data with Action assists program managers and policy-makers to better understand the vital need for good data to support decision making. It also helps those that collect data, researchers and M&E specialists, visualize how their work can be applied to the program and policy context. Lastly, the Framework benefits all health stakeholders by prioritizing decisions and data-collection activities.
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Tools for Data Demand and Use in the Health Sector
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2011 |
English |
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Significant human and financial resources have been invested worldwide in the improvement of health information systems. At the global level, efforts to improve monitoring and evaluation systems and other data sources have increased in response to the need to track Millennium Development Goals and respond to the performance-based release of funds from select donors. Despite these improvements, data demand and information use (DDU or DDIU) is often not used by key stakeholders to effectively inform policy and programmatic decision making. As a result, many health systems fail to fully link evidence to decisions and suffer from a decreased ability to respond to priority needs at all levels of the health system. There are many possible factors that undermine evidence-based decision making. Some factors can be traced to limited demand for information, stemming from a pervasive lack of “data ownership” where decision makers are not aware of existing data sources or do not fully understand the underlying methodology or scope of the data set. Others relate to the low value placed on data by decision makers because of a perception that the quality of the data is poor or the decision maker lacks the understanding of how the information could be useful. The failure to present data to decision makers in user-friendly, accessible formats also affects the ease of using it in the decision-making process. The factors that mitigate evidence-based decision making are many and relate to the varied types of decision makers, how information flows to these individuals and how they make their decisions; others to the context in which information is collected; and still others to the organizational infrastructure and technical capacity of those that generate and use the data. |
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Fact Sheet: Strengthening an Organization's Capacity to Demand and Use Data
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2011 |
English |
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Significant human and financial resources have been invested worldwide in the collection of population, facility, and community-based data. However, this information is often not used by key stakeholders to inform policy and programmatic decision making effectively, as part of an overall data demand and use (DDU or DDIU) plan. As a result, many health programs fail to fully link evidence to decisions and suffer from a decreased ability to respond to priority needs of the populations they serve. There are many possible factors that undermine evidence-based decision making which related to (1) how information flows to decision-makers and how they make their decisions, (2) the context in which information collected and decisions are made, and (3) the organizational infrastructure and technical capacity of those that generate and use data.
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Fact Sheet: Strengthening Health Service Delivery by Community-Based Organizations—The Role of Data
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2011 |
English |
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Data-informed decision making or data demand and use (DDU or DDIU) is the cornerstone of effective health programs. Significant human and financial resources have been invested worldwide in the collection of population, facility, and community-based data. However, this information is often not used by key stakeholders to effectively inform policy and programmatic decisions. In an effort to better understand the common constraints to data collection and use facing community-based organizations, a series of in-depth interviews were conducted with members of six organizations in six countries. Information was gathered from a convenience sample of 16 key informants using a semi-structured questionnaire. Key informants were selected by virtue of their decision-making positions within the organization and their roles in data collection and use. The information collected is synthesized in this document.
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Exploring Low Uptake of Skilled Delivery Services and Postpartum Family Planning Services among Women Living in Western Kenya
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Naanyu V, Baliddawa J, Peca E, Karfakis J, Nyagoha N, Koech B |
2011 |
English |
KENYA |
|
Background. Kenya has relatively poor maternal and infant health outcomes. Despite the fact that 92 percent of Kenyan women receive antenatal care (ANC), the 2008-2009 Kenya Demographic and Health Survey indicates that only 44 percent of births in Kenya were attended by a health care professional and 44 percent of deliveries occurred in health facilities. Moreover, 26 percent of women have an unmet need for family planning (FP) and the decline in total fertility rate has stalled at about 4.6 since 1995. Little is known about how women choose where to deliver their children and how they arrive at their postpartum FP decisions. This study explores the complex confluence of factors that influence delivery and FP decision making.
Methods. A total of 20 focus group discussions (FGDs) were conducted at two sites in western Kenya — one rural site and one urban — to explore delivery choices and postpartum FP. Ten FGDs at each site were conducted with the following groups: health care providers from the formal sector, traditional birth attendants, women who attended at least four ANC visits and gave birth at home, and women who attended at least four ANC visits and gave birth in a health care facility. Three in-depth interviews were conducted at each site with a combination of women who gave birth in a facility and at home. All discussions were recorded. Data were analyzed for thematic content by four research team members.
Results. Decisions pertaining to where women give birth are influenced by socioeconomic factors, cultural practices, fear of HIV testing at the hospital, quality of service provided, access to facilities, and stigma surrounding health facilities, among other factors. Findings illustrate that FP practices are determined by spousal and extended family support, literacy and access to accurate information about FP, fear of side effects, costs of FP methods, and religion. Our findings suggest changes in health care policy, service provision, better information dissemination, education campaigns, and respect for socio-cultural practices will encourage uptake of facility-based deliveries and postpartum FP practices.
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Spatial Analysis of Contraceptive Use and Unmet Need in Kenya
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Ettarh RR |
2011 |
English |
KENYA |
|
Objective: The objective of this study was to examine the geographical variation in the use of modern contraceptive use and unmet need for family planning across Kenya and in Nairobi slums, and to identify associated individual and contextual determinants.
Methods: Data were obtained for women aged between 15-49 years from the 2008-09 Kenya Demographic Health Survey (DHS) and the Maternal and Child Health Project (2007-09) of the Nairobi Urban Health and Demographic Surveillance System (NUHDSS). Multilevel logistic regression was used to identify associated determinants of modern contraceptive use and unmet need, and spatial techniques used to map prevalence at district and village level for the national and slum data respectively.
Results: Significant variation in the prevalence of modern contraceptive use and unmet need was found among districts in Kenya. Age, educational attainment, parity, and household wealth were associated with contraceptive use and unmet need across Kenya and in Nairobi slums.
Conclusion: The geographical variation in modern contraceptive use and unmet need in Kenya suggests that unidentified district-level factors influence these outcomes and need to be the focus of strategies to address the low prevalence across parts of the country.
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Fact Sheet: MEASURE Evaluation's Use of Geospatial Tools
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2011 |
English |
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MEASURE Evaluation promotes the use of spatial tools and data to help with monitoring and evaluation (M&E). Tools such as geographic information systems (GIS) can support M&E via their ability to link data and to produce data products, such as maps. We seek to build capacity in the use of spatial data and tools through trainings, workshops, and technical assistance.
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Locating the places people meet new sexual partners in a southern US city to inform HIV/STI prevention and testing efforts
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Wohl DA, Khan MR, Tisdale C, Norcott K, Duncan J, Kaplan AM, Weir SS |
2011 |
English |
UNITED STATES |
HIV/AIDS, Sexual Behavior |
Places where people meet new sex partners can be venues for the delivery of individual and environmental interventions that aim to reduce transmission of HIV and other sexually transmitted infections (STI). Using the Priorities for Local AIDS Control Efforts (PLACE) methodology we identified and characterized venues where people in a southeastern US city with high prevalence of both HIV and STI go to meet new sexual partners. A total of 123 community informants identified 143 public, private and commercial venues where people meet sex partners. Condoms were available at 14% of the venues, although 48% of venue representatives expressed a willingness to host HIV prevention efforts. Interviews with 373 people (229 men, 144 women) socializing at a random sample of 54 venues found high rates of HIV risk behaviors including concurrent sexual partnerships, transactional sex and illicit substance abuse. Risk behaviors were more common among those at certain venue types including those that may be overlooked by public health outreach efforts. The systematic methodology used was successful in locating venues where risky encounters are established and reveal opportunities for targeted HIV prevention and testing programs as well as research.
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High HIV risk behavior among men who have sex with men in Kigali, Rwanda: making the case for supportive prevention policy
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Chapman J, Koleros A, Delmont Y, Pegurri E, Gahire R, Binagwaho A |
2011 |
English |
RWANDA, Africa |
Rwanda, HIV/AIDS |
Rwanda has responded strongly to HIV/AIDS, but prevention among men who have sex with men (MSM) has not yet been addressed due to a strong cultural resistance to homosexuality, and a lack of data showing the public health value of attending to the sexual health needs of this group. We conducted an exploratory study on HIV risk among MSM in Kigali using snowball sampling involving peer leaders. The 99 respondents were demographically, socially, and sexually diverse. Respondents reported relatively high numbers of male and female partners, and considerable HIV risk behaviors including commercial sex with men and women, low condom use during anal and vaginal sex, and high mobility. Many respondents reported verbal and/or physical abuse due to their sexuality. This first study of MSM in Rwanda has brought attention to a previously neglected HIV risk group and their potential driving role in the Rwandan epidemic, demonstrating the need for sensitive and targeted interventions. |
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Do migrant children face greater health hazards in slum settlements? Evidence from Nairobi, Kenya
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Bocquier P, Beguy D, Zulu EM, Muindi K, Konseiga A, Yé Y |
2011 |
English |
Africa, KENYA |
Kenya, Africa, Child Mortality |
Between 60% and 70% of Nairobi City’s population live in congested informal settlements, commonly referred to as slums, without proper access to sanitation, clean water, health care and other social services. Children in such areas are exposed to disproportionately high health hazards. This paper examines the impact of mother and child migration on the survival of more than 10,000 children in two of Nairobi’s informal settlements—Korogocho and Viwandani—between July 2003 and June 2007, using a two-stage semi-parametric proportional hazards (Cox) model that controls for attrition and various factors that affect child survival. Results show that the slum-born have higher mortality than non-slum-born, an indication that delivery in the slums has long-term health consequences for children. Children born in the slums to women who were pregnant at the time of migration have the highest risk of dying. Given the high degree of circular migration, factors predisposing children born in the slums to recent migrant mothers to higher mortality should be better understood and addressed.
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Assessment of Healthy Timing and Spacing of Pregnancy Practices among Postpartum Women in Butembo, Eastern DRC, and Barriers to the Adoption of Family Planning Methods
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Mathe JK, Kasonia KK, Maliro AK |
2011 |
English |
CONGO, Africa, CONGO, THE DEMOCRATIC REPUBLIC OF THE |
Africa, Contraception, Maternal Health, Reproductive Health |
This study assesses the extent of the knowledge, attitudes, and practice (KAP) of family planning in Butembo, Democratic Republic of Congo, in order to help identify a plausible strategy for reducing unwanted pregnancies and the associated morbidity and mortality. The study also attempted to identify whether couples were following the healthy timing and spacing of pregnancies as recommended by the World Health Organization. The study focused on women who have just delivered because they were very likely to get pregnant again in a short period of time, but findings may reflect the extent of family planning use and the adherence to health timing and spacing of pregnancies within the larger community. Based on findings, recommendations are suggested for improving family planning use and adherence to health timing and spacing in the city and, ultimately, in the province and country.
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Nigeria End-of-Project Primary School Headmaster and Teacher Survey, 2009
|
Gage AJ, ed. |
2011 |
English |
NIGERIA |
Child Health, Health Services, Monitoring, Evaluation, Monitoring, Monitoring, Nigeria |
This report presents findings from the 2009 Nigeria end-of-project primary school survey among headmasters and teachers. The survey serves as the endline for the Community Participation for Action in the Social Sector Project (COMPASS). The survey was implemented in local government areas (LGAs) in the states of Bauchi, Federal Capital Territory (FCT), Kano, Lagos, and Nasarawa where the COMPASS Project was implemented. COMPASS represents an integration of three previous projects funded by the U.S. Agency for International Development mission in Nigeria (USAID/Nigeria): VISION, BASICS, and LEAP. The purpose of COMPASS was to enhance reproductive health and family planning services, as well as to promote child survival and improved literacy. The core idea behind COMPASS was to integrate the health, child survival, and education sectors through the promotion of community coalitions. Using a representative sample of men and women in the COMPASS target areas as a starting point, the survey teams collected information on all schools in the selected enumeration areas (EAs) used by the selected households’ children. The headmaster at each school and one teacher randomly selected from each grade at each school were interviewed. The objective of this report is to provide estimated values for a set of indicators that are used by COMPASS and USAID/Nigeria for monitoring program performance with respect to education services. Data from the end-of-project survey are compared with the 2005 baseline survey to measure changes in education indicators resulting from the COMPASS interventions. The results of the end-ofproject survey may also be used to redirect efforts or increase levels of interventions in selected areas, based on the needs of schools in COMPASS areas.
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Improving RHIS Performance For Better Health System Management: Routine Health Information System Course Participants Guide
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Aqil A, Lippeveld T |
2011 |
English |
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This training course on improving routine health information systems (RHIS) is an international course on the comprehensive assessment of information use, with an emphasis on problem-solving. The course uses the Performance of Routine Information System Management (PRISM) conceptual framework and tools.
The 2018 version of the PRISM Series, updated and with new modules (Toolkit, User’s Kit, and Training Kit) is available here: https://www.measureevaluation.org/prism |
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Fact Sheet: AIMEnet, HIV/AIDS Monitoring and Evaluation Network
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2011 |
English |
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HIV/AIDS |
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Fact Sheet: Improving Data Quality in Mozambique: Standardized Systems Yield Better Data
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2011 |
English |
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Data Quality |
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Nigeria End-of-Project Health Facility Survey, 2009 Final Report
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Gage AJ (ed.) |
2011 |
English |
NIGERIA, West Africa, Africa |
Reproductive Health |
This report presents findings from the 2009 Nigeria
End-of-Project Health Facility Survey. The survey serves as the endline for the
Community Participation for Action in the Social Sector (COMPASS) Project. The
survey was implemented in the local government areas (LGAs) in the states of
Bauchi, Federal Capital Territory (FCT), Kano, Lagos, and Nasarawa where
COMPASS is being implemented. COMPASS represents the integration of three
previous U.S. Agency for International Development (USAID/Nigeria) funded
projects: VISION, BASICS, and LEAP. The
purpose of COMPASS is to enhance reproductive health and family planning
services as well as to promote child survival and improved literacy. The core idea
behind COMPASS is to integrate the health and education sectors through the
promotion of community coalitions. From a representative
sample of men and women in the COMPASS target areas, the survey obtained
information on all health facilities reportedly used by the sample of
respondents. Information was collected
on the facility background; vaccine logistic systems; child health services;
antenatal and postpartum care; newborn and delivery care; sexually transmitted infection
(STI) and voluntary counseling and testing (VCT) services; and select
medications. The objective of this
report is to present a set of indicators that are used by COMPASS and USAID for
monitoring and evaluating program performance. Data from this end-of-project survey
will be used to measure changes in health service indicators in the LGAs served
by the COMPASS Project. Further, the results of the end-of-project survey may
be used to redirect efforts or increase levels of intervention in selected
areas based on the needs and goals of the health facilities in COMPASS project
areas. Chapter 1 presents an overview of healthcare facilities. Chapter 2
describes facility characteristics, including service provision, facility amenities,
outreach programs and infection prevention procedures. Chapter 3 provides information
on family planning (FP) services, and chapter 4, on antenatal and postpartum
care. Chapter 5 presents findings
related to child health and vaccination services. Chapter 6 describes STI and
VCT services; while chapter 7 presents a comparison of the 2005 baseline survey
and the 2009 endline survey to assess the degree of change in selected health
indicators. Findings from the end-of-project school and household surveys are
presented in separate reports.
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Millennium development goal 6 and HIV infection in Zambia: what can we learn from successive household surveys?
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Kandala NB, Brodish P, Buckner B, Foster S, Madise N |
2011 |
English |
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HIV/AIDS, Zambia |
Background: Geographic location represents an ecological measure of HIV status and is a strong predictor of HIV prevalence. Given the complex nature of location effects, there is limited understanding of their impact on policies to reduce HIV prevalence.
Methods: Participants were 3949 and 10 874 respondents from two consecutive Zambia Demographic and Health Surveys from 2001/2007 (mean age for men and women: 30.3 and 27.7 years, HIV prevalence 14.3% in 2001/2002; 30.3 and 28.0 years, HIV prevalence of 14.7% in 2007). A Bayesian geo-additive mixed model based on Markov Chain Monte Carlo techniques was used to map the change in the spatial distribution of HIV/AIDS prevalence at the provincial level during the 6-year period, accounting for important risk factors.
Results: Overall HIV/AIDS prevalence changed little over the 6-year period, but the mapping of residual spatial effects at the provincial level suggested different regional patterns. A pronounced change in odds ratios in Lusaka and Copperbelt provinces in 2001/2002 and in Lusaka and Central provinces in 2007 was observed following adjustment for spatial autocorrelation. Western province went from a lower prevalence area in 2001 (13.4%) to a higher prevalence area in 2007 (17.3%). Southern province went from the highest prevalence area in 2001 (17.3%) to a lower prevalence area in 2007 (15.9%).
Conclusion: Findings from two consecutive surveys corroborate the Zambian government's effort to achieve Millennium Developing Goal (MDG) 6. The novel finding of increased prevalence in Western province warrants further investigation. Spatially adjusted provincial-level HIV/AIDS prevalence maps are a useful tool for informing policies to achieve MDG 6 in Zambia.
The manuscript has been loaded into PubMed Central and made available for public access at:
http://www.pubmedcemtral.gov/articlerender.fcgi?artid=3145216
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Indonesian Couples' Pregnancy Ambivalence and Contraceptive Use
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Barden-O'Fallon JL, Speizer IS |
2010 |
English |
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CONTEXT: Most studies on pregnancy ambivalence are based on data from women and depend on the women's perceptions to measure their partner's pregnancy intentions. Because these perceptions may not be accurate, data collected directly from men are needed to understand the role of couple dynamics in fertility behavior.
METHOD: Matched couple data from the 2002-2003 Indonesia Demographic and Health Survey were used to examine contraceptive use, fertility desires and attitudes about becoming pregnant in the next few weeks - whether it would be a big problem, a small problem or no problem. Concordance between partners on these issues was evaluated. Inconsistent fertility desires and responses to the problem question are used to define ambivalence within couples. Multivariate logistic regression analyses were used to assess whether couples' pregnancy ambivalence was associated with contraceptive use.
RESULTS: Seventy-one percent of husbands and 54% of wives reported that a pregnancy in the next few weeks would be "no problem"; couples' concordance on this question was 64% among contraceptive users and 61% among nonusers. In the multivariate analysis, couples who were discordant on the issue of a pregnancy in the near future had 26% lower odds of using contraceptives than couples in which both partners agreed a pregnancy would be a big or small problem. Contraceptive use was also less likely for couples in which one partner wanted to delay or stop childbearing and the other wanted more children or was undecided (odds ratio, 0.4).
CONCLUSIONS: Husbands and wives influence each other's fertility attitudes and family planning use. Both husbands' and wives' pregnancy attitudes should be taken into account at the time of screening and method selection. |
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Multi-centred mixed-methods PEPFAR HIV care & support public health evaluation: study protocol
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Harding R, Simms V, Penfold S, McCrone P, Moreland S, Downing J, Powell RA, Mwangi-Powell F, Namisango E, Fayers P, Curtis S, Higginson IJ |
2010 |
English |
KENYA, UGANDA, Africa, East Africa |
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BACKGROUND:
A public health response is essential to meet the multidimensional needs of patients and families affected by HIV disease in sub-Saharan Africa. In order to appraise current provision of HIV care and support in East Africa, and to provide evidence-based direction to future care programming, and Public Health Evaluation was commissioned by the PEPFAR programme of the US government.
METHODS/DESIGN:
This paper described the 2-Phase international mixed methods study protocol utilising longitudinal outcome measurement, surveys, patient and family qualitative interviews and focus groups, staff qualitative interviews, health economics and document analysis. Aim 1) To describe the nature and scope of HIV care and support in two African countries, including the types of facilities available, clients seen, and availability of specific components of care [Study Phase 1]. Aim 2) To determine patient health outcomes over time and principle cost drivers [Study Phase 2]. The study objectives are as follows. 1) To undertake a cross-sectional survey of service configuration and activity by sampling 10% of the facilities being funded by PEPFAR to provide HIV care and support in Kenya and Uganda (Phase 1) in order to describe care currently provided, including pharmacy drug reviews to determine availability and supply of essential drugs in HIV management. 2) To conduct patient focus group discussions at each of these (Phase 1) to determine care received. 3) To undertake a longitudinal prospective study of 1200 patients who are newly diagnosed with HIV or patients with HIV who present with a new problem attending PEPFAR care and support services. Data collection includes self-reported quality of life, core palliative outcomes and components of care received (Phase 2). 4) To conduct qualitative interviews with staff, patients and carers in order to explore and understand service issues and care provision in more depth (Phase 2). 5) To undertake document analysis to appraise the clinical care procedures at each facility (Phase 2). 6) To determine principle cost drivers including staff, overhead and laboratory costs (Phase 2).
DISCUSSION:
This novel mixed methods protocol will permit transparent presentation of subsequent dataset results publication, and offers a substantive model of protocol design to measure and integrate key activities and outcomes that underpin a public health approach to disease management in a low-income setting.
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Cluster randomized trial of the uptake of a take-home infant dose of nevirapine in Kenya
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Reynolds HW, Gachuno O, Kayita J, Hays MA, Rakwar J |
2010 |
English |
Africa, KENYA, East Africa |
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Objective: To test whether a single take home dose of infant nevirapine increased infant uptake without decreasing institutional deliveries.
Design: Cluster randomized post-test only study with control group.
Setting: Ten hospitals in urban areas of Coast, Rift Valley, and Western provinces, Kenya.
Participants: Pregnant women with HIV, 18 years and older, and at least 32 weeks gestation recruited during antenatal care and followed up at home approximately one week after delivery.
Intervention: In the intervention group, women were given a single infant’s dose of nevirapine to take home prior to delivery. In the control group, no changes were made to the standard of care.
Main outcome measures: Mothers’ reports of infant uptake of nevirapine and place of delivery.
Results: Uptake of the infant’s nevirapine dose was high, 94% in the intervention group and 88% in the control group (p=0.096). Among women who delivered at home, uptake was higher significantly among infants whose mothers got the take home dose compared to women who did not get the dose (93% vs. 53%, p<0.01). The intervention did not influence place of delivery. Providers were positive about the take home dose concept; difficulties were attributed to HIV-related stigma.
Conclusions: Making take home infant nevirapine available, either as a single dose administered within 72 hours of birth or as part of a more complex six week postnatal regimen, will increase infant uptake especially among women who deliver at home without affecting place of delivery.
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Information tool for better health care in rural communities: making family folder operational
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Lemma I, Azim T, Akalu T, Kassahun H, Lemecha G, Mesfin G, Accorsi S, Mamo D |
2010 |
English |
ETHIOPIA, Africa |
Health Services, Ethiopia |
In the context of the health sector reform and decentralization in Ethiopia, health information that is standardized, integrated and well linked at all levels plays a central role to monitor the health services and health status of the population.
The organization of the family-based services in Ethiopia, the Health Extension Program, has called for the reorganization of information systems to collect and use information for action at local level using a Family Folder. This in turn drives a need for the careful assessment of what is required for local (community level) data collection, processing, analysis and dissemination, as well as linking to the national Health Management Information System. A collaborative effort made by the Policy, Planning and Finance General Directorate of the Federal Ministry of Health (FMOH), with the support of the World Health Organization (WHO) Country Office, Italian Cooperation, USAID-funded JSI/MEASURE Evaluation HMIS Project, and Tulane University Technical Assistance Project Ethiopia (TUTAPE), was carried out to pilot options for operationalization of the community-based health information system, of which the Family Folder is the center piece. The results of the pilot implementation are expected to inform the nation-wide scale-up of the community-based health information system in Ethiopia. It is foreseen that the findings from this exercise will be used principally by the national, regional and district experts and the Health Extension Program experts all over the country as well as experts at the Monitoring and Evaluation Units of the FMOH and Regional Health Bureaus.
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Women’s Empowerment and Choice of Family Planning Methods
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Do M, Kurimoto N |
2010 |
English |
UGANDA, SWAZILAND, ZAMBIA, Africa, GHANA, NAMIBIA |
Contraception, Gender, Reproductive Health |
This study examines the associations between women’s empowerment and contraceptive use in five African countries, testing the hypothesis that, compared to women who are not powered, those who are empowered will be more likely to use contraceptives that are female controlled, as well as couple methods that require the awareness and support of their husbands. Data come from the latest round of Demographic and Health Surveys conducted within the last five years in Namibia, Swaziland, Zambia, Ghana, and Uganda. The study found that there is a strong association between the overall score of women’s empowerment and contraceptive use in all countries.
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The challenge of promoting safe sex at sites where persons meet new sex partners in Jamaica: results of the Kingston PLACE randomized controlled trial
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Figueroa JP, Weir SS, Byfield L, Hall A, Cummings SM, Suchindran CM |
2010 |
English |
JAMAICA |
Jamaica, Monitoring |
OBJECTIVE: To determine whether a site-based Priorities for Local AIDS Control Efforts (PLACE) HIV prevention intervention in Kingston, Jamaica increased condom use among persons with new or multiple sex partners.
METHODS: A total of 147 sites where persons go to meet new sex partners were grouped into 50 geographic clusters and randomized to receive or not receive a multilevel PLACE prevention intervention. Baseline cross-sectional surveys of sites and patrons at sites were conducted in 2005 to determine the nature of social activities at sites to better plan the intervention and to ensure that the two arms of the trial were similar. The intervention was delivered by 50 trained outreach workers between January and June 2006. After the intervention two cross-sectional surveys were conducted to assess the extent of intervention implementation and to estimate the proportion of patrons at sites with recent new or concurrent partnerships and inconsistent condom use.
RESULTS: Characteristics of sites and patrons were similar for most variables at intervention and control sites at both baseline and post-intervention. A total of 1535 patrons (723 men, 812 women) were interviewed at intervention sites and 1324 patrons (661 men, 663 women) at control sites 6-9 months after the intervention. There were no significant differences between intervention and control groups in the proportions of men (37.8% and 31.6%) and women (24.6% and 22.6%) who reported new or multiple relationships in the past year and inconsistent condom use. There was no significant difference in the proportion of men or women showing a condom at interview, having a HIV test in the past 12 months or being exposed to the intervention.
CONCLUSIONS: An intent-to-treat analysis did not show any intervention effect. This was probably because of difficulty in implementing the intervention, the extent of patron mixing among sites, the intensity of national education campaigns, delay in conducting the post-intervention survey and evidence of other interventions at some control sites.
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Effect of an Expansion in Private Sector Provision of Contraceptive Supplies on Horizontal Inequity in Modern Contraceptive Use: Evidence from Africa and Asia
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Hotchkiss D, Godha D, Do M |
2010 |
English |
BANGLADESH, NIGERIA, UGANDA |
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One strategic approach available to policy makers to improve the availability of contraceptive supplies as well as the sustainability of family planning programs is to expand the role of the private sector in providing access to contraceptive supplies. However, critics of this approach argue that increased reliance on the private sector will not serve the needs of the poor, and could lead to increases in socio-economic disparities in the use of modern contraceptive methods. The purpose of this study is to investigate whether the expansion of the role of private providers in the provision of modern contraceptive supplies is associated with increased horizontal inequity in modern contraceptive use. The study is based on multiple rounds of Demographic and Health Survey data from four selected countries (Nigeria, Uganda, Bangladesh, and Indonesia) in which there was an increase in the private sector supply of contraceptives. The methodology involves estimating concentration indices to assess the degree of inequity in contraceptive use by wealth groups across time. In order to measure modern contraceptive prevalence rate (MCPR) inequity, the study controls for differences in the need for family planning services in relation to household wealth. Overall, the results suggest that the expansion of the private commercial sector supply of contraceptives in the four study countries did not lead to increased MCPR inequity. In fact, in three of the four study countries (Nigeria, Uganda, and Indonesia), MCPR inequity actually decreased over time; while in the fourth study country (Bangladesh), MCPR inequity fluctuated. Overall, the results offer support to the premise that government strategies that promote the role of the private commercial sector can help facilitate the achievement of equity objectives.
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Fact Sheet: Leadership Development Program Yields Collaboration and Results in Cote d’Ivoire
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2010 |
English |
COTE D'IVOIRE |
HIV/AIDS |
Collaboration is a key element in the successful collection, dissemination and use of HIV/AIDS data in almost any situation. It is easy to imagine, however, a situation where multiple ministries are responsible for these Monitoring and Evaluation (M&E) tasks and yet national indicators are not established, harmonized and validated because of a lack of coordination and collaboration. Such was the case in Cote d’Ivoire.
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Madagascar Diagonal Funding Study
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2010 |
English |
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Malaria, Madagascar |
The Global Fund to Fight AIDS, Tuberculosis and Malaria and the U.S. President’s Malaria Initiative commissioned the Madagascar Diagonal Funding Study with two objectives: (1) to assess whether malaria control activities reduced demand for therapeutic malaria services, and (2) to determine whether this reduction allowed a refocusing of clinical efforts, as has been anecdotally reported. This was accomplished by gathering key information from patient registers on malaria, pneumonia/acute respiratory infection (ARI), and diarrhea in children less than 5 years of age (children < 5) from 2003 to 2007. This report presents an analysis of register data from three districts in Madagascar to determine whether malaria activity scale-up reduced malaria burden, and whether this reduction corresponded with a change in the relative demand for services at facilities due to other common childhood illnesses such as pneumonia/ARI and diarrhea.
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Fact Sheet: The Virtual Leadership Development Program
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2010 |
English |
ETHIOPIA |
Monitoring, Evaluation |
In 2009, team members from the Ethiopian Interfaith Forum for Development Dialogue and Action participated in the Virtual Leadership Development Program (VLDP), a 13-week Internet-based learning program that strengthens the capacity of team members to to meet health challenges by developing action plans addressing real organizational or programmatic challenges. This fact sheet summarizes the team's experiences using the VLDP. |
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Community-Level Program Information Reporting for HIV/AIDS Programs. Module 1: Illustrative Program Indicators, Data Collection Tools and Indicator Reference Sheets for Prevention, HBC, and OVC Programs
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2010 |
English |
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Child Health, HIV/AIDS, Orphans and Vulnerable Children, PEPFAR |
This publication is Module 1: Illustrative Program Indicators, Data Collection Tools and Indicator Reference Sheets for Prevention, HBC, and OVC Programs, from the Community-Level Program Information Reporting for HIV/AIDS Programs (CLPIR) tools. CLPIR also include three other modules and an introction. CLPIR supports harmonized monitoring and reporting systems that capture indicator data from community-level programs; systems that are essential for effective program management and decision-making, and that facilitate the reporting of high-quality program performance data to host country governments and donors. A number of stakeholders involved in community-level HIV/AIDS programs in Kenya, Nigeria, Tanzania, Zambia, and the United States were consulted during the development of CLPIR. Early during the development process, field visits to community-level programs in Nigeria, Tanzania, and Zambia were conducted to talk to direct-service providers, to determine what information they considered useful in managing their programs. During this process, hundreds of existing indicators from service delivery programs, host country governments, and donor agencies were collected and reviewed. The indicators were then refined, consolidated into a manageable set, and reviewed by experts from a number of U.S.-based organizations. This body of information serves as the building block for CLPIR. |
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Community-Level Program Information Reporting for HIV/AIDS Programs. Module 2: Rapid Situation and Needs Assessment
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2010 |
English |
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Child Health, HIV/AIDS, Orphans and Vulnerable Children, PEPFAR |
This publication is Module 2: Rapid Situation and Needs Assessment, from the Community-Level Program Information Reporting for HIV/AIDS Programs (CLPIR) tools. CLPIR also include three other modules and an introduction. CLPIR supports harmonized monitoring and reporting systems that capture indicator data from community-level programs; systems that are essential for effective program management and decision-making, and that facilitate the reporting of high-quality program performance data to host country governments and donors. A number of stakeholders involved in community-level HIV/AIDS programs in Kenya, Nigeria, Tanzania, Zambia, and the United States were consulted during the development of CLPIR. Early during the development process, field visits to community-level programs in Nigeria, Tanzania, and Zambia were conducted to talk to direct-service providers, to determine what information they considered useful in managing their programs. During this process, hundreds of existing indicators from service delivery programs, host country governments, and donor agencies were collected and reviewed. The indicators were then refined, consolidated into a manageable set, and reviewed by experts from a number of U.S.-based organizations. This body of information serves as the building block for CLPIR. |
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Community-Level Program Information Reporting for HIV/AIDS Programs. Module 3: Indicator Harmonization
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2010 |
English |
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Child Health, HIV/AIDS, Orphans and Vulnerable Children |
This publication is Module 3: Indicator Harmonization, from the Community-Level Program Information Reporting for HIV/AIDS Programs (CLPIR) tools. CLPIR also includes three other modules and an introduction. CLPIR supports harmonized monitoring and reporting systems that capture indicator data from community-level programs; systems that are essential for effective program management and decision-making, and that facilitate the reporting of high-quality program performance data to host country governments and donors. A number of stakeholders involved in community-level HIV/AIDS programs in Kenya, Nigeria, Tanzania, Zambia, and the United States were consulted during the development of CLPIR. Early during the development process, field visits to community-level programs in Nigeria, Tanzania, and Zambia were conducted to talk to direct-service providers, to determine what information they considered useful in managing their programs. During this process, hundreds of existing indicators from service delivery programs, host country governments, and donor agencies were collected and reviewed. The indicators were then refined, consolidated into a manageable set, and reviewed by experts from a number of U.S.-based organizations. This body of information serves as the building block for CLPIR. |
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Community-Level Program Information Reporting for HIV/AIDS Programs. Module 4: Information System Rollout
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2010 |
English |
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Child Health, PEPFAR, HIV/AIDS |
This publication is Module 4: Information System Rollout, from the Community-Level Program Information Reporting for HIV/AIDS Programs (CLPIR) tools. CLPIR also include three other modules and an introduction. CLPIR supports harmonized monitoring and reporting systems that capture indicator data from community-level programs; systems that are essential for effective program management and decision-making, and that facilitate the reporting of high-quality program performance data to host country governments and donors. A number of stakeholders involved in community-level HIV/AIDS programs in Kenya, Nigeria, Tanzania, Zambia, and the United States were consulted during the development of CLPIR. Early during the development process, field visits to community-level programs in Nigeria, Tanzania, and Zambia were conducted to talk to direct-service providers, to determine what information they considered useful in managing their programs. During this process, hundreds of existing indicators from service delivery programs, host country governments, and donor agencies were collected and reviewed. The indicators were then refined, consolidated into a manageable set, and reviewed by experts from a number of U.S.-based organizations. This body of information serves as the building block for CLPIR. |
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Community-Level Program Information Reporting for HIV/AIDS Programs: Introduction
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2010 |
English |
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Child Health, Orphans and Vulnerable Children, PEPFAR, HIV/AIDS |
This publcation offers an introduction to the Community-Level Program Information Reporting for HIV/AIDS Programs (CLPIR) tools, which also include four modules. CLPIR supports harmonized monitoring and reporting systems that capture indicator data from community-level programs; systems that are essential for effective program management and decision-making, and that facilitate the reporting of high-quality program performance data to host country governments and donors. A number of stakeholders involved in community-level HIV/AIDS programs in Kenya, Nigeria, Tanzania, Zambia, and the United States were consulted during the development of CLPIR. Early during the development process, field visits to community-level programs in Nigeria, Tanzania, and Zambia were conducted to talk to direct-service providers, to determine what information they considered useful in managing their programs. During this process, hundreds of existing indicators from service delivery programs, host country governments, and donor agencies were collected and reviewed. The indicators were then refined, consolidated into a manageable set, and reviewed by experts from a number of U.S.-based organizations. This body of information serves as the building block for CLPIR. |
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Measuring and Interpreting Urban Fertility and Family Planning Indicators by Wealth in Two South Asian Countries
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Speizer IS, Luseno W |
2010 |
English |
BANGLADESH, PAKISTAN |
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As the population of the world becomes increasingly urban, there is a need to examine the fertility and family planning needs of urban populations, particularly among the urban poor. While it is often assumed that urban residents are better off than their rural counterparts, the reality in many settings is that the urban poor are equally disadvantaged because of over-crowding, high demand for limited resources, increased cost of services in urban settings, and lack of access to clean water and sanitation. The definition and measurement of poverty in a population has become increasingly important as reduction of poverty is identified as the first Millennium Development Goal. This study applies new approaches proposed by the MEASURE Evaluation project to classify wealth using nationally-representative surveys, such as the Demographic and Health Surveys (DHS). These approaches are particularly important in cases where identifying and targeting of services to the urban poor are of interest. Applying these new approaches to DHS data from Bangladesh and Pakistan, this paper demonstrates that the standard DHS wealth measures under-estimate the percent of the urban population that is poor and demonstrates that, using the re-classified wealth indices, women in the lowest quintiles remain worse off on fertility and family planning indicators. Even in Bangladesh, where family planning services are easily available, distinctions are still found between the urban poor and non-poor in terms of family planning method use and sources of methods. Larger differences are found in Pakistan, where programmatic efforts have been less widespread. Without reclassification of standard DHS wealth measures, programs risk misrepresenting the urban poor and may miss some of the women and households most in need of family planning services. Ensuring access to family planning among all women, men, and households, but particularly among the urban poor who lack access to some of the urban advantages available to their better-off counterparts, will lead to improved health outcomes for women and children, especially in concentrated urban areas. |
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PEPFAR Public Health Evaluation-Care and Support: Phase 2 Uganda
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Simms, Victoria et al. |
2010 |
English |
UGANDA |
HIV/AIDS, Uganda |
The aims of the evaluation were (a) to describe the nature and scope of HIV care and support provision supported by PEPFAR in two African countries, including the types of facilities available, clients seen, and availability of specific components of care (Phase 1); and (b) to evaluate how PEPFAR care and support programme components and costs are related to health outcomes (Phase 2). By meeting these aims, this study was designed to provide detailed descriptions of the care and support services that have been delivered through PEPFAR funding and identify the effective components and
costs of the services, to improve the health of people with HIV. Dissemination of the findings is planned, in conjunction with country teams, to inform effective care and support provision within the two PHE target countries and beyond, where lessons can be transferred to other PEPFAR countries.
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PEPFAR Public Health Evaluation-Care and Support: Phase 2 Kenya
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Harding, Richard et al. |
2010 |
English |
KENYA |
Kenya, HIV/AIDS |
The aims of the evaluation were to (a) describe the nature and scope of HIV care and support provision supported by PEPFAR in two African countries, including the types of facilities available, clients seen, and availability of specific components of care (Phase 1); and (b) evaluate how PEPFAR care and support programme components and costs are related to health outcomes (Phase 2). By meeting these aims, this study
was designed to provide detailed descriptions of the care and support services that have been delivered through PEPFAR funding and identify the effective components and costs of the services, to improve the health of patients with HIV. Dissemination of the findings is planned, in conjunction with country teams, to inform effective care and support provision within the two PHE target countries and beyond, where lessons can be transferred to other PEPFAR countries.
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(Summary) PEPFAR Public Health Evaluation-Care and Support: Phase 2 Uganda
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Simms, Victoria et al. |
2010 |
English |
UGANDA |
Uganda, HIV/AIDS |
This study is part of a larger, two-phase evaluation of PEPFAR-funded HIV/AIDS care and support services in Uganda and Kenya. The aims of this evaluation were to (a) describe the nature and scope of HIV/AIDS care and support services supported by PEPFAR, including
the types of facilities available, clients seen, and availability of specific components of care; (b) evaluate how programme components and costs are related to health outcomes.
The Phase 1 objective was to undertake a cross-sectional survey of facility configuration and activity on a 10% sample of PEPFAR-funded, HIV care and support facilities in Kenya and Uganda (2007). The Phase 2 objective was to collect longitudinal prospective quantitative outcome data on 1,200 new patients at 12 facilities in Kenya and Uganda, measuring both quality of life and care outcomes alongside components of care
received (2008). Phase 2 also involved a costing analysis to determine cost of care provided. This report presents findings from Phase 2 of the Uganda study only.
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(Summary) PEPFAR Public Health Evaluation-Care and Support: Phase 2 Kenya
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Harding, Richard, et al. |
2010 |
English |
KENYA |
Kenya, HIV/AIDS |
This study is part of a larger, two-phase evaluation of PEPFAR-funded HIV/AIDS care and support services in Uganda and Kenya. The aims of this evaluation were to (a) describe the nature and scope of HIV/AIDS care and support services supported by PEPFAR, including
the types of facilities available, clients seen, and availability of specific components of care; and (b) evaluate how programme components and costs are related to health outcomes. The Phase 1 objective was to undertake a cross-sectional survey of facility configuration and activity on a 10% sample of PEPFAR-funded, HIV care and support facilities in Kenya and Uganda (2007). The Phase 2 objective was to collect longitudinal prospective quantitative outcome data on 1200 new patients at 12 facilities in Kenya and Uganda, measuring both quality of life and care outcomes alongside components of care
received (2008). Phase 2 methodology also involved a costing analysis to determine cost of care provided per patient per year. This report presents findings from Phase 2 of the Kenya study only.
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Prevalence of and factors associated with extramarital sex among Nigerian men
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Oyediran K, Isiugo-Abanihe UC, Feyisetan BJ, Ishola GP |
2010 |
English |
NIGERIA |
HIV/AIDS |
This study used data on currently married and cohabiting men aged 15 to 64 years from the 2003 Nigeria Demographic and Health Survey to examine the prevalence of and factors associated with extramarital sex. The results show that 16% engaged in extramarital sex in the 12 months preceding the survey and had an average of 1.82 partners. The results also show statistically significant association between extramarital sex and ethnicity, religion, age, age at sexual debut, education, occupation, and place of residence. Based on the study results, it could be concluded that significant proportions of Nigerians are exposed to HIV infection through extramarital sex. A fundamental behavioral change expected in the era of HIV/AIDS is the inculcation of marital fidelity and emotional bonding between marital partners. The promotion of condom use among married couples should be intensified to protect women, a large number of whom are exposed to HIV infection from their spouses who engage in unprotected extramarital sex. And, because of gender-based power imbalances within the family, a large number of the women are unable to negotiate consistent condom use by their partners. |
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Physical and sexual abuse of wives in urban Bangladesh: Husbands’ reports
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Sambisa W, Angeles G, Lance P, Naved R, and Curtis S |
2010 |
English |
BANGLADESH |
Bangladesh, HIV/AIDS |
Using data from 8,320 husbands’ self reports for the 2006 Urban Health Survey, this article examines the prevalence of physical and sexual intimate partner violence (IPV) perpetrated by husbands against their wives in Bangladesh and identifies risk markers associated with such violence. Of the men included in the sample for this study, 55 percent reported perpetrating physical IPV against their wives at some point in their married lives, 23 percent reported perpetrating physical IPV in the past year, 20 percent reported ever perpetrating sexual IPV, and 60 percent reported ever perpetrating physical or sexual IPV. Bivariate analyses revealed that men residing in slums had a greater likelihood than those residing in nonslum areas and in district municipalities of perpetrating lifetime and past-year physical IPV, and any lifetime (physical or sexual) IPV. Lifetime sexual IPV prevalence, by contrast, was highest in district municipalities (26 percent), followed by slum (20 percent) and nonslum (17 percent) areas. Net of other factors, low socioeconomic levels were associated with men’s increased likelihood of perpetrating IPV. Alcohol and drug use, sexually transmitted disease infection, poor mental health, and holding attitudes supportive of wife beating were predictive of IPV perpetration. These results suggest that IPV-prevention programs targeting men should consider spousal abuse, substance use, and sexual risk behaviors as social and public health problems and should also consider the sociocultural context within which men who abuse their partners are embedded. |
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A Review of Constraints to Using Data for Decision Making: Recommendations to Inform the Design of Interventions
|
Harrison T, Nutley T |
2010 |
English |
|
|
This publication synthesizes findings of assessments of constraints to data demand and use (DDU or DDIU) conducted by MEASURE Evaluation and highlights recommendations for designing interventions to stimulate demand for and improve the use of data for decision making. |
|
Report on the Status of the Nigerian National HIV Monitoring and Evaluation System: Assessment Using 12 Components System Strengthening Tool
|
Mharadze TN, Ogungbemi K, Boone D, Oyediran K |
2010 |
English |
NIGERIA |
Africa, HIV/AIDS, Monitoring, Evaluation, Monitoring, Monitoring |
In reviewing the country's National Strategic Framework for responding to the HIV epidemic, it was critical to assess the status of national monitoring and evaluation systems, in preparation for the development of the next generation of the national M&E; plan. This report provides findings and recommendations from an assessment of those systems, using the recently developed 12 Components Systems Strengthening Tool. |
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Data Use in the Indian Health Sector
|
Moreland S, Misra SN, Agrawal S, Gupta RB, Harrison T |
2010 |
English |
|
Public Health, Health Facilities |
Recently, there has been increased attention to data demand and use (DDU or DDIU) in the international public health community with several groups, including the MEASURE Evaluation, the Health Metrics Network (HMN) at the World Health Organization, and the World Bank’s Global AIDS M&E Team (GAMET), contributing to this area. Major investments have been and continue to be made in data collection for public health programs but there is concern that such data are not being used to their full potential. One of the basic premises of our approach is that health data and information lack value unless they are used to inform decisions. Interventions that increase local demand for information and facilitate data use enhance evidence-based decision making. Data demand use, therefore, are critical to improving the effectiveness and sustainability of the health system. Unless the data are of value to the information recipient, however, they will not be used. The objectives of this study were to shed light on how data are used for decision making at different levels of government in India, highlight impediments to data utilization, and make a set of actionable recommendations on how the health sector could improve the utilization of data for decision making. |
|
Patient Monitoring: WHO’s Interlinked Patient Monitoring Systems for HIV, MCH, and Tuberculosis
|
|
2010 |
English |
|
HIV/AIDS, Maternal Health, Tuberculosis, Child Health |
The World Health Organization and collaborating partners updated and expanded an HIV care/antiretroviral therapy (ART) patient monitoring system in 2009 to strengthen linkages between services in order to reflect an integrated and holistic approach to patient monitoring. This fact sheet summarizes the 2009 updates and their relevance to The U.S. President’s Emergency Plan for AIDS Relief. |
|
Fourth International RHINO Workshop: Measuring and Improving RHIS Performance
|
|
2010 |
English |
MEXICO |
Knowledge Management |
RHINO organized its fourth international workshop
from March 8–12, 2010 in Guanajuato, Mexico. The
previous three RHINO workshops had been held in
three different continents (North America, Africa, and
Asia), and RHINO was eager to collaborate with and
encourage a high level of participation from the Latin
American continent. This workshop was the first to be
organized by the RHINO NGO, with support from
USAID through MEASURE Evaluation and collaborating
partners, the Mexican Federal MOH, the Mexican
Guanajuato State Secretariat for Health, PAHO, and
INSP. INSP and RHINO have collaborated closely over
the past eight years on RHIS issues. |
|
Evaluating the impact of community-based interventions on schooling outcomes among orphans and vulnerable children in Lusaka, Zambia
|
Chatterji M, Hutchinson P, Buek K, Murray N, Mulenga Y, Ventimiglia T |
2010 |
English |
ZAMBIA |
HIV/AIDS, Orphans and Vulnerable Children, Zambia |
This journal article appears in Vulnerable Children and Youth Studies,5(2):130–141. In sub-Saharan Africa, an estimated 12 million children under the age of 18 have lost a parent to acquired immune deficiency syndrome. Despite this situation, the evidence regarding effectiveness of interventions targeting these children remains scant. This article contributes to the literature by evaluating the impact of a community-based program implemented by a Zambian non-governmental organization on educational outcomes among orphans and vulnerable children (OVC) in Lusaka, Zambia. These outcomes included school enrollment and being at the correct age-for-grade. Our study design included two rounds of post-intervention data collection in 2003 and 2006; 2302 children aged 6–19 years were interviewed in 2003, and 3105 children aged 8–22 years were interviewed in 2006. We used a subsample of 2922 OVC aged 8–19 years. The effectiveness of Bwafwano was evaluated first using the individual cross-sectional samples and then using a difference-in-differences model on the pooled sample. Both crosssectional analyses found positive and statistically significant effects of the intervention on school enrollment, with marginal effects of 0.104 and 0.168, respectively. The difference-in-differences estimates for school enrollment were positive, but small and not statistically significant. For the estimations of the effects of Bwafwano on the outcome of appropriate age-for-grade, only the difference-in-differences models showed positive program effect, with participation in the program being associated with a 15.7% increase in appropriate age-for-grade for intervention children relative to control children. This study suggests that the Bwafwano program is a promising approach to improving educational outcomes among OVC in urban Zambia. |
|
Guanajuato SINAIS Assessment
|
Aqil A, et al |
2010 |
English |
MEXICO |
Knowledge Management, Health Services, Public Health |
The National Health Information System (SINAIS, by its Spanish acronym) assessment in Guanajuato State was conducted in January 2010 to provide information on the SINAIS situation of the Guanajuato State Department of Health. The findings from this assessment are going to be used by the Guanajuato State health officials as an integral part of their HMIS strengthening plans, and agreed to share these results to develop a case study for the Routine Health Information System Network (RHINO) 4th International Workshop. The case study illustrates how SINAIS assessment in general and specifically how the PRISM framework and its tools could help policy makers and SINAIS managers to identify strengths and weaknesses of the system and develop interventions for strengthening the SINAIS.
The following report provides the findings of the baseline assessment of SINAIS in Guanajuato State. The report also includes discussion of the methodology, the systems areas of strengths and recommendations to strengthen identified areas requiring improvement.
The 2018 version of the PRISM Series, updated and with new modules (Toolkit, User’s Kit, and Training Kit) is available here: https://www.measureevaluation.org/prism |
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Strategies Used by USG Country Teams for Dealing with Double Counting of Individuals and Sites - A Review
|
Obiero W, Schmidt S, and Foreit K |
2010 |
English |
|
Data Quality, PEPFAR |
The Office of the Global AIDS Coordinator (O/GAC) has invested substantially in improving results reporting so that the monitoring and evaluation of the President's Emergency Plan is based on valid and reliable data. Experience to date points to "double counting" as a particularly important data quality problem that can be detrimental to program planning and data-driven decision making. Double counting results in over-reporting (i.e. reporting more services or beneficiaries than were actually provided or served). It occurs when a partner or the program as a whole mistakenly counts an eligible person or event more than once during a reporting period, thereby inadvertently inflating the report of program results. Over-reporting of program results in turn will over-estimate program coverage and achievements, undermining the ability of decision-makers to determine which programs are worth scaling up, where coverage gaps exist, and how best to appropriately target interventions to address those gaps. Consequently, during preparation of the Semi Annual and Annual Program Reports to O/GAC the Emergency Plan USG country teams spend considerable efforts to adjust the reports of Implementing Partners for potential double counting.
Double counting occurs in a variety of forms: when the same individual beneficiary is counted more than once by the same partner, when the same individual is counted for the same service by two or more different partners, or when the same service site is counted by two or more different partners. However, there is no central guidance to identify the extent of double counting and/or to standardize adjustment procedures across different country programs.
|
|
Enlisting National Mapping Agencies in the Fight against HIV/AIDS: Building Partnerships with Ministries of Health and Social Services, and National AIDS Commissions
|
|
2010 |
English |
Africa |
Africa, HIV/AIDS, GIS, Reproductive Health, PEPFAR |
In a first of its kind meeting, representatives of government health and mapping agencies from throughout Africa met and committed to working jointly to combat HIV/AIDS through better mapping of health data. The workshop, which drew participants from 29 African countries, sought to initiate a pan-African community of health mapping practices and resulted in heightened
awareness among participants of the need to collaborate in the fight against HIV/AIDS, as well as the spoken desire of many of the participants to increase cooperation. More tangibly, groups produced a ranking of the major issues affecting mapping of health data and articulated resolutions for consideration.The workshop, held April 27, 2009, at the United Nations Conference Center in Addis Ababa, Ethiopia, was organized by MEASURE Evaluation with support from the U.S. President’s Emergency Plan for AIDS Relief and the U.S. Agency for International Development. Co-sponsoring the workshop with MEASURE Evaluation was the United Nations Economic Commission for Africa and the Joint United Nations Programme on HIV/AIDS. |
|
Data Quality Assurance
|
Various |
2010 |
English |
Global |
|
Methods for assessing M&E plans and systems that collect and report data for program management and reporting. |
|
Matching the gold standard: comparing experimental and nonexperimental evaluation techniques for a geographically targeted program
|
Handa S, Maluccio JA |
2010 |
English |
NICARAGUA |
Nicaragua, Child Health |
We compare non-experimental impact estimates using propensity score matching with those from a social experiment to determine whether this non-experimental approach can match the gold standard. The social experiment we use was carried out to evaluate a conditional cash transfer program implemented in Nicaragua in 2000. The outcomes we assess include total and food expenditure and a variety of children's health outcomes including vaccinations, morbidity, and breast feeding. We find that PSM does better at replicating the benchmark for individual outcomes but does poorly for expenditure outcomes. Judicious choice of sample improves the performance of PSM for all outcomes. A more detailed analysis of the components of expenditures shows the degree of bias is related to the importance of the item in the household budget and persists even when differences in prices and consumption habits are controlled for by comparing households from the same geographic region. The PSM technique seems most promising for evaluating individual, and easily measured outcomes, such as those related to child schooling and health, but less so for more complex outcomes such as expenditures. |
|
Report of a Technical Consultation on Information Systems for Community-Based HIV Programs
|
|
2010 |
English |
|
HIV/AIDS, Orphans and Vulnerable Children, PEPFAR |
On July 21-22, 2009, more than 50 people representing multinational agencies, international profit and nonprofit organizations, and local implementing partners met to obtain consensus on a way forward to strengthen information systems for community-based HIV programs, to provide high quality data that are used to improve programs and facilitate reporting and use throughout the health system and beyond. The tools and experiences presented during the two-day meeting highlighted a variety of users and stakeholders at different levels of the health system, from the community to the national level. Recommendations emerging from the meeting underscored the fundamental need to strengthen monitoring and data use at the community-based program level by implementing monitoring and evaluating systems that yield quality, complete, relevant, and timely data. The Global Fund to Fight AIDS, Tuberculosis, and Malaria; World Bank; Joint United Nations Programme on HIV/AIDS; World Health Organization; MEASURE Evaluation; and U.S. Agency for International Development; among others, have ongoing efforts to strengthen information systems for community-based HIV programs. |
|
Zambia Sexual Behaviour Survey 2009
|
Central Statistical Office, Ministry of Health, National HIV/AIDS/STI/TB Council, University of Zambia, MEASURE Evaluation |
2010 |
English |
ZAMBIA, Southern Africa |
Zambia, Sexual Behavior, HIV/AIDS, Orphans and Vulnerable Children |
The Government of the Republic of Zambia, through the Central Statistical Office and the Ministry of Health, National AIDS Council, and the University of Zambia, and with technical assistance from MEASURE Evaluation, conducted the 2009 national Zambia Sexual Behaviour Survey, the fifth in a series of such surveys to monitor knowledge, attitudes, and behaviors regarding HIV/AIDS in Zambia. The main objective of the survey is to obtain national estimates of a number of key indicators (including international standardized indicators) important to monitoring progress of the national HIV/AIDS/STDs programme.The survey provides indicators on HIV/AIDS/STI-related knowledge, attitudes, and sexual behaviour, as well as information on orphans and vulnerable children, and assistance to households and communities affected by the HIV/AIDS pandemic. The 2009 survey provides national estimates that can be disaggregated by residence (rural/urban), age groups (adolescents, youths, young adults and adults), and by sex (males, females). |
|
Targeting HIV interventions for adolescent girls and young women in Southern Africa: use of the PLACE methodology in Hwange District, Zimbabwe
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Singh K, Sambisa W, Munyati S, Chandiwana B, Chingon A, Monasch R, Weir S |
2010 |
English |
ZIMBABWE, Africa |
Monitoring, HIV/AIDS, Sexual Behavior |
This paper addresses the issue of how to target interventions to girls 15-19 and young women 20-24 in a resource poor setting of Hwange District, Zimbabwe. The Priorities for Local AIDS Control efforts methodology was used to understand where these young people socialize and also to understand whether age disparate relationships were a common occurrence. Findings indicated prevention efforts for those 15-19 would need to focus on everyday sites as these are the places where the majority of girls socialized. However, the girls 15-19 with the riskiest sexual behaviors were found at venues affiliated with alcohol. Prevention efforts for those 20-24 would also need to largely focus on venues affiliated with alcohol. Women at such sites generally reported more risky behaviors than women in other types of venues. Reporting of a partner 5 or more years older was common across age groups and across venues. Tackling HIV in Zimbabwe will take a multifaceted approach targeted towards the places girls 15-19 and young women 20-24 are meeting new partners.
|
|
Eléments de base de S&E, Mini-Cours Autoguidé
|
Frankel N, Gage A |
2009 (rev. 2015) |
French |
Global |
Monitoring, Monitoring, Evaluation |
Le suivi et évaluation (S&E) est un volet essentiel de toute intervention, tout projet ou programme. Ce mini-cours, qui s'inscrit dans cette logique, traite des fondamentaux du suivi et évaluation de programme dans le cadre des programmes pour les populations, des programmes de santé et de nutrition. Il définit également les termes usuels et indique pourquoi le S&E est essentiel pour la gestion des programmes.
Au terme de ce cours, vous serez à même de :
identifier les objectifs de base et l'étendue du S&E ;
différencier les fonctions de suivi des fonctions d'évaluation ;
indiquer les fonctions d'un plan de S&E ;
identifier les principales composantes d'un plan de S&E ;
identifier et faire la distinction entre les cadres conceptuels, les cadres de résultats et les modèles logiques ;
décrire comment les cadres sont utilisés aux fins de la planification du S&E ;
identifier les critères de sélection des indicateurs ;
décrire comment les indicateurs sont liés aux cadres ;
identifier les types de sources de données ;
décrire comment les informations peuvent informer la prise de décision.
|
|
Fundamentos de monitoreo y evaluación, Cursillo autodirigido
|
Frankel N, Gage A |
2009 (rev. 2015) |
Spanish |
Global |
Monitoring, Monitoring, Evaluation |
El monitoreo y la evaluación son componentes esenciales en la ejecución de cualquier intervención, proyecto o programa. Este cursillo abarca los fundamentos de monitoreo y evaluación de programas de población, salud y nutrición. Además, incluye definiciones de algunos términos y explica por qué el monitoreo y la evaluación son fundamentales para la gestión de programas.
Al concluir este curso, usted tendrá la capacidad de:
Identificar los propósitos y alcance básicos del monitoreo y la evaluación
Distinguir entre las funciones de monitoreo y las funciones de evaluación
Describir las funciones de un plan de monitoreo y evaluación
Identificar los principales componentes de un plan de monitoreo y evaluación
Identificar y distinguir entre marcos conceptuales, marcos de resultados y modelos lógicos
Describir cómo se utilizan los marcos en la planificación del monitoreo y la evaluación
Identificar los criterios a aplicar en la selección de indicadores
Describir cómo se relacionan los indicadores con los marcos
Identificar los tipos de fuentes de datos
Describir cómo se puede utilizar información en la toma de decisiones
|
|
7 Steps to Use Routine Information to Improve HIV/AIDS Programs
|
Nicole R. Judice |
2009 |
English |
|
HIV/AIDS |
This document presents concrete steps and illustrative examples that can be used to facilitate the use of information as a part of the decision-making processes guiding program design, management, and service provision in the health sector. Specifically, seven steps to data demand and information use (DDIU or DDU) outlined in this document will help address barriers to using routinely-collected data by providing guidance in (1) linking questions of interest to program managers and providers to existing data; (2) analyzing, graphing, and interpreting data; and (3) continuing to monitor key indicators to information improvements. |
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Ghana Child Verbal Autopsy Study 2008
|
Ghana Statistical Service, Ghana Health Service, ICF Macro |
2009 |
English |
GHANA |
Vital Registration |
The objective of the 2008 Ghana Child Verbal Autopsy Study (GCVAS) is to gather data about the causes of death of children under age five in Ghana. Since many of the children in Ghana do not die in health facilities, information on the causes of death based on death certificates completed by health professionals is rare, and therefore not representative of the country as a whole. This study is based on a reliable sample of deaths among children under five that was collected in the 2008 Ghana Demographic and Health Survey (DHS). Households that reported the death of a child under five in 2005 or after were revisited during a DHS data collection, and the primary caretaker or others in the household were interviewed with a verbal autopsy questionnaire designed to determine the causes of death. The study was implemented by the Ghana Statistical Services (GSS) and the Ghana Health Service. Technical assistance was provided by MEASURE Evaluation and MEASURE DHS projects. Funding for the local costs was provided through MEASURE DHS, which managed funds from the U.S. Agency for International Development, the Ghana Ministry of Health, GSS, Ghana AIDS Commission, United Nations Children's Fund, United Nations Population Fund, and the Danish International Development Agency.
|
|
Benefits and costs of expanding access to family planning programs to women living with HIV
|
Halperin DT, Stover J, Reynolds HW |
2009 |
English |
Global |
HIV/AIDS |
This analysis models the potential benefits and costs of adding family planning to national strategies for achieving universal access to programs to prevent mother-to-child HIV transmission. Methods: We assume a service delivery perspective and estimate the cost-effectiveness of programs to reduce the number of HIV-infected children through using antiretroviral prophylaxis to prevent perinatal transmission, and of family planning programs to avert additional infant infections not already averted by antiretroviral prophylaxis, as well as of family planning to reduce the number of total unintended births to women living with HIV. Data are presented from the 139 countries included in the 2008 Annual United Nations Joint Programme on HIV/AIDS Report, although the main results are for the 14 countries with the largest number of HIV-infected pregnant women. Results: Programs to prevent perinatal HIV transmission would, if accessed by all women in need with the most efficacious antiretroviral regimen available, prevent over 240 000 infant HIV infections in the top 14 countries (over 300 000 globally) at an estimated cost of over $131 million ($208 million globally). However, almost 72 000 infant HIV infections would still occur in the 14 countries (over 90 000 globally) that could have been averted by preventing unintended pregnancies at a cost of only about $26 million (over $33 million globally). If all unintended births (whether or not resulting in HIV-infected children) to HIV-positive women were prevented with family planning, the cost per birth averted would be $61 in the 14 countries ($63 globally). Conclusion: This analysis suggests that national strategies should adopt a comprehensive approach to preventing mother-to-child transmission and thus focus on preventing perinatal HIV transmission as well as unintended pregnancies. Family planning is costeffective for preventing HIV transmission and unintended pregnancies and will also reduce infant and maternal mortality and result in fewer orphans. |
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Sexual violence and reproductive health outcomes among South African female youths: a contextual analysis
|
Speizer I, Pettifor A, Cummings S, MacPhail C, Kleinschmidt I, Rees H |
2009 |
English |
Africa, SOUTH AFRICA |
Maternal Health |
Objectives. We studied whether female youths from communities with higher sexual violence were at greater risk of negative reproductive health outcomes.
Methods. We used data from a 2003 nationally representative household survey of youths aged 15–24 years in South Africa. The key independent variable was whether a woman had ever been threatened or forced to have sex. We aggregated this variable to the community level to determine, with control for individual-level experience with violence, whether the community-level prevalence of violence was associated with HIV status and adolescent pregnancy among female, sexually experienced, never-married youths.
Results. Youths from communities with greater sexual violence were significantly more likely to have experienced an adolescent pregnancy or to be HIV-positive than were youths from communities experiencing lower sexual violence. Youths from communities with greater community-level violence were also less likely to have used a condom at their last sexual encounter. Individual-level violence was only associated with condom nonuse.
Conclusions. Programs to reduce adolescent pregnancies and HIV risk in South Africa and elsewhere in sub-Saharan Africa must address sexual violence as part of effective prevention strategies.
|
|
Using multiple sampling approaches to measure sexual risk-taking among young people in Haiti: programmatic implications
|
Speizer IS, Beauvais H, Gómez AM, Finn Outlaw T, Roussel B |
2009 |
English |
HAITI |
HIV/AIDS, Haiti |
No previous published research has examined the applicability of varying methods for identifying young people who are at high risk of experiencing unintended pregnancy and acquiring HIV infection. This study compares three surveys of young people aged 15–24 in Port-au-Prince, Haiti, in terms of their sociodemographic characteristics and sexual behaviors and the surveys’ usefulness for identifying young people at high risk and for program planning. The surveys consist of responses from: a representative sample of young people in the 2005–06 Haiti Demographic and Health Survey (HDHS), a 2004 facility-based study, and a 2006–07 venue-based study that used the Priorities for Local AIDS Control Efforts (PLACE) method. The facility-based and PLACE studies included larger proportions of single, sexually experienced young people and people who knew someone with HIV/AIDS than did the HDHS. More respondents in the PLACE sample had multiple sex partners in the past year and received money or gifts in return for sex, compared with respondents in the facility study. At first and last sex, more PLACE respondents used contraceptives, including condoms. Experience of pregnancy was most commonly reported in the data from the facility-based sample; however, more ever-pregnant PLACE respondents than others reported ever having terminated a pregnancy. Program managers seeking to implement prevention activities should consider using facility- or venue-based methods to identify and understand the behaviors of young people at high risk.
|
|
Inconsistent fertility motivations and contraceptive use behaviors among women in Honduras
|
Speizer IS, Irani L, Barden-O'Fallon J, Levy J |
2009 |
English |
HONDURAS |
Honduras, Maternal Health, Pregnancy, Fertility |
Background: Recent studies have demonstrated that it is common for women to report inconsistent fertility motivations and family planning behaviors. This study examines these inconsistencies among urban Honduran women interviewed at two points in time and presents reasons for inconsistent fertility motivations and contraceptive behaviors at follow-up. Methods: Data come from a one-year panel study conducted in Honduras from October 2006 to December 2007. A total of 633 women aged 15-44 years were interviewed at baseline and follow-up and have non-missing information on the key variables of interest. At baseline and follow-up, women were asked how much of a problem it would be (no problem/small problem/big problem) if they got pregnant in the next couple of weeks. At follow-up, women were asked an open-ended question on reasons it would be no problem, a small problem, or a big problem. The open-ended question was recoded into a smaller set of response categories. Univariate and bivariate analyses are presented to examine inconsistencies and reasons for stated inconsistencies. Results: At follow-up, over half the women using a contraceptive method said that it would be no problem if they got pregnant. Nearly half of the women changed their perceptions between baseline and follow-up. Common reasons for reporting no problem among contraceptive users were that they accepted a child as God's will or that children are a blessing, their last child was old enough and they wanted another child. Common reasons for reporting a big/small problem among non-users of family planning (who have an unmet need for family planning) were that they were not in a stable relationship, the husband was not present, and they would expect a negative response from their family. Conclusion: Inconsistent fertility motivations and contraceptive behaviors are common among effective contraceptive users. Women who are using contraception and become pregnant will not necessarily report the pregnancy as unintended, given the widespread acceptance of unintended pregnancies in Honduras. Family planning providers need to recognize that fertility motivations vary over time and that women may not have firm motivations to avoid a pregnancy. |
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Muhtasari wa Tafiti Tano za Kaya Kufuatilia Idadi ya Watu waliofikiwa na Matokeo ya Afua za Malaria Tanzania, 2007-2008
|
Foreit KGF, Patton EG, Walker DM |
2009 |
Swahili |
East Africa, Africa, TANZANIA |
Malaria |
Taarifa hii inatoa muhtasari wa matokeo makuu ya tafiti tano huru za kaya kuhusu afua za malaria zilizofanywa Tanzania Bara kati ya Oktoba 2007 na Septemba 2008. Mwezi Novemba 2008, Mpango wa Taifa wa Kudhibiti Malaria (NMCP) na Mfuko wa Rais wa Marekani wa Kupambana na Malaria (PMI) waliitisha mkutano wa siku mbili, Dar es Salaam kuwezesha uwasilishaji wa njia na matokeo ya tafiti zote tano. Tafiti za Kaya ni muhimu sana katika mazingira ya ugonjwa wa malaria kwa ajili ya kupima kufikiwa na afua zilizolenga ngazi ya Kaya, kama vile vyandarua vyenye dawa (ITN) na katika kuelewa mielekeo ya matumizi ya mbinu za kuzuia malaria miongoni mwa walengwa. Kila utafiti ulichunguza jukumu mahususi la wakati ulipopangwa na kutekelezwa mwaka 2007-2008. Hata hivyo katika ari ya juhudi za Kupunguza Kasi na athari za Malaria ili kuboresha uwianishaji wa utafiti mkubwa wa Kaya, NMCP na PMI viliwakutanisha watafiti wa tafiti tano zilizohusika kujadili matokeo katika mkutano wa wazi. Matokeo yaliyomo katika chapisho hili la muhtasari yanayonyesha idadi ya vatu waliofikiwa na data za matokeo mara baada ya kampeni ya kitaifa ya usambazaji bure vyandarua vyenye dawa ya muda mrefu (LLINS) kwa watoto wote wenye umri wa chini ya miaka mitano (iliyozinduliwa rasmi, Mei, 2009) na kampeni nyingine kwa ajili ya usambazaji bure wa LLINS kwa kaya zote zilizobaki (inakadiriwa kuzinduliwa mwanzoni mwa 2010). Chapisho hili linakusudiwa kuwa kama chapisho moja la chanzo cha taarifa ya matokeo muhimu kutoka tafiti zote tano. Maelezo mahususi yanayohusu njia za utafiti (ikiwemo utayarishaji wa sampuli na dodoso), matokeo mengi zaidi yatafuatiliwa katika taarifa kamili za kila utafiti unaohusika. |
|
Summary of Five Household Surveys to Monitor Population-Level Coverage and Impact of Malaria Interventions in Tanzania, 2007-2008
|
Foreit KGF, Patton EG, Walker DM |
2009 |
English |
TANZANIA, East Africa, Africa |
Malaria, Tanzania, Public Health |
This report summarizes the main findings of five independent household surveys of malaria interventions conducted on the Tanzania Mainland between October 2007 and September 2008. In November of 2008 the National Malaria Control Programme (NMCP) and the U.S. Presidents Malaria Initiative (PMI) convened a two-day meeting in Dar es Salaam to facilitate presentation of the methods and results of all five surveys. Household surveys are especially relevant in malaria endemic settings for measuring coverage of interventions that primarily target the household level, such as insecticide-treated nets (ITNs), and for understanding patterns of antimalarial use among target populations. Each survey served a specific role at the time it was planned and implemented in 2007-08. Nevertheless, in the spirit of Roll Back Malarias efforts to improve harmonization of large household surveys, NMCP and PMI brought together investigators of the five surveys to discuss the findings in an open forum. The results in this summary document provide population-level coverage and impact data immediately preceding the national campaign to distribute free long lasting insecticidal bednets (LLINs) for all children under five years of age (officially launched in May 2009) and another campaign for free distribution of LLINs to cover all remaining sleeping spaces (estimated launch date early 2010). This document is meant to serve as a single source document for the major findings from all five surveys. Specific details concerning methods (including sampling and questionnaire design) more extensive results will need to be pursued from the full reports of each individual survey. |
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Development of a Monitoring Framework for Referral within a Network of HIV/AIDS Service Providers: Condensed Final Report Based on Four Case Studies
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Ricca JG, Negroustoueva S |
2009 |
English |
KENYA, ZAMBIA, Southern Africa, West Africa, East Africa, Africa, SWAZILAND, NIGERIA |
HIV/AIDS |
The number and scope of services available for prevention, support, care, and treatment of HIV/AIDS has risen dramatically in the last several years. In this increasingly complex service environment, integrating HIV services among themselves and with other services is important for making those services accessible to clients and their delivery efficient for the health system, and ultimately for improving individual and family outcomes. Based on findings from HIV/AIDS referral systems examined in Kenya, Nigeria, Swaziland, and Zambia, this report provides a proposed checklist for assessing such referral networks. For a key service needed by clients, the ultimate goal is that clients have timely access to the service (and, therefore, utilize that service appropriately). The checklist can be used to decide if referral is the best option for achieving this goal and, if so, some key considerations for structuring the referral system and its monitoring.(This report is a condensed version of Development of a Monitoring Framework for Referral within a Network of HIV/AIDS Service Providers: Final Report Based on Four Case Studies.) |
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Development of a Monitoring Framework for Referral within a Network of HIV/AIDS Service Providers: Final Report Based on Four Case Studies
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Ricca JG, Negroustoueva S |
2009 |
English |
ZAMBIA, Southern Africa, West Africa, East Africa, Africa, SWAZILAND, NIGERIA, KENYA |
HIV/AIDS |
The number and scope of services available for prevention, support, care, and treatment of HIV/AIDS has risen dramatically in the last several years. In this increasingly complex service environment, integrating HIV services among themselves and with other services is important for making those services accessible to clients and their delivery efficient for the health system, and ultimately for improving individual and family outcomes. Based on findings from HIV/AIDS referral systems examined in Kenya, Nigeria, Swaziland, and Zambia, this report provides a proposed checklist for assessing such referral networks. For a key service needed by clients, the ultimate goal is that clients have timely access to the service (and, therefore, utilize that service appropriately). The checklist can be used to decide if referral is the best option for achieving this goal and, if so, some key considerations for structuring the referral system and its monitoring. |
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Patient Experiences In Antiretroviral Therapy Programmes In Kwazulu-Natal, South Africa
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Yoder PS, Mkhize S, Nzimande S |
2009 |
English |
SOUTH AFRICA, Southern Africa |
HIV/AIDS |
This report presents the methods and findings of a qualitative study of the experiences of patients taking medication for HIV infection as part of an antiretroviral therapy (ART) program in five sites in KwaZulu-Natal, South Africa. The study, known as the ADHERE Project, was designed by MEASURE Evaluation and implemented in collaboration with Health Systems Trust to provide information to the KwaZulu-Natal Department of Health for use in expanding and improving their ART services. Through conversations with about 200 individuals about ART programs in which they had participated, the study was able to identify aspects that patients found most troubling. |
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Slowly but Surely: Evaluations of Three Programs Supporting Most Vulnerable Children in Tanzania Show Some Benefits
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Nyangara F, Lema E |
2009 |
English |
Africa, TANZANIA, East Africa |
Orphans and Vulnerable Children, Tanzania, HIV/AIDS, Maternal Health, Child Health |
This policy brief provides a concise summary of key findings from three orphan and vulnerable children (OVC) program evaluations conducted in Tanzania. It examines the policy and programmatic implications of study results and offers recommendations for service providers and other decision-makers at the program and national levels. The three OVC programs evaluated were Mama Mkubwa & Kids' Club implemented by The Salvation Army, which had been operating for two years in the Mbeya region; Tumaini Project implemented by CARE International, Family Health International, and a faith-based organization Allamano, operating for five years in Iringa region; and Jali Watoto, implemented by Pact and a community-based organization, SAWAKA, operating for four years in Karagwe, Kagera region. These programs implemented different combinations of intervention strategies, including community mobilization and sensitization; health education and HIV prevention activities; home visits by trained volunteers; kids' clubs; income generating activities; and the provision of direct material support such as school materials, health services, and food support. |
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Effects of a Community-Focused Approach Supporting the Most Vulnerable Children: Evaluation of SAWAKA Jali Watoto Program in Kagera, Tanzania
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Nyangara F, Obiero W |
2009 |
English |
TANZANIA, East Africa, Africa |
Orphans and Vulnerable Children, HIV/AIDS, Child Health |
In 2007-08, the MEASURE Evaluation project evaluated the Jali Watoto (Care for Children) project in Tanzania. Jali Watoto is a child and community-centered program supported by Pact, an international nongovernmental organization, and implemented through local community-based organizations, including SAWAKA (Zaidia Wazee Karagwe, which means "help the elderly in Karagwe"). The program provides support to most-vulnerable children and their caregivers. The main purpose of this evaluation was to assess the effectiveness of the Jali Watoto program model in improving the well-being of most-vulnerable children and their caregivers in communities affected by HIV/AIDS. In addition, this paper outlines the programmatic implications of the findings for service providers and other stakeholders and makes recommendations regarding effective, replicable interventions. Findings show that the program had mixed effects on most-vulnerable children and their caregivers in terms of the psychosocial well-being, support networks, and perceptions of community stigma, among other outcomes. |
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SAWAKA Jali Watoto Program Supporting Most-Vulnerable Children, Tanzania: A Case Study
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Nyangara F, Matiko C, Kalungwa Z |
2009 |
English |
TANZANIA, Africa, East Africa |
Orphans and Vulnerable Children, HIV/AIDS, Child Health |
This case study provides a detailed account of the Pact/Jali Watoto project in supporting orphans and other vulnerable children (OVC) in Karagwe district of Tanzania. The case study will guide the development of questionnaires and other pre-data collection preparations that are needed for evaluating the program. The primary audience for this study includes OVC program implementers in Tanzania and others in sub-Saharan Africa, researchers and evaluators, as well as policy-makers and funding agencies addressing OVC needs. The case study is based upon program document review; program site visits, including discussions with local and national Pact staff, volunteers, beneficiaries, and community members; and observations of program activities. |
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HIV/AIDs in Namibia: Behavioral and Contextual Factors Driving the Epidemic
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de la Torre C, Khan S, Eckert E, Luna J, Koppenhaver T |
2009 |
English |
NAMIBIA, Africa |
HIV/AIDS |
This report identifies and describes what current evidence indicates are the main behavioral and contextual factors that are driving the HIV epidemic in Namibia. The report is intended to assist in the development of a national prevention strategy for combating the HIV/AIDS epidemic. Data from several sources are triangulated to assess which factors are most likely to contribute to the spread of HIV across the population. |
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Effects of Programs Supporting Orphans and Vulnerable Children: Key Findings, Emerging Issues, and Future Directions from Evaluations of Four Projects in Kenya and Tanzania
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Nyangara F, Thurman TR, Hutchinson P, Obiero W |
2009 |
English |
TANZANIA, West Africa, KENYA, Africa |
Orphans and Vulnerable Children, Kenya, Tanzania, PEPFAR |
This report provides a summary of key findings from evaluations of four programs, two in Kenya and two in Tanzania, supporting orphans and other vulnerable children (OVC). The aim of these evaluations was to ascertain the extent to which program interventions are effective in improving the well-being of OVC and their families, and the interventions' cost-effectiveness in achieving key outcomes. This report focuses on the overarching outcomes, emerging issues, and lessons learned from these evaluation studies of OVC programs. Reflections as to the implications of the findings are offered to provide guidance to OVC service providers, donors, and policy-makers to make informed decisions that ultimately improve the well-being of children and their families. The evaluations focused on specific intervention components, including home visits by trained volunteers, kids' clubs, support group and income-generating activities for guardians, community HIV education and OVC sensitization activities, and the provision of material support, such as school supplies, food, and health services. |
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Analyzing the Cost-Effectiveness of Interventions to Benefit Orphans and Vulnerable Children: Evidence from Kenya and Tanzania
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ThurmanTR, Hutchinson P |
2009 |
English |
West Africa, Africa, KENYA, TANZANIA |
Orphans and Vulnerable Children, Kenya, Tanzania, PEPFAR, HIV/AIDS, Maternal Health, Child Health |
In an attempt to improve the lives of orphans and vulnerable children (OVC) in sub-Saharan Africa, the U.S. President's Emergency Plan for AIDS Relief provides funding to programs that supply wide-ranging services to OVC and their families. While the programs have a similar objective, the improvement of OVC well-being, they may differ substantially in the types of services they provide: educational support, vocational training, or other income generating skills; food aid; support groups for guardians; home visiting that includes basic psychosocial support or assistance with anti-retroviral therapy; HIV education, recreational opportunities, and individual counseling for children. Their approaches may involve (individually or jointly) direct support to OVC, indirect support to OVC guardians, or more widespread support to communities as a whole. In order to provide some further insight on the success of these programs, this paper attempts a rudimentary cost-effectiveness analysis by linking measures of intervention costs for four OVC programs in Kenya and Tanzania to measures of program outcomes. These results provide some evidence that investments in OVC programs, particularly school-based HIV education and counseling for children and savings and internal lending committees for guardians, can achieve improvements in their well-being at a fairly low cost per beneficiary. |
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Community-Based Psychosocial Intervention for HIV-Affected Children and their Caregivers: Evaluation of The Salvation Army
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Nyangara F, Obiero W, Kalungwa Z, Thurman TR |
2009 |
English |
East Africa, Africa, KENYA |
Orphans and Vulnerable Children, HIV/AIDS, Child Health |
This report presents the post-test findings from an outcome evaluation of the Mama Mkubwa community-centered psychosocial support program implemented by the Salvation Army, Tanzania Command, that provides assistance to OVC and their families and communities. In addition, the paper discusses the programmatic implications of the findings for program implementers and policy-makers to help them make informed decisions on how to meet OVC needs and reduce their vulnerabilities. |
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Promoting HIV Prevention and Testing: Evaluation of the Integrated AIDS Program-Thika in Kenya
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ThurmanTR, Hutchinson P, Lavin B, Ikamari L |
2009 |
English |
East Africa, Africa, KENYA |
Kenya, Orphans and Vulnerable Children, HIV/AIDS, Child Health |
This paper examines the effectiveness of HIV prevention interventions by the Integrated AIDS Program-Thika (IAP) operating in Kenya to promote HIV education and voluntary counseling and testing within the broader community. |
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Community Education and Sensitization as an OVC Care and Support Strategy: Evaluation of the Integrated AIDS Program-Thika in Kenya
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ThurmanTR, Hutchinson P, Ikamari L, Gichuhi W, Murungaru K, Nyangara F |
2009 |
English |
East Africa, Africa, KENYA |
Orphans and Vulnerable Children, HIV/AIDS, Kenya, Child Health |
This paper presents the findings from the evaluation of the Integrated AIDS Program-Thika (IAP) operating within Kenya. IAP is a community and faith-based organization that receives technical and financial support from Pathfinder International. This evaluation explores the impact of IAP's community education and sensitization efforts focusing on care and support for orphans and vulnerable children (OVC). These efforts aim to enhance child protection and reduce stigma concerning OVC and people living with AIDS, and these outcomes are examined with a post-test study design. The indirect influence of living in "high acceptance" or "high stigma" communities on the level of community support provided to OVC is also explored. This paper further provides a profile of the characteristics and needs of OVC relative to other children. The programmatic implications of these findings are discussed. |
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The Difference Interventions for Guardians Can Make:Evaluation of the Kilifi Orphans and Vulnerable Children Project in Kenya
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ThurmanTR, Rice J, Ikamari L, Jarabi B, Mutuku A, Nyangara F |
2009 |
English |
East Africa, KENYA, Africa |
Orphans and Vulnerable Children, HIV/AIDS, Kenya, Child Health |
This evaluation examines the effectiveness of specific program strategies on improving the lives of orphans and vulnerable children (OVC) and their guardians. This paper presents the findings from the 2007 outcome evaluation of the Catholic Relief Services Kilifi OVC project operating within Kenya. The evaluation explored the impact of interventions that aim to support and build the capacity of OVC guardians. |
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Promoting a Home-Based Program Model for Supporting Children Affected by HIV/AIDS: Evaluation of Tumaini Project in Iringa Region, Tanzania
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Nyangara F, Kalungwa Z, Obiero W, Thurman TR, Chapman J |
2009 |
English |
Africa, TANZANIA, East Africa |
Orphans and Vulnerable Children, Tanzania, HIV/AIDS, Evaluation, Child Health |
This report presents the post-test findings from a 2007 evaluation of the Tumaini home-based care program model implemented by CARE and by Family Health International through Consolata sisters Allamano, a faith-based organization, in the Iringa region of Tanzania. This information is useful to government agencies, program staff, and organizations providing services to orphans and vulnerable children (OVC), to help them make informed decisions on how to meet OVC needs and to reduce their vulnerabilities. |
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Comment rendre exploitables les résultats de recherche
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|
2009 |
French |
Global |
|
Les chercheurs fournissent des informations pour permettre aux parties prenantes de pendre des décisions fondées sur des données probantes. Pourtant, bien souvent, les données de recherche ne sont pas disponibles, accessibles, pertinentes ou utiles, ce qui limite leur applicabilité dans l'amélioration des systèmes de santé. On peut augmenter la prise en compte de la recherche par les parties prenantes en développant une stratégie de diffusion des informations. Cette stratégie doit être envisagée au cours du processus de planification de la recherche et correspondre aux objectifs de communication, aux publics cibles, aux canaux de communication adéquats et à l'évaluation de l'emploi des données. |
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Making Research Findings Actionable: A Quick Reference to Communicating Health Information for Decision-Making
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|
2009 |
French |
|
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Researchers provide health information to empower stakeholders in making evidence-based decisions. Yet, research is frequently not available, accessible, relevant, or useful, which limits its applicability for improving health systems. Developing an information dissemination strategy, which is part of data demand and use (DDU, or DDIU), is likely to increase stakeholders' research uptake. The strategy should be considered during the research planning process and address the communication objectives, target audiences, appropriate channels, and assessment of use. |
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Basic Statistics on Health Facility Status and Readiness to Deliver Quality Services
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Fronczak, N, Fapohunda, B |
2009 |
English |
|
Health Facilities |
This chartbook presents comparable cross-country information on key indicators that represent the capacity of a health facility to provide quality services. These indicators provide a baseline for measuring changes in infrastructure and resources over time. This information will help stakeholders for health to identify key aspects of facility-based services that are internationally assessed as important to quality of services, identify differences between countries in the readiness of facilities to provide quality services, provide objective information that can be used to prioritize specific indicators or domains for sustained improvement, and provide a baseline against which change can be measured. |
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Pillars of Health Facility Assessment: An Illustrative Capacity-Building Curriculum for Mid- and Senior-Level Managers
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Fapohunda B, Gragg B |
2009 |
English |
|
Public Health |
Developed by the International Health Facility Assessment Network, this three-day workshop curriculum is designed to reinforce the importance of health facility data collection as an essential component of health information systems. With this knowledge, participants will be in a better position to advocate effective health facility assessments in their home-country contexts. Workshop participants learn about the different types of health facility assessments now in use; the main elements of such an assessment (data collection instruments, techniques, and core indicators derived from data); see actual results from assessments and the way they have and can be used to inform policy-making; learn to extract, analyze, and interpret real data, venturing implications for programmatic decision-making; examine the role of these assessments in health information systems (e.g., planning, monitoring and evaluation, advantages and limitations); and discuss options for funding and the potential for undertaking assessments in their countries. |
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Quick Poverty Score Toolkit: User's Guide and Spreadsheet
|
|
2009 |
English |
UGANDA, Eastern Europe, Latin America and the Caribbean, East Africa, Asia, PHILIPPINES, PAKISTAN, INDIA, HONDURAS, HAITI, GUATEMALA, BOLIVIA, BANGLADESH, AZERBAIJAN |
Poverty |
The Quick Poverty Score (QPS) is a simple, easy-to-use tool that health service programs can use to assess the prevalence of poverty among their clients. Using three components, QPS provides a snapshot of uptake of program services by those living below the national poverty line, below U.S. $2 per day, and below U.S. $1 per day. Country-specific user's guides explain how to apply QPS and interpret outputs in 10 countries, with Microsoft Excel spreadsheets for each country (Spanish translations are available for Honduras and Guatemala). |
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PRISM Tools for Assessing, Monitoring, and Evaluating RHIS Performance
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Aqil A, Lippeveld T |
2009 |
English |
|
|
The Performance of Routine Information System Management (PRISM) framework and its tools of application have expanded since 2004. Version 3.0, produced in June 2008, is provided in this document.
The 2018 version of the PRISM Series, updated and with new modules (Toolkit, User’s Kit, and Training Kit) is available here: https://www.measureevaluation.org/prism |
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Jamaica National HIV/STI Programme: Monitoring and Evaluation System Operations Manual
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|
2009 |
English |
JAMAICA, Latin America and the Caribbean |
Monitoring, Evaluation, Monitoring, Evaluation, HIV/AIDS, Jamaica |
Monitoring and Evaluation (M&E) is the backbone of public health systems for providing essential information and evidence regarding the best practices and lessons learned in health programmes. The Jamaica National HIV/STI Programmes (NHP) M&E system collects high quality data, analyses that data to produce programme information and supporting evidence for decision-makers and stakeholders throughout the programme. The M&E system is described in two documents: the M&E Plan (Document A) and the M&E Operations Manual (Document B). They are fundamental follow-on documents to the National Strategic Plan (NSP). It is a companion document to the 2007-2012 National Strategic Plan (NSP); therefore, please refer to the NSP for detailed information on the programmes specific objectives and interventions. This document is the M&E Operations Manual. This document complements the M&E Plan (Document A) by clearly detailing how each piece of the M&E system functions. Whereas the M&E Plan describes the overall M&E system and structural components (i.e., databases, indicators, etc.), the M&E Operations Manual provides specific national guidance on procedures, protocols, policies, roles, responsibilities, timelines and other implementation factors described in the M&E Plan. It also details the value of programme information for decision-making at the local, national and donor levels. It is important to note that the M&E Operations Manual was developed in collaboration with key stakeholders from across the HIV Response. The M&E Operations Manual is intended to be used by stakeholders at all levels that contribute to or participate in the national M&E system to ensure high quality data is reported and resulting information is received in a timely manner at all levels of programme implementation (i.e., facility, local, national and donor levels). |
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PRISM framework: a paradigm shift for designing, strengthening and evaluating routine health information systems
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Aqil A, Lippeveld T, Hozumi D |
2009 |
English |
Global |
|
The utility and effectiveness of routine health information systems (RHIS) in improving health system performance in developing countries has been questioned. This paper in the journal Health Policy and Planning argues that the health system needs internal mechanisms to develop performance targets, track progress, and create and manage knowledge for continuous improvement. Based on documented RHIS weaknesses, we have developed the Performance of Routine Information System Management (PRISM) framework, an innovative approach to design, strengthen and evaluate RHIS. The PRISM framework offers a paradigm shift by putting emphasis on RHIS performance and incorporating the organizational, technical and behavioural determinants of performance. By describing causal pathways of these determinants, the PRISM framework encourages and guides the development of interventions for strengthening or reforming RHIS. Furthermore, it conceptualizes and proposes a methodology for measuring the impact of RHIS on health system performance. Ultimately, the PRISM framework, in spite of its challenges and competing paradigms, proposes a new agenda for building and sustaining information systems, for the promotion of an information culture, and for encouraging accountability in health systems.
The 2018 version of the PRISM Series, updated and with new modules (Toolkit, User’s Kit, and Training Kit) is available here: https://www.measureevaluation.org/prism |
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Impact of Oportunidades on skilled attendance at delivery in rural areas
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Urquieta J, Angeles G, Mroz T, Lamadrid-Figueroa H, Hernandez B |
2009 |
English |
MEXICO |
Public Health, Poverty, Maternal Mortality, Health Services, Mexico, Pregnancy |
Oportunidades (formerly PROGRESA) is a conditional cash transfer program aun by the Mexican federal government designed to break the intergenerational cycle of poverty. Among other activities, it provides free delivery attendance for women enrolled in the program. Skilled attendance at delivery has been identified as an effective strategy to reduce maternal mortality, an important health problem in Mexico. In this paper we assess the impact of Oportunidades on skilled attendance at delivery taking advantage of the experimental design implemented for the evaluation of this program in rural areas and using a variety of analytical techniques. The main results of the study indicate that Oportunidades had, at best, only a small effect on skilled attendance at delivery in treatment communities. The program had larger effects on those women who had one birth just prior to the experimental treatment and another birth subsequent to the experimental treatment. These results should lead to a review about the strategies used by Oportunidades to increase skilled attendance at delivery. |
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Sexual violence and reproductive health outcomes among South African Female youths: a contextual analysis
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Speizer IS, Pettifor A, Cummings S, Macphail C, Kleinschmidt I, Rees HV |
2009 |
English |
SOUTH AFRICA, Africa |
Maternal Health, HIV/AIDS, Pregnancy |
Objectives.We studied whether female youths from communities with higher sexual violence were at greater risk of negative reproductive health outcomes.
Methods. We used data from a 2003 nationally representative household survey of youths aged 15-24 years in South Africa. The key independent variable was whether a woman had ever been threatened or forced to have sex. We aggregated this variable to the community level to determine, with control for individual-level experience with violence, whether the community-level prevalence of violence was associated with HIV status and adolescent pregnancy among female, sexually experienced, never-married youths.
Results. Youths from communities with greater sexual violence were significantly more likely to have experienced an adolescent pregnancy or to be HIV positive than were youths from communities experiencing lower sexual violence. Youths from communities with greater community-level violence were also less likely to have used a condom at their last sexual encounter. Individual-level violence was only associated with condom nonuse.
Conclusions. Programs to reduce adolescent pregnancies and HIV risk in South Africa and elsewhere in sub-Saharan Africa must address sexual violence as part of effective prevention strategies.
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Sexual violence and reproductive health among youth in Port-au-Prince, Haiti
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Gómez MA, Speizer IS, Beauvais H |
2009 |
English |
HAITI, Latin America and the Caribbean |
Child Health, Maternal Health, Pregnancy, Haiti |
We examine sexual violence and reproductive health outcomes among sexually experienced youth in Port-au-Prince, Haiti, using the Priorities for Local AIDS Control methodology to identify participants in locations where sexual partnerships are formed. Our findings indicated that sexual violence is common and is significantly associated with condom use, pregnancy experience, and recent sexually transmitted infection symptoms. |
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Experience with side effects among users of injectables, the IUD, and oral contraceptive pills in four urban areas of Honduras
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Barden-O'Fallon J, Speizer I, Rodriguez F, Calix J |
2009 |
English |
HONDURAS |
Honduras |
Contraceptive side effects are often the most commonly reported reason for method discontinuation, particularly of modern methods. We use data from eight focus groups and 800 exit interviews to examine women's experiences with contraceptive side effects in four urban areas of Honduras. Ease of treatment and differences in motivation to avoid pregnancy are suggested explanations for why side effects cause some women to continue and others to discontinue. Although side effects are a common reason for discontinuation in this population, less than half of the surveyed women were informed about potential side effects by a health worker on the day of the interview. |
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Impact of oportunidades on skilled attendance at delivery in rural areas
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Urquieta J, Angeles G, Mroz T, Lamadrid-Figueroa H, Hernández B |
2009 |
English |
MEXICO |
Child Health, Maternal Health, Poverty, Maternal Mortality |
Oportunidades (formerly PROGRESA) is a conditional cash transfer program ran by the Mexican federal government designed to break the intergenerational cycle of poverty. Among other activities, it provides free delivery attendance for women enrolled in the program. Skilled attendance at delivery has been identified as an effective strategy to reduce maternal mortality, an important health problem in Mexico. In this paper we assess the impact of Oportunidades on skilled attendance at delivery taking advantage of the experimental design implemented for the evaluation of this program in rural areas and using a variety of analytical techniques. The main results of the study indicate that Oportunidades had, at best, only a small effect on skilled attendance at delivery in treatment communities. The program had larger effects on those women who had one birth just prior to the experimental treatment and another birth subsequent to the experimental treatment. These results should lead to a review about the strategies used by Oportunidades to increase skilled attendance at delivery. |
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Fact Sheet: Antiretroviral Adherence
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Yoder, Stan |
2009 |
English |
SOUTH AFRICA, Africa |
HIV/AIDS |
MEASURE Evaluation, in partnership with Health Systems Trust, and in collaboration with the Department of Health of KwaZulu-Natal (KZN), and conducted a study of patient experiences on antiretroviral therapy (ART) in KZN to learn about patients concerns in taking antiretrovirals (ARVs). Researchers sought to identify adherence strategies that succeeded or failed in helping patients take ARVs on time and remain in the program. The findings were used to develop a tool to assess the circumstances of ART patients with the goal of increasing adherence and retention. For the study, 172 current and former patients enrolled in ART programs in five facilities across the province were interviewed, including 52 patients who had dropped out of a program. Health care providers working in these programs were also interviewed. |
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Fact Sheet: Mozambique Database
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2009 |
English |
MOZAMBIQUE, Africa |
Mozambique |
MEASURE Evaluation developed a project-management database to help Mozambiques Ministry of Woman and Social Action cooperation department. |
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Fact Sheet: Ensuring Sustainability
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2009 |
English |
|
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MEASURE Evaluation builds strong, dynamic, and sustainable leadership and organizations with customized Organization Development assistance. |
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Fact Sheet: Knowledge Management
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2009 |
English |
|
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Creating on-demand access to knowledge, so that every situation may be addressed with the sum total of everything learned from a similar situation |
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Curricula Review of Emergency Plan Centrally-Funded HIV Prevention Programs for Youth
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Lopez C, Speizer I |
2009 |
English |
TANZANIA, Africa, MOZAMBIQUE, KENYA, HAITI, ETHIOPIA |
PEPFAR, HIV/AIDS, Child Health |
In an effort to mitigate the spread of HIV in developing nations, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) supports HIV prevention programs that emphasize "abstinence and be faithful for youth" (ABY)among a broader array of prevention interventions. The focus of this report is on multi-country, multi-year PEPFAR ABY programs implemented by 14 nongovernmental and faith-based organizations that were awarded a total of $100 million in central funding by the U.S. Agency for International Development's Office of HIV/AIDS at the beginning of PEPFAR. Most of these ABY programs are curriculum-based programs; however, to date, the curricula have not been evaluated for quality. Furthermore, few published standards and guidelines exist for HIV prevention curricula, especially for developing countries. This paper uses an evaluation tool that compiles known characteristics of high quality reproductive health and HIV prevention curricula to evaluate the strengths and weaknesses of curricula used by centrally-funded PEPFAR ABY programs. Recommendations are made for strengthening the curricula reviewed. In general, curricula reviewed used a variety of participatory teaching methods and addressed such life skills as self-esteem and effective communication, covered topics in a logical sequence, and addressed multiple risk and protective factors affecting sexual behaviors. Curricula vary greatly in their use of skills-based exercises within the lessons, with curricula for younger youth being more likely to use strategies that build skills of participants. Curricula for older adolescents and young adults were weaker since they did not adequately address the needs of sexually experienced youth, including secondary abstinence, mutual faithfulness, and condom use. Topics such as sexual violence, drugs, and communication with parents were not well covered in most of the curricula reviewed. This review is useful for program managers 1) seeking to strengthen their current curricula (if using one of the curricula reviewed), 2) searching for a curriculum to use in a future HIV prevention program for youth, 3) wanting to identify lessons that could be borrowed from other curricula to strengthen their current program, or 4) designing new curricula that are sure to have the components of effective curriculum-based programs. |
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A Comparative Analysis of Select Health Facility Survey Methods Applied in Low and Middle Income Countries
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Edward A, Matsubiyashi T, Fapohunda B, Becker S |
2009 |
English |
|
|
MEASURE Evaluation's 2006 "Profiles of Health Facility Assessment Methods" [TR-06-36] provides a succinct overview of commonly applied health facility assessment methods in developing countries. This working paper further examines the sampling methods and provides a comparison of the various approaches in an attempt to identify the distinctive features of each method. |
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Evaluating the Impact of Community-Based Interventions on Schooling Outcomes among Orphans and Vulnerable Children in Lusaka, Zambia
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Chatterji M, Hutchinson P, Murray N, Buek K, Mulenga Y, Ventimiglia T |
2009 |
English |
ZAMBIA, Southern Africa, Africa |
Zambia, Orphans and Vulnerable Children, Child Health |
This paper evaluates the impact of a community-based program implemented by a Zambian nongovernmental agency (NGO) on educational outcomes among orphans and vulnerable children (OVC) in Lusaka, Zambia. These outcomes included school enrollment and being at the correct age-for-grade. The study design included two rounds of post-intervention data collection, in 2003 and 2006. There were 2,302 children, ages 6-19, interviewed in 2003; and 3,105 children or young adults, ages 8-22, interviewed in 2006. A sub-sample of 2,922 orphans and vulnerable children, ages 8-19, was used. The effectiveness of Bwafwano Community Home-Based Care Organization, an NGO working in Lusaka, was evaluated, first using the individual cross-sectional samples and then using a differences-in-differences model on the pooled sample. Both cross-sectional analyses found positive and statistically significant effects of the intervention on school enrollment, with marginal effects of 0.104 and 0.168 respectively. The differences-in-differences estimates for school enrollment were positive, but small and not statistically significant. For the estimations of the effects of Bwafwano on the outcome of appropriate age-for-grade, only the difference-in-difference models showed positive program effect, with participation in the program being associated with a 15.7 percentage point increase in appropriate age-for-grade for intervention children, relative to control children. This study suggests that the Bwafwano program is a promising approach to improving educational outcomes among orphans and vulnerable children in urban Zambia. |
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2008 Baseline Urban Bangladesh Smiling Sun Franchise Program (BSSFP) Evaluation Survey
|
Lance P, Angeles G, Islam S |
2009 |
English |
South Asia, BANGLADESH, Asia |
Bangladesh, Evaluation, Health Services, Maternal Health, Contraception, Child Health, Monitoring, Asia |
The 2008 Baseline Urban Bangladesh Smiling Sun Franchise Program (BSSFP) Evaluation Survey is the first installment in a series of two surveys intended to assess the efficacy of the urban component of the BSSFP program in terms of its ability to deliver an essential services package (ESP) of family planning and maternal and child health services to under-served populations across Bangladesh. The baseline survey is designed to provide a picture of circumstances at the population level in BSSFP catchment areas and similar, nearby non-project areas where the BSSFP is not operating but the government is. Useful in its own right as a source of information as critical programmatic decisions are made in the early phase of the BSSFP project, the baseline survey also provides information regarding circumstances on the eve of conversion from the operational model of the National Service Delivery Program (NSDP, which the BSSFP succeeds) to that of the BSSFP. This is critical information which, when combined with that from a follow-up wave to be conducted three years hence, will allow for the tracking of the performance of the program over time. |
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2008 Baseline Rural Bangladesh Smiling Sun Franchise Program (BSSFP) Evaluation Survey
|
Lance P, Angeles G, Hayat Khan MS |
2009 |
English |
Asia, BANGLADESH, South Asia |
Bangladesh, Evaluation, Health Services, Maternal Health, Contraception, Child Health, Monitoring, Asia |
The 2008 Baseline Rural Bangladesh Smiling Sun Franchise Program (BSSFP) Evaluation Survey is the first installment in a series of two surveys intended to assess the efficacy of the rural component of the BSSFP program in terms of its ability to deliver an essential services package (ESP) of family planning and maternal and child health services to under-served populations across Bangladesh. The baseline survey is designed to provide a picture of circumstances at the population level in BSSFP catchment areas and similar, nearby non-project areas where the BSSFP is not operating but the government is. Useful in its own right as a source of information as critical programmatic decisions are made in the early phase of the BSSFP project, the baseline survey also provides information regarding circumstances on the eve of conversion from the operational model of the National Service Delivery Program (NSDP, which the BSSFP succeeds) to that of the BSSFP. This is critical information which, when combined with that from a follow-up wave to be conducted three years hence, will allow for tracking performance of the program over time. |
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Exploring HIV Risk among MSM in Kigali, Rwanda
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Binagwaho, Dr. Agnes; Chapman, Jenifer; Koleros, Andrew; Utazirubanda; Yves; Pegurri, Elisabetta |
2009 |
English |
RWANDA, Africa |
HIV/AIDS, Rwanda |
This report presents findings from a behavioral surveillance study (BSS) of men who have sex with men(MSM) in Kigali carried out in 2008-2009. The aim of this study was to describe the population of MSM in Kigali and explore the nature of sexual activity between MSM. |
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Coverage and Effects of Child Marriage Prevention Activities in Amhara Region, Ethiopia - Findings from a 2007 Study
|
Gage A (Ed.) |
2009 |
English |
ETHIOPIA, Africa |
Child Health |
This study, hereafter referred to as the Early Marriage Evaluation Study (EMES), was a household survey of 3,677 female adolescents aged 10-19 years, 1,737 male youth aged 15-24 years, and 4,670 caretakers in Amhara Region, Ethiopia. The primary purpose of the EMES was to provide policymakers and program managers with detailed information on the reach and effects of early marriage prevention activities in the region to support program efforts in addressing the challenges posed by child marriage for womens reproductive health, education and status, and for national development. The 2007 EMES is the first large-scale household survey in Ethiopia to provide population-based estimates on levels of exposure to early marriage prevention messages and their influence on knowledge, attitudes, and skills conducive to delaying marriage. The survey was conducted from July 16 to August 20, 2007. The study differentiated woredas (that is, districts) in which early marriage prevention activities were integrated into USAID-funded community-based reproductive health and basic education programs (hereafter referred to as program areas) from woredas in which early marriage prevention activities were not integrated into these USAID-funded programs (hereafter referred to as non-program areas). It is to be noted that the study collected largely descriptive information and could not determine the impact of early marriage prevention activities as there were no comparable baseline surveys and no control/comparison woredas were selected before the start of early marriage prevention activities. As a result of the lack of control/comparison woredas and the widespread dissemination of early marriage prevention messages by various parties throughout Amhara Region since the enactment of the legal minimum age at marriage, the distinctions made between program areas and non-program areas were not clear-cut. Moreover, it was difficult to assess how much change had occurred over time in early marriage knowledge, attitudes, and practices. Given these considerations, the study was an assessment of early marriage knowledge, attitudes, and preferences and showed whether areas in which early marriage prevention activities were integrated in a systematic way into USAID-funded reproductive health and basic education programs differed in the outcomes of interest from other areas. |
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PEPFAR Public Health Evaluation: Care and Support - Phase 1 Uganda
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Harding, R, Simms V, Penfold, S, et al. |
2009 |
English |
UGANDA |
Uganda |
A Public Health Evaluation (PHE) was commissioned to examine HIV care and support funded by the Presidents Emergency Plan for AIDS Relief (PEPFAR). Phase 1 of this PHE aimed to describe the nature and scope of care and support provision according to the five PEPFAR care and support areas (HIV/AIDS Palliative Care Guidance#1 2006), including the types of facilities, clients seen, and availability of specific components of care. |
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PEPFAR Public Health Evaluation: Care and Support - Phase 1 Kenya
|
Harding R, Penfold S, Simms V, et al. |
2009 |
English |
KENYA |
Kenya |
A Public Health Evaluation (PHE) was commissioned to examine PEPFAR-funded HIV care and support. Phase 1 of this PHE aimed to describe the nature and scope of care and support provision according to the five PEPFAR care and support areas (HIV/AIDS Palliative Care Guidance# 1 2006), including the types of facilities, clients seen, and availability of specific components of care. |
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(Summary) PEPFAR Public Health Evaluation: Care and Support - Phase 1 Uganda
|
Harding, R, Simms V, Penfold, S, et al. |
2009 |
English |
UGANDA |
Uganda |
A Public Health Evaluation (PHE) was commissioned to examine PEPFAR-funded HIV care and support. Phase 1 of this PHE aimed to describe the nature and scope of care and support provision according to the five PEPFAR care and support areas (OGAC 2006), including the types of facilities, clients seen, and availability of specific components of care. Phase 2 consisted of a longitudinal study of patients outcomes |
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(Summary) PEPFAR Public Health Evaluation: Care and Support - Phase 1 Kenya
|
Harding R, Penfold S, Simms V, et al. |
2009 |
English |
KENYA |
Kenya |
A Public Health Evaluation (PHE) was commissioned to examine PEPFAR-funded HIV care and support. Phase 1 of this PHE aimed to describe the nature and scope of care and support provision according to the five PEPFAR care and support areas (OGAC 2006), including the types of facilities, clients seen, and availability of specific components of care. Phase 2 consisted of a longitudinal study of patients outcomes. |
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A Randomized Controlled Trial to Investigate Impact of Site-Based Safer Sex Programs in Kingston, Jamaica: Trial Design, Methods, and Results
|
Weir SS, Figueroa JP, Byfield L, Hall A, Cummings S, Hobbs M, Suchindran CM |
2009 |
English |
Latin America and the Caribbean, JAMAICA |
Jamaica, Monitoring, HIV/AIDS, Monitoring |
In 2001, a Priorities for Local AIDS Control Efforts (PLACE) study identified over 400 public sites in Kingston where persons meet new sexual partners. People attending these sites had higher rates of new and concurrent sexual partnerships than persons in the general population. The Jamaica Ministry of Health developed and piloted a package of site-based prevention program components that could be tailored for use at sites as diverse as commercial sex street sites, fast food restaurants, bars, and night clubs; and 147 of the 400 sites were grouped into 50 geographic clusters. The clusters were randomized to receive or not receive site-based prevention program components. Following a baseline survey in 2005, follow-up surveys with site patrons were conducted in 2006 and 2007 to estimate the proportion of patrons with recent, new, or concurrent partnerships and inconsistent condom use. Baseline and follow-up characteristics of sites and patrons were similar at intervention and control sites, both at baseline and follow-up. In spite of sustained efforts by outreach workers,implementation of intervention components proved very difficult. At follow-up, only 56% of the 75 intervention sites reported having condom promotion activities at the site since March 2006; only 17% reported on-site efforts to promote HIV testing; and only 30% reported regular visits by health ministry staff since March 2006. Among the 1,383 men and 1,475 women interviewed on-site at follow-up, there were no differences in reported condom use at intervention compared to control sites among men (36% and 33%) and women (20% in both groups) who reported new or multiple partnerships in the past year. |
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Changes in the timing of sexual initiation among young Muslim and Christian women in Nigeria
|
Agha S |
2009 |
English |
NIGERIA, Africa |
Nigeria |
Sexual initiation during adolescence has important demographic and health consequences for a population, yet no systematic analysis of changes in the timing of sexual initiation has been conducted in Nigeria. Two rounds of national surveys conducted in 1990 and 2003 were used to examine changes in the timing of sexual initiation among female adolescents in Nigeria. Multivariate survival analysis using Cox proportional hazards models was used to assess changes in the risk of sexual initiation and to identify the correlates of first sex. Contrary to what has been reported in severalNigerian studies, therewas no decline in age at first sex among Christian adolescents. Age at first sex did not change significantly forChristianadolescents, althoughpremarital sex appears to have increasedprimarily due to an increase in the age at marriage. Age at first sex did increase among Muslim women. Premarital sex remained low amongMuslimwomen. Anumberof socioeconomicvariableswere associatedwiththe timing of sexual initiation.Weeklyexposure tothemassmedia was associated with earlier sexual initiation. The degree to which an environment was liberal or restrictive was a key determinant of the timing of sexual initiation in Nigeria. The findings also illustrate the important role of socioeconomic factors indeterminingthe timingof sexual initiationinNigeria. As secondary education increases in Northern Nigeria, additional increases in the age at sexual debut are likely among Muslimwomen.The study raises concerns about the influence of the mass media on the timing of first sex in Nigeria. The evidence of an absence of changes in the timing of sexual initiation among Christian women in more than a decade implies that programs which aimto delay the timing of sexual initiation in Southern Nigeriamay have limited success.With age at marriage already high among Christian women, programs that focus on abstinence until marriage may also be pursuing an approach with limited chances of success. |
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Child Status Index
|
MEASURE Evaluation |
2008, revised 2014 |
English |
|
Child Health, Children |
The Child Status Index (CSI) provides a framework for identifying the needs of children, creating individualized goal-directed service plans for use in monitoring the well-being of children and households, and program-level monitoring and planning at the local level.
As of 2013, the CSI has been used in 17 countries in sub-Saharan Africa, Asia, and Latin America. It has been translated for use in a variety of geographical, linguistic, and cultural contexts.
The last several years of CSI implementation have enabled MEASURE Evaluation and others to learn about how the CSI fits into the overall package of information gathering tools and when, and in which circumstances, the tool is best used. A document providing clarification on usage of the CSI was developed which describes its primary use as a case management tool and lessons learned about best usage.
The full collection of CSI resources is also available at https://www.measureevaluation.org/resources/tools/ovc/child-status-index/ |
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Child Status Index - Manual
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O'Donnell K, Nyangara F, Murphy R, Cannon M, Nyberg B |
2008, revised 2014 |
English |
KENYA, TANZANIA, Africa |
Rwanda, Tanzania, Orphans and Vulnerable Children, Monitoring, Evaluation, Ethiopia, Child Health, Kenya |
The Child Status Index (CSI) provides a framework for identifying the needs of children, creating individualized goal-directed service plans for use in monitoring the well-being of children and households, and program-level monitoring and planning at the local level. As of 2013, the CSI has been used in 17 countries in sub-Saharan Africa, Asia, and Latin America. It has been translated for use in a variety of geographical, linguistic, and cultural contexts.
MEASURE Evaluation has conducted two studies of CSI use to understand how the tool is implemented and its utility as a job aid for decision making. These studies have provided useful information that has helped enhance the tool’s implementation processes, support materials, and its effectiveness. While the CSI remains essentially the same, this second edition published in 2013 provides further guidance in key areas, such as training, best practices for using the CSI, and developing plans to respond when CSI scores indicate a need for a child. Insights gleaned from CSI users in the field – both at the program level and care worker level – are reflected in this second edition.
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Data Quality Audit: Guidelines and Templates
|
|
2008 |
English |
|
DQA, Data Quality Audit, Data Quality, Data |
The objectives of the Data Quality Audit (DQA) Tool are to:
Verify the quality of reported data for key indicators at selected sites; and
Assess the ability of data management systems to collect and report quality data.
This zip file includes the guidelines and Excel verification templates, all available in English, French, and Spanish. |
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Guide for Monitoring and Evaluating Avian Influenza Programs in Southeast Asia
|
|
2008 |
English |
Asia, South Asia |
|
This guide is intended to encourage the use of monitoring and evaluation (M&E) to support effective and evidence-based national highly pathogenic avian influenza (HPAI) programs. The development of an M&E framework is a critical component for monitoring progress in the prevention and control of HPAI and the reduction of the risk of an influenza pandemic. The constantly changing nature of these diseases often hampers effective strategic planning and program development. However, as countries respond to an increasing geographic spread of HPAI, the early development of a comprehensive M&E framework provides programs with standard measures to monitor progress at national, regional, and global levels. In this spirit, a broad-based group of stakeholders came together to develop this guide.
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Outil de Vérification de la Qualité des Données – Manuel de Mise en Oeuvre
|
Hardee K |
2008 |
French |
Global |
|
Les programmes nationaux et les projets financés par des donateurs œuvrent dans le but de réaliser les ambitieux objectifs liés à la lutte contre les maladies telles que le Syndrome d’Immunodéficience Acquis (SIDA), la tuberculose et le paludisme. La mesure du succès et l’amélioration de la gestion de ces initiatives reposent sur des systèmes solides de suivi et d’évaluation (S&E) qui produisent des données de qualité relatives à l’exécution du programme.
Dans l’esprit du “Three Ones”, du “Stop TB Strategy » et du « RBM Global Strategic Plan », un certain nombre d’organisations multilatérales et bilatérales ont collaboré pour élaborer ensemble un outil d’Evaluation de la Qualité des Données (EQD). L’objectif de cette initiative harmonisée est de fournir une approche commune pour l’évaluation et l’amélioration de la qualité des données dans leur ensemble. Un outil unique contribue à s’assurer que les normes sont harmonisées et permet une mise en œuvre conjointe entre les partenaires et avec les programmes nationaux.
L’outil d’EQD met exclusivement l’accent sur (1) la vérification de la qualité des données rapportées, et (2) l’évaluation des systèmes sous-jacents de gestion et de notification des données pour des indicateurs de résultat standards au niveau du programme. L’outil d’EQD n’est pas destiné à évaluer tout le système de S&E de la réponse d’un pays au VIH/SIDA, à la tuberculose ou au paludisme. Dans le contexte du VIH/SIDA, l’EQD concerne la composante 10 (c’est-à-dire la supervision de soutien et la vérification des données) du « Cadre organisationnel pour un système national fonctionnel de S&E du HIV »
Deux versions de l’outil d’EQD ont été développées: (1) L’ « Outil de vérification de la qualité des données » donne les directives à utiliser par une équipe externe d’audit pour évaluer la capacité d’un programme/projet à fournir des données de qualité ; et (2) l’ « Outil d’évaluation de routine des données de qualité » est une version simplifiée de l’EQD pour l’audit; il permet aux programmes et projets d’évaluer la qualité de leurs données et de renforcer les systèmes de gestion et de notification des données.
Les objectifs de la version de l’Outil d’EQD pour la vérification consistent à :
Vérifier la qualité des données rapportées pour les principaux indicateurs sur les sites sélectionnés; et
Evaluer la capacité des systèmes de gestion des données à collecter et rapporter des données de qualité.
Par ailleurs, pour les programmes/projets à auditer, les conclusions de l’EQD peuvent s’avérer très utiles pour le renforcement de leur système de gestion et de notification des données. |
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Auditoria Sobre Calidad de Datos – Guías Para su Aplicación
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Hardee K |
2008 |
Spanish |
Global |
|
Los programas nacionales y proyectos por donación están trabajado
en el logro de ambiisosos objetivos en la lucha contra el síndrome de
inmunodeficiencia adquirida (SIDA), la tuberculosis (TB) y la Malaria. Para
medir el éxito y mejorar la administración de estas iniciativas, se deben contar
con sistemas de monitoreo y evaluación (M y E) sólidos y que produzcan datos de
calidad sobre el proceso de implementación.
Bajo el principio de los “Tres unos”, las estrategias “Alto
a la Tuberculosis” y la “Alianza Global para Retroceder la Malaria”, varias
organizaciones multilaterales y bilaterales han colaborado para desarrollar
conjuntamente una herramienta para auditar la calidad de la información (Data
Quality Assessment [DQA]). El objetivo de esta iniciativa es proveer un método
común para evaluar y mejorar la calidad general de los datos y la información.
Una herramienta única garantizaría la armonización de la normas y permitiría
una aplicación conjunta entre socios y responsables de programas nacionales.
El enfoque exclusivo de la herramienta DQA es (1) la
verificación de la calidad de los datos reportados, y (2) la evaluación de los
sistemas subyacentes en el procesamiento de datos y presentación de informes
sobre los indicadores de resultado a nivel del programa. La herramienta DQA no
fue diseñada para evaluar todo el sistema de M y E de la respuesta nacional
contra el VIH/SIDA, la tuberculosis o malaria. Dentro del contexto del
VIH/SIDA, DQA se relaciona al componente 10 (es decir, supervisión capacitante
y control o auditoria de datos) en el “Marco organizacional del sistema
nacional de M y E del programa de VIH”.
Existen dos versiones de la herramienta DQA: (1) La “Herramienta
para la auditoria de la calidad de la información” (cuyas siglas en inglés, DQA, se usarán de aquí
en adelante) establece pautas para que un equipo de auditoria externa evalúe la
capacidad de un programa/proyecto de producir informes con datos de calidad; y
(2) La “Herramienta de evaluación rutinaria de la calidad de los datos” (cuyas
siglas en inglés, RDQA, que se usarán de aquí en adelante) es una versión
simplificada de la herramienta DQA para realizar auditorias internas para que
los programas y proyectos evalúen la calidad de sus datos, fortalezcan sus
sistemas de procesamiento y manejo de datos y presentación de informes.
Los objetivos de la herramienta DQA para auditoria de datos
son:
Verificar la calidad de los datos de los informes sobre
indicadores claves en puntos selectos; yEvaluar la capacidad de los sistemas en la recopilación,
manejo de datos y presentación de informes con datos de calidad.
En adición, los hallazgos de DQA también pueden ser muy
útiles para fortalecer los sistemas de administración de datos y sistemas de
presentación de informes de los programas/proyectos que están siendo auditados.
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Data Quality Audit Tool – Guidelines for Implementation
|
Hardee K |
2008 |
English |
Global |
Data Quality, Data |
National programs and donor-funded projects are working towards achieving ambitious goals related to the fight against diseases such as Acquired Immunodeficiency Syndrome (AIDS), Tuberculosis (TB), and Malaria. Measuring the success and improving the management of these initiatives is predicated on strong monitoring and evaluation (M&E) systems that produce quality data related to program implementation.
In the spirit of the “Three Ones,” the “Stop TB Strategy,” and the “RBM Global Strategic Plan,” a number of multilateral and bilateral organizations have collaborated to jointly develop a Data Quality Assessment (DQA) Tool. The objective of this harmonized initiative is to provide a common approach for assessing and improving overall data quality. A single tool helps to ensure that standards are harmonized and allows for joint implementation between partners and with National Programs.
The DQA Tool focuses exclusively on (1) verifying the quality of reported data, and (2) assessing the underlying data management and reporting systems for standard program-level output indicators. The DQA Tool is not intended to assess the entire M&E system of a country’s response to HIV/AIDS, Tuberculosis, or Malaria. In the context of HIV/AIDS, the DQA Tool relates to component 10 (i.e., supportive supervision and data auditing) of the “Organizing Framework for a Functional National HIV M&E System.1” Two versions of the DQA Tool have been developed: (1) the “Data Quality Audit Tool” which provides guidelines to be used by an external audit team to assess a program/project’s ability to report quality data; and (2) the “Routine Data Quality Assessment Tool” (RDQA) which is a simplified version of the DQA Tool for auditing that allows programs and projects to assess the quality of their data and strengthen their data management and reporting systems.
The objectives of the DQA Tool for auditing are to:
Verify the quality of reported data for key indicators at selected sites; and
Assess the ability of data management systems to collect and report quality data.
In addition, for the programs/projects being audited, the findings of the DQA can also be very useful for strengthening their data management and reporting systems. |
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OVC Mapping Reference Document
|
|
2008 |
English |
|
Orphans and Vulnerable Children |
An orphans and vulnerable children (OVC) mapping activity was designed to help the U.S. President's Emergency Plan for AIDS Relief programs serve OVC more efficiently and effectively. The OVC mapping activity provides guidance on how data and geographic mapping can be used to support decision makers and program planners in allocating resources. This document provides an overview of the mapping activity, as well as recommendations on ways data can be used to support program decisions, including ways to organize data and use mapping to evaluate programs and services.
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Manual do Aluno
|
|
2008 |
Portuguese |
MOZAMBIQUE |
Monitoring, Monitoring, Monitoring, Evaluation |
Manual do Aluno foi desenvolvido como parte do processo de capacitação técnica em monitoria e avaliação (M&A) para o Ministério da Mulher e Ação Social em Moçambique. O manual foi desenhado para um treinamento de 8 dias e apresentado a diversos participantes de todo o país no que se refere aos conceitos básicos, ferramentas e estruturas de M&A. O Projeto MEASURE Evaluation coordenou todas as atividades relativas ao desenvolvimento do currículo do curso e a rpodução de todos materiais utilizados. Os materiais incluem esse Manual do Aluno e um CD com as apresentações em Microsoft Powerpoint e também bibliografia adicional como referência técnica que estão disponíveis dentro do material para os treinadores.
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The unintended consequences of intended pregnancies: youth, condom use, and HIV transmission in Mozambique
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Speizer I, White J |
2008 |
English |
MOZAMBIQUE, Africa |
Contraception, Pregnancy, HIV/AIDS |
Although unwanted pregnancies can cause social and economic problems for Sub-Saharan African youth, the consequences of "intended" adolescent pregnancies have gone unnoticed. Rarely do studies recognize that youth who desire a pregnancy are less likely to practice safe sex and, therefore, are at greater risk of contracting sexually transmitted infections (STIs), including HIV. This study uses data from the 2003 Mozambique Demographic and Health Survey to explore youth fertility desires and condom use. In multivariate analyses, controlling for other factors associated with condom use, female youth who want to get pregnant soon are significantly less likely (odds ratio: 0.35; 95% confidence interval: 0.22-0.55) to use condoms with nonmarital partners than youth who want to delay childbearing. Programs for sexually active youth should recognize the importance of fertility desires as a potential moderator of condom use, even if the woman is at risk of HIV or STI. Recommendations are provided for HIV prevention counseling for youth who want to get pregnant and youth who are ambivalent about a future pregnancy. |
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Measurement of HIV Prevention Indicators: A Comparison of the PLACE Method and a Household Survey in Zambia
|
Tate J, Singh K, Ndubani P, Kamwanga J, Buckner B |
2008 |
English |
ZAMBIA, Africa |
Zambia, Monitoring, Africa |
Reaching populations at greatest risk for acquiring HIV is essential for efforts to combat the epidemic. This paper presents, the Priorities for Local AIDS Control Efforts (PLACE) method which focuses on understanding the venues where people are meeting new sexual partners and behaviors which put people at risk. A comparison of data from two PLACE studies in Zambia with a national household survey, the Zambia Sexual Behavior Survey 2005, indicated that the PLACE population was at greater risk of acquiring HIV. Respondents in the two PLACE studies were significantly more likely to report 1? new partners in the past 4 weeks, 2? partners in the past 12 months, 1? new partner in the past 12 months and transactional sex. Data from the PLACE method is important for targeting interventions for those most likely to acquire and transmit HIV. |
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Fact Sheet: Secondary Analysis of Data
|
|
2008 |
English |
|
Evaluation |
MEASURE Evaluation funded several studies based on the secondary analysis of existing innovative evaluation data sets. The objective was to increase the evidence-base on program impact and evaluate the strengths and weaknesses of recent evaluation methodological developments. These studies answer questions of particular importance to global health and evaluation research. |
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Early Marriage Evaluation Study, Amhara Region, Ethiopia: Preliminary Report, Prepared for Bahir Dar Dissemination Workshop
|
|
2008 |
Amharic--basic conversational |
ETHIOPIA, Africa |
Ethiopia |
|
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Discontinuación Anticonceptiva: Un Estudio de Seguimiento al Año con Usuarias de Métodos Femeninos Reversibles en el Área Urbana de Honduras
|
Barden-O'Fallon J, Speizer I, Cáceres Zelaya S, Cálix Borjas J, Rodriguez Valenzuela F |
2008 |
Spanish |
HONDURAS |
|
La finalidad del presente estudio es evaluar el uso de anticonceptivos de las mujeres participantes prospectivamente durante un período de un año. Se trata de ir más allá de las investigaciones anteriores determinando la importancia relativa de y las interacciones entre el ambiente de servicio de planificación familiar, las características individuales de las mujeres, y su experiencia con efectos secundarios en la continuación o la discontinuación de los anticonceptivos. Los resultados complementan el estudio realizado en Honduras, Encuesta Nacional de Demografía y Salud 2005-2006 (ENDESA) (Secretaría de Salud y Macro internacional, 2006). La ENDESA es un estudio transversal de una muestra nacional-representativa de todas las mujeres con edades entre 15-49 años que incluye medidas retrospectivas y actuales de uso anticonceptivo. El estudio actual sigue a un grupo de mujeres reclutadas en los servicios de planificación familiar que a la hora de la primera entrevista eran usuarias subsiguientes o nuevas de un método anticonceptivo (reversible) temporal. El estudio examina patrones del uso de anticonceptivos durante el período de seguimiento. En comparación a las mujeres examinadas en ENDESA, las usuarias de planificación familiar en este estudio son significativamente más jóvenes, menos probables de estar empleadas, y menos probables de tener una afiliación religiosa. El estudio fue realizado en cuatro áreas urbanas de Honduras: Tegucigalpa, San Pedro Sula, Santa Rosa de Copán/La Entrada, y Gracias. Incluyó tres fases de la recolección de datos. |
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Contraceptive Discontinuation: A One-Year Follow-Up Study of Female Reversible Method Users in Urban Honduras
|
Barden-O'Fallon J, Speizer I, Cáceres Zelaya S, Cálix Borjas J, Rodriguez Valenzuela F |
2008 |
English |
HONDURAS |
Contraception |
This study examines women's contraceptive use prospectively over a one-year period in four urban areas of Honduras. It goes beyond previous research by assessing the relative importance of and interactions among the family planning service environment, women's individual characteristics, and their experience with side effects on contraception continuation or discontinuation. The findings from this study complement the Honduras Encuesta Nacional de Demografía y Salud 2005-2006 (ENDESA), a cross-sectional survey sample of women aged 15-49 that includes retrospective and current measures of contraceptive use. The present study followed a panel of women recruited from family planning service sites who, at the time of the first interview, were either continuing or new users of a temporary (reversible) contraceptive method. The majority of women who switched methods during the study did so because of side effects or health concerns with their baseline method. Headaches were the most common side effect experienced by women, followed by the lack of menses, and uterine pain. |
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Linkages and Referrals within AIDS Care and Treatment National Service Delivery Systems, Swaziland
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Swaziland Referral Technical Working Group |
2008 |
English |
SWAZILAND, Southern Africa |
HIV/AIDS |
Appropriate and timely referral for HIV/AIDS treatment is essential for a functioning health system. Unfortunately, it is often among the weakest components of a system. In Swaziland, as antiretroviral treatment and other treatment services are rolled out, identifying and addressing barriers to a strong referral system is critical to ensure access to services and continuity of care for people living with HIV and AIDS. This study, which is one facet of a phased plan to improve the national referral system, has gathered evidence as to how referral is understood by key stakeholders. The information is intended for use by decision makers at the Ministry of Health and Social Welfare and other stakeholders to create and implement policies and procedures that improve care and support for people living with HIV and AIDS. |
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Data Demand and Information Use in the Health Sector: Case Study Series
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MEASURE Evaluation |
2008 |
English |
Asia, Africa, SAINT VINCENT AND THE GRENADINES, SAINT LUCIA, SAINT KITTS AND NEVIS, KENYA, GRENADA, GHANA, DOMINICA, BARBADOS, BANGLADESH, ANTIGUA AND BARBUDA, RWANDA, COTE D'IVOIRE, TANZANIA, Latin America and the Caribbean |
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These data demand and use (DDU) case studies from a variety of settings give examples of how interventions have successfully facilitated data demand and changed how information is used. Examples are from Bangladesh, Cote d'Ivoire, Ghana, Kenya, Rwanda, Tanzania, and nine Caribbean countries. This publication is part of a series that includes a data demand and information use (DDIU) conceptual framework for evidence-based decision-making in the public health arena presented, and strategies and tools for taking concrete "next steps" in implementing DDIU or DDU activities. |
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PRISM Case Studies: Strengthening and Evaluating RHIS
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Aqil A |
2008 |
English |
UGANDA, MEXICO, SOUTH AFRICA, PAKISTAN |
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The MEASURE Evaluation project has developed a conceptual framework to evaluate routine health information systems (RHIS), called Performance of Routine Information System Management (PRISM). The case studies presented here (drawn from work in Mexico, South Africa, Uganda and Pakistan) illustrate how PRISM helps design, strengthen, monitor, and evaluate RHIS in various settings.
The 2018 version of the PRISM Series, updated and with new modules (Toolkit, User’s Kit, and Training Kit) is available here: https://www.measureevaluation.org/prism |
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Integrated AIDS Program Thika, Kenya
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Thurman TR, Neudorf K |
2008 |
English |
KENYA |
HIV/AIDS, Kenya, Orphans and Vulnerable Children |
The global HIV and AIDS epidemic has affected sub-Saharan Africa more than any other region in the world. AIDS deaths in sub-Saharan Africa account for 72% of AIDS deaths worldwide (UNAIDS, 2006a). As a result, the number of children who have been orphaned or otherwise made vulnerable by HIV and AIDS is also highest in this region. Despite the influx of programs and policies in the last decade to address this crisis, very little evidence is available as to the impact and effectiveness of these programs. In an attempt to fill this knowledge gap, MEASURE Evaluation is undertaking a targeted evaluation of four programs for orphaned and vulnerable children (OVC) in four unique settings in Kenya and Tanzania. The targeted evaluation includes household surveys, focus group discussions, a costing analysis and in-depth case studies of the selected programs. |
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Child Status Index (CSI) Made Easy
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Nyangara F, Nyberg B, Murphy R, O'Donnell K |
2008 |
English |
KENYA, TANZANIA, Africa |
Ethiopia, Child Health, Tanzania, Rwanda, Kenya, Monitoring, Evaluation, Orphans and Vulnerable Children |
The Child Status Index (CSI) is very easy to use. You don't have to be a monitoring and evaluation (M&E) expert to use it. If you do home visits and talk to children and their caregivers, then you can use this index to assess the well-being of each child. This booklet contains both a picture and written form of the CSI. The drawings or pictures show children both in a very good status (far left) and in a very bad status (far right) for each of the 12 factors. The booklet also provides basic instructions for how to complete the CSI, including sample questions and observations to enable you to make your own judgments and rate the child in all 12 outcome areas based on local standards. For each factor you are not required to ask all the suggested questions or observe all the suggested examples, but it is important to understand what you are looking for in each factor. Please read the CSI Field Users' Guide, 2008, for more detailed instructions on how to use the CSI. If you require more information about the CSI, please read the CSI Manual, 2008. |
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Child Status Index (CSI) - Field Users' Guide
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Nyangara F, O'Donnell K, Murphy R, Nyberg B |
2008 |
English |
KENYA, TANZANIA, Africa |
Rwanda, Child Health, Kenya, Orphans and Vulnerable Children, Ethiopia, Tanzania, Monitoring, Evaluation |
This Field Users' Guide is part of the Child Status Index (CSI) toolkit consisting of a CSI Manual, CSI Rating and Record Forms, a pictorial CSI, a CSI Made Easy booklet and this quick-reference guide for field users of the tool. It is specifically written to serve as a quick reference for frontline staff including volunteers and other field workers who have been trained on and are using the CSI toolkit to gather information about the well-being of children in their care. The Guide presents a brief overview of the domains and factors assessed by the CSI and provides step-by-step instructions on how to use the CSI and the Record Form to gather information on the child's well-being status. |
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Violence Against Women and Girls: A Compendium of Monitoring and Evaluation Indicators
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Bloom SS |
2008 |
English |
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Gender-based violence, Women, Gender Norms, Indicators, GBV, Violence, Gender |
At the request of the USAID East Africa Regional Mission in collaboration with the Inter-agency Gender Working Group, MEASURE Evaluation developed this compendium with a technical advisory group (TAG) of experts.
The TAG was comprised of specialists from USAID, OGAC, CDC, WHO, UNFPA, UNHCR, and NGOs, and prominent researchers and programmatic experts in the field. The compendium was developed for managers, organizations, and policy makers working in the field of VAW/G program implementation and evaluation in developing countries, as well as for people who provide technical assistance to these individuals and organizations. Indicators were developed to measure the following areas within VAW/G:
Magnitude and characteristics of different forms of VAW/G (skewed sex rations, intimate partner violence, violence from someone other than an intimate partner, female genital cutting/mutilation and child marriage)
Programs addressing VAW/G by sector (health, education, justice/security, social welfare)
Under-documented forms of VAW/G and emerging areas (humanitarian emergencies, trafficking in persons, femicide), and preventing VAW/G (youth, community mobilization, working with men and boys).
The indicators can also be used by programs that may not specifically focus on VAW/G, but include reducing levels of VAW/G as part of their aims. The indicators have been designed to address information needs that can be assessed with quantitative methods to measure program performance and achievement at the community, regional and national levels. While many of the indicators have been used in the field, they have not necessarily been tested in multiple settings. |
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Flow Chart of Steps to Conduct a Health Facility Assessment
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International Health Facility Assessment Network |
2008 |
English |
|
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The flow chart is a step-by-step guide, in visual form, of key stages in the preparation and conduct of a health facility assessment (HFA). It has two parts, the first being a short presentation of the actual stages, the people involved in them, any documentation available for more details, and any special considerations. The second part is a narrative description of issues related to each stage, and information to help the reader understand how each stage is connected to the preceding and subsequent stages. |
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Contextual influences on contraceptive use in the Eastern Cape, South Africa
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Stephenson R, Beke A, Tshibangu D |
2008 |
English |
SOUTH AFRICA, Africa |
Contraception |
This paper uses linked individual and health facility data from the 1998 South Africa Demographic and Health Survey and the 1998 Eastern Cape Facility Survey to explore community and health facility influences on modern contraceptive use. Several pathways of influence between the community and individual contraceptive adoption are identified, centering primarily on the community climate of female autonomy. Few significant effects of the health facility environment on contraceptive adoption are identified. The residual variation in contraceptive use highlights the deficits that exist in current datasets for capturing community influences on contraceptive behavior. |
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High-Risk Sexual Behavior at Social Venues in Madagascar
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Khan MR, Rasolofomanana JR, McClamroch KJ, Ralisimalala A, Zafimanjaka MG, Behets F, Weir SS |
2008 |
English |
MADAGASCAR, Africa |
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Background: Persistent high levels of sexually transmitted infection (STI) in Madagascar indicate current prevention strategies are inadequate. STI/HIV prevention based in social venues may play an important role in reaching individuals at risk of infection. We identified venues where people meet sexual partners and measured the need and potential for venue-based prevention. |
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Randomized controlled trial to investigate impact of site-based safer sex programmes in Kingston, Jamaica: trial design, methods and baseline findings
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Weir SS, Figueroa JP, Byfield L, Hall A, Cummings S, and Suchindran C |
2008 |
English |
JAMAICA, Latin America and the Caribbean |
Jamaica, Monitoring, HIV/AIDS, Sexual Behavior |
Objective: To describe the design, methods and baseline findings of a multi-level prevention intervention to increase consistent condom use among persons at public social sites in Kingston, Jamaica, who have new or concurrent sexual partnerships.
Methods: A two-arm randomized controlled trial (RCT) of 147 sites where persons meet new sex partners. Sites were identified by community informants as places where people meet new sexual partners, which include bars, street locations, bus stops, malls and others. Sites were sorted into 50 clusters based on geographic proximity and type of site and randomized to receive a multi-level site-based intervention or not. Intervention components include on-site HIV testing, condom promotion and peer education. Effectiveness of the intervention will be measured by comparing the proportion of persons with new or multiple partners in the past year who report recent inconsistent condom use at intervention vs. control sites.
Results: Baseline surveys were conducted at 66 intervention (711 men, 845 women) and 65 control sites (654 men, 738 women). Characteristics of intervention and control sites as well as the characteristics of patrons at these sites were similar. The outcome variable was balanced with approximately 30% of men and 25% of women at intervention and control sites reporting a new partner or more than one partner in the past year and recent inconsistent condom use.
Conclusions: The baseline findings confirm that the population is an appropriate target group for HIV prevention and that randomization will provide the means to estimate programme effectiveness.
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Timing and duration of incarceration and high-risk sexual partnerships among African Americans in North Carolina
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Khan MR, Miller WC, Schoenbach VJ, Weir SS, Kaufman JS, Wohl DA, Adimora AA |
2008 |
English |
UNITED STATES |
HIV/AIDS, Poverty, Sexual Behavior |
PURPOSE: Incarceration may contribute to HIV transmission by disrupting stable partnerships and promoting high-risk partnerships. We investigated incarceration and high-risk partnerships among African Americans in North Carolina. METHODS: We conducted a weighted analysis using the North Carolina Rural Health Project (N = 320), a population-based case-control study of HIV among African Americans. We measured associations between timing and duration of incarceration and high-risk partnerships (multiple partnerships or sex trade for money or drugs). RESULTS: Duration of incarceration appeared to be more important than how long ago incarceration occurred. After adjustment for sociodemographic indicators, high-risk partnerships were associated with short-term (<1 month) incarceration of the respondent versus no respondent incarceration (men: adjusted prevalence ratio (aPR) 1.9, 95% confidence interval (95% CI) 1.2-2.8; women: aPR 3.1, 95% CI 1.2-8.3). High-risk partnerships also were associated with incarceration of a partner versus no partner incarceration (men: aPR 1.8, 95% CI 1.1-3.0; women: aPR 2.0, 95% CI 1.1-3.8). Among men, associations remained when adjusting for substance use. Among women, adjustment for substance use weakened estimates due to the strong correlation between substance use and incarceration. CONCLUSIONS: HIV-prevention programs targeting currently and formerly incarcerated individuals and their partners may decrease HIV in African American communities with high incarceration rates. |
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Fact Sheet: OVC Mapping Activity
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2008 |
English |
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Orphans and Vulnerable Children, GIS |
Using maps and the data infrastructure to help make better decisions for orphans and vulnerable children |
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Fact Sheet: MEASURE Evaluation - Spanish
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2008 |
Spanish |
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Trabajamos alrededor mundo con programas de países anfitriones para abordar temas de salud y población |
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Fact Sheet: MEASURE Evaluation - English
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2008 |
English |
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Public Health |
Working around the world with host-country programs to address health and population issues |
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Impact of Oportunidades on Contraceptive Methods Use in Adolescent and Young Adult Women Living in Rural Areas, 1997-2000
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Lamadrid-Figueroa H, Angeles G, Mroz T, Urquieta-Salomón J, Hernández-Prado B, Cruz-Valdez A, Téllez-Rojo MM |
2008 |
English |
MEXICO |
Contraception |
Oportunidades is a social program run by the Mexican government that seeks to improve education, health, nutrition, and living conditions of those living in extreme poverty. People supported by the program attend monthly health talks, which include information on contraceptive methods. Reduction in fertility, especially among youths, is deemed crucial to accomplish the program's goals. We analyze information on contraceptive method use among young women from the Oportunidades evaluation surveys conducted in the years 1997 to 2000. We present intention to treat effect estimates, and other estimates obtained by several statistical procedures performed to evaluate the impact of the program on contraceptive methods use by young women. To accomplish this, we took advantage of the experimental design setting that was implemented to evaluate the program in rural areas. We found that among women 20- to 24-years-old, the program increased the prevalence of contraceptive methods use by 5 to 10 percentage points after two years of exposure to the program. The impact appears to have occurred mostly to those with the lowest socio-economic level. |
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Using the 2004 Kenya Service Provision Assessment Survey for Health Service Delivery Improvement
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International Health Facility Assessment Network |
2008 |
English |
KENYA, East Africa |
Kenya |
This case study provides several examples of data demand and information use (DDIU or DDU) interventions designed to improve the use of information for evidence-based decision-making in health service delivery. Data and information from a 2004 Kenya Service Provision Assessment (SPA) survey were used for planning purposes, improving health facilities, and advocating for more resources. Dissemination activities for the SPA findings, funded by the U.S. Presidents Plan for AIDS Relief, included workshops targeting hospital administrators. Following a presentation at Kenyatta Hospital, other hospitals requested access to the survey findings. |
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Health Facility Assessment Relevant Resources/Supporting Documents and Mapping Resources Annotated Bibliography
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International Health Facility Assessment Network |
2008 |
English |
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GIS |
This annotated bibliography compiles relevant resources and supporting documents of health facility assessment (HFA) surveys. It cites over 80 relevant documents, including data collection instruments such as questionnaires and manuals, analytical reports, technical and survey reports, and articles that cited data from major HFA surveys. For most of these, abstracts are presented. The document also includes relevant resources on mapping HFA survey data using geographic information systems, ranging from databases and data repositories to Web sites that provide GIS application tools. Where available, each item contains details of its availability from the original source and other contact information. |
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Overview of Issues Concerning Confidentiality and Spatial Data
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MEASURE GIS Working Group |
2008 |
English |
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GIS |
Geographic information systems (GIS) play a vital role within a variety of research settings. However, the use of such spatial data means that confidentiality and privacy issues relevant to these data must be carefully addressed. This white paper presents the current literature on the topic of confidentiality and spatial data. It is intended to provide guidance on the issue. The document provides an overview of the terms that are important to the discussion, and then presents some examples of spatial risks to confidentiality. An overview of approaches that have been proposed for preserving confidentiality is then presented. |
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Measurement of HIV Prevention Indicators: A Comparison of the PLACE Method and a Demographic Health Survey in Rwanda
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Commission Nationale de Lutte contre le SIDA, MEASURE Evaluation |
2008 |
English |
RWANDA, Africa |
Rwanda, HIV/AIDS, Monitoring, Monitoring |
The 2005 Rwandan Demographic Health Survey (DHS) found that nearly 90 percent of the general population knew about HIV and prevention methods; however, it also found that condom use was very low (only 20 percent of people used a condom with a non-cohabiting partner). To respond better to the large gap between knowledge and safe sexual behavior, and to coordinate local efforts better in the fight against AIDS, the Commission Nationale de Lutte contre le SIDA (CNLS), with technical assistance from MEASURE Evaluation, implemented the Priorities for Local AIDS Control Efforts (PLACE) protocol in 12 provinces. The 2005 PLACE and Rwandan DHS results are useful tools for program managers wishing to focus scarce resources in effective HIV prevention. The DHS results provide information concerning the general population and provide a global picture of peoples HIV knowledge, attitudes, and behaviors. The PLACE results provide information about populations that exhibit riskier sexual behavior than the general population. Together, the survey results from PLACE and DHS can provide program managers and other stakeholders working in HIV/AIDS comprehensive information on knowledge, attitudes, and practices in both the general population and specific subgroups. The aim of this report is to compare results between the two surveys and illustrate how both surveys can be used together, giving HIV/AIDS program managers and policymakers a better picture of certain determinates of the generalized epidemic in Rwanda. |
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Do Women Respond to Expansions in Reproductive Health Care?
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Frankenberg E, Buttenheim A, Sikoki B, Suriastini W |
2008 |
English |
Asia |
Maternal Health |
We use data from the Indonesia Family Life Survey to investigate the impact of a major expansion in access to midwifery services on use of prenatal care and delivery assistance for women of reproductive age. Between 1991 and 1998, Indonesia trained some 50,000 midwives, placing them in relatively poor communities that were relatively distant from health centers. We show that regardless of a womans educational level, additions of village midwives to communities are associated with significant increases in receipt of iron tablets and in choices about care during delivery, which reflect a movement away from reliance on traditional birth attendants. For women with relatively low levels of education, village midwives have the additional benefits of increasing use of any prenatal care and use of prenatal care during the first trimester. The results are robust to the inclusion of fixed effects at the individual level, a strategy that addresses many of the concerns about biases because of non-random program placement. |
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Impact of Oportunidades on Skilled Attendance at Delivery in Rural Areas
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Urquieta J, Angeles G, Mroz T, Lamadrid-Figueroa H, Hernández B |
2008 |
English |
MEXICO |
Maternal Health |
Oportunidades (formerly Progresa) is a conditional cash-transfer program run by the Mexican federal government aimed to break the inter-generational cycle of poverty, which among other activities, provides free delivery attendance for women enrolled in the program. Skilled attendance to delivery has been identified as an effective strategy to reduce maternal mortality. In this paper, we assess the impact of Oportunidades on skilled attendance to delivery, taking advantage of the experimental design implemented for the evaluation of this program in rural areas The main results of the study indicate that Oportunidades had, at best, only a small effect on skilled attendance at delivery in treatment communities. The effect of the program, however, appears to be higher for women with a poverty score near to the eligibility cut-off point, whereas it seems not to have an effect on women in the poorest households. We also find that the program had larger effects on those women who had one birth just prior to the experimental treatment and another birth subsequent to the experimental treatment. However, the impacts of the program seem to be null or even negative when comparing enrolled vs. non-enrolled women in intervention areas. These results should lead to a review about the strategies used by Oportunidades to increase skilled attendance to delivery. |
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2006 Bangladesh Urban Health Survey (UHS)
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Angeles G, Al-Sabir A, Lance P, Buckner B, Streatfield PK, Karar ZA, et al |
2008 |
English |
BANGLADESH, Asia |
Bangladesh, Maternal Health, Child Health, Public Health |
Nearly all of the global population growth in the next three decades will occur in urban areas, primarily as a massive migration occurs from the rural areas of middle and lower-income societies to their cities. Many, if not most of these migrants, who are generally possessed of low human and financial capital on arrival in the city, will settle in slums, the areas of concentrated poverty and environmental vulnerability that are already a dominant feature of much of the urban landscape of the developing world. Bangladesh will be no exception to these trends. The growth in her urban population is set to outstrip by a wide margin that in rural areas. Moreover, the urban growth already experienced in recent decades demonstrates that slums will likely be an increasingly important feature of urban existence in Bangladesh. Anticipating these developments, USAID and the Government of Bangladesh tasked a research team based in Bangladesh and the United States (at the University of North Carolina at Chapel Hill) with conducting a survey designed to obtain a broad health profile of the urban population of Bangladesh. The ultimate fruit of this effort was the 2006 Urban Health Survey (2006 UHS), a rich, microlevel health-interview survey of communities, households, and individuals throughout the City Corporations and a sample of District Municipalities. |
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PLACE in Zimbabwe: Identifying Gaps in HIV Prevention among Orphans and Young People in Hwange District, 2006
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Singh K, Sambisa W, Munyati S, Chandiwana B, Chingono A, Mahati S, Mashange W |
2008 |
English |
ZIMBABWE, Southern Africa |
Orphans and Vulnerable Children, HIV/AIDS, Monitoring |
The Priorities for Local AIDS Control Efforts (PLACE) method is a methodological tool to identify areas where HIV transmission is most likely to occur, and, within these areas, to identify gaps in prevention programs. In Zimbabwe, the PLACE method was used to understand what risk factors are putting adolescent girls (orphans and non-orphans) and young women 18-24 years of age at risk of acquiring HIV. Because there is an indication that men may sexually abuse adolescent girls in their homes and because it was believed that some adolescent girls may not frequent public places, a household survey was added to the PLACE method. Community informants listed 357 public venues were people, particularly young people, meet new partners. Individual interviews were conducted at selected venues among a sample of 592 males and 516 females. Data were stratified by type of venue nightlife/drinking sites (bars, hotels, etc.), open-transport related sites (schools, churches, boreholes, etc.) and events/private or hidden sites (sporting events, concerts, weddings, tea parties). In the household survey that was added to the PLACE method, an additional 538 girls aged 12-17 years old were interviewed. Based on findings from the study, programmatic recommendations were made to help improve HIV prevention efforts. |
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Should data from demographic surveillance systems be made more widely available to researchers?
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Chandramohan D, Shibuya K, Setel P, Cairncross S, Lopez AD et al. |
2008 |
English |
Global |
Public Health |
Demographic surveillance (the process of monitoring births, deaths, causes of deaths, and migration in a population over time) is one of the cornerstones of public health research, particularly in investigating and tackling health disparities. An international network of demographic surveillance systems (DSS) now operates, mostly in sub-Saharan Africa and Asia. Thirty-eight DSS sites are coordinated by the International Network for the Continuous Demographic Evaluation of Populations and Their Health (INDEPTH). In this debate, Daniel Chandramohan and colleagues argue that DSS data in the INDEPTH database should be made available to all researchers worldwide, not just to those within the INDEPTH Network. |
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M&E Fundamentals: A Self-Guided Minicourse
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Frankel N, Gage A |
2007 (rev. 2016) |
English |
Global |
Indicators, Monitoring, Evaluation |
Monitoring and Evaluation (M&E) is an essential component of any intervention, project, or program. This mini-course covers the basics of program monitoring and evaluation in the context of population, health and nutrition programs. It also defines common terms and discusses why M&E is essential for program management.
At the end of this course, you will be able to:
Identify the basic purposes and scope of M&E
Differentiate between monitoring functions and evaluation functions
Describe the functions of an M&E plan
Identify the main components of an M&E plan
Identify and differentiate between conceptual frameworks, results frameworks, and logic models
Describe how frameworks are used for M&E planning
Identify criteria for the selection of indicators
Describe how indicators are linked to frameworks
Identify types of data sources
Describe how information can be used for decision-making
Available in EPUB and Kindle editions and as an online certificate course. |
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NHỮNG NGUYÊN TẮC CƠ BẢN VỀ GIÁM SÁT VÀ ĐÁNH GIÁ, KHOÁ TỰ HỌC
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Frankel N, Gage A |
2007 (rev. 2015) |
Vietnamese |
VIET NAM, Global |
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Giám sát và đánh giá (M&E) là thành phần thiết yếu của bất kì một can thiệp, một dự án hay một chương trình nào. Khoá học này bao gồm những khái niệm cơ bản về giám sát và đánh giá chương trình trong bối cảnh các chương trình về dân số, sức khỏe và dinh dưỡng. Khóa học cũng đưa ra những định nghĩa về các thuật ngữ thông dụng và thảo luận tại sao M&E cần thiết cho việc quán lý chương trình.
Cuối khóa học, học viên sẽ có thể:
Xác định phạm vi và mục đích cơ bản của M&E.
Phân biệt giữa chức năng giám sát và chức năng theo dõi.
Mô tả được chức năng của một kế hoạch M&E.
Xác định các thành phần chính của một kế hoạch M&E.
Xác định và phân biệt giữa khung khái niệm (conceptual frameworks), khung kết quả và mô hình logic.
Mô tả làm thế nào các khung cấu trúc (frameworks) được sử dụng cho lập kế hoạch M&E.
Xác định tiêu chí lựa chọn các chỉ số.
Mô tả làm thế nào các chỉ số được liên kết với khung cấu trúc.
Xác định các nguồn dữ liệu, và
Mô tả làm thế nào thông tin được sử dụng cho việc ra quyết định.
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Fundamentos de M&A, Um Mini‐Curso Dirigido
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Frankel N, Gage A |
2007 (rev. 2015) |
Portuguese |
Global, PORTUGAL |
Monitoring, Evaluation, Monitoring |
Monitoria e avaliação (M&A) é um componente essencial de qualquer intervenção, projeto ou programa. Este mini-curso aborda os fundamentos de monitoria e avaliação de programas no contexto de programas de nutrição, saúde e população. Ele também define termos comuns e discute porque a M&A é essencial para a administração de um programa.
Ao final deste curso, você será capaz de:
identificar os propósitos básicos e o escopo da M&A;
diferenciar entre funções de monitoria e funções de avaliação;
descrever as funções de um plano de M&A;
identificar os componentes principais de um plano de M&A;
identificar e diferenciar entre estruturas conceituais, estruturas de resultados e modelos lógicos;
descrever como as estruturas são usadas para o planejamento da M&A;
identificar critérios para a seleção de indicadores;
descrever como indicadores são vinculados as estruturas;
identificar tipos de fontes de dados; e
descrever como as informações podem ser usadas para tomadas de decisão.
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Monitoring and Evaluation Systems Strengthening Tool
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Hardee K |
2007 |
English |
|
Monitoring, M&E, Systems strengthening, Tool, Monitoring, Evaluation |
The Monitoring and Evaluation Systems Strengthening Tool (MESST) was developed under the premise that it is important to understand the system through which data are generated, aggregated and reported in order to assess their quality. This tool includes three checklists that programs or projects can use to: assess their monitoring and evaluation (M&E) plans; take stock of the capabilities of management units to manage data related to the implementation of the program/project(s); and assess the data-collection and reporting systems for each program area, including the ability to report valid, accurate and high quality data related to implementation.
The zip file includes both English and French versions of the resources. |
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Outil de Renforcement des Systèmes de S&E
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Hardee K |
2007 |
French |
Global |
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Les gouvernements nationaux et les donateurs luttent contre
de nombreuses maladies et notamment contre le VIH/SIDA, la tuberculose et le
paludisme. Ils s’efforcent aussi d’apporter des améliorations dans un certain nombre
de domaines liés à la santé. À mesure que se développent les programmes
nationaux et les projets associés visant à les financer, l’obligation de rendre
des comptes sur le financement et les résultats announces prend de plus en plus
d’importance. Ces programmes et projets associés fixent des objectifs
ambitieux, dont la réalisation est contrôlée par des indicateurs de suivi et
évaluation (S&E), tels que les questions suivantes :
Quelle est l’incidence et la prévalence de la
maladieCombien de personnes suivent actuellement un
traitement?Combien de personnes appartenant à des
populations spécifiques ont été contactées pour des activités de prévention?Combien de collaborateurs ont suivi une
formation pour pouvoir fournir des services?Combien de produits ont été distribués?Y a-t-il un changement de comportement et une
baisse de la morbidité ou de la mortalité?
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Sample Vital Registration with Verbal Autopsy: Data Processing Manager's Manual
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Osborne S, Michael T |
2007 |
English |
|
Vital Registration, Census |
Sample Vital Registration with Verbal Autopsy (SAVVY) is a library of best practice methods for improving the quality of vital statistics where high coverage of civil registration and/or good cause of death data are not available. This manual provides both an overview and a step-by-step discussion of the SAVVY data processing system. There are three main data processing applications needed to support SAVVY. Each of these three focus on one of the three components of the SAVVY system: baseline census, verbal autopsy, and census update. |
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A Guide for Monitoring and Evaluating Population-Health-Environment Programs
|
Finn T |
2007 |
English |
|
Monitoring, Evaluation, Indicators |
Access the second edition of this resource at https://www.measureevaluation.org/resources/publications/ms-18-131.
For well over three decades, dozens of community-based development and conservation projects experimented with a seemingly unlikely innovation: combining efforts to help communities manage and conserve their natural resource base with efforts to improve their health and access to family planning information and services. These projects came about as conservation or community development projects focusing on natural resource management found that women came forward and asked for help to plan pregnancies and improve their communities health. Conservation, community development, and health nongovernmental organizations (NGOs) then took the initiative to create programs linking health and conservation. These programs evolved into the current generation of population, health, and environment projects, or PHE projects as they are now more commonly known. |
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Matching the Gold Standard: Evidence from a Social Experiment in Nicaragua
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Handa S, Maluccio JA |
2007 |
English |
NICARAGUA |
Nicaragua, Public Health |
We compare non-experimental impact estimates using propensity score matching with those from a social experiment to determine whether this non-experimental approach can match the gold standard. The social experiment we use was carried out to evaluate a conditional cash transfer program implemented in Nicaragua in 2000. The outcomes we assess include total and food expenditure and a variety of childrens health outcomes including vaccinations, morbidity, and breast feeding. We find that PSM does better at replicating the benchmark for individual outcomes but does poorly for expenditure outcomes. Judicious choice of sample improves the performance of PSM for all outcomes. A more detailed analysis of the components of expenditures shows the degree of bias is related to the importance of the item in the household budget and persists even when differences in prices and consumption habits are controlled for by comparing households from the same geographic region. The PSM technique seems most promising for evaluating individual, and easily measured outcomes, such as those related to child schooling and health, but less so for more complex outcomes such as expenditures. |
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Assessment of the Reach and Usefulness of the Compendium of Indicators for Monitoring and Evaluating National Tuberculosis Programs
|
Lucy Wilson, Stephanie Mullen |
2007 |
English |
NIGERIA, MEXICO, MALAWI, INDIA, ETHIOPIA, TANZANIA |
|
The Compendium of Indicators for Monitoring and Evaluating National Tuberculosis Programs, was published in by a consortium of agencies led by the Stop TB Partnership of the World Health Organization (WHO), the U.S. Agency for International Development (USAID), and MEASURE Evaluation, intended for use by tuberculosis control and other public health professionals. It provides monitoring and evaluation guidance for TB-related programs.
In 2006, an assessment of the compendium was conducted to determine whether the guide is reaching its intended audiences and is a useful tool for improving monitoring and evaluation skills. Main components of the assessment included a study of its reach, online surveys and telephone interviews with potential users, and an analysis of comparable publications.
This report provides the findings of the assessment, including three key recommendations. First, training opportunities should continue to be offered alongside the distribution of the compendium so that users can become familiar with how to use the guide. Second, a supplemental guide should be developed to capture broader areas of TB programming, such as pediatric TB, TB-related stigma, and behavior change communication. Finally, dissemination of the compendium in its various formats and languages should be expanded, aiming for all national TB programs to have access to a copy.
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Community and Health Facility Influences on Contraceptive Method Choice in the Eastern Cape, South Africa
|
Stephenson R, Beke A, Tshibangu D |
2007 |
English |
SOUTH AFRICA, Southern Africa |
Contraception |
Although there have been a growing number of studies that examine how community factors influence contraceptive use, there is a lack of studies that examine how community actors shape contraceptive method choice. This paper uses linked individual and health facility data from the 1998 South Africa Demographic and Health Survey and the 1998 Eastern Cape Facility Survey to explore community and health facility influences on the choice of contraceptive methods other than the injection (the most commonly used method in South Africa). Several pathways of influence between the community and individual contraceptive method choice are identified. Health facility staffing levels and clinic preparedness are significant influences on contraceptive method choice. Other non-health facility related community factors that influence contraceptive method choice include the climate of female autonomy, levels of education, and community socio-economic status. The residual variation in contraceptive use highlights the deficits that exist in current data sets for capturing community influences on contraceptive behavior. |
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Community and Health Facility Influences on Contraceptive Use in the Eastern Cape, South Africa
|
Stephenson R, Beke A, Tshibangu D |
2007 |
English |
SOUTH AFRICA, Southern Africa |
Condoms, Contraception, Health Facilities |
This paper uses linked individual and health facility data from the 1998 South Africa Demographic and Health Survey and the 1998 Eastern Cape Facility Survey to explore community and health facility influences on modern contraceptive use. Several pathways of influence between the community and individual contraceptive adoption are identified, centering primarily on the community climate of female autonomy. Few significant effects of the health facility environment on contraceptive adoption are identified. The residual variation in contraceptive use highlights the deficits existing in current data sets for capturing community influences on contraceptive behaviour. |
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An HIV and AIDS Situational Assessment: Barriers to Access to Services for Vulnerable Populations in Saint Kitts and Nevis
|
MEASURE Evaluation |
2007 |
English |
SAINT KITTS AND NEVIS, Latin America and the Caribbean |
HIV/AIDS |
The Ministry of Health in Saint Kitts and Nevis are planning to undertake the revision of its current strategy plan. A key step in this process is the implementation of Situational Assessment, which provides the opportunity for examining and using current data sources, to access the current socio-cultural contexts for key stakeholders and community members in relationship to HIV and AIDS, and to provide recommendations to strengthen strategic planning, and therefore the national response to HIV and AIDS. <p>This year, MEASURE Evaluation and the International HIV/AIDS Alliance worked to support Saint Kitts and Nevis in implementing the Situational Assessment presented here. It was proposed that MEASURE Evaluation support this gap in data on vulnerable populations by conducting the assessment and with approval from the Permanent Secretary in December; implementation began in January 2007.<p> The goal of the assessment was to understand the vulnerability of certain groups to HIV and AIDS infection, the community barriers to accessing HIV-specific services, and recommendations for addressing those barriers. This assessment also seeks to understand how service providersnamely clinicaland governmental/non-governmental organisation (NGO) persons understand who might be vulnerable to HIV, and obtain their insight in implementing services targeting these populations.<p> The information provided in this report should be not be used in a vacuum to inform strategic planning and community programming efforts in Saint Kitts and Nevis; rather what is presented here can be used in collaboration with most current and available data sources. |
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Sample Vital Registration with Verbal Autopsy: Verbal Autopsy Supervisor Training Guide
|
Williams D, Mswia R, Nguyen LY, Whiting D, Hemed Y, Setel P |
2007 |
English |
|
Vital Registration, Census |
Sample Vital Registration with Verbal Autopsy (SAVVY) is a library of best practice methods for improving the quality of vital statistics where high coverage of civil registration and/or good cause of death data are not available. This guide is intended to help trainers prepare SAVVY verbal autopsy supervisors, by providing the supervisors with a complete description of their roles and responsibilities. |
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Sample Vital Registration with Verbal Autopsy: Verbal Autopsy Supervisor's Manual
|
Whiting D, Williams D, Mswia R, Hemed Y, Setel P |
2007 |
English |
|
Vital Registration, Census |
Sample Vital Registration with Verbal Autopsy (SAVVY) is a library of best practice methods for improving the quality of vital statistics where high coverage of civil registration and/or good cause of death data are not available. This manual describes the roles and responsibilities of the verbal autopsy (VA) supervisor in the SAVVY mortality surveillance system. The manual specifies the procedures and criteria to be used during selection and training of various cadres; it also highlights the supervisory and administrative arrangements that need to be made and implemented before, during, and after completion of data collection. There are separate manuals for key informants and verbal autopsy interviewers, used for training and reference during the course of data collection. This manual is relevant for district officials who will function as SAVVY VA supervisors. A VA supervisor may refer to this manual as a guide for day-to-day operation of the death reporting system and verbal autopsy data collection activities. |
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Sample Vital Registration with Verbal Autopsy: Verbal Autopsy Interviewer Training Guide
|
Mswia R, Williams D, Nguyen LY, Whiting D, Hemed Y, Setel P |
2007 |
English |
|
Vital Registration, Census |
Sample Vital Registration with Verbal Autopsy (SAVVY) is a library of best practice methods for improving the quality of vital statistics where high coverage of civil registration and/or good cause of death data are not available. This guide is intended to help trainers prepare SAVVY verbal autopsy interviewers (VAIs), by providing the VAIs with a complete description of their roles and responsibilities. |
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Sample Vital Registration with Verbal Autopsy: Verbal Autopsy Interviewer's Manual
|
Williams D, Mswia R, Whiting D, Hemed Y |
2007 |
English |
|
Vital Registration, Census |
Sample Vital Registration with Verbal Autopsy (SAVVY) is a library of best practice methods for improving the quality of vital statistics where high coverage of civil registration and/or good cause of death data are not available. This manual is intended to provide verbal autopsy interviewers (VAIs) with a complete description of their roles and responsibilities. The manual is to be used as a training and reference guide during a VAIs course of work within their assignment areas. The manual provides guidelines for working with key informants (who report deaths that have occurred within assignment areas) and procedures to follow when conducting verbal autopsy interviews with bereaved families. This manual also serves as a reference for those who work with and supervise VAIs, including supervisors, field office managers, and physician VA reviewers/coders. |
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Sample Vital Registration with Verbal Autopsy: Verbal Autopsy Certifier and Coder's Manual
|
Hemed Y, Mswia R, Whiting D, Williams D, Chandramohan D, Rao C, Semu G, Setel P |
2007 |
English |
|
Vital Registration, Census |
Sample Vital Registration with Verbal Autopsy (SAVVY) is a library of best practice methods for improving the quality of vital statistics where high coverage of civil registration and/or good cause of death data are not available. This manual provides an overview of cause-of-death certification and an outline of the step-by-step process involved in coding information collected from verbal autopsy procedures. Guidelines for diagnostic criteria for symptoms and signs for common conditions that are encountered in verbal autopsy procedures are included. This manual also serves as a basic training and reference guide for verbal autopsy cause-of-death certification and WHO International Classification of Disease (ICD) coding. The coding process follows the guidelines provided in three volumes of ICD-10. |
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Sample Vital Registration with Verbal Autopsy (SAVVY): An Overview
|
|
2007 |
English |
|
Vital Registration, Census |
This overview booklet describes the rationale, methods, outputs, and uses of a sample vital registration system that includes active follow-up of deaths in the community to determine their likely causes. This system is called Sample Vital Registration with Verbal Autopsy, or SAVVY. SAVVY is a library of best practice methods for improving the quality of vital statistics where high coverage of civil registration and/or good cause of death data are not available. SAVVY manuals, training guides, and related materials are also available on the MEASURE Evaluation Web site. |
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Sample Vital Registration with Verbal Autopsy: Key Informant Training Guide
|
Mswia R, Williams D, Nguyen LY, Whiting D, Hemed Y, Setel P |
2007 |
English |
|
Vital Registration, Census |
Sample Vital Registration with Verbal Autopsy (SAVVY) is a library of best practice methods for improving the quality of vital statistics where high coverage of civil registration and/or good cause of death data are not available. This guide is intended to help trainers prepare SAVVY verbal autopsy key informants (KIs), by providing the KIs with a complete description of their roles and responsibilities. |
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Sample Vital Registration with Verbal Autopsy: Key Informant's Manual
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Mswia R, Williams D, Whiting D, Hemed Y, Setel P |
2007 |
English |
|
Vital Registration, Census |
Sample Vital Registration with Verbal Autopsy (SAVVY) is a library of best practice methods for improving the quality of vital statistics where high coverage of civil registration and/or good cause of death data are not available. This manual is intended to provide the key informant (KI) with complete information on roles and responsibilities in the SAVVY system. The manual is to be used as a training and reference guide for the KI's work as a reporter of deaths in the KI's assignment areas. The manual contains guidelines for reporting deaths, and procedures to follow for setting up appointments for verbal autopsy interviews with the bereaved families. This manual also serves as a reference for all SAVVY officers who work with and support the KIs, including verbal autopsy interviewers, supervisors, and district managers. |
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Sample Vital Registration with Verbal Autopsy: Field Office Manager's Manual
|
Williams D, Osborne S, Nguyen LY, Whiting D, Setel P |
2007 |
English |
|
Vital Registration, Census |
Sample Vital Registration with Verbal Autopsy (SAVVY) is a library of best practice methods for improving the quality of vital statistics where high coverage of civil registration and/or good cause of death data are not available. This manual describes the roles and responsibilities of the field office manager a senior district official who will be responsible for managing operations of the SAVVY system at the district/province level. This manual specifies the procedures to be used during the recruitment and training of various positions, and highlights the supervisory and administrative arrangements that need to be made and implemented before, during, and after data collection. |
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Sample Vital Registration with Verbal Autopsy: Census Update Interviewer's Workbook
|
Osborne S |
2007 |
English |
|
Vital Registration, Census |
Sample Vital Registration with Verbal Autopsy (SAVVY) is a library of best practice methods for improving the quality of vital statistics where high coverage of civil registration and/or good cause of death data are not available. This workbook is to be used by census update interviewers during their training. |
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Sample Vital Registration with Verbal Autopsy: Census Update Interviewer Training Guide
|
Osborne S |
2007 |
English |
|
|
Sample Vital Registration with Verbal Autopsy (SAVVY) is a library of best practice methods for improving the quality of vital statistics where high coverage of civil registration and/or good cause of death data are not available. This guide is intended to help trainers prepare SAVVY census update interviewers, by providing the interviewers with a complete description of their roles and responsibilities. |
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Sample Vital Registration with Verbal Autopsy: Census Supervisor Coordinator's Manual
|
Osborne S |
2007 |
English |
|
Vital Registration, Census |
Sample Vital Registration with Verbal Autopsy (SAVVY) is a library of best practice methods for improving the quality of vital statistics where high coverage of civil registration and/or good cause of death data are not available. This manual is intended to provide census supervisor coordinators with a complete description of their roles and responsibilities. The manual is to be used as a reference guide during a census supervisor coordinators course of work with his or her assigned field office. The manual combines descriptions of the major duties of the census supervisor coordinator during the baseline census and the census update rounds. The manual provides guidelines on the field observation of census supervisors in order to determine if interviewers are being properly trained and monitored during the interview period; provides tools for helping the census supervisor maintain his or her schedule under unusual or difficult circumstances; provides instructions on actions to take if there is a suspicion of falsification of data; and provides guidance about communication between the census supervisor coordinator and census supervisors. |
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Sample Vital Registration with Verbal Autopsy: Census Supervisor Training Guide
|
Sengupta M |
2007 |
English |
|
Vital Registration, Census |
Sample Vital Registration with Verbal Autopsy (SAVVY) is a library of best practice methods for improving the quality of vital statistics where high coverage of civil registration and/or good cause of death data are not available. This guide is intended to help trainers prepare SAVVY census supervisors, by providing the supervisors with a complete description of their roles and responsibilities. |
|
Sample Vital Registration with Verbal Autopsy: Census Supervisor's Manual
|
Sengupta M |
2007 |
English |
|
Vital Registration, Census |
Sample Vital Registration with Verbal Autopsy (SAVVY) is a library of best practice methods for improving the quality of vital statistics where high coverage of civil registration and/or good cause of death data are not available. This manual is intended to provide census supervisors with a complete description of their roles and responsibilities. The manual is to be used as a training and reference guide during a census supervisors course of work within his or her supervisory area. The manual combines descriptions of supervisory work during the baseline and the update rounds of the census. It provides guidelines for supervising interviewers when they are canvassing assignment areas, reading and updating AA maps, completing address listing books, and completing SAVVY census questionnaires. |
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Sample Vital Registration with Verbal Autopsy: Census Interviewer's Workbook
|
Hoffman R |
2007 |
English |
|
Vital Registration, Census |
Sample Vital Registration with Verbal Autopsy (SAVVY) is a library of best practice methods for improving the quality of vital statistics where high coverage of civil registration and/or good cause of death data are not available. This workbook is to be used by census interviewers during their training. |
|
Sample Vital Registration with Verbal Autopsy: Census Interviewer Training Guide
|
Hoffman R |
2007 |
English |
|
Vital Registration, Census |
Sample Vital Registration with Verbal Autopsy (SAVVY) is a library of best practice methods for improving the quality of vital statistics where high coverage of civil registration and/or good cause of death data are not available. This guide is intended to help trainers prepare SAVVY census interviewers, by providing the interviewers with a complete description of their roles and responsibilities. |
|
Sample Vital Registration with Verbal Autopsy: Census Interviewer's Manual
|
Osborne S, Hoffman R |
2007 |
English |
|
Vital Registration, Census |
Sample Vital Registration with Verbal Autopsy (SAVVY) is a library of best practice methods for improving the quality of vital statistics where high coverage of civil registration and/or good cause of death data are not available. This manual is intended to provide census interviewers with a complete description of their roles and responsibilities. The manual is to be used as a training and reference guide during census interviewers work within their assignment area. The manual provides guidelines for canvassing assignment areas, reading and updating the assignment area map, completing the address listing book, and completing the SAVVY census questionnaire. The manual also provides guidelines on interview instructions, unusual or difficult situations, and how to turn in completed work to a supervisor. |
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Sample Vital Registration with Verbal Autopsy: SAVVY Budget Manual
|
Whiting D, Williams D, Hemed Y, Mswia R, Setel P |
2007 |
English |
|
Vital Registration, Census |
Sample Vital Registration with Verbal Autopsy (SAVVY) is a library of best practice methods for improving the quality of vital statistics where high coverage of civil registration and/or good cause of death data are not available. This manual and the SAVVY budget spreadsheet have been developed to assist in the budgeting process for SAVVY planning. SAVVY builds on the experiences of other demographic surveillance sites, and the budget spreadsheet has been developed based on this experience. |
|
Evidence for a successful implementation of the minimum package of HIV prevention interventions in Burma
|
Ruth Bessinger, Maung Maung Nyein Chan, Kim Longfield, Tin Aung, Habibur Rahman |
2007 |
English |
BURMA, Asia |
HIV/AIDS, Burma |
This case study aims to share a successful implementation of the minimum package approach to HIV prevention for most-at-risk populations. The minimum package approach, which aims to implement a package of effective HIV prevention interventions in a coordinated fashion, is being implemented in a number of sites across the Mekong region. The program in Burma is one of the more established of these, and it presents a wealth of data that can be used to better understand the implementation of the Burma program and demonstrate its effectiveness. The experience from Burma may help inform other programs in the region. |
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Suriname Carribean Region HIV and AIDS Service Provision Assessment Survey 2006
|
St. George's University, MEASURE Evaluation |
2007 |
English |
Latin America and the Caribbean, SURINAME |
HIV/AIDS |
The Suriname HIV and AIDS service provision assessment (HSPA) findings provide information on both basic- and advanced-level HIV and AIDS services and the availability of record-keeping systems for monitoring HIV and AIDS care and support. Within the Caribbean region, there is a concern for the recent training of health professionals who provide HIV and AIDS services, for health worker attitudes toward people living with HIV and AIDS and for patient movement within the region. The Suriname HSPA captured information on these region-specific indicators in addition to the standard HSPA indicators. Since HIV and AIDS services are not offered across all facilities or facility types, and these services are relatively few, the sample is disproportionately representative of known sites for HIV and AIDS services. Although the emphasis of the HSPA is on public facilities, given the important role played by private or non-governmental facilities as providers of HIV and AIDS services in Suriname, both public and non-governmental facilities are included. The survey was conducted in a sample of 23 facilities (4 government and 19 non-governmental facilities) in Suriname, including hospitals, health centers, specialized clinics, and laboratories. |
|
Tobago Carribean Region HIV and AIDS Service Provision Assessment Survey 2006
|
St. George's University, MEASURE Evaluation |
2007 |
English |
Latin America and the Caribbean, TRINIDAD AND TOBAGO |
HIV/AIDS |
Focusing on the formal public health sector in Tobago, the HIV and AIDS service provision assessment (HSPA) findings provide information on both basic and advanced-level HIV and AIDS services and the availability of record-keeping systems for monitoring HIV and AIDS care and support. Within the Caribbean region, there is a concern for the recent training of health professionals who provide HIV and AIDS services, for health worker attitudes towards people living with HIV and AIDS and for patient movement within the region. The Tobago HSPA captured information on these region-specific indicators in addition to the standard HSPA indicators. Since HIV and AIDS services are not offered across all facilities or facility types, and these services are relatively few, the sample is disproportionately representative of known sites for HIV and AIDS services. Although the emphasis of the HSPA is on public facilities, if private or non-government facilities are important providers of HIV and AIDS services, they were also included. The survey was conducted in a sample of nine public facilities in Tobago, including hospitals, health centers, laboratories and other health facilities. |
|
Trinidad Carribean Region HIV and AIDS Service Provision Assessment Survey 2006
|
St. George's University, MEASURE Evaluation |
2007 |
English |
TRINIDAD AND TOBAGO, Latin America and the Caribbean |
HIV/AIDS |
Focusing on the formal public health sector in Trinidad, the HIV and AIDS service provision assessment (HSPA) findings provide information on both basic and advanced-level HIV and AIDS services and the availability of record-keeping systems for monitoring HIV and AIDS care and support. Within the Caribbean region, there is a concern for the recent training of health professionals who provide HIV and AIDS services, for health worker attitudes towards people living with HIV and AIDS and for patient movement within the region. The Trinidad HSPA captured information on these region-specific indicators in addition to the standard HSPA indicators. Since HIV and AIDS services are not offered across all facilities or facility types, and these services are relatively few, the sample is disproportionately representative of known sites for HIV and AIDS services. Although the emphasis of the HSPA is on public facilities, if private or non-government facilities are important providers of HIV and AIDS services, they were also included. The survey was conducted in a sample of 32 facilities (21 public facilities) in Trinidad, including hospitals, health centers, medical stations and laboratories. |
|
A Guide for Monitoring and Evaluating Avian Influenza Programs in Southeast Asia
|
Eckert E, Hoffman N, Hyslop A, Johnson D, Suzuki C, Wuerker E |
2007 |
English |
East Asia, South Asia |
|
This guide provides standard M&E terminology for avian influenza (AI)indicators and information systems for programs in Southeast Asia. The use of standard indicators facilitates data aggregation and provides information for consistent national, regional, and global-level monitoring of progress for AI programs. Because the understanding of the disease is evolving, this guide allows for adaptation as new programs and interventions come into place (an interim guide was first released in 2007; the current edition was revised in September 2008). The guide provides a logic model for understanding regional and national-level AI programs that share the central goal of reducing the risk of a human pandemic influenza. The four program components that support this goal are national planning and policy, animal health, risk reduction, and human health. For each of these components, the guide provides indicators designed to measure key elements of AI prevention and control programs. Because there is no global standard for M&E of AI programs, all indicators in the guide are newly developed, with extensive input from technical experts involved in global, regional and national level programs. The guide is a result of broad-based collaboration involving MEASURE Evaluation, Abt Associates, AED, AFAP, AVSP, CARE, CRS, FAO, USAID, UNDP, UNICEF, UNSIC, US-CDC, WHO, Ministry of Agriculture and Rural Development (Vietnam), National Institute for Hygiene and Epidemiology (Vietnam), Ministry of Public Health (Thailand), Ministry of Health (Lao P.D.R), and the National Animal Health Center (Lao P.D.R). |
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A Framework for Monitoring and Evaluating HIV Prevention Programmes for Most-At-Risk Populations
|
Joint United Nations Programme on HIV/AIDS (UNAIDS) |
2007 |
English |
Global |
Monitoring, Evaluation, Evaluation, HIV/AIDS, Monitoring |
The organizing framework described in this document is the result of over two years of development work and reflects the input of many individuals, national and international organizations concerned with the planning, the monitoring and the evaluation of prevention programmes for those individuals and populations most-at-risk of acquiring HIV. It is intended for national and subnational programme managers and others involved in (1) planning and implementing programmes; (2) monitoring and evaluation; and (3) using data and information for policy development and programme improvement. |
|
Mama Mkubwa Psychosocial Support Program
|
Littrell M, Thurman TR, Chatterji M, Brown L |
2007 |
English |
TANZANIA, Southern Africa, East Africa, Africa |
Orphans and Vulnerable Children, Monitoring, Evaluation, Tanzania, HIV/AIDS, Child Health |
An estimated 12 million children aged 17 and younger have lost one or both parents to AIDS in sub-Saharan Africa (UNICEF, 2006). Despite recognition of the magnitude and negative consequences of this problem, there is little evidence on what works to improve the well-being of children affected by HIV and AIDS. In an attempt to fill this knowledge gap, MEASURE Evaluation is conducting targeted evaluations of five programs for orphans and vulnerable children (OVC) in five unique settings two in Kenya and three in Tanzania. Case studies are the first phase of MEASURE Evaluations targeted evaluations and begin the process of information sharing on lessons learned in programming for OVC. Additional evaluation activities include impact assessments and costing studies of each program. This case study was conducted to impart a thorough understanding of The Salvation Armys (TSA) Mama Mkubwa Psychosocial Support Program model and to document lessons learned that could be applied to other initiatives. While TSA is additionally piloting the WORTH Program in Tanzania intended to improve economic security of OVC, this case study focuses on the Psychosocial Support Program. Case study information gathering activities included program document review and program site visits. The primary audience for this case study includes OVC program implementers in Tanzania and elsewhere in Africa, as well as relevant policy makers and funding agencies addressing OVC needs. |
|
The Tumaini Home-Based Care Program
|
Littrell M, Thurman TR, Chatterji M, Brown L |
2007 |
English |
TANZANIA, Southern Africa, East Africa, Africa |
Orphans and Vulnerable Children, Tanzania, HIV/AIDS, Monitoring, Evaluation, Child Health |
An estimated 12 million children aged 0-17 have lost one or both parents to AIDS in sub-Saharan Africa (UNICEF, 2006). Despite recognition of the magnitude and negative consequences of this problem, there is little evidence on what works to improve the well-being of children affected by HIV and AIDS. In an attempt to fill this knowledge gap, MEASURE Evaluation is conducting targeted evaluations of five programs for orphans and vulnerable children (OVC) in five unique settings two in Kenya and three in Tanzania. Case studies are the first activity of MEASURE Evaluations targeted evaluations and begin the process of information sharing on lessons learned in programming for orphans and vulnerable children. Additional evaluation activities include an impact assessment and costing activity for each of the five selected programs. This case study was conducted to impart a thorough understanding of the Tumaini Home-Based Care Program model and to document lessons learned that could be applied to other initiatives. While the Tumaini program addresses the needs of both people living with HIV and AIDS (PLHA) as well as OVC, the case study focuses particular attention on specific services and program impact for OVC. Case study information-gathering activities included program document review; program site visits, including discussions with sub-grantee staff, volunteers, beneficiaries, and community members; and observations of program activities. The primary audience for this case study includes OVC program implementers in Tanzania and elsewhere in Africa, as well as relevant policy makers and funding agencies addressing OVC needs. |
|
Community-Based HIV/AIDS Prevention, Care, and Support Program
|
Hoffman A, Thurman TR, Chatterji M, Brown L |
2007 |
English |
KENYA, Southern Africa, East Africa, Africa |
Monitoring, Evaluation, Orphans and Vulnerable Children, HIV/AIDS, Kenya, Child Health |
An estimated 12 million children aged 17 and under have lost one or both parents to AIDS in sub-Saharan Africa (UNICEF, 2006a). Despite recognition of the magnitude and negative consequences of this problem, there is little evidence on what works to improve the well being of children affected by HIV and AIDS. In an attempt to fill this knowledge gap, MEASURE Evaluation is conducting targeted evaluations of five programs for orphans and vulnerable children (OVC) in five unique settings two in Kenya and three in Tanzania. Case studies are the first phase of MEASURE Evaluations targeted evaluations and begin the process of information sharing on lessons learned in programming for OVC. Additional evaluation activities under the MEASURE Evaluation targeted evaluation activity include an impact assessment and costing activity of each of the five selected programs. This case study was conducted to impart a thorough understanding of U.S. Pathfinder in Kenyals OVC program model and to document lessons learned that could be applied to other initiatives. This case study is based upon a program document review; program site visits, including discussions with local staff, volunteers, beneficiaries and community members; as well as observations of program activities. The primary audience for this case study includes OVC program implementers in Kenya and elsewhere in Africa, as well as relevant policymakers and funding agencies addressing OVC needs. |
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Kilifi Orphans and Vulnerable Children Project
|
Hoffman A, Thurman TR, Chatterji M, Brown L |
2007 |
English |
East Africa, Africa, KENYA, Southern Africa |
Monitoring, Evaluation, Orphans and Vulnerable Children, HIV/AIDS, Kenya, Child Health |
An estimated 12 million children aged 17 or younger have lost one or both parents to AIDS in sub-Saharan Africa (UNICEF, 2006a). Despite the recognition of the magnitude and negative consequences of this problem, there is little evidence on what works to improve the well-being of children affected by HIV and AIDS. In an attempt to fill this knowledge gap, MEASURE Evaluation is conducting targeted evaluations of five orphans -and-vulnerable-children (OVC) programs in five unique settings two in Kenya and three in Tanzania. Case studies are the first phase of MEASURE Evaluations targeted evaluations and begin the process of information sharing on lessons learned in OVC programming. Additional evaluation activities under the MEASURE Evaluation targeted evaluation activity include an impact assessment and costing activity of each of the five selected programs. This case study was conducted to impart a thorough understanding of Catholic Relief Services (CRS) OVC program model in Kenya and to document lessons learned that could be applied to other OVC initiatives. This case study is based upon a program document review; program site visits, including discussions with local staff, volunteers, beneficiaries and community members; as well as observations of program activities. The primary audience for this case study includes OVC program implementers in Kenya and elsewhere in Africa, as well as relevant policy makers and funding agencies addressing OVC needs. |
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Field Assessment of Emergency Plan Centrally-Funded HIV Prevention Programs for Youth
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Speizer I, Lopez C |
2007 |
English |
ETHIOPIA, East Africa, Latin America and the Caribbean, HAITI, KENYA, MOZAMBIQUE, TANZANIA |
PEPFAR, HIV/AIDS |
In an effort to mitigate the spread of HIV among youth in developing nations, the U.S. Presidents Emergency Plan for AIDS Relief funded 14 faith-based and nongovernmental organizations in 2004 and 2005 to carry out multi-country HIV prevention programs that have as their primary objective the promotion of abstinence until marriage, fidelity in marriage and sexual relationships, and avoidance of unhealthy sexual behaviors among youth aged 10-24. In 2006, MEASURE Evaluation began an evaluation to assess and improve the quality of these centrally-funded programs in Haiti, Kenya, Mozambique, Ethiopia, and Tanzania. The evaluation was divided into two phases: a process evaluation phase (Phase I) and an outcome evaluation phase (Phase II). The primary focus of Phase I was to produce information useful for making recommendations for mid-course corrections to the programs to help maximize their potential benefits. This Phase I report provides an assessment of the quality and rigor of the programs, as well as overall recommendations for strengthening these and other abstinence and partner reduction programs for youth. |
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Sample Vital Registration with Verbal Autopsy: Census Update Interviewer's Manual
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Hoffman R, Osborne S |
2007 |
English |
|
Vital Registration, Census |
Sample Vital Registration with Verbal Autopsy (SAVVY) is a library of best practice methods for improving the quality of vital statistics where high coverage of civil registration and/or good cause of death data are not available. This manual is intended to provide census update interviewers with a complete description of their roles and responsibilities. The manual is to be used as a training and reference guide during a census update interviewers course of work within his or her assignment area. The manual provides guidelines for canvassing an assignment area, reading and updating an assignment area map, reading and revising a pre-printed address listing book, and completing the SAVVY census update questionnaire and the SAVVY census change questionnaire. The manual also provides guidelines on interview instructions and how to deal with unusual or difficult situations. |
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MEASURE Evaluation Global Positioning System Toolkit
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Spencer J |
2007 |
English |
Global |
GIS |
One of the fundamental principles of monitoring and evaluation is ensuring that services and interventions are effective and adequately address health needs. Knowing the location of the service or intervention, as well as the population in need, can provide meaningful context and strengthen the analysis. A vital tool for obtaining location are global positioning system (GPS) receivers.<p> This document provides an overview of the use of GPS receivers for MEASURE Evaluation Projects. It is intended to provide standardized data collection protocols as well as training materials and troubleshooting guides. This toolkit is designed to be taken into the field, along with the GPS units, and serve as a reference for data collection personnel. |
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Data Quality Assurance Tool for Program Level Indicators
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Brown W |
2007 |
English |
Global |
Data, Data Quality |
The Data Quality Assurance Tool for Program Level Indicators addresses issues intrinsic to the M&E systems supported by the Emergency Plan and others. These factors, which can systematically compromise data quality, are: The inaccurate application of the upstream and downstream framework for target setting and results reporting; The double-counting of service outputs and/or recipients; and The lack of comparability of results reported over time. Taken together, these are the fundamental data quality challenges to compiling and summarizing data for the Semi-Annual and Annual Program Results, and for setting programmatic targets in the context of Country Operational Plans or their equivalent. The Data Quality Assurance Tool for Program Level Indicators tool consists of diagnostics, guidance, worksheets, and text-boxes that emphasize preventing and managing data quality challenges and documenting processes so that reporting systems are auditable. The overall goal of the tools use is to provide clear and practical guidance to M&E officers so that each Emergency Plan country program and its implementing partners understand the constraints to good results reporting and address them in a uniform way. |
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Monitoring and Evaluation Systems Strengthening Tool – MESST
|
Hardee K |
2007 |
English |
Global |
Monitoring, Evaluation |
The Monitoring and Evaluation Systems Strengthening Tool (MESST) was developed under the premise that it is important to understand the system through which data are generated, aggregated and reported in order to assess their quality. This tool includes three checklists that Programs or projects can use to: Assess their monitoring and evaluation (M&E) plans; Take stock of the capabilities of Management Units to manage data related to the implementation of the Program/project(s); and Assess the data-collection and reporting systems for each program area, including the ability to report valid, accurate and high quality data related to implementation. The M&E Systems Strengthening Tool has been endorsed by the Emergency Plan, the Global Fund, UNAIDS, WHO, the World Bank, Health Metrics Network, and Roll Back Malaria, and is published by the MEASURE Evaluation Project. Its wide use will help focus stakeholder attention on actionable gaps in M&E systems that relate to data collection and indicator reporting and will complement ongoing efforts to strengthen M&E more broadly. |
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An assessment of sites where persons go to meet sexual partners in St. James, Jamaica, using the PLACE method
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Figueroa JP, Brewer CB, Dale D, Bassett Hileman S, Weir S |
2007 |
English |
JAMAICA, Latin America and the Caribbean |
|
Objective: The objective of this study was to assess sexual behavior of persons at risk of HIV infection. Goal: The goal of this study was to identify sites where HIV prevention is needed. Study Design: Customers at sites where persons meet new sex partners in St. James, Jamaica, were surveyed. Results: Of 421 sites, 282 men and 200 women (random sample, 23 sites) and 320 men and 265 women (special sample, 26 sites) were interviewed. Over one fourth of men and 14% (special) and 4% (random) of women had one or more new sex partners in the last 4 weeks. Seventy-eight percent of men reported condom use at last sex with a new partner compared with 66% of women. Approximately 50% of respondents reported condom use at last sex with a regular partner. Conclusion: Sites at which people meet new sex partners were diverse with significant opportunities for prevention. Commercial and transactional sex are features at many sites. |
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Is public health expenditure in Ecuador progressive or regressive?
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Angeles G, Trujillo AJ, and Lastra A |
2007 |
English |
ECUADOR |
Public Health |
This paper uses a benefit incidence analysis (BIA) to evaluate whether public health expenditure in Ecuador is regressive or progressive. This paper overcomes several limitations of previous BIA analyses in developing countries: a) it develops a framework to allocate the operational and administrative government expenditures among providers at a centralised level according to their level of activity; b) it uses a household health survey in which an individual's consumption of medical care can be tied to a specific health provider. We rank the economic status of medical care users according to the consumption per adult equivalent, and using an index obtained from the availability of durable goods in the household. The findings suggest that the Ministry of Public Health expenditure is progressive, while the Ecuadorian Social Security Institute expenditure is regressive. We offer policy suggestions to increase the efficiency and equity of public health expenditures in Ecuador. |
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Family planning programs in 2004: new assessments in a changing environment
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Ross J, Stover J, Adelaja D |
2007 |
English |
Global, Africa |
HIV/AIDS |
CONTEXT: Periodic assessments between 1972 and 1999 found consistent increases in the intensity and types of effort exerted by national family planning programs in developing countries. An updated evaluation was needed to examine whether these trends have been affected by recent changes in the family planning environment, such as decentralization, the HIV/AIDS pandemic and funding reductions. METHODS: In 2004, informants in 82 developing countries completed a questionnaire that assessed 30 dimensions of program effort and included several new scales to explore current issues. Selected results were compared with findings from prior rounds of the study. RESULTS: Family planning effort increased between 1999 and 2004, both globally and within regions. When the data were weighted by country population size, effort declined slightly overall but increased in four of six regions. Countries with low initial scores improved more than those with high initial scores. Contraceptive access varied by region and was lowest in Sub-Saharan Africa. The strongest justifications for programs were improving maternal and child health and preventing unwanted births. Changes in funding were often judged to have had negative effects on programs. Unmarried youth and women receiving postabortion care received the least emphasis among special populations of interest. CONCLUSIONS: Although average program effort scores have risen again, increases in effort, funding and access to contraceptive methods are still needed in many countries, especially in rural areas and among the poor. More emphasis should be placed on providing postpartum and postabortion family planning services. |
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Socio-economic status, permanent income, and fertility: a latent-variable approach
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Bollen K, Glanville J, Stecklov G |
2007 |
English |
Global, West Africa, PERU, GHANA, Africa |
Maternal Health, Fertility |
This paper examines how permanent income and other components of socio-economic status (SES) are related to fertility in less developed countries. Because permanent income cannot be measured directly, we employ a latent-variable method. We compare our results with those of the more common proxy-variable method and investigate the consequences of not accounting for measurement error. Using data from Ghana and Peru, we find that permanent income has a large, negative influence on fertility and that research must take the latent nature of permanent income into account to uncover its influence. Controlling for measurement error in the proxies for permanent income can also lead to substantial changes in the estimated effects of control variables. Finally, we examine which of the common proxies for permanent income most closely capture the concept. The results have implications beyond this specific dependent variable, providing evidence on the sensitivity of microanalyses to the treatment of long-term economic status. |
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Setting international standards for verbal autopsy
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Baiden F, Bawah A, Biai S, Binka F, Boerma T, Byass P, Chandramohan D, Chatterji S, Engmann C, Greet D, Jakob R, Kahn K, Kunii O, Lopez AD, Murray CJ, Nahlen B, Rao C, Sankoh O, Setel P, Shibuya K, Soleman N, Wright L, and Yang G |
2007 |
English |
Global |
Vital Registration, Public Health |
In many countries most deaths occur at home. Such countries often have civil registration systems that are limited or non-existent and therefore most deaths go unrecorded. Countries that cannot record the number of people who die or why they die cannot realize the full potential of their health systems. Health systems need reliable numbers and causes of death to function properly. But in these circumstances (in the absence of a complete picture of the population's health) there are tools and techniques that can be used to obtain a fairly accurate representation of mortality trends. |
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Can family planning outreach bridge the urban-rural divide in Zambia?
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White J, Speizer I |
2007 |
English |
ZAMBIA, Africa |
|
Background: Zambia experienced declining aggregate fertility and increasing aggregate contraceptive use from 1990 to 2000. Yet, in rural Zambia, progress in family planning has lagged far behind the advances made in Zambia's urban areas. The contraceptive prevalence rate in Lusaka and other urban areas outstripped the rate in rural Zambia by nearly 25 percentage points (41.2 percent versus 16.6 percent) in 2001. The total fertility rate varied between urban and rural areas by 2.5 children (4.3 versus 6.9 children). This paper considers the urban-rural differentials in Zambia and assesses family planning outreach as a tool to narrow this divide.
Methods: This study uses the Zambia Demographic and Health Survey (DHS) data, collected between 2001 and 2002. Logistic regression techniques were employed to examine factors associated with contraceptive use. The first analysis tested modern contraceptive use versus traditional method use and no use. In addition, separate models were run for samples stratified by type of residence (rural or urban) to determine if different factors were associated with use by residence. A simulation determined the effect of all women receiving at least one household visit from a health worker if all other variables were held constant.
Results: Differences in modern contraceptive use between urban and rural areas persist (OR: 1.56, 95 percent CI: 1.241.96) even after adjusting for a number of demographic, socioeconomic, cognitive, and attitudinal factors. Household visits by a community health worker significantly increased the likelihood of modern contraceptive use among rural women (OR: 1.83; 95 percent CI: 1.292.58). If all rural women received at least one outreach visit per year, the prevalence rate for modern contraceptive methods would be expected to increase for this group by 5.9 percentage points, a marked increase but less than one-quarter of the total urban-rural differential.
Conclusion: Outreach in the form of health worker visits can improve access to family planning services, but it does not eliminate barriers to access or address continued high-fertility desires in Zambia. Until policymakers consider strategies that address both family planning demand creation and supply of services, progress in Zambia and the rest of sub-Saharan Africa will continue to lag behind the rest of the world. |
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Who counts? 4. The way forward
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AbouZahr C, Cleland J, Coullare F, Macfarlane SB, Notzon FC, Setel P, Szreter S on behalf of the Monitoring of Vital Events (MoVE) writing group |
2007 |
English |
Global |
Public Health |
Good public-health decisionmaking is dependent on reliable and timely statistics on births and deaths (including the medical causes of death). All high-income countries, without exception, have national civil registration systems that record these events and generate regular, frequent, and timely vital statistics. By contrast, these statistics are not available in many low-income and lower-middle-income countries, even though it is in such settings that premature mortality is most severe and the need for robust evidence to back decisionmaking most critical. Civil registration also has a range of benefits for individuals in terms of legal status, and the protection of economic, social, and human rights. However, over the past 30 years, the global health and development community has failed to provide the needed technical and financial support to countries to develop civil registration systems. There is no single blueprint for establishing and maintaining such systems and ensuring the availability of sound vital statistics. Each country faces a different set of challenges, and strategies must be tailored accordingly. There are steps that can be taken, however, and we propose an approach that couples the application of methods to generate better vital statistics in the short term with capacity-building for comprehensive civil registration systems in the long run. |
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Who counts? 3. Interim measures for meeting needs for health sector data: births, deaths, and causes of death
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Hill K, Lopez AD, Shibuya K, Jha P on behalf of the Monitoring Vital Events (MoVE) Writing Group |
2007 |
English |
Global |
Public Health |
Most developing countries do not have fully effective civil registration systems to provide necessary information about population health. Interim approachesboth innovative strategies for collection of data, and methods of assessment or estimation of these datato fill the resulting information gaps have been developed and refined over the past four decades. To respond to the needs for data for births, deaths, and causes of death, data collection systems such as population censuses, sample vital registration systems, demographic surveillance sites, and internationally-coordinated sample survey programmes in combination with enhanced methods of assessment and analysis have been successfully implemented to complement civil registration systems. Methods of assessment and analysis of incomplete information or indirect indicators have also been improved, as have approaches to ascertainment of cause of death by verbal autopsy, disease modelling, and other strategies. Our knowledge of demography and descriptive epidemiology of populations in developing countries has been greatly increased by the widespread use of these interim approaches; although gaps remain, particularly for adult mortality. However, these approaches should not be regarded as substitutes for complete civil registration but rather as complements, essential parts of any fully comprehensive health information system. International organisations, national governments, and academia all have responsibilities in ensuring that data continue to be collected and that methods continue to be improved. |
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Who counts? 2. Civil registration systems and vital statistics: successes and missed opportunities
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Mahapatra P, Shibuya K, Lopez AD, Coullare F, Notzon FC on behalf of the Monitoring Vital Events (MoVE) Writing Group |
2007 |
English |
Global |
Public Health |
The need for reliable national statistics for births, deaths, and causes of death has never been greater - but countries and developmental partners have not recognised this as a priority. Authors of the second paper look at inconsistency the lack of data from sub-Saharan Africa and the inconsistency in data from developed countries. They conclude: "It is unacceptable for us to be as ignorant about the state of a nation's health in 50 years time as we are today. |
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Who counts? 1. A scandal of invisibility: making everyone count by counting everyone
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Setel P, Macfarlane S, Szreter S, Mikkelson L, Jha P, Stout S, and AbouZahr C on behalf of the MoVE writing committee |
2007 |
English |
Global |
|
Most people in Africa and Asia are born and die without leaving a trace in any legal record or official statistic. Absence of reliable data for births, deaths, and causes of death are at the root of this scandal of invisibility, which renders most of the world's poor as unseen, uncountable, and hence uncounted. This situation has arisen because, in some countries, civil registration systems that log crucial statistics have stagnated over the past 30 years. Net of debt relief, official development assistance reached US$80 billion in 2004. Yet because of the weakness in recording vital statistics, we have little authoritative evidence that these funds have their desired effects on either mortality or poverty reduction. Sound recording of vital statistics and cause of death data are public goods that enable progress towards Millennium Development Goals and other development objectives that need to be measured, not only modelled. Vital statistics are most effectively generated by comprehensive civil registration. Civil registration has a dual function, both statistical and legal; it also helps with economic development. 30 years of stagnation will not be overcome quickly, although new efforts to develop national statistical capacities offer a unique opportunity to refocus attention on civil registration. Now is the time to make the long-term goal of comprehensive civil registration in developing countries the expectation rather than the exception. The international health community can assist by sharing information and methods to ensure both the quality of vital statistics and cause of death data, and the appropriate use of complementary and interim registration systems and sources of such data. The continued cost of ignorance borne by countries without civil registration far outweighs the affordable necessity of action. |
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Kernel density estimation as a technique for assessing availability of health services in Nicaragua
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Spencer J, Angeles G |
2007 |
English |
NICARAGUA |
Nicaragua |
Typically, accessibility ratios have been calculated through a simple mathematical division of the number of people in an area by the number of facilities (or staff) in that area. This approach does not take into account the service area of the facility or its proximity to population centers, and is often performed using aggregate numbers for an administrative region. This paper describes an approach to calculating accessibility ratios such as population to facility ratios or population to staff ratios using Kernel density estimation (KDE) within a geographic information system. KDE disperses discrete phenomena across continuous space and is unrestrained by administrative boundaries. Therefore it provides a better representation of the spread of people and services across the landscape. Two types of accessibility ratios are calculated on a national level for Nicaragua: population-per-facility and population-per-staff; the merits of using KDE over traditional approaches are discussed. |
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The reach and effect of radio communication campaigns on condom use in Malawi
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Meekers D, Van Rossem R, Silva M, Koleros A |
2007 |
English |
SOUTH AFRICA, Southern Africa, Africa |
|
This study uses data from the 2004 Malawi Demographic and Health Survey to assess the reach of selected radio programs about family planning and health in Malawi and their effect on condom use and discussion of family planning. The results show that such radio programs in Malawi reach a broad audience: eight of the 12 programs were heard by at least half of the respondents, although women were less effectively reached than men. For both women and men, the radio programs were found to have a significant impact on family planning discussion with one's partner. The programs' effect on condom use was limited, however. A positive association was found with ever use of condoms, but no association was found with condom use at last intercourse. This limited impact suggests that such radio communication campaigns need to be informed by research identifying the specific constraints to current condom use in Malawi. |
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Estimating cause-specific mortality from community-and facility-based data sources in Tanzania: options and implications for mortality burden estimates
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Whiting D, Setel P, Chandramohan D, Wolfson L, Hemed Y, Lopez A |
2007 |
English |
TANZANIA, Southern Africa, East Africa, Africa |
Vital Registration |
OBJECTIVE
To compare mortality burden estimates based on direct measurement of levels and causes in communities with indirect estimates based on combining health facility cause-specific mortality structures with community measurement of mortality levels.
METHODS
Data from sentinel vital registration (SVR) with verbal autopsy (VA) were used to determine the cause-specific mortality burden at the community level in two areas of the United Republic of Tanzania. Proportional cause-specific mortality structures from health facilities were applied to counts of deaths obtained by SVR to produce modelled estimates. The burden was expressed in years of life lost.
FINDINGS
A total of 2884 deaths were recorded from health facilities and 2167 recorded from SVR/VAs. In the perinatal and neonatal age group cause-specific mortality rates were dominated by perinatal conditions and stillbirths in both the community and the facility data. The modelled estimates for chronic causes were very similar to those from SVR/VA. Acute febrile illnesses were coded more specifically in the facility data than in the VA. Injuries were more prevalent in the SVR/VA data than in that from the facilities.
CONCLUSION
In this setting, improved International classification of diseases and health related problems, tenth revision (ICD-10) coding practices and applying facility-based cause structures to counts of deaths from communities, derived from SVR, appears to produce reasonable estimates of the cause-specific mortality burden in those aged 5 years and older determined directly from VA. For the perinatal and neonatal age group, VA appears to be required. Use of this approach in a nationally representative sample of facilities may produce reliable national estimates of the cause-specific mortality burden for leading causes of death in adults.
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Fertility desires of Yoruba couples of South-Western Nigeria
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Oyediran KA |
2007 |
English |
Africa, NIGERIA, West Africa |
Fertility |
Using the matched wife husband (763) sample from the data collected from Ogbomoso and Iseyin towns in Oyo State, Nigeria, this paper examines factors associated with couples' fertility intention. The analysis used logistic regression models for predicting the effects of selected socioeconomic background characteristics on a couples fertility intention. Results indicate high levels of concurrence among husbands and wives on fertility intention. Where differences exist, husbands are more pronatalists than their wives. About 87% of pairs of partners reported similar fertility preferences. Of these couples, 59·5% wanted more children while only 27·8% reported otherwise. The logistic regression models indicated that a couples fertility intention was associated with age, education, place of residence, frequency of television-watching and number of living children. Therefore, programme interventions aimed at promoting fertility reduction in Nigeria should convey fertility regulation messages to both husbands and wives. |
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HIV-related sexual behavior in urban, rural and border areas of Burkina Faso
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Khan M, Brown L, Nagot N, Salouka S, Weir SS |
2007 |
English |
Africa, BURKINA FASO, Southern Africa, West Africa |
Monitoring, HIV/AIDS, Rural Populations, Sexual Behavior |
As HIV/AIDS prevention resources are scarce, program planners must first reach areas at highest risk of HIV transmission. High transmission areas are often locations where increased social mixing intersects with increased commercial activity (e.g., hotels for truck drivers at the intersection of major commercial routes, bars near trading centers and migrant worker residences). This study examined differences in HIV-related sexual behavior among urban, rural and border areas of Burkina Faso, which had the second-highest HIV prevalence in West Africa, after its southern neighbor, Cote d’Ivoire. The study compared the prevalence of new and multiple partnerships among a sample of individuals socializing at a sample of venues in each geographic setting; and determined the venue-level and individual-level predictors of new and multiple partnerships in each setting, so that intervention activity is focused on venues and venue patrons most in need. |
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Unmet fertility expectations and the perception of fertility problems in a Malawian village
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Barden-O'Fallon J |
2007 |
English |
Africa, MALAWI, Southern Africa |
Child Health, Health Services, Africa, Maternal Health |
This study analyses in-depth interviews with 15 women and 11 men living in a rural Malawian village to know how fertility problems are identified and interpreted in a context of high fertility demand. Results of the analysis show that although ideal family size may be falling, expectations to quickly achieve pregnancies remain high. Individual and social expectations about childbearing inform the perception of fertility problems if more than a few months pass without a noticeable pregnancy. Such problems are usually attributed to women, especially if the male partner has proven his fertility with another spouse/sexual partner. Community education on variation in the time to conception is needed, as is an understanding of how perceived infertility, regardless of actual waiting time to pregnancy, can lead to treatment seeking and risky sexual behaviour. |
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Fact Sheet: M&E of PHN Programs
|
|
2007 |
English |
|
Nutrition, Workshop, Public Health |
MEASURE Evaluation provides regional training workshops to meet a great need in developing countries for professionals with M&E skills |
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Fact Sheet: M&E of Impact Evaluation
|
|
2007 |
English |
|
Workshop |
MEASURE Evaluation provides regional training workshops to meet a great need in developing countries for professionals with M&E skills |
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Evaluations of Five Programs for Orphans and Vulnerable Children in Kenya and Tanzania
|
|
2007 |
English |
TANZANIA, East Africa, KENYA |
Child Health |
In sub-Saharan Africa, an estimated 12 million children 17 years of age or younger have lost one or both parents to AIDS. Many more children live with one or more chronically ill parent.1 Despite the recognition of the magnitude and negative consequences of this problem, there is little empirical evidence on what works to improve the well-being of children affected by HIV and AIDS. |
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Fact Sheet: Mapping health service availability in Nicaragua with new techniques
|
|
2007 |
English |
NICARAGUA, Global |
GIS |
Researchers from MEASURE Evaluation recently employed a data analysis technique called kernel density estimation (KDE) to assess the availability of health care throughout Nicaragua. KDE can estimate how the number of health facilities, and the number of health facility staff members in a region compare to the number of people in a given population. These estimates will help researchers better understand health-care accessibility and guide future health-improvement efforts. |
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Fact Sheet: Using maps to better understand populations, programs, and health
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|
2007 |
English |
Global |
GIS |
Geographic informations systems (GIS) provide researchers with spatial tools they can use to map and analyze characteristics of people, objects, and events. Recorded locations of populations, health facilities, roads, regional boundaries, and other variables can be stored as different layers of multi-dimensional maps. Researchers can then perform detailed analyses of the complex interactions between those layers. |
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Fact Sheet: Improving global M&E of programs for orphans and vulnerable children
|
|
2007 |
English |
Global |
Child Health |
This fact sheet provides an introduction to how MEASURE Evaluation is working to improve the lives of orphans and vulnerable children by providing much-needed data about OVC programs and populations to the countries and organizations implementing these projects. There are four major components to MEASURE Evaluations OVC work: 1) targeted evaluations of existing programs; 2) examinations of behavioral habits and other characteristics of at-risk populations; 3) a new toolkit, the Child Status Index, to aid OVC programs; and 4) providing mapping of OVC populations in relation to available aid organizations, health centers, and other locations. |
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Fact Sheet: Using PRISM to strengthen and evaluate health information systems
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|
2007 |
English |
Global |
Public Health |
A fact sheet about the PRISM framework -- Performance of Routine Information System Management -- and the toolset that MEASURE Evaluation has developed for identifying the strengths and weaknesses of routine health information system performance.
The 2018 version of the PRISM Series, updated and with new modules (Toolkit, User’s Kit, and Training Kit) is available here: https://www.measureevaluation.org/prism |
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Fact Sheet: Providing tools to reliably measure the well being of vulnerable children
|
|
2007 |
English |
Global |
Child Health |
Early methods for monitoring and evaluation (M&E) of OVC aid efforts had two serious flaws. First, M&E of orphaned and vulnerable children tended to focus on aspects of their lives that were directly related to HIV/AIDS at the expense of other equally important variables that affect overall child wellbeing. Second, previous M&E efforts have focused on services provided, not on how aid affected childrens overall health, providing effective monitoring but ineffective evaluation. A new tool developed by MEASURE Evaluation aims to overcome these two flaws. |
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Fact Sheet: Guide for M&E of avian influenza programs in Southeast Asia
|
|
2007 |
English |
VIET NAM, South Asia, East Asia, Asia, THAILAND, LAOS |
|
The development of an M&E framework is a critical component for monitoring progress in the prevention and control of avian influenza and the reduction of risk of a pandemic influenza in Southeast Asia. MEASURE Evaluation and its partners are developing a guide for M&E of avian influenza (AI) programs in Southeast Asia. The guide, scheduled for release in mid-2007, is a result of broad-based collaboration, and it will provide standard M&E terminology for AI indicators and information systems. The use of standard indicators facilitates data aggregation and provides information for consistent national, regional and global-level monitoring of progress for AI programs. Because the understanding of the disease is still evolving, this guide will allow for adaptation as new programs and interventions come into place. |
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Guidance for Selecting and Using Core Indicators for Cross-Country Comparisons of Health Facility Readiness to Provide Services
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Health Facility Assessment Technical Working Group |
2007 |
English |
|
Health Information Systems |
Health information systems depend on health facility surveys for data. International and program-based approaches using health facility data include the Service Provision Assessment (SPA), Macro International; the Facility Audit of Service Quality (FASQ), MEASURE Evaluation; the Service Availability Mapping (SAM) census, World Health Organization; and the Health Facility Censuses (HFC) with a focus on infrastructure, Japan International Cooperation Agency. Several rounds of data from these sources are available for selected countries. A key gap in facility-based information is that definitions of indicators and data elements differ from approach to approach. The recommended core indicators in this document were selected based on existing tools and data. The indicators assess health systems functionality rather than the health status of the targeted population. |
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Measurement of HIV Prevention Indicators: A Comparison of the PLACE Method and a Household Survey in Zambia
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Tate J, Singh K, Ndubani P, Kamwanga J, Buckner B |
2007 |
English |
ZAMBIA, Southern Africa |
Zambia, HIV/AIDS |
This analysis compares data from three studies carried out in Zambia in 2005, where it was possible to coordinate instrument design, sampling, and timing of fieldwork for a biannual household survey with two Priorities for Local AIDS Control Efforts (PLACE) studies. Taking advantage of this opportunity, the paper compares district-level data from the household survey measuring HIV/AIDS prevention indicators with data from two PLACE studies carried out in the same districts. In the two districts compared, all household and PLACE method interviews were completed during the period of May 2005 to October 2005. |
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Características de las usuarias de los métodos femeninos reversibles en cuatro áreas urbanas de Honduras: Resultados del estudio de línea de base sobre la calidad de servicio, motivación del uso de anticonceptivos, y la discontinuación de anticonceptivos
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Barden-O'Fallon J, Speizer I, Cáceres Zelaya S, Cálix Borjas J, Rodriguez Valenzuela F |
2007 |
Spanish |
HONDURAS |
Honduras |
La finalidad de este estudio es determinar como, en forma conjunta, tres niveles de influencia (ambiente de servicio, características individuales, experiencia/temor a efectos colaterales) afectan el uso continuo de anticonceptivos. El muestreo consiste de 800 mujeres entre las edades de 15 a 44 años provenientes de hospitales y centros de salud en Honduras. |
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Characteristics of Female Reversible Method Users in Four Urban Areas of Honduras:Results from the Baseline Survey of the Study of Service Quality, Motivation for Contraceptive Use, and Contraceptive Discontinuation
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Barden-O'Fallon J, Speizer I, Cáceres Zelaya S, Cálix Borjas J, Rodriguez Valenzuela F |
2007 |
English |
HONDURAS |
Honduras, Contraception |
The overall goal of this study is to determine how, together, three levels of influence (family planning service environment, individual characteristics, and previous experience/fear of side effects) affect contraceptive continuation. While these three levels of influence have all been shown to be important to contraception adoption and continuation, especially for reversible methods, they have not been examined simultaneously to determine how they jointly affect contraceptive continuation, controlling for method used. The sample consists of 800 women aged 15-44 years presenting at selected hospitals and health clinics in Honduras. |
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Use of HIV/AIDS Information in Kenya
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Salentine S, Gichuhi W, Hyslop A |
2007 |
English |
KENYA, Africa |
HIV/AIDS, PEPFAR, Kenya |
HIV/AIDS information is generated using substantial financial, technical and organizational resources. The investment in producing high quality HIV/AIDS data pays off when this information is used beyond reporting to governments and donors and informs program and policy decisions. The purpose of this assessment is to support the Kenyan National AIDS Control Council (NACC), the National AIDS and STD Control Program (NASCOP) and the Presidents Emergency Plan for HIV/AIDS Relief (PEPFAR) in Kenya in identifying opportunities for using information so that program managers and M&E; officers can plan for facilitating the use of this data for better operational and strategic decision-making while engendering a local commitment to data quality. To achieve this purpose, the assessment has the following objectives: To identify gaps and synergies for use of HIV/AIDS information across all users; To identify existing best practices; To inform the development of strategies for local use of data; and To provide recommendation of next steps for implementing selected strategies. The assessment of HIV information use in Kenya consisted of four separate tasks: (1) a stakeholder analysis of members of the reporting structure; (2) in-depth interviews of information use stakeholders; (3) a desk review of available HIV information resources; and (4) an information use mapping exercise. This report presents the findings from the in-depth interviews with NACC, NASCOP and PEPFAR program directors, managers and implementers regarding their current use and perceived need for HIV/AIDS data. Based on these findings, recommendations are made. The findings from the desk review and the mapping exercise are presented separately. |
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Unmet Need for Family Planning in Rwanda and Madagascar: An Analysis Report for the Repositioning of Family Planning Initiatives
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Nyangara F, Hart C, Speizer I, Moreland S |
2007 |
English |
MADAGASCAR, RWANDA, Africa, East Africa, Southern Africa |
Madagascar, Contraception, Rwanda |
This report examines differentials across five groups of currently married women in Rwanda and Madagascar with need or no need for modern contraception, including: unmet need to space; unmet need to limit; met need to space; met need to limit; and nonusers with no need. Both Rwanda and Madagascar have relatively high total fertility rates (TFRs), 5.8 and 5.2, respectively; almost similar desired ideal number of children, 4.8 and 4.9, respectively; and high percentages of women who want to limit births. However, their contraceptive prevalence rates are significantly different (Rwanda 13% and twice as much for Madagascar 27%). Recent data from these two countries provides an opportunity to examine the reasons why the use of contraception is lower in Rwanda compared to Madagascar despite the similarities in TFR and comparable demand for children (number of children desired). The analysis explores whether the reported country differentials in contraceptive use can be attributed to country differences or to other factors that distinguish the family planning need types in the two countries, and determine the significant predictors for each when controlling for other confounding factors. This information provides important evidence to guide program and policy decisions on the repositioning of family planning initiatives. |
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The link between HIV/AIDS and recent fertility patterns in Kenya
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Magadi M, Agwanda A |
2007 |
English |
Africa, KENYA, Southern Africa, East Africa |
Maternal Health, Fertility, HIV/AIDS |
The relationship between fertility and the HIV/AIDS epidemic is not well understood. HIV/AIDS may influence fertility through one or more behavioral and/or biological proximate fertility determinants. In this study, we explore: (i) the regional variations in the link between HIV/AIDS and fertility; (ii) possible mechanisms through which HIV/AIDS may influence fertility; and (iii) the effect of individual and contextual community-level HIV/AIDS factors on fertility. The study is based on secondary analysis of the 2003 Kenya DHS data, which provides a unique opportunity to explore the impact of the HIV/AIDS epidemic on the affected populations, being the fourth survey in the international DHS program to include HIV testing, and the first to anonymously link the HIV results with key behavioral, social, and demographic factors at individual and household level. |
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The Signature Domain and Geographic Coordinates: A Standardized Approach for Uniquely Identifying a Health Facility
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Health Facility Technical Working Group |
2007 |
English |
|
Health Facilities, Indicators |
A list of standardized indicators for health facility surveys is proposed by the Health Facility Assessment Technical Working Group, composed of members from several organizations and led by the U.S. Agency for International Developments MEASURE Evaluation project. The adoption and use of these standard indicators would make cross-survey comparisons possible and promote the increased use of the information collected for health facility surveys. |
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Using Health Facility Profiles as a Monitoring Tool: An Example Based on Data from Three African Countries
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Fronczak N, Fapohunda B, Buckner B, Schenck-Yglesias C |
2007 |
English |
|
|
Substantial investments have been and continue to be made to improve health services in countries with weak health systems. However, useful information on the status of services and the overall health systems within which they operate is rarely available. Sound decisions about where to invest resources to improve health services require knowledge of the existing health infrastructure, the services currently offered, the systems needed to support the services, and the availability of equipment and consumable supplies. As a first step towards improving access to this information, the International Health Facility Assessment Network has compiled a recommended set of core indicators that measure the presence or absence of minimal, basic standards for facility-based health based services. In this paper, Service Provision Assessment data from three countries (Ghana, Kenya, and Tanzania) were used to calculate the core indicators and to develop a profile of the health facilities in these countries. |
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Jamaican Youth Risk and Resiliency Behaviour Survey 2006: Community-Based Survey on Risk and Resiliency Behaviours of 15-19 Year Olds
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Wilks R, Younger N, McFarlane S, Francis D, Van Den Broeck J |
2007 |
English |
JAMAICA, Latin America and the Caribbean |
Jamaica, Reproductive Health, HIV/AIDS, Child Health |
Objectives of the Jamaica youth risk and resiliency behavior survey were to: describe lifestyle and behavior patterns (exercise, cigarette smoking and alcohol consumption) by demographic and socio-economic characteristics; determine and document the context of adolescent reproductive and sexual health, including the magnitude, determinants and consequences for adolescents lives; determine the association between resiliency and markers of abnormal mental health on risk-taking behaviors, including involvement in violence; obtain anthropometric measurements, fasting glucose levels and cholesterol levels in youth and relate these to chronic disease risks; and identify the sources of information influencing adolescents health and health seeking behavior. The survey was a collaborative effort of the University of the West Indies at Mona, the Jamaican Ministry of Health, and U.S. Agency for International Development, with technical assistance from the MEASURE Evaluation project. Information was gathered from 1,318 participants (599 males and 721 females) island-wide who were representative of the 1519 year old population stratum. Data analysis was weighted to yield population parameter estimates. |
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Nigeria Reproductive Health, Child Health, and Education Household, School, and Health Facility Midline Surveys, 2007
|
Keating J |
2007 |
English |
NIGERIA, West Africa |
Nigeria, Child Health, Maternal Health |
This report presents findings from the 2007 Nigeria Reproductive Health, Child Health and Education Midline Household, Health Facility and Primary School Surveys. The surveys provide data for midline monitoring and evaluation activities for the Community Participation for Action in the Social Sectors (COMPASS) Project and for the U.S. Agency for International Development mission in Nigeria. The surveys were implemented in 51 local government areas in the states of Bauchi, Federal Capital Territory, Kano, Lagos, and Nasarawa where the COMPASS Project is being implemented. From a representative sample of men and women in the target areas, survey teams collected information on the respondents background, contraception use, pregnancy status and history, antenatal care, breastfeeding activities, childhood illnesses, use of mosquito nets, childhood vaccinations, home-based disease prevention practices, and educational status of children living in the household. The objective of this report is to present a second set of estimated values for a set of indicators used to monitor program performance. |
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Nigeria Reproductive Health, Child Health, and Education Household, School, and Health Facility Midline Surveys, 2007: Executive Summary
|
Keating J |
2007 |
English |
NIGERIA, West Africa |
Nigeria, Maternal Health, Child Health |
This report presents an executive summary of findings from the 2007 Nigeria Reproductive Health, Child Health and Education Midline Household, Health Facility and Primary School Surveys. The surveys provide data for midline monitoring and evaluation activities for the Community Participation for Action in the Social Sectors (COMPASS) Project and for the U.S. Agency for International Development mission in Nigeria. The surveys were implemented in 51 local government areas in the states of Bauchi, Federal Capital Territory, Kano, Lagos, and Nasarawa where the COMPASS Project is being implemented. From a representative sample of men and women in the target areas, survey teams collected information on the respondents background, contraception use, pregnancy status and history, antenatal care, breastfeeding activities, childhood illnesses, use of mosquito nets, childhood vaccinations, home-based disease prevention practices, and educational status of children living in the household. The objective of this report is to present a second set of estimated values for a set of indicators used to monitor program performance. |
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PLACE in St. Lucia: Identifying Gaps in HIV Prevention in Castries, Gros Islet, and Anse la Raye, 2007
|
National AIDS Programme Secretariat, MEASURE Evaluation |
2007 |
English |
SAINT LUCIA, Latin America and the Caribbean |
Monitoring, HIV/AIDS |
Information on the most-at-risk populations in St. Lucia is needed to guide programs and policies for HIV/AIDS prevention. PLACE is a rapid assessment methodology that relies on collecting data at venues where people most at risk of becoming infected with or of transmitting HIV are likely to socialize. In 2007, a steering committee comprised of representatives from the St. Lucia Ministry of Health, the National AIDS Programme Secretariat, community nursing, Ministry of Education, the Caribbean Drug Abuse Research Institute, the Caribbean Association for Feminist Research and Action, the Red Cross, the Peace Corps, and sexually transmitted disease nurses decided to implement PLACE in strategically-chosen areas. A total of three distinct priority prevention areas (PPAs) were selected based on contextual factors in the district that suggested that the incidence of HIV infection is likely to be highest in these areas.The results of PLACE will be used as the basis for local HIV/AIDS strategic plans and to guide prevention programming decisions. |
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Comportement à risque chez les jeunes fréquentant certains lieux particuliers de Carrefour, Haïti : Adaptation de la Méthodologie PLACE
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Speizer I, Finn T, Manchikanti A, Beauvais H, Roussel B |
2007 |
French |
HAITI, Targeted Evaluation |
Haiti, HIV/AIDS, Monitoring, Monitoring |
Les ressources disponibles pour les programmes de prévention du VIH étant fort limitées, il y a un besoin urgent de concentrer les interventions là où elles savèrent être les plus rentables. Afin de prévenir de façon rentable de nouvelles infections, les programmes de prévention du SIDA devraient être concentrés sur des zones où le risque dincidence de linfection a tendance à être le plus élevé. La méthode Priorities for Local AIDS Control Efforts (PLACE, sigles en anglais) est un instrument de contrôle qui aide à identifier les zones où le risque dincidence de linfection a tendance à être le plus élevé. <p>A lintérieur de ces zones, PLACE identifie les endroits spécifiques où les programmes de prévention du SIDA devraient être concentrés afin datteindre les personnes courant le plus de risques de contracter le VIH ou le transmettre, fournit des indicateurs qui aident à surveiller la couverture des programmes de prévention du VIH /SIDA, et identifie les lacunes dans les programmes de prévention. Dans des études antérieures utilisant la méthodologie PLACE, les résultats détudes ont mobilisé efficacement la population locale à faire des progrès pour adresser les lacunes des programmes de prévention. |
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Risk-Taking Behaviors among Youth Socializing in Target Venues of Carrefour, Haiti: Adaptation of the Priorities for Local AIDS Control Efforts (PLACE) Methodology
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Speizer I, Finn T, Manchikanti A, Beauvais H, Roussel B |
2007 |
English |
HAITI, Targeted Evaluation |
Haiti, HIV/AIDS, Monitoring, Monitoring |
Because resources for HIV prevention programs are extremely limited, there is an urgent need to focus interventions where they are most cost effective. To prevent new infections in a costeffective way, AIDS prevention programs should focus on areas likely to have a higher incidence of infection. The Priorities for Local AIDS Control Efforts (PLACE) method is a monitoring tool to identify areas likely to have a higher incidence of infection.<p> <p>Within these areas, PLACE identifies specific venues where AIDS prevention programs should be focused to reach those most at risk of acquiring and transmitting HIV, provides indicators that monitor HIV/AIDS prevention program coverage, and identifies gaps in prevention programs. In previous studies that used the PLACE methodology, the study results effectively mobilized local populations to make progress in addressing gaps in prevention programs. |
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Jamaican Youth Risk and Resiliency Behaviour Survey 2005: School-based Survey on Risk and Resiliency Behaviours of 10-15 year olds
|
Fox K, Gordon-Strachan G |
2007 |
English |
JAMAICA, Latin America and the Caribbean |
Sexual Behavior, Nutrition, HIV/AIDS, Public Health |
The 2005 Jamaica Youth Risk and Resiliency Behaviour Survey (2005 JYRRBS) interviewed a nationally representative sample of 3003 in-school youth aged 10-15, of whom 1,422 were males and 1581 were females. The main purpose of the survey was to determine health status, nutritional habits and lifestyles of children and young teenagers aged 10-15 years in a nationally representative sample of Jamaican children currently in school and relate these to demographic and socio-economic factors. In addition, the 2005 JYRRBS included questions on risk and resiliency to determine factors which provide protection from teen pregnancy, HIV/AIDS, violence and obesity to inform programs targeted at the early adolescent period. The survey included the following modules: demographic information; the child and school; physical activity; dietary practices; medical care and perception of self; emotions and mental health; resiliency; violence and unintentional injuries; alcohol, tobacco and drug use; sexual behaviour; sources of information; anthropometry - weight, height, and waist and hip circumference; and literacy and numeracy. |
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Grenada Caribbean Region HIV and AIDS Service Provision Assessment Survey 2005
|
MEASURE Evaluation, St. George's University |
2007 |
English |
GRENADA, Latin America and the Caribbean |
HIV/AIDS |
The HIV and AIDS Service Provision Assessment (HSPA) was developed to assess the quality and capacity of HIV- and AIDS-related services in high prevalent situations. However, the findings of the Eastern Caribbean HSPA need to be interpreted within a low prevalence context. Small islands with few facilities may not require all of the HIV and AIDS-related services to be at full capacity in every facility. Nevertheless, an efficient system to identify, counsel and treat those who are HIV positive and to prevent the spread of the virus requires a quality HIV testing and counseling system, accessible antiretroviral therapy and opportunistic infection treatment services, and a prevention strategy that reaches the vulnerable and at risk populations. A solid record-keeping and reporting system is essential for monitoring and the surveillance of the epidemic and the capacity of the health system to respond. No matter what level health planners decide is best for the country, each service should be provided at the highest quality possible. The results of the 2006 Grenada HSPA provide baseline information for decision-making on how and where to scale up or strengthen HIV- and AIDS-related services. Focusing on the formal public health sector in Grenada, the HSPA findings provide information on both basic- and advanced-level HIV and AIDS services and the availability of record-keeping systems for monitoring HIV and AIDS care and support. |
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Nevis Caribbean Region HIV and AIDS Service Provision Assessment Survey 2005
|
MEASURE Evaluation, St. George's University |
2007 |
English |
SAINT KITTS AND NEVIS, Latin America and the Caribbean |
HIV/AIDS |
The HIV and AIDS Service Provision Assessment (HSPA) was developed to assess the quality and capacity of HIV- and AIDS-related services in high prevalent situations. However, the findings of the Eastern Caribbean HSPA need to be interpreted within a low-prevalence context. Small islands with few facilities may not require all of the HIV and AIDS-related services to be at full capacity in every facility. Nevertheless, an efficient system to identify, counsel, and treat those who are HIV positive and to prevent the spread of the virus requires a quality HIV testing and counseling system, accessible antiretroviral therapy (ART), treatment services for opportunistic infections (OIs), and a prevention strategy that reaches the vulnerable and at-risk populations. A solid record-keeping and reporting system is essential for monitoring and surveillance of the epidemic and to assess the capacity of the health system to respond. No matter what level health planners decide is best for the country, each service should be provided at the highest quality possible. The results of the 2006 Nevis HSPA provide baseline information for decision-making on how and where to scale up or strengthen HIV- and AIDS-related services. Focusing on the formal public health sector in Nevis, the HSPA findings provide information on both basic- and advanced-level HIV and AIDS services and the availability of record-keeping systems for monitoring HIV and AIDS care and support. |
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Saint Kitts Caribbean Region HIV and AIDS Service Provision Assessment Survey 2005
|
MEASURE Evaluation, St. George's University |
2007 |
English |
SAINT KITTS AND NEVIS, Latin America and the Caribbean |
HIV/AIDS |
The HIV and AIDS Service Provision Assessment (HSPA) was developed to assess the quality and capacity of HIV- and AIDS-related services in high prevalent situations. However, the findings of the Eastern Caribbean HSPA need to be interpreted within a low prevalence context. Small islands with few facilities may not require all of the HIV and AIDS-related services to be at full capacity in every facility. Nevertheless, an efficient system to identify, counsel and treat those who are HIV-positive and to prevent the spread of the virus requires a quality HIV testing and counseling system, accessible antiretroviral treatment(ART), treatment services for opportunistic infections (OIs), and a prevention strategy that reaches the vulnerable and at-risk populations. A solid record-keeping and reporting system is essential for monitoring and surveillance of the epidemic and to assess the capacity of the health system to respond. No matter what level health planners decide is best for the country, each service should be provided at the highest quality possible. The results of the 2006 Saint Kitts HSPA provide baseline information for decision-making on how and where to scale up or strengthen HIV- and AIDS-related services. Focusing on the formal public health sector in Saint Kitts, the HSPA findings provide information on both basic and advanced-level HIV and AIDS services and the availability of record-keeping systems for monitoring HIV and AIDS care and support. |
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Antigua and Barbuda Caribbean Region HIV and AIDS Service Provision Assessment Survey 2005
|
MEASURE Evaluation, St. George's University |
2007 |
English |
ANTIGUA AND BARBUDA, Latin America and the Caribbean |
HIV/AIDS |
The HIV and AIDS Service Provision Assessment (HSPA) was developed to assess the quality and capacity of HIV- and AIDS-related services in high prevalent situations. However, the findings of the Eastern Caribbean HSPA need to be interpreted within a low prevalence context. Small islands with few facilities may not require all of the HIV and AIDS-related services to be at full capacity in every facility. Nevertheless, an efficient system to identify, counsel, and treat those who are HIV positive and to prevent the spread of the virus requires a high-quality HIV testing and counseling system, accessible antiretroviral therapy (ART), treatment services for opportunistic infections (OIs), and a prevention strategy that reaches the vulnerable and at-risk populations. A solid recordkeeping and reporting system is essential for monitoring the surveillance of the epidemic and the capacity of the health system to respond. No matter what level health planners decide is best for the country, each service should be provided at the highest quality possible. The results of the 2006 Antigua and Barbuda HSPA provide baseline information for decision-making on how and where to scale up or strengthen HIV- and AIDS-related services. Focusing on the formal public health sector in Antigua and Barbuda, the HSPA findings provide information on both basic and advanced-level HIV and AIDS services and the availability of record-keeping systems for monitoring HIV and AIDS care and support. |
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Dominica Caribbean Region HIV and AIDS Service Provision Assessment Survey 2005
|
AID Inc., MEASURE Evaluation, St. George's University |
2007 |
English |
DOMINICA, Latin America and the Caribbean |
|
The results of the 2005 Dominica HSPA provide baseline information for decisionmaking on how and where to scale up or strengthen HIV and AIDS-related services. Focusing on the formal public health sector in Dominica, the HSPA findings provide information on both basic and advanced level HIV and AIDS services and the availability of recordkeeping systems for monitoring HIV and AIDS care and support. Within the Caribbean region, there is a concern for the recent training of health professionals who provide HIV and AIDS services, for health worker attitudes towards people living with HIV and AIDS (PLHIV) and for patient movement within the region. The Dominica HSPA captured information on these region-specific indicators in addition to the standard HSPA indicators. Since HIV and AIDS services are not offered across all facilities or facility types, and these services are relatively few, the sample is disproportionately representative of known sites for HIV and AIDS services. Although the emphasis of the HSPA is on public facilities, if private or non-government facilities are important providers of HIV and AIDS services, they were also included. The survey was conducted in a sample of 18 facilities (16 public facilities) in Dominica, including hospitals, health centers, specialized clinics and laboratories. Therefore any interpretation of the findings should be limited to the sample and to the capacity to scale-up existing HIV and AIDS services. The HIV and AIDSrelated services that were assessed include counseling and testing capability, care and support services (CSS), ART, post-exposure prophylaxis (PEP), prevention of mother-to-child transmission (PMTCT) and youth-friendly services. |
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St. Lucia Caribbean Region HIV and AIDS Service Provision Assessment Survey 2005
|
MEASURE Evaluation, AID Inc., St. George's University |
2007 |
English |
SAINT LUCIA, Latin America and the Caribbean |
|
The 2005 Saint Lucia HIV/AIDS Service Provision Assessment (HSPA) survey report provides baseline information for decisionmaking on how and where to scale up or strengthen HIV and AIDS-related services. Focusing on the formal public health sector in St. Lucia, the HSPA findings provide information on both basic- and advanced-level HIV and AIDS services and the availability of recordkeeping systems for monitoring HIV and AIDS care and support. Within the Caribbean region, there is a concern for the recent training of health professionals who provide HIV and AIDS services, for health worker attitudes towards people living with HIV and AIDS (PLHIV) and for patient movement within the region. The St. Lucia HSPA captured information on these region-specific indicators in addition to the standard HSPA indicators. Since HIV and AIDS services are not offered across all facilities or facility types, and these services are relatively few, the sample is disproportionately representative of known sites for HIV and AIDS services. Although the emphasis of the HSPA is on public facilities, if private or non-government facilities are important providers of HIV and AIDS services, they were also included. The survey was conducted in a sample of 17 facilities (12 public facilities) in Saint Lucia, including hospitals, polyclinics, health centers, specialized clinics and laboratories. Therefore any interpretation of the findings should be limited to the sample and to the capacity to scale up existing HIV and AIDS services. The HIV and AIDSrelated services that were assessed include counseling and testing capability, care and support services (CSS), antiretroviral therapy (ART), post-exposure prophylaxis (PEP), prevention of motherto- child transmission (PMTCT) and youth-friendly services. |
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St. Vincent and the Grenadines Caribbean Region HIV and AIDS Service Provision Assessment Survey 2005
|
MEASURE Evaluation, AID Inc., St. George's University |
2007 |
English |
Latin America and the Caribbean, SAINT VINCENT AND THE GRENADINES |
|
The results of the 2005 St. Vincent and the Grenadines HIV/AIDS Service Provision Assessment (HSPA) provide baseline information for decision making on how and where to scale up or strengthen HIV and AIDS-related services. Focusing on the formal public health sector in St. Vincent and the Grenadines, the HSPA findings provides information on both basic and advanced-level HIV and AIDS services and the availability of record-keeping systems for monitoring HIV and AIDS care and support. Within the Caribbean region, there is a concern for the recent training of health professionals who provide HIV and AIDS services, for health worker attitudes towards people living with HIV and AIDS (PLHIV) and for patient movement within the region. The St. Vincent and the Grenadines HSPA captured information on these regionspecific indicators in addition to the standard HSPA indicators. Since HIV and AIDS services are not offered across all facilities or facility types, and these services are relatively few, the sample is disproportionately representative of known sites for HIV and AIDS services. Although the emphasis of the HSPA is on public facilities, if private or non-government facilities are important providers of HIV and AIDS services, they were also included. The survey was conducted in a sample of 24 facilities (18 public facilities) in St. Vincent and the Grenadines, including hospitals, health centers, specialized clinics and laboratories. Therefore any interpretation of the findings should be limited to the sample and to the capacity to scale up existing HIV and AIDS services. The HIV and AIDS-related services that were assessed include counseling and testing capability, care and support services (CSS), antiretroviral therapy (ART), post-exposure prophylaxis (PEP), prevention of mother-to-child transmission (PMTCT) and youthfriendly services. |
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Barbados Caribbean Region HIV and AIDS Service Provision Assessment Survey 2005
|
AID Inc., MEASURE Evaluation, St. George's University |
2007 |
English |
BARBADOS, Latin America and the Caribbean |
HIV/AIDS |
The 2005 Barbados HIV/AIDS Service Provision Assessment (Barbados HSPA) survey report provides baseline information on the capacity of the formal public health sector in Barbados to provide both basic and advanced level HIV and AIDS services and the availability of recordkeeping systems for monitoring HIV and AIDS care and support. Within the Caribbean region, there is a concern for the recent training of health professionals who provide HIV and AIDS services, for health worker attitudes towards people living with HIV (PLHIV) and for patient movement within the region. The Barbados HSPA captured information on these region-specific indicators in addition to the standard HSPA indicators. Since HIV and AIDS services are not offered across all facilities or facility types, and these services are relatively few, the sample is disproportionately representative of known sites for HIV and AIDS services. Although the emphasis of the HSPA is on public facilities, if private or non-government facilities are important providers of HIV and AIDS services, they were included. The survey was conducted in a sample of 22 facilities (17 public facilities) in Barbados, including hospitals, polyclinics, specialized clinics and laboratories. Therefore, any interpretations should be limited to the sample and to the capacity to scale up existing HIV and AIDS services. The HIV and AIDS-related services that were assessed include counseling and testing capability, care and support services (CSS), antiretroviral therapy (ART), post-exposure prophylaxis (PEP), prevention of mother-to-child transmission (PMTCT) and youthfriendly services (YFS). |
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Decision Maker Perceptions in Kenya and Nigeria: an Assessment of Data Use Constraints
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Ikamari L, Adewuyi AA, Akinlo A |
2007 |
English |
East Africa, KENYA, Africa, NIGERIA |
Kenya, Nigeria |
Assessments conducted in 2005 in Kenya and Nigeria are used to obtain a more thorough understanding of decision makers' use of health-related data in evidence-based decision making and their perceptions of the constraints and barriers to data demand and use (DDU or DDIU). |
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Validating the self-reported fertility status of rural Malawian women
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Barden-O’Fallon J, Suchindran C, Tsui AO |
2006 |
English |
MALAWI |
|
This study uses data from a population-based survey to examine the fertility schedules of 704 women in a rural district of Malawi. The main objective is to assess selfreported fecundity status as a measure of fertility impairment. Life tables are used to examine the timing and tempo of births for women reporting difficulty getting pregnant as compared to women with no reported fecundity difficulties. Results of the analysis indicate that women with self-reported fecundity difficulties are older at each birth and have longer median birth intervals than do women with no reported difficulties. Cox proportional hazards models show that the report of a difficulty getting pregnant is significantly associated with at least a 30% lower likelihood of a first, second, or third birth. The relationships are not modified when accounting for demographic characteristics, previous sexual behaviors, or STI status.
|
|
Using strength of fertility motivations to identify family planning program strategies
|
Speizer I |
2006 |
English |
KENYA, Southern Africa, West Africa, East Africa, Africa, GHANA, BURKINA FASO |
Contraception, Sub-Saharan Africa, Fertility |
CONTEXT: Use of unmet need for family planning to identify prospective clients may misrepresent the actual family planning needs of a population, given that a large proportion of women have ambivalent fertility desires. METHODS: Survey data for 1998 and 2003 from Burkina Faso, Ghana and Kenya were used to examine the fertility desires and motivations of women who said they wanted to delay or limit childbearing. A question on how much of a problem it would be if women found out they were pregnant in the next few weeks measured the strength of their fertility motivations. RESULTS: In Burkina Faso and Ghana, about a quarter of women who said they wanted to delay or limit childbearing also reported that it would be no problem or a small problem if they became pregnant soon. This response pattern was equally common among contraceptive users and nonusers. In Kenya, more than four in 10 women gave such ambivalent responses. Among women with an unmet need for means of delaying or limiting childbearing, 1631% of those in Burkina Faso and Ghana, and 3056% of those in Kenya, said that getting pregnant in the next few weeks would be no problem or a small problem. CONCLUSIONS: It is critical to consider the strength of fertility motivations when determining which women have family planning needs. Targeting women who are the most motivated to avoid childbearing will likely have the greatest impact on reducing unintended pregnancy in Sub-Saharan Africa. |
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Validity of verbal autopsy procedures for determining cause of death in Tanzania
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Setel P, Whiting D, Hemed Y, Chandramohan D, Wolfson L, Alberti K |
2006 |
English |
Southern Africa, East Africa, Africa, TANZANIA |
Child Mortality, Vital Registration |
Objectives: To validate verbal autopsy (VA) procedures for use in sample vital registration. Verbal autopsy is an important method for deriving cause-specific mortality estimates where disease burdens are greatest and routine cause-specific mortality data do not exist. Methods: Verbal autopsies and medical records (MR) were collected for 3123 deaths in the perinatal/ neonatal period, post-neonatal <5 age group, and for ages of 5 years and over in Tanzania. Causes of death were assigned by physician panels using the International Classification of Disease, revision 10. Validity was measured by: cause-specific mortality fractions (CSMF); sensitivity; specificity and positive predictive value. Medical record diagnoses were scored for degree of uncertainty, and sensitivity and specificity adjusted. Criteria for evaluating VA performance in generating true proportional mortality were applied. results Verbal autopsy produced accurate CSMFs for nine causes in different age groups: birth asphyxia; intrauterine complications; pneumonia; HIV/AIDS; malaria (adults); tuberculosis; cerebrovascular diseases; injuries and direct maternal causes. Results for 20 other causes approached the threshold for good performance. Conclusions: Verbal autopsy reliably estimated CSMFs for diseases of public health importance in all age groups. Further validation is needed to assess reasons for lack of positive results for some conditions. |
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Family Planning Programs in 2004: Efforts, Justifications, Influences,
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Ross J, Stover J, Adelaja D |
2006 |
English |
Global, Asia, Africa, East Africa, West Africa, Southern Africa, Latin America and the Caribbean, East Asia, South Asia, Middle East, Europe and Eurasia (was ENIS), Eastern Europe, Newly Independant States, Central Asian Republics, Central American Project |
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Context: Six study cycles from 1972 to 2004 were conducted to measure the intensity and types of effort exerted by national family planning programs. In 2004 a simpler questionnaire was used and new questions added to explore current issues. Methods: Informants in each of 83 developing countries completed a standard questionnaire. The returns were analyzed centrally with immediate feedback provided to the countries. Results: Family planning effort increased from 1999 to 2004 overall and within each region using unweighted country data; with weighted country data all regions except Asia rose. The 2004 effort profile across 30 indices is nearly identical to 1999. Countries beginning with low scores have improved more than countries beginning at high levels. Policy scores are more favorable than scores for actual services. Contraceptive access is uneven by method and limited in sub-Saharan Africa. Negative influences bearing on the programs especially concern changes in domestic and donor funding. The strongest justifications for the programs concern improved child and maternal health and avoiding unwanted births. Among groups of special interest unmarried youth and postabortion women receive the least emphasis. Conclusions: Overall program effort rose again despite competition with HIV/AIDS programs and the post-Cairo broadening of attention, as well as decentralization of health programs, and reallocations of donor funding. Increased program effort is consistent with continuing increases in contraceptive practice. National justifications for the programs stress health and prevention of unplanned births more than economic development or fertility reduction. Unexplained questions concern the persistence of the same or better program effort ratings despite fragile contraceptive security, some losses in funding, and worsening institutional environments. Acknowledgement: Support for this research was provided by USAID through the MEASURE Evaluation Project implemented by the University of North Carolina. |
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Slums of Urban Bangladesh: Mapping and Census, 2005
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Islam N, Mahbub A, Nazem NI, Angeles G, Lance P |
2006 |
English |
BANGLADESH, South Asia, East Asia, Asia |
Census, GIS |
Slums of Urban Bangladesh, Mapping and Census, 2005 was carried out to physically identify the boundaries of slums and sqatter settlements in the six City Corporations of Bangladesh to facilitate implementation of the urban health survey. |
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Zambia Sexual Behaviour Survey 2005
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Buckner B, Singh K, Tate J |
2006 |
English |
ZAMBIA, Southern Africa, Africa |
Sexual Behavior, Maternal Health, Child Health, Zambia, HIV/AIDS |
The Zambia Sexual Behavior Survey (ZSBS) 2005 is the fourth in a series of surveys designed to monitor knowledge, attitudes and behaviors regarding HIV/AIDS in Zambia. The ZSBS obtains national estimates of international standardized indicators importeant to monitoring progress of Zambia's HIV/AIDS/STD program. The ZSBS 2005 interviewed a nationally representative sample of Zambians about their beliefs about HIV transmission, their sexual behaviors, whether or not they had been tested for HIV, and other important questions. The 2005 ZSBS also identified the prevalence of orphans and the proportion of the population exposed to Youth Peer Education. |
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Community-Level Influences on Early Sexual Initiation in Nigeria
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Agha S, Van Rossem R, Ankomah A |
2006 |
English |
West Africa, Africa, NIGERIA, Southern Africa |
Condoms, Public Health, HIV/AIDS, Sexual Behavior |
Using national survey data from Nigeria, this study examines individual and community-level determinants of early sexual initiation. Community-level factors exercise important effects on the early onset of sexual initiation. Consistent with the social capital hypothesis, young people living in communities that are more knowledgeable about HIV/AIDS transmission and prevention, communities that are open to receiving HIV/AIDS information, and communities that support condom use as well as family planning are more likely to delay sexual initiation than others. The disadvantages associated with living in a community that is less well informed, less supportive of condom use and less open to receiving information on HIV/AIDS are significantly higher for women. Women who live in communities where attitudes about reproductive health are not positive or where there is lack of social support for condom use are at a heightened risk of early sexual initiation. |
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Programa para el Fortalecimiento Técnico de las Unidades de Monitoría y Evaluación de la Gestión (UMEG), de las Regiones Sanitarias Departamentales de Salud de: Copán, Lempira, Intibucá y La Paz
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2006 |
Spanish |
HONDURAS |
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La Misión de la USAID en Honduras ha contratado, a través de un Acuerdo Cooperativo (CA), a MEASURE Evaluation para desarrollar dos intervenciones técnicas en Honduras, una apoyando a la Secretaría de Salud y, la otra, dirigida a apoyar a la Oficina de Salud de la Misión de USAID en Honduras. La primera intervención, que tiene lugar en el marco del apoyo a la reforma del sector salud, está orientada a fortalecer la capacidad técnica de las Unidades de Monitoría y Evaluación (UMEG) de las Regiones Sanitarias Departamentales (RSD) en los departamentos en los cuales la USAID ha focalizado la asistencia técnica y financiera: Copán, Lempira, Intibucá y La Paz. Se espera que al final de la asistencia técnica: a) se haya implementado y esté funcionando un sistema de monitoria y evaluación de la gestión departamental, con base en el Sistema de Monitoría y Evaluación de la Gestión (SIMEG) y en el Plan Estratégico Regional; b) que las decisiones se tomen en los diferentes niveles de la región de salud, con base en los datos que genere el sistema; y c) que otros actores sociales dentro de la comunidad que participan en el proceso de la reforma del sector, manejen y apliquen el concepto de Monitoria y Evaluación ( M&E), para facilitar la administración y gerenciar basados en evidencias, sus intervenciones en salud. |
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Gasto Publico en Salud: Progresivo o Regresivo?
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Angeles G, Trujillo A, Lastra A |
2006 |
Spanish |
ECUADOR |
Public Health |
Por medio de la aplicación del Benefit Incidence Analysis (BIA), se evalúa la regresividad o progresividad del gasto público en salud en Ecuador. La aplicación de esta metodología a las fuentes utilizadas permite superar limitaciones de análisis anteriores realizados en países en vías de desarrollo. En primer lugar, se elabora un marco que admite cuantificar los gastos totales -operacionales y administrativoscon proveedores de servicios de salud del gobierno central, de acuerdo a su nivel de actividad. Este estudio tiene la ventaja de usar una encuesta de salud aplicada a hogares en la cual el consumo individual de servicios médicos puede asociarse a un proveedor de salud específico. Asimismo, la información de la encuesta permite obtener dos ordenamientos del status económico de los usuarios, uno usando el consumo por unidad de adulto equivalente y otro usando un índice sobre la disponibilidad de bienes durables en el hogar. Los resultados sugieren que el gasto del Ministerio de Salud Publica es progresivo, mientras que el del Instituto Ecuatoriano de Seguridad Social es regresivo. También se proponen opciones de política que mejorarían la eficiencia y equidad de este tipo de gastos. |
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Patient Monitoring Guidelines for HIV Care and Antiretroviral Therapy (ART)
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World Health Organization |
2006 |
English |
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HIV/AIDS |
Patient Monitoring Guidelines for HIV Care and Antiretroviral Therapy (ART) is a collaborative work coordinated by MEASURE Evaluation and the World Health Organization (WHO), and endorsed by the Joint United Nations Programme on HIV/AIDS (UNAIDS), the U.S. Presidents Emergency Plan for AIDS (PEPFAR), U.S. Agency for International Development (USAID), and other international partners. The guidelines are intended to facilitate stakeholder consensus on a minimum, standardized set of data elements to be included in patient monitoring tools, and aid in the development of an effective national HIV care and ART patient monitoring system. The document is aimed at those involved at various levels of the development or revision of patient monitoring tools such as HIV care and ART patient and facility records, registers and reports, or electronic systems, and may include national AIDS programme managers, ministries of health, and monitoring and evaluation (M&E) officers. |
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Demanda de Datos y el Uso de la Información en el Sector de la Salud: Estructura Conceptual
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Foreit K, Moreland S, LaFond A |
2006 |
Spanish |
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Esta publicación ofrece una estructura para mejorar el uso de la información con el objetivo de guiar la creación de políticas, diseño de programas, prestación de servicios en el sector de la salud en países en vías de desarrollo. Está dirigida a profesionales de la salud y de la información que recopilan datos y generan información (o desarrollan herramientas para facilitar estas prácticas) para mejorar su comprensión del papel que desempeña la información en la toma de decisiones en el sistema sanitario. El método que se propone aquí también es relevante para las personas involucradas a todos los niveles en el sistema sanitario de los directores de programas, profesionales y creadores de políticas a los miembros de la sociedad civil, grupos de la comunidad y pacientes para fomentar un uso de datos e información sanitarios más estratégico y efectivo en las decisiones, ya sean rutinarias o de una sola ocasión, sencillas o complejas, no muy importantes o críticas. |
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Demande de Données et l'Utilisation de l'Information dans le Secteur de la Santé: Structure Conceptuelle
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Foreit K, Moreland S, LaFond A |
2006 |
French |
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Cette publication fournit une structure pour améliorer lutilisation de linformation afin de mieux guider la prise de décision, la conception de programmes, la gestion et la prestation de services dans le secteur santé des pays en développement. Elle est dirigée aux professionnels de la santé et de linformation qui saisissent les données et génèrent de linformation (ou développent les outils nécessaires pour faciliter ces pratiques) et, ce, dans le but daméliorer leur compréhension du rôle que joue linformation dans la prise de décisions pour le système de santé. Lapproche proposée ici est également pertinente pour les parties prenantes à tous les niveaux du système de santédes directeurs de programmes, praticiens et décideurs aux membres de la société civile, groupes communautaires et patientsafin dencourager une utilisation plus stratégique et effective des données et de linformation relatives à la santé dans les décisions, que celles-ci soient routinières ou occasionnelles, simples ou complexes, secondaires ou essentielles. |
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Data Demand and Information Use in the Health Sector: Strategies and Tools
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Foreit K, Moreland S, LaFond A |
2006 |
English |
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Data Demand and Information Use (DDIU or DDU) is a strategy to identify opportunities for and constraints to effective and strategic data collection, analysis, availability, and use. This strategy begins with an assessment that helps stakeholders, policy-makers, and monitoring and evaluation (M&E;) practitioners determine points of entry for DDIU intervention. Once specific needs are identified, DDIU core tools can be utilized to stimulate data demand and capacity building and enhance evidence-based decision making. |
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Data Demand and Information Use in the Health Sector: A Conceptual Framework
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Foreit K, Moreland S, LaFond A |
2006 |
English |
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Data Demand and Information Use (DDIU or DDU) is a strategy to identify opportunities for and constraints to effective and strategic data collection, analysis, availability, and use. This strategy begins with an assessment that helps stakeholders, policy-makers, and monitoring and evaluation (M&E) practitioners determine points of entry for DDIU intervention. Once specific needs are identified, DDIU core tools can be utilized to stimulate data demand and capacity building and enhance evidence-based decision making. |
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HIV-related sexual behavior in urban, rural and border areas of Burkina Faso
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Khan M, Brown L, Nagot N, Salouka S, Weir S |
2006 |
English |
SOUTH AFRICA, Africa |
HIV/AIDS, Africa |
As HIV/AIDS prevention resources are scarce, program planners must first reach areas at highest risk of HIV transmission. "High transmission areas" are often locations where increased social mixing intersects with increased commercial activity (e.g., hotels for truck drivers at the intersection of major commercial routes, bars near trading centers and migrant worker residences). Nationally-representative surveys provide serological evidence that HIV prevalence is highest in urban areas, where "high transmission areas" are concentrated. However, such areas are also found outside urbanized settings. Even within relatively small rural areas, large differences in prevalence by residence have been observed. In a 1997 review of urban-rural differences in sexual behavior and HIV risk, Carael emphasized that simultaneous epidemics occur within both urban and non-urban areas, and the interplay between these epidemics as a result of population mobility is important. Especially considering that the majority of the population in sub-Saharan Africa lives in non-urban areas, understanding HIV transmission risk in both urban and non-urban areas is warranted. (excerpt) |
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Core verbal autopsy procedures with comparative validation results from two countries
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Setel PW, Rao C, Hemed Y, Whiting DR, Yang G, et al |
2006 |
English |
TANZANIA, East Africa, Asia, Africa, Southern Africa, CHINA |
Vital Registration, Maternal Health, Child Health |
Background Cause-specific mortality statistics remain scarce for the majority of low-income countries, where the highest disease burdens are experienced. Neither facility-based information systems nor vital registration provide adequate or representative data. The expansion of sample vital registration with verbal autopsy procedures represents the most promising interim solution for this problem. The development and validation of core verbal autopsy forms and suitable coding and tabulation procedures are an essential first step to extending the benefits of this method. Methods and Findings Core forms for peri- and neonatal, child, and adult deaths were developed and revised over 12 y through a project of the Tanzanian Ministry of Health and were applied to over 50,000 deaths. The contents of the core forms draw upon and are generally comparable with previously proposed verbal autopsy procedures. The core forms and coding procedures based on the International Statistical Classification of Diseases (ICD) were further adapted for use in China. These forms, the ICD tabulation list, the summary validation protocol, and the summary validation results from Tanzania and China are presented here. Conclusions The procedures are capable of providing reasonable mortality estimates as adjudged against stated performance criteria for several common causes of death in two countries with radically different cause structures of mortality. However, the specific causes for which the procedures perform well varied between the two settings because of differences in the underlying prevalence of the main causes of death. These differences serve to emphasize the need to undertake validation studies of verbal autopsy procedures when they are applied in new epidemiological settings. |
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Assessing effects of a media campaign on HIV/AIDS awareness and prevention in Nigeria: results from the VISION Project
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Keating J, Meekers D, Adewuyi A |
2006 |
English |
West Africa, Africa, NIGERIA, Southern Africa |
Sexual Behavior, Child Health, HIV/AIDS |
Background In response to the growing HIV epidemic in Nigeria, the U.S. Agency for International Development (USAID) initiated the VISION Project, which aimed to increase use of family planning, child survival, and HIV/AIDS services. The VISION Project used a mass-media campaign that focused on reproductive health and HIV/AIDS prevention. This paper assesses to what extent program exposure translates into increased awareness and prevention of HIV/AIDS. Methods This analysis is based on data from the 2002 and 2004 Nigeria (Bauchi, Enugu, and Oyo) Family Planning and Reproductive Health Surveys, which were conducted among adults living in the VISION Project areas. To correct for endogeneity, two-stage logistic regression is used to investigate the effect of program exposure on 1) discussion of HIV/AIDS with a partner, 2) awareness that consistent condom use reduces HIV risk, and 3) condom use at last intercourse. Results Exposure to the VISION mass media campaign was high: 59%, 47%, and 24% were exposed to at least 1 VISION radio, printed advertisement, or TV program about reproductive health, respectively. The differences in outcome variables between 2002 baseline data and the 2004 follow-up data were small. However, those with high program exposure were almost one and a half (Odds Ratio [O.R.] = 1.47, 95% Confidence Interval [C.I.] 1.012.16) times more likely than those with no exposure to have discussed HIV/AIDS with a partner. Those with high program exposure were over twice (O.R. = 2.20, C.I. 1.493.25) as likely as those with low exposure to know that condom use can reduce risk of HIV infection. Program exposure had no effect on condom use at last sex. Conclusion The VISION Project reached a large portion of the population and exposure to mass media programs about reproductive health and HIV prevention topics can help increase HIV/AIDS awareness. Programs that target rural populations, females, and unmarried individuals, and disseminate information on where to obtain condoms, are needed to reduce barriers to condom use. Improvements in HIV/AIDS prevention behaviour are likely to require that these programmatic efforts be continued, scaled up, done in conjunction with other interventions, and targeted towards individuals with specific socio-demographic characteristics. |
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Imbalances in the health labour force: an assessment using data from three national health facility surveys
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Barden-O'Fallon J, Gustavo A, Tsui A |
2006 |
English |
TANZANIA, Latin America and the Caribbean, Southern Africa, Asia, Africa, NICARAGUA, BANGLADESH |
Rural Populations, Public Health, Health Facilities |
Accurate knowledge of the characteristics of the health labour force that can affect health care production is of critical importance to health planners and policymakers. This study uses health facility survey data to examine characteristics of the primary health care labour force in Nicaragua, Tanzania and Bangladesh. The characteristics examined are those that are likely to affect service provision, including urban/rural distribution, demographic characteristics, and experience and in-service training, for three types of providers (physicians, nurses and auxiliary nurses). The profiles suggest a pattern of urban/rural imbalances in Nicaragua and Tanzania. The Bangladesh facility survey did not include hospitals, thereby making concrete conclusions on the supply and distribution of providers difficult to make. Multivariate logistic regressions are used to assess the relationship between the urban/rural placement of providers by health need, population demand and facility characteristics. Health need, as measured by child mortality rates, does not have a significant association with the placement of providers in either country, unlike population size and annual growth rates. The mean number of years providers have worked at a facility is significantly associated with a decreased likelihood of rural placement for the three types of providers in Nicaragua. The mean age and percentage of female providers at each facility has a negative association with the placement of rural providers in Tanzania. The use of health facility data to profile the health care labour force is also discussed. |
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Fact Sheet: Providing New Tools for the M&E of Health Facilities
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2006 |
English |
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Indicators, Public Health |
An inventory of health-facility assessment methods and new standardized indicators will lead to better data about where people receive health care. |
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Fact Sheet: Advancing the State of Routine Health Information Worldwide
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2006 |
English |
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Public Health |
Reliable health information is a key component of an efficient health system. However, availability and use of relevant and quality health information for evidence-based decision making is problematic in most developing countries. |
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Fact Sheet: Patient Monitoring Guidelines for HIV Care and Antiretroviral Therapy
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2006 |
English |
Global |
HIV/AIDS, Public Health |
The ability of countries to provide and sustain effective long-term HIV care with antiretroviral therapy and prevention is critical. This requires an effective patient monitoring system integrated with care, prevention, and treatment at the health facility. |
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Fact Sheet: HIV-AIDS Workshops
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2006 |
English |
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HIV/AIDS |
MEASURE Evaluation provides regional training workshops to meet a high need for professionals with monitoring and evaluation skills in developing countries. |
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Fact Sheet: Promoting Demand, Improving Quality, and Increasing Use of HIV/AIDS Data
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2006 |
English |
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HIV/AIDS |
Overview: MEASURE Evaluation provides an innovative approach and toolset to support evidence-based decision making, one of the most important uses of HIV and AIDS information. |
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Fact Sheet: Promoting Demand, Improving Quality and Increasing Use of Data
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2006 |
English |
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Child Health |
Data demand and use is a systematic approach that applies proven, effective best practices and appropriate tools to help increase demand for health system data and ensure that the information is used in an evidence-based decision-making process. |
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Fact Sheet: Using GIS tools and techniques to improve HIV/AIDS programs
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2006 |
English |
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GIS, HIV/AIDS, Health Facilities |
Whether HIV intervention programs reach the populations in need and where facilities are providing antiretroviral therapy are examples of the important questions that geographic information systems can help address. |
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Fact Sheet: Support for Zambia's Sexual Behavior and AIDS Indicator Surveys
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2006 |
English |
Africa, ZAMBIA, Southern Africa |
HIV/AIDS, Sexual Behavior, Indicators |
MEASURE Evaluation has worked closely with the Zambia Ministry of Health and Central Statistics Office to implement four biennial rounds of the Zambia Sexual Behavior Survey/AIDS Indicator Survey. |
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Fact Sheet: Data Quality Assurance
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2006 |
English |
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Data Quality, Tuberculosis, Malaria, At-Risk Populations, HIV/AIDS, Public Health |
Strategies for improving public health M&E capabilities: At MEASURE Evaluation, we believe that improved analysis and use of data lead to better health program decision-making and, ultimately, improved health outcomes. MEASURE Evaluation has developed innovative tools for strengthening the monitoring and evaluation of public health interventions. |
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Fact Sheet: Extending the PLACE Method
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2006 |
English |
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Monitoring, HIV/AIDS |
Overview: The Priorities for Local AIDS Control Efforts (PLACE) method is a rapid assessment tool to improve AIDS prevention program coverage in areas where HIV transmission is most likely to occur. The basic protocol can be adapted to estimate the size of most-at-risk populations, evaluate intervention effectiveness, and estimate the prevalence of infection with HIV and other sexually transmitted pathogens. |
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Fact Sheet: The PLACE Method for HIV Prevention
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2006 |
English |
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Monitoring, HIV/AIDS, At-Risk Populations, Monitoring |
MEASURE Evaluation and its partners have developed a guide to monitoring and evaluating HIV prevention programs for most-at-risk populations in concentrated epidemic settings. |
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Fact Sheet: MARP: M&E of HIV Prevention Programs for Most-At-Risk Populations
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2006 |
English |
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HIV/AIDS, At-Risk Populations, Public Health |
MEASURE Evaluation and its partners have developed a guide to monitoring and evaluating HIV prevention programs for most-at-risk populations in concentrated epidemic settings. |
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Fact Sheet: Capacity Building
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2006 |
English |
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HIV/AIDS |
MEASURE Evaluation works globally to help host-country agencies collect, analyze, and use data to strengthen health and population programs |
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Fact Sheet: SAVVY: A Toolset for Counting Every Person
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2006 |
English |
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Vital Registration, HIV/AIDS, Public Health |
Accurate information about basic demographic events births, deaths, and causes of death is important for rational health and public policy. Yet most of the worlds poorest countries lack reliable sources for these vital statistics. Sample vital registration with verbal autopsy can help solve that. |
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Fact Sheet: AIMEnet Listserv
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2006 |
English |
Global |
HIV/AIDS |
This one-page fact sheet invites readers to join the HIV/AIDS Monitoring and Evaluation Network(AIMEnet) listserv. This listserv was established to create a global sharing/learning space for trained professionals working in monitoring and evaluation (M&E) of HIV/AIDS programs. |
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Fact Sheet: Training for Results
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2006 |
English |
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Workshop |
One of MEASURE Evaluation's capacity-building priorities is to establish partnerships with selected universities and training/research centers in developing countries in order to offer M&E training programs and related activities. To build professional M&E capacity, MEASURE Evaluation and its institutional training partners offer two-week non-degree workshops that provide training in the design and implementation of M&E systems. |
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Fact Sheet: Training for Success
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2006 |
English |
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Workshop |
This two-page brochure, "Training for Success," discusses MEASURE Evaluation's training and capacity building efforts to prepare new leaders in monitoring and evaluation (M&E), both by sponsoring and assisting master's programs in M&E, and by conducting regional M&E workshops. |
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Opportunities for Training and Capacity Building in Monitoring & Evaluation
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2006 |
English |
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MEASURE Evaluation works globally to strengthen the Monitoring and Evaluation (M&E;) of technical capacity of in-country individuals and organizations. This booklet provides an overview of MEASURE Evaluation's efforts, including regional and special-topic workshops, partnerships with regional universities, partnerships with master's degree programs with an M&E; focus, and in providing online learning materials. |
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Third International RHINO Workshop, Information for Action: Facility and Community Focus
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Lippeveld T, Spohr M |
2006 |
English |
East Asia, THAILAND, South Asia, Asia |
HIV/AIDS, Maternal Health, Public Health, Child Health, Knowledge Management |
The Routine Health Information Network (RHINO) held its third workshop in Chiang Rai, Thailand, from February 26 to March 3, 2006. The workshop represented a milestone in the development of its user community with the maturing and application of the principles of the discipline of routine health information systems (RHIS). Each of the three RHINO workshops has broken new ground and has advanced the discipline. The first workshop set out the principles and strategies of the network; the second proposed the performance of routine information system management (PRISM) approach for developing district-managed RHIS; and the third proved the utility of the approach by applying it to facility- and community-based data collection and use of information. The RHINO user community has also grown and contributed a large variety of tools to improve the collection and use of routine health information.
RHINO was created in 2001 under the MEASURE Evaluation Project, a project funded by the United States Agency for International Development (USAID), which focuses on improving the use of information for evidence-based decision making. The RHINO Initiatives mission is to advance the state of the art in routine health information systems (RHIS), as well as to improve the practice of RHIS design and implementation worldwide through cross-fertilization of lessons learned and of best practices from various countries and organizations. |
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Socioeconomic Status, Permanent Income, and Fertility: A Latent Variable Approach
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Bollen KA, Glanville JL, Stecklov G |
2006 |
English |
West Africa, PERU, Latin America and the Caribbean, GHANA, Southern Africa |
Maternal Health |
Regardless of the specific, underlying theoretical model, it is safe to say that most studies of the determinants of childbearing focus on or control for the role of socioeconomic factors. In this paper we examine how permanent income, one of several components of SES, relates to fertility in developing countries and also pay attention to the role of other socioeconomic factors. Given that we cannot directly measure permanent income, we employ a latent variable approach to studying its impact on fertility. We compare our results to the more common practice of using a proxy variable to measure permanent income and thereby investigate the consequences of not accounting for the measurement error that is inherent in proxies. Using micro survey data from Ghana and Peru, we find that permanent income has a large, negative influence on fertility and that research must take the latent nature of permanent income into account to uncover its influence. Our results also show that controlling for measurement error in the proxies of permanent income, can lead to substantial changes in the estimated effects of control variables. Finally, we examine which of the common proxies for permanent income most closely capture the concept. Though our focus is on childbearing, our results have implications beyond this specific dependent variable, providing evidence on the sensitivity of microanalyses to the treatment of long-term economic status. |
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PLACE in Zambia: Identifying Gaps in HIV Prevention in Kapiri Mposhi, Central Province, 2005
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Ndubani P, Kamwanga J, Tate J, Buckner B |
2006 |
English |
ZAMBIA, Southern Africa, Africa |
Sexually Transmitted Infections (STIs), Monitoring, HIV/AIDS, At-Risk Populations |
The Priorities for Local AIDS Control Efforts method (PLACE) identifies specific venues where HIV/AIDS prevention programs can reach those most at risk of acquiring and transmitting HIV. Kapiri Mposhi in Zambia's Central Province was selected for a PLACE study because data from antenatal clinics and official projections suggest that the level of HIV prevalence in Kapiri Mposhi is high. HIV prevalence among women attending antenatal care was 20.2% in 2004. Official projections estimate an overall prevalence of 17.4% in Kapiri Mposhi district for 2006. The town of Kapiri Mposhi, located along the Great North Road, is a major transportation hub. The TAZARA rail line that links Zambia and Tanzania terminates in Kapiri Mposhi. At a junction just north of the town, the Lusaka-Ndola road to the Copperbelt merges with the Great North Road leading to neighbouring Tanzania. A large number of people from all parts of Zambia and from many other countries pass through the town of Kapiri Mposhi over the course of a year, and many spend at least one night in or near the town. Because of its central location, the town is susceptible to a high prevalence of sexually transmitted infections, including HIV/AIDS. |
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PLACE in Zambia: Identifying Gaps in HIV Prevention in Mongu, Western Province, 2005
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Ndubani P, Kamwanga J, Tembo R, Tate J, Buckner B |
2006 |
English |
Africa, ZAMBIA, Southern Africa |
HIV/AIDS, At-Risk Populations, Monitoring |
The Priorities for Local AIDS Control Efforts method (PLACE) identifies specific venues where HIV/AIDS prevention programs can reach those most at risk of acquiring and transmitting HIV. Mongu in Zambia's Western Province was selected for a PLACE study because data from antenatal clinics and official projections suggest that the level of HIV prevalence in Mongu is high. HIV prevalence among pregnant women attending antenatal care was 28.2% in 2004. Official projections estimate an overall prevalence in Mongu district around 21% in 2006. Urban Mongu, a provincial capital, has an active harbor and many markets, and serves as a crossroads for commerce and trade. Increasingly, large numbers of people from other parts of Zambia, neighboring countries, and international tourists pass through Mongu every year. Business men, tradesmen, migrants, and tourists meet and socialize with each other and with the local population, and this social mixing can create opportunities for HIV transmission. |
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МЕСТО в России: Выявление Пробелов в Профи
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Ловцова Н. |
2006 |
Russian |
RUSSIAN FEDERATION, Eastern Europe, Europe and Eurasia (was ENIS), Asia |
Monitoring, HIV/AIDS |
Исполнительный комитет, состоящий из представителей Центра социальной политики и гендерных исследований, НКО «Социум», «Мегаполис», «Здоровое будущее», «Человек», службы «Толерант»- телефон доверия приняли решения применить методику PLACE в городах Саратове и Энгельсе. Эти районы были выбраны на основе оценки показателей распространения ВИЧ/СПИД инфекции а также на основе оценки уровня усилий и способностей местных властей в деле профилактики дальнейшего распространения СПИДа. Значение имели также контекстуальные факторы, свидетельствующие о высокой степени вероятность роста уровня заболеваемости СПИдом. Результаты применения методики PLACE планируется использовать в качестве основы для разработки местного стратегического плана профилактики ВИЧ/СПИД, а также принятия решений о направленности профилактических программ. Благодаря применению методике PLACE указанные города получат информацию, необходимую для организации превентивных мероприятий. Также собрана некоторая информация о ВИЧ/СПИД программах, не относящихся непосредственно к программам профилактики. (An English translation of this report, TR-06-41-en, is also available.) |
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PLACE in Russia:Identifying Gaps in HIV Prevention in Saratov-Engels, 2005
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Lovtsova N |
2006 |
English |
RUSSIAN FEDERATION, Europe and Eurasia (was ENIS), Asia |
HIV/AIDS, Monitoring, At-Risk Populations |
A steering committee comprised of representatives from Saratov Centre for Social Policyand Gender Studies, nongovernmental organization (NGO) Socium (Engels), NGO Megapolys (Saratov), NGO Healthy Future(Saratov), NGO Man (Saratov), and the Saratov Hot Line Centre Tolerance decided to implement PLACE in 10 strategically chosen areas located in the cities of Saratov and Engels. These areas were selected based on estimated high level of HIV/AIDS infection, a lack of capacity of the local authority to prevent further spread, and contextual factors in the areas that suggested that the incidence of HIV infection is likely to be highest in these areas. The results of PLACE will be used as the basis for local HIV/AIDS strategic plans and to guide prevention programming decisions. A Russian-language version of this report, МЕСТО в России: Выявление Пробелов в Профи, is also available. |
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A Closer Look at KDHS 2003: Further Analysis of the Contraceptive Prevalence & Fertility Stalls (Summaries of selected NCAPD working papers 2005)
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NCAPD |
2006 |
English |
Africa, East Africa, KENYA, Southern Africa |
Contraception, Fertility, Kenya |
While contraceptive use has risen impressively in many countries over the past two to three decades, there have been occasional periods of stalling, raising serious concerns about the effectiveness of national family planning programmes. The stalls have been caused by, among others, a narrow choice of family planning methods, lack of focus or other weaknesses in reproductive health programmes, and difficulty in coping with the rapid increases in the population of reproductive age. This document presents eight article summaries with further analysis of the 2003 Kenya Demographic and Health Survey. |
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Nigeria Reproductive Health, Child Health, and Education Baseline Household Survey, 2005
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Keating J |
2006 |
English |
NIGERIA, Southern Africa, West Africa, Africa |
Child Health, Reproductive Health, HIV/AIDS, Maternal Health |
This report presents findings from the 2005 Nigeria Reproductive Health, Child Health, and Education Baseline Household Survey. The survey serves as a baseline for the Community Participation for Action in the Social Sector Project (COMPASS) and for the U.S. Agency for International Development mission in Nigeria (USAID/Nigeria). It was implemented in 51 local government areas (LGA) in the states of Bauchi, Federal Capital Territory (FCT), Kano, Lagos, and Nasarawa where the COMPASS project is being implemented. |
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Nigeria Baseline Primary School Headmaster and Teacher Survey, 2005
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Keating J |
2006 |
English |
Africa, NIGERIA, West Africa, Southern Africa |
Nigeria, Child Health |
This report presents findings from the 2005 Nigeria Education Baseline Primary School Headmaster and Primary School Teacher Survey. The results of the survey serve as a baseline for the Community Participation for Action in the Social Sector Project (COMPASS). It was implemented in the 51 local government areas (LGA) in the states of Bauchi, Federal Capital Territory (FCT), Kano, Lagos, and Nasarawa where the COMPASS project is being implemented. |
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Nigeria Baseline Health Facility Survey, 2005
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Keating J |
2006 |
English |
NIGERIA, Southern Africa, West Africa, Africa |
Nigeria, Health Facilities, Maternal Health, Child Health, Reproductive Health, HIV/AIDS |
This report presents findings from the 2005 Nigeria Baseline Health Facility Survey. The survey serves as a baseline for the Community Participation for Action in the Social Sector Project (COMPASS). It was implemented in the local government areas (LGAs) in the states of Bauchi, Federal Capital Territory (FCT), Kano, Lagos, and Nasarawa where COMPASS is being implemented. |
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Nigeria Reproductive Health, Child Health, and Education Household, School, and Health Facility Baseline Surveys, 2005: Executive Summary
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Keating J |
2006 |
English |
NIGERIA, Southern Africa, Africa, West Africa |
Nigeria, Child Health, Health Facilities, Maternal Health, HIV/AIDS |
This executive report summarizes findings from the 2005 Nigeria reproductive health, child health and education household, school, and health facility baseline surveys (three surveys total). Additional results from the three surveys can be found in the three respective reports: Nigeria Reproductive Health, Child Health, and Education Baseline Household Survey, 2005; Nigeria Baseline Health Facility Survey, 2005; and Nigeria Baseline Primary School Headmaster and Teacher Survey, 2005. |
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2005 Urban NGO Service Delivery Program (NSDP) Evaluation Survey
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Angeles G, Lance P |
2006 |
English |
BANGLADESH, South Asia, East Asia, Asia |
HIV/AIDS, Sexually Transmitted Infections (STIs), Maternal Health, Child Health, Public Health |
This survey addresses the urban portion of the 2005 NGO Service Delivery Program (NSDP), which delivers an Essential Service Package (ESP)of primary health care interventions to underserved urban populations of Bangladesh. The Survey's main objective was to collect information about knowledge, awareness and use of services related to family planning and maternal and child health provided through the NSDP project and its alternatives. This survey is part of a continuing evaluation conducted in 1998, 2001, and 2003, by Mitra and Associates with technical assistance from MEASURE Evaluation. It includes data from 5,923 women served by the NSDP and 4,343 women from non NSDP areas. |
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2005 Rural NGO Service Delivery Program (NSDP) Evaluation Survey
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Angeles G, Lance P |
2006 |
English |
Asia, BANGLADESH, East Asia, South Asia |
Rural Populations, HIV/AIDS, Maternal Health, Child Health, Public Health |
The 2005 Rural NGO Service Delivery Program (NSDP) Evaluation Survey in Bangladesh provides data to evaluate the rural component of the NGO Service Delivery Program (NSDP), a four-year, USAID-funded health and population project. It provides information on the use of Essential Service Package (ESP) components for a representative sample of 7,651 women in NSDP project areas and 4,418 women in non-NSDP areas, including utilization of services at the NSDP network of facilities (static and satellite clinics and depotholders) and alternative providers, knowledge of health promotion behaviors, awareness of NSDP services, and the quality of treatment at NSDP clinics. The survey, part of a continuing evaluation that began with a baseline survey in 1998 followed by mid-project evaluation surveys in 2001 and 2003, was conducted by Associates for Community and Population Research (ACPR), a Dhaka-based research firm, with technical assistance from the MEASURE Evaluation Project at the University of North Carolina at Chapel Hill. |
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Profiles of Health Facility Assessment Methods
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Hozumi D, Fronczak N, Noriega Minichiello S, Buckner B, Fapohunda B |
2006 |
English |
|
Health Facilities |
This document profiles four instruments used for health facility assessment, and specifies their management utility. These instruments are: Service Provision Assessment (SPA), Facility Audit of Service Quality (FASQ), Health Facility Census (HFC), and Service Availability Mapping (SAM). |
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Report of the Strategic Information Assessment in Swaziland
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Kemerer V |
2006 |
English |
Africa, SWAZILAND, Southern Africa |
HIV/AIDS |
MEASURE Evaluation, under direction from USAID-RHAP, visited Swaziland to discuss the feasibility of an assessment to establish a baseline from which to track strategic information (SI) system development and an accountability framework for the national monitoring and evaluation (M&E) work plan. During a second visit, key activities were defined in the National HIV/AIDS M&E Road Map through a participatory process with the Global AIDS Monitoring and Evaluation Team (GAMET), UNAIDS and Nercha that would guide the assessment. The specific objectives of the assessment are to define data flow of national level output indicators; outline data collection, management, reduction, use, and dissemination challenges; assess the Ministry of Health and Social Welfare (MOHSW) M&E structures and institutional capacity to provide the necessary HIV/AIDS program data on a routine basis; develop a list of stakeholder groups and stakeholders by programmatic area; and develop a directory of HIV researchers, HIV research organizations, and HIV research to use as a reference resource for future partnership in conducting targeted evaluation. |
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МЕСТО в России:профилактике ВИЧ в Самаре, 2005
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Kozina I |
2006 |
Russian |
RUSSIAN FEDERATION, Europe and Eurasia (was ENIS), Asia |
At-Risk Populations, HIV/AIDS, Monitoring |
Самара была выбрана для реализации методики МЕСТО с целью получить больше информации о группах с высокими рисками приобретения и передачи ВИЧ. Самарская область находится в десятке регионов Российской Федерации с высоким уровнем распространения СПИД, причем в Самаре этот уровень выше, чем в целом по области. Понимание того, какие группы находятся в зоне риска,позволит целенаправленно развивать профилактические программы. |
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PLACE in Russia: Identifying Gaps in HIV Prevention in Samara, 2005
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Kozina I |
2006 |
English |
Europe and Eurasia (was ENIS), Asia, RUSSIAN FEDERATION |
HIV/AIDS, At-Risk Populations, Monitoring |
Samara was selected for a PLACE study to gain more information about the populations at high-risk of acquiring and transmitting HIV. Samara oblast is among the top 10 oblasts in the Russia Federation with a high incidence of HIV infection. The city of Samara has higher rates than those of the oblast. Understanding who is at-risk of infection will aid in the development of prevention programs. |
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HIV voluntary counseling and testing service preferences in a rural Malawi population
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deGraft-Johnson J, Paz-Soldan V, Kasote A, Tsui A |
2005 |
English |
MALAWI |
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Voluntary counseling and testing (VCT) services have become an integral component of HIV prevention efforts in sub-Saharan Africa. This study of a rural Malawi district population examined variation in past and desired use of VCT services among 868 women aged 15 to 34 and 648 men aged 20 to 44 aware of HIV/AIDS. Only 11% of men and 7% of women had been tested, but of those untested, 76% of men and 61% of women desired testing. Ninety percent of respondents willing to know their results preferred to hear them from a test site counselor and on the same day of the test. However, 27% of women wanting to be tested did not want to know their test results, a finding significantly associated with knowing someone affected by AIDS and perceiving oneself at HIV infection risk. Knowledge of the behaviors of HIV prevention, knowing someone with AIDS, knowing the locations of a test site, and perceived risk of HIV infection all had a consistently significant association with past and future VCT use for men and women.
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Forced migration and under-five mortality: a comparison of refugees and hosts in north-western Uganda and southern Sudan
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Singh K, Karunakara U, Burnham G, Hill K |
2005 |
English |
SUDAN, UGANDA |
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Millions of people around the world live as displaced persons, often for lengthy periods of time. Little, however, is known about the correlates of health outcomes in displaced populations. This research article used data from north-western Uganda and southern Sudan to understand if and how forced migration and resulting residential arrangements impact under-five mortality for long-term displaced and corresponding host populations. Multivariate logistic regression revealed that over the long-run forced migration and residential arrangement did not significantly impact under-five mortality.
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The role of user charges and structural attributes of quality on the use of maternal health services in Morocco
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Hotchkiss D, Krasovec K, Zine-Eddine El-Idrissi M, Eckert E, Mehryar Karim A |
2005 |
English |
MOROCCO, Africa |
Maternal Health |
This study examines the role of household out-of-pocket costs and structural attributes of quality on the use of maternity care in Morocco using empirical data collected from both households and health care facilities. The study uses a nested mixed multinomial logit model to estimate the effects of structural attributes of quality, price, distance, and individual characteristics of women on the utilization of skilled and unskilled delivery assistance. The availability of a special DHS supplement on household out-of-pocket health care expenditures, as well as individual-, household-, and facility-specific information, makes this the first study of the demand for maternity care based on DHS data. The Moroccan setting provides substantial variation in the types of assistance available to women, ranging from home delivery aided only by friends and relatives at one extreme, to modern private hospitals at the other end of the spectrum. The reduced-form model specifications contains price, travel time, and different combinations of structural attributes of quality, including the availability of medical equipment, drugs, and infrastructure, the numbers and types of practitioners in the facility, and the availability various types of maternity services, and the interaction of these variables with individual characteristics of Moroccan women. The coefficient estimates are used to carry out policy simulations of the impact of changes in the level of out-of-pocket fees on utilization patterns for maternity care in Morocco. As of 1995, the majority of Moroccan women still gave birth at home, without the assistance of a skilled birth attendant (55.9 percent). Rural women were five times as likely as urban women to have home births without skilled assistance (78.7 percent vs. 18.8 percent). All forms of maternity care were more economically and geographically accessible to urban compared to rural women. The public sector was the most common source of facility based care (34 percent), as well as a more important source of care for urban (58 percent) than rural (19 percent) women. Rural women from richer households were considerably more likely than poor women to use public providers; while in urban areas, where there is better availability of private practitioners, wealthier women were slightly less likely to use public providers. Facility-based private health care providers assisted 16 percent of urban deliveries, but fewer than one percent of rural deliveries. On the whole, quality of care measures, such as the availability of drugs, equipment and infrastructure, were not substantially better in private facilities than in public facilities. |
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Associates of self-reported fertility status and infertility treatment-seeking in a rural district of Malawi
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Barden-O'Fallon J |
2005 |
English |
Africa, MALAWI, Southern Africa |
Fertility, Africa, Pregnancy |
BACKGROUND: This study examines the demographic, fertility preference, health/infection and behavioural factors associated with self-reported fertility problems and infertility treatment-seeking in a rural district of Malawi. METHODS: Data come from a population-based survey of 678 women and 362 men. RESULTS: Having a higher ideal number of children than actual number of children, i.e. a child deficit, is highly associated with women's reported fertility impairment and treatment-seeking. Other factors associated with women's infertility treatment-seeking are being educated and reporting infertility in self or spouse. In contrast, being in a polygamous union, having exchanged money or goods for sex, and having multiple sex partners are significantly associated with men's reported fertility impairment. Significant factors associated with men's infertility treatment-seeking are having no education, having a long waiting time to pregnancy and having a child deficit. CONCLUSIONS: There is a sex difference in which factors are associated with reported fertility impairment. Fertility preference variables are more often significantly related to women's reported fertility impairment, whereas sexual behaviours are more often significantly related to men's reported fertility impairment. |
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Perceptions of Nigerian women on domestic violence: evidence from 2003 Nigeria Demographic and Health Survey
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Oyediran KA, Isiugo-Abanihe UC, Bankole SA |
2005 |
English |
West Africa, NIGERIA |
Nigeria, Africa |
To facilitate the design of effective programmes to eliminate violence against women in Nigeria, this paper examined women's perceptions of wife beating. The data were derived from the 2003 Nigeria Demographic and Health Survey (NDHS). Both descriptive and analytical methods were used to assess the net effects of socio-demographic factors on women's perceptions of domestic violence. The study demonstrates that a large percentage of Nigerian women agreed that a man is justified in beating or hitting his wife; 66.4% and 50.4% of ever-married and unmarried women respectively expressed consent for wife beating. Respondents' approval of wife beating or abuse varied by personal attributes. Ethnic affiliation, level of education, place of residence, wealth index and frequency of listening to radio were significantly related to concurrence with wife beating. This paper highlights the cultural factors responsible for, and negative effects of, domestic violence against women in Nigeria and makes a case for raising public consciousness against it. |
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On reuse of clusters in repeated studies
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Kolenikov S, Angeles G |
2005 |
English |
BANGLADESH, East Asia, South Asia, Asia |
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Suppose data for a survey with multistage design is to be collected in two periods of time. This paper assesses the relative merits of keeping the same clusters in the sample vs. sampling new clusters, under differential statistical (correlation between clusters and overtime) and logistical (costs of survey) scenarios. The design effect of reusing the same clusters from the master sample over time is of the form 1 − Aρπ/n where ρ is intertemporal correlation of the cluster totals, n is the number of clusters, π is the proportion of clusters retained from the previous round, and A > 0 is a fixed constant. As long as the efficiency gains appear to be minor, the value of the designs that reuse the clusters comes from the logistical (cost of the survey) considerations. Empirical demonstrations that use Demographic and Health Survey (DHS) data for Bangladesh, 1996 and 2000, and a Monte Carlo simulation, are provided. |
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A Guide for Monitoring and Evaluating Child Health Programs
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Gage A, Ali D, Suzuki C |
2005 |
English |
|
Monitoring, Evaluation, Malaria, Child Health, Indicators |
Large-scale international efforts are currently being made to improve the health of infants and young children in several areas: the Millennium Development Goals, Roll Back Malaria, the Global Alliance for Vaccines and Immunization, and others. This guide intends to help these efforts succeed by providing information about effectively monitoring and evaluating these efforts. The specific objectives of this guide are to: compile indicators judged to be most useful for monitoring and evaluating child health programs; to encourage the consistent use of standardized definitions of indicators and terminology across the child health community; to serve as a central source of obtaining measures of process and output that can be reasonable linked to program activities; and to promote the monitoring and evaluation of child health programs by making indicators better known and easier to use. |
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Informatics Technology for Use in HIV/AIDS Treatment in Resource-Poor Settings
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Rodriguez M, Spohr M, Lippeveld T, Edwards M |
2005 |
English |
|
HIV/AIDS |
This paper reviews information technology tools that have the potential to facilitate the collection, analysis or evaluation, and dissemination of data necessary for delivering high quality HIV/AIDS care in resource-poor settings. Some of these technologies are currently used in the health care field and have been field tested in resource poor settings. Others need further investigation. |
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Guide to the Monitoring and Evaluation of the National Response for Children Orphaned and Made Vulnerable by HIV/AIDS
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UNICEF |
2005 |
English |
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HIV/AIDS, Orphans and Vulnerable Children, Child Mortality, Indicators, Child Health |
The AIDS epidemic continues to result in increasing numbers of children being orphaned and made vulnerable by HIV/AIDS. One of the major challenges facing governments, international organizations and non-governmental organizations (NGOs) in their response is the lack of data on the quality and effectiveness of their interventions. This document provides guidance to governments, international organizations and NGOs in the monitoring and evaluation of the national response for children orphaned and made vulnerable by HIV/AIDS. It includes methods and tools for measurement at the national level. The indicators in this guide supplement the UN General Assembly Special Session on HIV/AIDS (UNGASS/AIDS) and MDG "orphan school attendance" indicator with a set of recommended standardized core indicators that each country could monitor to assess the effectiveness of its national response and thereby inform programming. While monitoring should be an integrated activity conducted from the global to the local level, this guide does not cover the much more detailed monitoring and evaluation needs of individual projects for children orphaned and made vulnerable by HIV/AIDS. Some of the indicators may remain relevant at the level of monitoring and evaluating a specific intervention by one community-based organization, but they will certainly not cover the full range of project monitoring and evaluation needs. Also, at project/community level the indicators will probably need to be adjusted to the situation of the beneficiaries and the response for specific communities for which an intervention is programmed. Neither does this manual attempt to cover in detail the more general aspects of monitoring and evaluation. This guide has been developed under the direction of the UNAIDS Monitoring and Evaluation Reference Group. It complements other indicator guidelines on monitoring and evaluation related to HIV/AIDS (HIV prevention among young people, prevention of infections among infants and young children, care and support for people living with HIV/AIDS, etc.) coordinated by the MERG. |
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Priorities for Local AIDS Control Efforts: A Manual for Implementing the PLACE Method
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Weir SS, Tate J, Hileman SB, Khan M, Jackson E, Johnston A, Herman C |
2005 |
English |
|
Monitoring, HIV/AIDS, At-Risk Populations |
Using a venue-based approach, the PLACE Method lays out a step-by-step method for monitoring AIDS prevention among most-at-risk populations. This manual provides readers with an in-depth guide for using this method, which is designed for implementation within a short period of time by local personnel equipped with a word-processing program and freely available data entry, analysis, and mapping programs such as Epi-Info. The method includes participatory feedback workshops to ensure that results are used to tailor local interventions. |
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Costs and results of information systems for health and poverty indicators in the United Republic of Tanzania
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Rommelmann V, Setel P, Hemed Y, Angeles G, Mponezya H, Whiting D, Boerma T |
2005 |
English |
Africa, TANZANIA, East Africa, Southern Africa |
Child Health, Public Health, Maternal Health, Indicators, Poverty |
OBJECTIVE To examine the costs of complementary information generation activities in a resource-constrained setting and compare the costs and outputs of information subsystems that generate the statistics on poverty, health and survival required for monitoring, evaluation and reporting on health programmes in the United Republic of Tanzania. METHODS Nine systems used by four government agencies or ministries were assessed. Costs were calculated from budgets and expenditure data made available by information system managers. System coverage, quality assurance and information production were reviewed using questionnaires and interviews. Information production was characterized in terms of 38 key sociodemographic indicators required for national programme monitoring. FINDINGS In 200203 approximately US$ 0.53 was spent per Tanzanian citizen on the nine information subsystems that generated information on 37 of the 38 selected indicators. The census and reporting system for routine health service statistics had the largest participating populations and highest total costs. Nationally representative household surveys and demographic surveillance systems (which are not based on nationally representative samples) produced more than half the indicators and used the most rigorous quality assurance. Five systems produced fewer than 13 indicators and had comparatively high costs per participant. CONCLUSION Policy-makers and programme planners should be aware of the many trade-offs with respect to system costs, coverage, production, representativeness and quality control when making investment choices for monitoring and evaluation. In future, formal cost-effectiveness studies of complementary information systems would help guide investments in the monitoring, evaluation and planning needed to demonstrate the impact of poverty-reduction and health programmes. |
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Explaining inconsistencies between data on condom use and condom sales
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Meekers D, Van Rossem R |
2005 |
English |
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Condoms, HIV/AIDS, Sexual Behavior |
Background
Several HIV prevention programs use data on condom sales and survey-based data on condom prevalence to monitor progress. However, such indicators are not always consistent. This paper aims to explain these inconsistencies and to assess whether the number of sex acts and the number of condoms used can be estimated from survey data. This would be useful for program managers, as it would enable estimation of the number of condoms needed for different target groups.
Methods
We use data from six Demographic and Health Surveys to estimate the total annual number of sex acts and number of condoms used. Estimates of the number of sex acts are based on self-reported coital frequency, the proportion reporting intercourse the previous day, and survival methods. Estimates of the number of condoms used are based on self-reported frequency of use, the proportion reporting condom use the previous day and in last intercourse. The estimated number of condoms used is then compared with reported data on condom sales and distribution.
Results
Analysis of data on the annual number of condoms sold and distributed to the trade reveals very erratic patterns, which reflect stock-ups at various levels in the distribution chain. Consequently, condom sales data are a very poor indicator of the level of condom use. Estimates of both the number of sexual acts and the number of condoms used vary enormously based on the estimation method used. For several surveys, the highest estimate of the annual number of condoms used is tenfold that of the lowest estimate.
Conclusions
Condom sales to the trade are a poor indicator of levels of condom use, and are therefore insufficient to monitor HIV prevention programs. While survey data on condom prevalence allow more detailed monitoring, converting such data to an estimated number of sex acts and condoms used is not straightforward. The estimation methods yield widely different results, and it is impossible to determine which method is most accurate. Until the reliability of these various estimation methods can be established, estimating the annual number of condoms used from survey data will not be feasible. Collecting survey data on the number of sex acts and the number of condoms used in a fixed time period may enable the calculation of more reliable estimates of the number of sex acts and condoms used.
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The determinants of fertility in rural Peru: Program effects in the early years of the national family planning program
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Angeles G, Guilkey DK, Mroz TA |
2005 |
English |
PERU, Latin America and the Caribbean |
Rural Populations, Fertility |
Using data from the 1991 Peru Demographic Health Survey, a linked Situation Analysis, and a unique region-level data set, this paper examines the determinants of fertility in rural Peru before and after the 1985 enactment of its National Policy on Population. The empirical framework combines a model of the timing and spacing of conceptions with a model of the timing of the placement of family planning services in communities in order to control for non-random placement of services. Results show the program helped reduce fertility post 1985. The magnitude of the effects is quantified with simulations. |
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The effects of education and family planning programs on fertility in Indonesia
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Angeles G, Guilkey DK, Mroz TA |
2005 |
English |
Asia, South Asia, East Asia |
Fertility |
Numerous studies indicate that female education is a major determinant of fertility and that the estimated effects are large relative to other variables, including family planning program variables. There are, however, two serious deficiencies in the research relating educational attainment to fertility that could give rise to invalid inferences. First, many public programs, including health and family planning programs, may influence a woman's decisions about education, and these indirect programmatic effects might be large. Second, nearly all existing studies of the impacts of education on fertility assume that a woman's educational attainment is exogenous. Education could be serving as a proxy for such unobservable determinants as ability, motivation, and parental background, as these factors most likely are important determinants of a woman's educational attainment. We use the 1993 Indonesian Family Life Survey to compare the estimated impacts of education on fertility from a simple model that assumes the exogeneity of education and an unobserved factor model that allows for endogeneity of schooling. The model imposing questionable exogeneity assumptions appears to overpredict the fertility-reducing effects of female education, better schools, and higher government health expenditures and to underpredict the importance of family planning programs for reducing fertility and for inducing young women to remain in school. |
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The impact of community-level variables on individual-level outcomes, theoretical results and applications
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Angeles G, Guilkey DK, Mroz TA |
2005 |
English |
|
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The authors study alternative estimators of the impacts of higher level variables in multilevel models. This is important since many of the important variables in social science research, such as school characteristics, community level access to family planning facilities, and other community level factors, are higher level factors having impacts on many lower level outcomes such as school achievement and contraceptive use. While the large sample properties of alternative estimators for these models are well known, there is little evidence about the relative performance of these estimators in the sample sizes typical in social science research. We attempt to fill this gap by presenting evidence about point estimation and standard error estimation for both two- and three-level models. A major conclusion of the paper is that readily available commercial software can be used to obtain both reliable point estimates and coefficient standard errors in models with two or more levels as long as appropriate corrections are made for possible error correlations at the highest level. |
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Injury morbidity in an urban and a rural area in Tanzania: an epidemiological survey
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Moshiro C, Heuch I, Åstrøm A N, Setel P, Hemed Y, Kvåle G |
2005 |
English |
Africa, TANZANIA, East Africa, Southern Africa |
Rural Populations, Public Health |
Background: Injuries are becoming a major health problem in developing countries. Few population based studies have been carried out in African countries. We examined the pattern of nonfatal injuries and associated risk factors in an urban and rural setting of Tanzania. Methods: A population-based household survey was conducted in 2002. Participants were selected by cluster sampling. A total of 8,188 urban and 7,035 rural residents of all ages participated in the survey. All injuries reported among all household members in the year preceding the interview and resulting in one or more days of restricted activity were included in the analysis. Results: A total of 206 (2.5%) and 303 (4.3%) persons reported to have been injured in the urban and rural area respectively. Although the overall incidence was higher in the rural area, the incidence of major injuries (≥ 30 disability days) was similar in both areas. Males were at a higher risk of having an injury than females. Rural residents were more likely to experience injuries due to falls (OR = 1.6; 95% CI = 1.1 2.3) and cuts (OR = 4.3; 95% CI = 3.0 6.2) but had a lower risk of transport injuries. The most common causes of injury in the urban area were transport injuries and falls. In the rural area, cuts and stabs, of which two thirds were related to agriculture, formed the most common cause. Age was an important risk factor for certain types of injuries. Poverty levels were not significantly associated with experiencing a nonfatal injury. Conclusion: The patterns of injury differ in urban and rural areas partly as a reflection of livelihoods and infrastructure. Rural residents are at a higher overall injury risk than urban residents. This may be important in the development of injury prevention strategies. |
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Effect of recall on estimation of non-fatal injury rates: a community based study in Tanzania
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Moshiro C, Heuch I, Åstrøm A N, Setel P, Kvåle G |
2005 |
English |
TANZANIA, UNITED STATES, BRAZIL, Africa, East Africa, West Africa, Southern Africa, Latin America and the Caribbean, GHANA |
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Injuries are becoming a major cause of mortality and morbidity in less developed countries. The relative contribution of injuries to disability adjusted life years is expected to rise from 15% in 1990 to 20% in 2020 with the largest increase expected to occur in sub-Saharan Africa. Most studies on the incidence of injuries are based on health facility data. Self reported data obtained through community based surveys play an important part in the study of injury morbidity in less developed countries due to incompleteness and low utilisation of health facilities. However, one major limitation of such studies is recall bias. A number of studies have investigated the effect of recall period on the estimates of injury rates for non-occupational and occupational injuries. A study in the United States examined the effect of recall in estimating injury rates among children and adolescents with a reference period of 12 months. The largest declines in injury rates were observed for the 04 year old children and for minor injuries. Similarly, Mock et al investigated the effect of recall bias on annual injury rates in a household survey in Ghana. They found a remarkable decline in injury rates from a one month recall to a 12 month recall, which was influenced by severity of injury but not by age, gender, and locality. A population based study in Brazil compared retrospective and prospective data collection methods among preschool children. Use of diaries prospectively resulted in five times as many injuries reported than the recall method, particularly for injuries not requiring medical care. In the United States, injury rates for farmers were compared using two months, 12 months, and 10 years recall. The results showed that a recall period of more than two months was likely to underestimate injury rates. Most of the studies on effect of recall on injury rates have been conducted in developed countries. A review of literature produced only one study from sub-Saharan Africa on time effects in recall of injuries. In this paper, we investigate the effect of recall on estimates of annual injury rates as an initial step in analysing data from a survey that measured injury morbidity in an urban and a rural location of Tanzania. The effects of recall are also examined for various subpopulations and by severity of injury. |
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Integrating demographic and epidemiologic approaches to research on HIV/AIDS: the proximate-determinants framework
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Boerma JT, Weir SS |
2005 |
English |
|
HIV/AIDS |
This article presents a conceptual framework for the study of the distribution and determinants of human immunodeficiency virus (HIV) infection in populations, by combining demographic and epidemiological approaches. The proximate-determinants framework has been applied extensively in the study of fertility and child survival in developing countries. Key to the framework is the identification of a set of variables, called "proximate determinants," that can be influenced by changes in contextual variables or by interventions and that have a direct effect on biological mechanisms to influence health outcomes. In HIV research, the biological mechanisms are the components that determine the reproductive rate of infection. The proximate-determinants framework can be used in study design, in the analysis and interpretation of risk factors or intervention studies that include both biological and behavioral data, and in ecological studies. |
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A Rapid Assessment of Strategic Information Systems for Lesotho
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2005 |
English |
LESOTHO, Southern Africa, Africa |
HIV/AIDS |
The Lesotho Strategic Information Systems Assessment (SISA) was intended to produce a common understanding among HIV/AIDS stakeholders regarding strategic information mandates, data availability, data collection and use activities and other plans dealing with strategic information collection and use in Lesotho. This report collects and details strengths, weaknesses, and predicted changes to the SI capabilites of Lesotho's healthcare system. Data were collected from key informats with technical experience and skills in national M&E capacity and coordination; policy; population-based surveys; facility-based surveys; HIV and AIDS surveillance; routine facility-based HIV/AIDS service statistics; ART client monitoring and managment; community-based program monitoring; and national databases. |
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Encuesta Demografica y de Salud Materna e Infantil, ENDEMAIN 2004
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|
2005 |
Spanish |
ECUADOR, Latin America and the Caribbean |
Maternal Health, HIV/AIDS |
La ENDEMAIN-2004 tendrá como principales objetivos, los siguientes: Mantener una evaluación periódica y proporcionar información oportuna y de alta calidad a todas las instituciones gubernamentales, privadas, agencias de cooperación internacional e investigadores, sobre indicadores demográficos, salud de la madre y el niño, salud sexual y reproductiva, violencia doméstica, enfermedades de transmisión sexual y SIDA, seguridad social, cuidado de la salud y otras variables de gran importancia, para implementar políticas, diseñar, administrar y evaluar programas sociales actualmente existentes, y orientar la definición de una agenda de políticas sociales a mediano plazo; Asegurar a las instituciones de desarrollo social e investigación el acceso libre y permanente a indicadores actuales y oportunos, a fin de establecer líneas de base para nuevos programas de salud y de lucha contra la pobreza, especialmente a nivel regional, provincial y local, en sus poblaciones urbana y rural; Comparar sus resultados con variables investigadas en el último censo de población y vivienda del 2001 y las encuestas ENDEMAIN de los años 1987, 1989, 1994 y 1999, a fin de examinar niveles, tendencias y diferenciales, especialmente de fecundidad, mortalidad infantil y en la niñez, regulación de la fecundidad, y salud de la madre y el niño; Actualizar bases de datos de información comparable a nivel internacional en los tópicos de fecundidad, mortalidad y de salud, a través de los Informes sobre Desarrollo Humano del Programa de las Naciones Unidas para el Desarrollo (PNUD), Sistema Integrado de Indicadores Sociales del Ecuador (SIISE), y Diferencias Socioeconómicas en Salud, Nutrición y Población (Banco Mundial); Incorporar en la encuesta nuevos temas específicos sobre: mortalidad materna; antropometría (peso y talla de niños menores de cinco años y de la mujer entrevistada); asistencia escolar de niños de 5 a 16 años; y uso de servicios y gastos en salud, y consumo del hogar; y Propiciar una cultura democrática de la información, mediante una amplia y adecuada difusión. |
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2003 Urban NGO Service Delivery Program (NSDP) Evaluation Survey
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2005 |
English |
Asia, East Asia, BANGLADESH, South Asia |
Maternal Health, Child Health |
The 2003 Urban NGO Service Delivery Program (NSDP) Evaluation Survey in Bangladesh provides data to evaluate the urban component of the NSDP in terms of delivering an Essential Service Package (ESP) of primary health care interventions to under-served urban populations of Bangladesh. The surveys main objective was to collect information about knowledge, awareness, and use of services related to family planning and maternal and child health provided through the NSDP project and its alternatives. Part of a continuing evaluation that began with a 1998 baseline survey and a 2001 mid-project impact evaluation, the 2003 survey was conducted by Mitra and Associates with technical assistance from the MEASURE Evaluation project at the University of North Carolina at Chapel Hill. Data were collected from 5,691 women in urban areas served by the NSDP and from 4,201 women in non-NSDP urban areas. |
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2003 BPHC Evaluation Survey
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2005 |
English |
BANGLADESH, East Asia, South Asia, Asia |
Reproductive Health, Maternal Health, Child Health |
Since 1988, the principal objective of the BPHC project has been to deliver maternal and child health and family planning services to poor and underserved communities in Bangladesh. The 2003 BPHC evaluation survey was conducted in Bangladesh to assess the performance of BPHC nongovernmental organizations (NGOs) in terms of this objective. The survey was designed to assess performance as measured by U.S. Agency for International Development (USAID) performance indicators relative to the rural component of the NGO Service Delivery Partnership (NSDP) and comparable NSDP project areas adjacent to BPHC project areas. |
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2003 Rural NGO Service Delivery Program (NSDP) Evaluation Survey
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2005 |
English |
BANGLADESH, South Asia, Asia, East Asia |
Child Health, Maternal Health, Reproductive Health, Rural Populations |
The 2003 Rural NGO Service Delivery Program (NSDP) Evaluation Survey in Bangladesh provides data to evaluate the rural component of the NSDP, a four-year health and population project funded by the U.S. Agency for International Development (USAID). It provides information on the use of Essential Service Package (ESP) components for 7,507 women in NSDP project areas and 4,372 women in non-NSDP areas, including utilization of services at the NSDP network of facilities (static and satellite clinics, and depotholders) and alternative providers, knowledge of health promotion behaviors, awareness of NSDP services, and the quality of treatment at NSDP clinics. The survey, part of a continuing evaluation that began with a baseline survey in 1998 followed by a mid-project evaluation survey in 2001, was conducted by Associates for Community and Population Research (ACPR), a Dhaka-based research firm, with technical assistance from the MEASURE Evaluation project at the University of North Carolina at Chapel Hill. |
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Developing and implementing monitoring and evaluation methods in the new era of expanded care and treatment of HIV/AIDS
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Wolf R, Bicego G, Marconi KM, Rugg D, Bessinger R, et al. |
2004 |
English |
Global |
HIV/AIDS |
National program managers need data from different geographical areas within the country to plan for and monitor improvements in service coverage and capacity for care and treatment of patients with HIV/AIDS. They need to ensure equitable access to services by those in need. |
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Compendio de Indicadores para el Monitoreo y la Evaluación de los Programas Nacionales de Tuberculosis
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World Health Organization |
2004 |
Spanish |
|
Monitoring, Evaluation, Tuberculosis |
La Organización Mundial de la Salud (OMS) declaró la Tuberculosis (TB) como unaemergencia global en 1993, como respuesta al aumento constante en la incidencia de casos de TB, al cambio en la dinámica de la enfermedad relacionado con la epi demia del virus de inmunodeficiencia humana adquirido (VIH/SIDA) y la aparición de la TB multidrogorresistente (TB-MDR). El aumento en la incidencia de TB se de be a varios factores incluyendo la negligencia de los gobiernos en el control de la TB, un manejo inadecuado de los programas de control de la TB, la diseminaci ón del VIH, la pobreza, el crecimiento poblacional y la urbanización rápida y de scontrolada en los países. Como respuesta a estos factores se desarrolló una est rategia que es costo-efectiva y eficiente, conocida como DOTS/TAES (Tratamiento Acortado Estrictamente Supervisado) una estrategia internacionalmente recomendad a para el control de la TB. La estrategia DOTS/TAES fue diseñada con el objetivo de corregir las debilidades existentes en modelos previos sobre manejo de progr amas y para fortalecer los servicios de diagnóstico y tratamiento. "Compendium o f Indicators for Monitoring and Evaluating National Tuberculosis Programs" es un version de este reportaje en ingles. |
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An evaluation of post-campaign knowledge and practices of exclusive breastfeeding in Uganda
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Gupta N, Katende C, Bessinger R |
2004 |
English |
Southern Africa, Africa, UGANDA |
Child Health, Maternal Health |
Despite the benefits of exclusive breastfeeding for the health of mothers and children, its practice has markedly declined throughout the developing world. Mass media-communication programmes could play an important role in reversing this trend. This study evaluated the extent to which exposure to behaviour change communication (BCC) messages in the media determined recent improvements in exclusive breastfeeding knowledge and practices in areas targeted by the Delivery of Improved Services for Health (DISH) Project of Uganda. Data were drawn from the 1999 DISH Evaluation Survey. The survey collected information from representative samples of women and men of reproductive age. Multiple logistic regressions were used for assessing the independent influences of BCC exposure on breastfeeding knowledge and practices, controlling for several confounding factors. The results indica-ted that the exposure to BCC messages was strongly associated with womens knowledge of six months as the ideal duration for exclusive breastfeeding. Positive influences on knowledge of men were also found. Media effects on womens current practice of exclusively breastfeeding their infants up to six months were less conclusive, possibly because of the short interval between the launch of the BCC campaign and survey implementation. While there was some evidence of bias of self-reported exposure, results of exploratory analysis of the indirect effects of communication campaigns suggest that impacts may be compounded as overall awareness is increased at the community level eventually leading to improved knowledge among individuals. |
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Measuring sexual behaviour in the era of HIV/AIDS: the experience of Demographic and Health Surveys and similar enquiries
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Curtis SL, Sutherland EG |
2004 |
English |
Africa, East Africa, West Africa, Southern Africa, Latin America and the Caribbean, Central American Project |
HIV/AIDS, Sexually Transmitted Infections (STIs), Sexual Behavior |
Objectives: To review the sexual behaviour data collected in the Demographic and Health Surveys (DHS) and other similar national surveys from the perspective of data quality. Methods: Two indicators of premarital and higher risk sexual behaviour were analysed for 31 surveys in 10 countries in sub-Saharan Africa and Latin America and the Caribbean. The analysis focused on the internal consistency of trends and gender differences in the reported indicators. Results: The authors found fluctuating trends in premarital sex in sub-Saharan Africa but consistent increases in Latin America and the Caribbean. Changes in questionnaire design do not seem to contribute to these trends and there is evidence that the increase in premarital sex is genuine in Latin America. Trends in sex with non-spousal, non-cohabiting partners show large fluctuations and inconsistencies between surveys in some countries but not others. Men are consistently more likely to report non-marital sexual partners than women and unmarried women are less likely than unmarried men to report casual partners. Conclusions: Surveys are potentially a valuable source of information on sexual behaviour but there are sufficient grounds for concern to warrant considerable caution in the use of survey data to monitor trends in sexual behaviour. Survey findings must be evaluated carefully and interpreted in the context of other available information. These results caution against placing heavy emphasis on short term changes in sexual behaviour between individual surveys and highlight the need for attention to quality in data collection. |
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Where the action is: monitoring local trends in sexual behaviour
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Weir SS, Tate JE, Zhusupov B, Boerma JT |
2004 |
English |
KAZAKHSTAN, SOUTH AFRICA, Europe and Eurasia (was ENIS), Southern Africa, Asia, Africa, Newly Independant States, Central Asian Republics |
Monitoring, HIV/AIDS, Monitoring, Sexually Transmitted Infections (STIs), At-Risk Populations |
Objectives: To assess the role in an overall monitoring strategy of the PLACE method of estimating local trends in sexual behaviour among individuals at social venues in areas at increased risk of HIV transmission. Methods: Public venues identified by community informants as places where people meet new sexual partners were visited and characterised in Karaganda, Kazakhstan, in 2002 and 2003, and in a township in South Africa in 2000 and 2003. At a subset of venues, a representative sample of individuals socialising at the venue were interviewed about their sexual behaviour. The age distribution and partnerships rates of those socialising at these venues were compared by year and with national data from Kazakhstan and South Africa obtained via household surveys. Results: Women and men socialising at venues were younger and had higher rates of new and concurrent partnerships than men and women interviewed in national household surveys. There was little apparent change in sexual behaviour between 2002 and 2003 in Karaganda. In the South African township, there was a reduction in sexual partnerships and an increase in condom use, possibly due to a local AIDS prevention programme. Conclusion: Findings from the PLACE method supplement national data on sexual behaviours with data from key populations in high transmission areas, inform local targeting of interventions, and, when subsequent rounds of PLACE are implemented, can evaluate change in target populations. |
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Strengthening Monitoring and Evaluation of National AIDS Programs in Asia. Bangkok, Thailand, November 4-7, 2003
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2004 |
English |
East Asia, Asia, CHINA, INDIA, THAILAND, VIET NAM, CAMBODIA, South Asia |
Sexual Behavior, Monitoring, Evaluation, HIV/AIDS |
This report summarizes the main themes discussed and the action plans developed by country teams participating in the "Strengthening Monitoring and Evaluation of National AIDS Programs in Asia" workshop held in Bangkok, Thailand, from November 4-7, 2003. Participants from five countries--Cambodia, China, India, Thailand, and Vietnam were invited to the workshop, which had two primary goals: to strengthen participants' M&E capacity by giving them the opportunity to share and discuss country practices and plans, and to create a forum to discuss the global M&E indicators of AIDS programs within the Asian context. |
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The Use of Discrete Data in PCA: Theory, Simulations, and Applications to Socioeconomic Indices
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Kolenikov S, Angeles G |
2004 |
English |
|
|
The last several years have seen a growth in the number of publications in economics that use principal component analysis (PCA), especially in the area of welfare studies. This paper gives an introduction into the principal component analysis and describes how the discrete data can be incorporated into it. The effects of discreteness of the observed variables on the PCA are overviewed. The concepts of polychoric and polyserial correlations are introduced with appropriate references to the existing literature demonstrating their statistical properties. A large simulation study is carried out to shed light on some of the issues raised in the theoretical part of the paper. The simulation results show that the currently used method of running PCA on a set of dummy variables as proposed by Filmer & Pritchett (2001) is inferior to other methods for analyzing discrete data, both simple such as using ordinal variables, and more sophisticated such as using the polychoric correlations. |
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AIDS in Africa during the Nineties: Kenya. A review and analysis of survey and research results
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Kenya National AIDS Control Council, Ministry of Health, Kenya National AIDS/STD/TB/Leprosy Control Programme, MEASURE Evaluation, Population Services International |
2004 |
English |
KENYA, East Africa, Southern Africa |
Orphans and Vulnerable Children, HIV/AIDS, Public Health, Condoms |
This report presents data and information that document the changes in the epidemiology of HIV and in AIDS-related knowledge and behavior that occured in Kenya during the 1990s. This 79-page report merges HIV seroprevalence data taken from Kenya's Ministry of Health, with several cross-sectional, population-based national surveys conducted in Kenya between 1989 and 2000. Data and analysis in this report are broken up into six topics: the spread of HIV in Kenya, AIDS-related knowledge and attitudes, sexual behavior, knowledge and use of condoms, and the impact of the epidemic on mortality and orphans. |
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Guidelines for Core Population Coverage Indicators for Roll Back Malaria: To Be Obtained from Household Surveys
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Roll Back Malaria, WHO, UNICEF, MEASURE Evaluation |
2004 |
English |
|
Malaria, Public Health |
An effective system for monitoring progress and evaluating results is critical for assessing the success of the Roll Back Malaria (RBM) partnerships technical strategies. To facilitate this process, the RBM partners established a set of core indicators for population coverage that can be collected through household surveys that permit national-level monitoring of these technical strategies. The purpose of this manual is to provide country partners with technical guidance on the detailed specifications of the core indicators for population coverage that can be measured through household surveys, the data required for their construction, as well as issues related to their interpretation. Details of the data collection methods required for estimating these indicators through national-level household surveys are also provided. Developed by the RBM partnership, World Bank, the United Nations Childrens Fund (UNICEF), and MEASURE Evaluation, this manual is intended to maximize internal consistency and comparability of the indicators across countries and over time, and to ensure consistency in the types of data collection methods used. |
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Second International RHINO Workshop on: Enhancing the Quality and Use of Routine Health Information at the District Level
|
|
2004 |
English |
Africa, SOUTH AFRICA, Southern Africa |
Knowledge Management, Workshop |
From September 29 to October 4, 2003, The Routine Health Information Network (RHINO) held its second international gathering in South Africa. Around 100 health and information professionals from over 24 countries came to South Africa to share experiences and define strategies for Enhancing the Quality and Use of Health Information at the District Level. Based on the Networks experience to date and feedback from network members, this workshop intentionally focused on practical field-based challenges to improving routine health information. The format and tenor of the workshop emphasized participant interaction and learning to encourage maximum exchange of field-based experience and lessons learned. This report summarizes the proceedings and results of the workshop, including lessons learned for strengthening routine health information systems at the district level. |
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Explaining Inconsistencies Between Data on Condom Use and Condom Sales
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Meekers D, Van Rossem R |
2004 |
English |
Africa |
Condoms, HIV/AIDS |
<P>This study uses data from six Demographic and Health Surveys (DHS) to estimate the total annual number of sex acts and condoms used and compares these totals with reported data on condom sales and distribution. The ability to estimate the number of condoms used from survey data would be a useful tool for program managers, as it would enable estimation of the number of condoms needed for different target groups. <P>Analyses of data on the annual number of condoms sold and distributed reveals very erratic patterns. The fluctuations appear to reflect stock-ups at various levels in the distribution chain. Consequently, available data on the number of condoms sold and distributed yield a very poor indicator of the actual number of condoms sold to consumers and the level of condom use. <P>The results of our survey analyses show that estimates of both the number of sexual acts and number of condoms used varied greatly based on the estimation method used. For several surveys, the highest estimate of the annual number of condoms used is tenfold that of the lowest estimate. While some estimation methods can be disregarded because the results obtained are clearly not plausible, it is impossible to determine which of the remaining methods yield the most accurate results. Until the reliability of these various estimation methods can be established, estimating the annual number of condoms used from survey data will not be feasible. |
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The Reach and Impact of Social Marketing and Reproductive Health Communication Campaigns in Zambia
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Meekers D, Van Rossem R |
2004 |
English |
ZAMBIA, Southern Africa, Africa |
HIV/AIDS, Reproductive Health, Condoms |
<P>Objectives: To address reproductive health problems and the HIV/AIDS epidemic in Zambia, several reproductive and HIV/AIDS prevention programs are being implemented. This paper assesses the reach of selected radio and television programs about family planning and HIV/AIDS and of communications about the socially marketed Maximum condoms in Zambia, as well as their impact on discussion of family planning and condom use. <P>Data and Methods: The analysis was based on data from the 2001û2002 Zambia Demographic and Health Survey, which contained information on a representative sample of women age 15û 49 and men age 15û59. To control for self-selection and endogeneity, we use a two-stage regression model to estimate the effect of program exposure on the behavioral outcomes. <P>Results: Results for both men and women show that those who were exposed to radio and television programs about family planning and HIV/AIDS were more likely to have discussed family planning with their partner (OR = 1.14 for men and 1.06 for women) and to have ever used a condom (OR = 1.12 and 1.04, respectively). Men with high exposure to socially marketed Maximum condoms were more likely than those with low exposure to the program to have discussed family planning (OR = 1.30), as well as to have ever used a condom (OR = 1.35) and to have used a condom at their last sexual intercourse (OR = 1.15). <P>Conclusion: Findings suggest that the reproductive health and social marketing campaigns in Zambia reached a large portion of the population and had a significant impact on family planning discussion and condom use. |
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Sexual Violence against Women in Lesotho
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|
2004 |
English |
LESOTHO, Southern Africa, Africa |
HIV/AIDS, Sexually Transmitted Infections (STIs), Maternal Health, Public Health |
This report discusses the outcomes of the Sexual Health and Rights Promotion (SHARP!), a USAID-funded activity that addresses sexual violence in Lesotho. This report also presents findings about the nature and magnitide of sexual violence in Lesotho. Qualitative and quantitatve data were collected for this report, which found that sexual violence and forced sexual contact were extremely common in Lesotho. MEASURE Evaluation conducted this study as part of its effort to provide M&E assistance for the Regional HIV/AIDS Program for Southern Africa (RHAP-SA). |
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Priorities for Local AIDS Control Efforts (PLACE) for Use in Border Areas of Lesotho and South Africa
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|
2004 |
English |
Africa, LESOTHO, SOUTH AFRICA, Southern Africa |
Monitoring, HIV/AIDS, At-Risk Populations, Condoms, Monitoring |
Each day thousands upons thousands of workers migrate from Lesotho to South Africa to work as miners, truck drivers, taxi drivers, sex workers, and other groups prone to high-risk activities, and these workers often put their partners living in Lesotho at risk. MEASURE Evaluation, Sechaba Consultants, CARE Lesotho, and Population Services International Lesotho worked together to prepare this study, which used PLACE protocol to identify areas with high incidence of infection, to map HIV/AIDS prevention activites in these areas and to identify high-risk populations attending these areas. These populations can then be targeted with specially-tailored HIV/AIDS prevention efforts. |
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AIDS in Africa During the Nineties Malawi: A review and analysis of surveys
|
|
2004 |
English |
Southern Africa, Africa, MALAWI |
Contraception, Sexual Behavior, Condoms, HIV/AIDS, Public Health |
This 70-page report is one in a series of reports examining trends in AIDS-related knowledge, attitudes, and behaviors in sub-Saharan Africa throughout the 1990s. During this period, most global efforts to prevent and control HIV infection focued on increasing knowledge and changing behaviors that put individuals at risk. Although Malawi has not experienced a decline in HIV prevalence, the prevalence appears to have leveled off toward the end of the decade; it is important to examine changes in corresponding knowledge and behaviors to identify which programs were the most effective and where challenges are still present. This report is broken up into seven chapters, which discuss, respectively: an introduction to HIV/AIDS in Malawi; the spread of HIV in Malawi; AIDS-related knowledge; sexual behavior; condom knowledge and use; the impact of the epidemic on mortality; and young adults and HIV/AIDS. |
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AIDS in Africa During the Nineties: Tanzania Youth Report - A Review and Analysis of Surveys and Research Studies
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Bloom S, Ukwuani F, Finn T, Singh K |
2004 |
English |
East Africa, Africa, Southern Africa, TANZANIA |
Rural Populations, Condoms, HIV/AIDS |
This 83-page report analzyses five surveys that examined the knowledge and behaviors of youth ages 15 to 24 in Tanzania during the 1990s. Characteristics of Tanzanian youth are broken down into seven areas: demographic characteristics, HIV-related knowledge, age at first sex and premarital sex, sex with multiple partners, condom use, knowledge and behavior, and HIV-prevalence levels. Findings from the five surveys show the following results: During the 1990s, exposure to HIV/AIDS prevention media fell, particularly in rural areas. However, trends in marriage remained relatively constant. Contraceptive use increased, but remained at relatively low levels. AIDS awareness became very high among youth during the 1990s, but there remained a large gap between awareness and accurate prevention knowledge. Finally, condom use increased during the 1990s, particularly for young urban men. |
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AIDS in Africa During the Nineties Uganda: Young people, sex, and AIDS in Uganda
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The Uganda HIV/AIDS Partnership, Uganda Ministry of Health, Uganda AIDS Commission, MEASURE Evaluation Project |
2004 |
English |
UGANDA, Southern Africa, Africa |
Sexual Behavior, HIV/AIDS, Condoms |
Uganda has frequently been cited as a success story in HIV/AIDS prevention, because of large declines in HIV prevalence that occurred throughout the 1990s. This report attempts to better understand how, why, and to what extent these declines occurred among Ugandan adolescents. Understanding how changes in HIV/AIDS prevalence, as well as changes in HIV/AIDS-related knowledge and behavior occurred, will provide information on the current state of the epidemic in Uganda, and will assess the effectiveness of HIV-prevention programs used in Uganda during the 1990s. This report brings together previously disparate information sources of information about Ugandan adolescents knowledge of AIDS and sexual behavior, primarily the Ugandan demographic and health surveys conducted in 1998-1989, 1995, and 2000-2001. |
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HIV and Increases in Childhood Mortality in Kenya in the Late 1980s to the Mid-1990s
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|
2004 |
English |
KENYA, East Africa, Africa, Southern Africa |
Child Mortality, HIV/AIDS |
Data from the 1998 Kenya Demographic and Health Survey (KDHS) show that the mortality rate of children under five increased by about 25% from the late 1980s to the mid-1990s. The factors responsible for this increase have been poorly understood and controversial. The objective of this 26-page document is to clarify the situation. Data from the 1993 and 1998 KDHSs have been analyzed and merged into a single data set. Additionally, socioeconomic and reproductive dynamic controls, as well as estimates of HIV prevalence in each Kenyan district, were included in the analysis. The results of this analysis strongly suggest that the HIV epidemic played a major role in the recent child-mortality increases in Kenya.
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Transitions to Adulthood in the Context of HIV/AIDS in South Africa.
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2004 |
English |
SOUTH AFRICA, Africa, Southern Africa |
Reproductive Health, HIV/AIDS |
The Transitions to Adulthood project examines adolescent sexual and reproductive behaviors in relation to their surrounding context, including educational and work opportunities, family, and environmental conditions. The study is designed to provide a better understanding of opportunities and risks that South African adolescents face in the context of already high and increasing HIV/AIDS prevalence. Data were collected on individual, household, and community levels in 2000 and 2001. This report had the primary objective of providing descriptive results for the second round of data collection of the community module of the Transitions study. |
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Compendium of Indicators for Monitoring and Evaluating National Tuberculosis Programs
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World Health Organization |
2004 |
English |
RUSSIAN FEDERATION, PHILIPPINES, PERU, KAZAKHSTAN, HONDURAS, HAITI, SOUTH AFRICA, Central American Project, Central Asian Republics, Newly Independant States, Europe and Eurasia (was ENIS), South Asia, East Asia, Latin America and the Caribbean, Southern Africa, Global, Asia, Africa |
Indicators |
The Compendium of Indicators for Monitoring and Evaluating National Tuberculosis Programs is a joint product of a working group that was created to discuss the need for a comprehensive tool for M&E of TB programs. This compendium provides a comprehensive and standardized listing of the most widely used indicators relevant to developing countries, and it strives to achieve uniformity in defining indicators to allow comparisons over time and between different programs. During this process, assessments of current TB M&E systems were conducted in Honduras, South Africa, Russia and the Philippines and the majority of indicators were field-tested in Peru, Kazakhstan, Haiti and Thailand. The working group consists of partners such as the World Health Organization (WHO), International Union against TB and Lung Disease UNION), KNCV Tuberculosis Foundation, Center for Disease Control (CDC), U.S. Agency for International Development (USAID), Global Drug Facility in collaboration with Management Sciences for Health (GDF/MSH), the World Bank, and MEASURE Evaluation. A Spanish-language version of this compendium, "Compendio de Indicadores para el Monitoreo y la Evaluación de los Programas Nacionales de Tuberculosis," is also available. |
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Evaluating HIV/AIDS Prevention Projects: A Manual for Nongovernmental Organizations
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Bertrand JT, Solis M |
2004 |
English |
|
HIV/AIDS |
Evaluation allows study or program implementors to identify successful strategies, modify or discontinue interventions not yielding desired results, share findings with programs in other countries or regions, provide donors with evidence of the results of their investment, and demonstrate their interest in accountability. The purpose of this manual is to demystify the evaluation process, especially for staff who are not specialized in evaluation techniques. This manual will guide users in both designing and implementing evaluations of HIV/AIDS prevention projects. The principal audience for this manual is nongovernmental organizations, who deal with their own set of problems, advantages and challenges compared to other public health stakeholders, yet who all want to slow and stop the spread of HIV and AIDS.
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The delayed contraceptive revolution in Guatemala
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Santiso-Galvez R, Bertrand JT |
2004 |
English |
GUATEMALA, Central American Project, Latin America and the Caribbean |
Contraception |
Guatemala has the second lowest level of contraceptive use of any country in Latin America, despite an active private family planning program for over 30 years. Previous analyses identify correlates of contraceptive use but fail to address the fundamental question: Why does Guatemala differ so markedly from the rest of Spanish-speaking Latin America in the acceptance of family planning? This case study explores political and historical factors at the macrolevel that have shaped the evolution of family planning in Guatemala. These include the anti-imperialistic leftist movements of the 1960s and 1970s; the large percentage of the population that is indigenous; the civil unrest that peaked in the 1980s and paralyzed social programs, especially in the western highlands; and the powerful alliance between the government and the Catholic Church. Although none of these factors is unique to Guatemala, the convergence of the four in a single country explains why Guatemala lags far behind its Latin American neighbors in the acceptance of family planning. However, recent events give reason for guarded optimism that Guatemala is advancing toward greater acceptance of family planning. |
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Multi-media campaign exposure effects on knowledge and use of condoms for STI and HIV/AIDS prevention in Uganda
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Bessinger R, Katende C, Gupta N |
2004 |
English |
UGANDA, Southern Africa, Africa |
Condoms, HIV/AIDS |
This study examined the influences of behavior change communication (BCC) campaigns on knowledge and use of condoms for prevention of HIV/AIDS and other sexually transmitted infections in target areas of Uganda. Data were drawn from the 1997 and 1999 Delivery of Improved Services for Health (DISH) evaluation surveys, which collected information from representative samples of women and men of reproductive age in the districts served by the DISH project. Logistic regressions were used to assess the associations between BCC exposure and condom knowledge and use, controlling for individuals' background characteristics. Results indicated that BCC exposure was strongly associated with higher condom knowledge: women and men who reported being exposed to messages in the mass media were at least twice as likely as those with no exposure to know of condoms as a mean to avoid HIV/AIDS. A doseresponse effect was observed, suggesting that campaigns using multiple media channels may be most effective in improving sexual health knowledge. At the same time, certain gender differences of the influences on condom use were found, with the channel and content of messages seemingly more important in terms of instilling safer sex practices. While there was some evidence of bias of self-report, exploratory analysis of the indirect effects of communications campaigns suggested that impacts may be compounded as overall awareness is increased at the community level eventually leading to behavior change among individuals. |
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How family planning ideas are spread within social groups in rural Malawi
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Paz Soldan VA |
2004 |
English |
Africa, MALAWI, Southern Africa |
Rural Populations |
Using data from in-depth interviews conducted between March and June 2002 in a rural district of Malawi, this study explores how family planning attitudes and practices spread among members of social groups. Gender differentials are found in how people determine other group members' practices: Men "knew" about such practices from their observations of others' family size and child spacing, whereas women's knowledge was based on their conversations with other women. The discussion topics relating to family planning also varied by sex: Men spoke about the pros and cons of limiting family size, whereas women spoke in detail about types of contraceptive methods, where to get them, their side effects, and covert contraceptive use. For men and women, the main trigger for family planning discussions was gossip. Whereas, generally, women first heard about family planning at the hospital, men stated that their first source of information was the radio or health-drama group. |
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Communities, opportunities, and adolescent sexual behavior in KwaZulu, South Africa
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Kaufman CE, Clark S, Manzini N, May J |
2004 |
English |
SOUTH AFRICA, Southern Africa, Africa |
Condoms, HIV/AIDS, Sexually Transmitted Infections (STIs), Sexual Behavior |
In 2002, the prevalence of HIV among South African clinic attendees under the age of 20 was 15 percent, suggesting a correspondingly high level of unprotected sex and risky sexual behavior. Past research focused on the dynamics of individuals' and partners' sexual decisionmaking without accounting for the larger context in which such decisions are made. Do adolescents' opportunities for schooling, work, and other community activities make a difference? This study uses data collected from a representative sample of young people living in KwaZulu-Natal, South Africa, to explore these questions. Logit analyses show that for girls, higher levels of education reduced the probability of having had sex in the 12 months prior to the survey, and average wages were positively associated with condom use. Greater participation in community sports increased risk-taking behaviors among boys but decreased them among girls. Within the household, education of adults had a positive effect on condom use for both boys and girls. |
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The role of conflict in the rapid fertility decline in Eritrea and prospects for the future
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Blanc AK |
2004 |
English |
Southern Africa, Africa, East Africa, ERITREA |
Pregnancy, Fertility |
The large fertility decline observed in Eritrea between the mid-1990s and the early part of the new century is examined using data from two detailed national household surveys. Little evidence is found that this decrease infertility signals the beginning of a sustained decline. Rather, the results indicate that one of the outcomes of the military mobilization and displacement associated with the 1998-2000 border conflict with Ethiopia was a steep reduction in the proportion of women exposed to the risk of pregnancy. Part of this reduction was due to delayed age at marriage, but it came about largely because married women were less likely to be living with their husbands in 2002 than in 1995. Projections of the number of births that could occur if women implement their stated reproductive intentions and a postwar "baby boom" results show that the health system may be facing an increased demand for child health services over the next several years. |
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Monitoring trends in sexual behaviour in Zambia, 1996-2003
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Slaymaker E, Buckner B |
2004 |
English |
Africa, ZAMBIA, Southern Africa |
Condoms, HIV/AIDS |
Objectives: This paper assesses the evidence of changes in sexual behaviour in Zambia, accounting for differences in the composition of survey samples and for evidence of changes in reporting bias. It compares the estimates of sexual behaviour measures obtained using two different survey methodologies. Methods: Data from five nationally representative household surveys carried out between 1996 and 2003 were analysed for change in selected sexual behaviours. Results: There is some evidence for an increase in mens age at first sex. The proportion of people reporting multiple partnerships and not using a condom at last sex has declined since 1996. Unprotected sex with non-cohabiting partners is reported less frequently in the later surveys. The socioeconomic and demographic composition of the survey samples has changed across the years but the declines in behaviour remain statistically significant after adjustment for these changes. There is evidence of a changing reporting bias over the period of interest, with respondents less likely to report a young age at first sex in later surveys. Conclusions: Between 1996 and 2003, reported sexual behaviour has changed in Zambia among both men and women. Different survey methods produce significantly different estimates of sexual behaviour. This must be taken into account when carrying out trend analyses using data from different sources. |
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Monitoring sexual behaviour in general populations: a synthesis of lessons of the past decade
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Cleland J, Boerma JT, Carael M, Weir SS |
2004 |
English |
|
HIV/AIDS |
This supplement contains selected papers from a workshop on the measurement of sexual behaviour in the era of HIV/AIDS held at the London School of Hygiene and Tropical Medicine in September 2003. The focus was on low and middle income countries, where the majority of HIV infections occur. The motive for holding such a meeting is easy to discern. As the AIDS pandemic continues to spread and as prevention programmes are scaling up, the need to monitor trends in sexual risk behaviours becomes ever more pressing. Behavioural data are an essential complement to biological evidence of changes in HIV prevalence or incidence. Biological evidence, though indispensable, is by itself insufficient for policy and programme guidance. AIDS control programmes need to be based on monitoring of not only trends in infections but also of trends in those behaviours that underlie epidemic curtailment or further spread. |
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Bulletin 7: Strengthening Monitoring & Evaluation of Maternal Health Programs.
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|
2004 |
English |
Africa, BENIN, GUATEMALA, Latin America and the Caribbean, West Africa |
Pregnancy, Maternal Mortality, Maternal Health |
Each year, more than 500,000 women die as a result of pregnancy and childbirth, and more than 50 million women suffer from poor reproductive health. This issue of the MEASURE Evaluation Bulletin summarizes the results of several activities related to the monitoring and evaluation of maternal health programs. Two articles describe complementary studies undertaken in Guatemala and Benin that assess the status, current use, and potential use of facility-based maternity registers for monitoring maternal health programs at different system levels. A third article discribes efforts to increase use of the Latin American Center for Perinatology database by developing Web-based data analysis tools. Finally, MEASURE Evaluation compiled a Web-based compendium of existing tools for monitoring and evaluation of maternal and newborn health programs. |
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Monitoring and Evaluation of National AIDS Programs: Taking Stock of Progress. Dakar, Senegal, Oct. 6-8, 2003
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|
2004 |
English |
SENEGAL, West Africa, Africa |
Workshop, HIV/AIDS |
This report, written in both French and English, summarizes the discussion and action plans developed at a M&E workshop of national AIDS programs held in Dakar Senegal in October 2003. The workshop, titled "Monitoring and Evaluation of National AIDS Programs: Taking Stock of Progress" was designed to review country progress in development and implementation of M&E activities and to discuss lessons learned. |
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PLACE in South Africa: Monitoring AIDS Prevention in Two Townships in Port Elizabeth, 2001-2003
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Pailman C, Weir S S, Herman C K |
2004 |
English |
Southern Africa, Africa, SOUTH AFRICA |
Monitoring, HIV/AIDS, Monitoring, Sexually Transmitted Infections (STIs), At-Risk Populations |
Researchers implemented the PLACE (Priorities for Local AIDS Control Efforts) method in two townships in the Eastern Cape of South Africa in 2001 and 2003. As part of an initiative to focus on these locals that have an elevated risk of HIV and other sexually transmitted infections, the PLACE protocal was implemented to identify specific high-risk locations where locals met to find new sexual partners and inject drugs and to monitor strategically located prevention efforts. Townships in Port Elizabeth and Utienhage were selected because of high levels of poverty, population mobility, and unemployment. A list of sites where people meet new sexual partners was developed, and interview teams visited and mapped each site. Researchers then asked people attending these venues about their sexual behaviors, knowledge, and receptivity to HIV/AIDS prevention efforts. This 106-page report provides the results of these protocols and provides recommendation for future HIV/AIDS prevention interventions. |
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The Reach and Impact of Radio Communication Campaigns on Reproductive Health in Malawi
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Meekers D, Van Rossem R, Silva M, Koleros A |
2004 |
English |
MALAWI, Southern Africa, Africa |
Condoms, Reproductive Health |
State-sponsored radio programs in Malawi attempt to educate the population about family planning, health, and condom use. This paper assesses the reach of these program and analyzes their actual impact on family planning and condom use. Researchers used data from the 2000 Malawi Demographic and Health Survey. Researchers found that exposure to radio programs about family planning and health was very high, particularly for males. Both men and women who were exposed to radio programs about family planning and HIV/AIDS were more likely to have discussed family planning with their partners, but unfortunately had no significant effect on condom use in last intercourse for either sex. To insure that future radio programs increase their effectiveness in increasing condom use for HIV prevention and family planning, this report recommends that qualitative research be used to inform the design of key campaign messages. |
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Report of PLACE Assessments in Tashkent, Uzbekistan, Central Asia, 2002 and 2003
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Abdullaev S, Tate J E, Bassett-Hileman S, Weir S S |
2004 |
English |
UZBEKISTAN, Central Asian Republics, Newly Independant States, Europe and Eurasia (was ENIS), Asia |
Monitoring, HIV/AIDS, Sex Workers, Monitoring, Sexually Transmitted Infections (STIs), At-Risk Populations |
Previous HIV surveillance in Uzbekistan suggested that the HIV epidemic is concentrated among urban injection drug users, but that HIV has the potential to spread to the general population via heterosexual transmission. The PLACE (Priorities for Local AIDS Control Efforts) protocol was implemented in the Uzbek city of Tashkent in 2002 and 2003 to determine whether there was any overlap between injecting-drug-user and sexual networks, and to determine how HIV-prevention efforts should be focused to be most effective. Key informants identified nearly 2,000 sites where people meet new sexual partners, commercial sex workers solicit clients, and injection drug users socialize. Researchers then interviewed people visiting these sites about their sexual and injecting-drug-use behaviors and attitudes, as well as their receptivity to HIV/AIDS prevention efforts. This 228-page working paper summarizes researchers' findings, provides analysis, and suggests future directions for HIV/AIDS prevention efforts in Uzbekistan. |
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Report of PLACE Assessments in Osh, Kyrgyzstan, Central Asia 2002 and 2003
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Elibezova E, Tate J E, Bassett-Hileman S, Weir S S |
2004 |
English |
KYRGYZSTAN, Central Asian Republics, Newly Independant States, Europe and Eurasia (was ENIS), Asia |
Monitoring, Condoms, HIV/AIDS, Sex Workers, Monitoring, Sexual Behavior, At-Risk Populations |
The limited HIV surveillance in Kyrgyzstan suggests that the HIV epidemic is concentrated among urban injection drug users, but models of the epidemic predict that HIV could spread into the general population via heterosexual transmission. The PLACE (Priorities for Local AIDS Control Efforts) protocol was implemented in Osh, Kyrgyzstan in 2002 and 2003 to see if IDU and sexual networks overlap, and to identify where HIV prevention efforts should focus to be most effective. Key informants identified about 250 sites in the city of Osh where people meet to find sexual partners and to inject drugs. Researchers verified and visited these sites, and then they interviewed people there about their sexual and injecting-drug-use behaviors, knowledge, and attitudes towards prevention efforts. This 230-page report details the results of these interviews, and offers analysis and recommendations for future HIV-prevention efforts. |
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Report of PLACE Assessments in Karaganda, Kazakhstan, Central Asia, 2002 and 2003
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Zhussupov B, Alimbekova G, Tate J E, Bassett-Hileman S, Weir S S |
2004 |
English |
KAZAKHSTAN, Central Asian Republics, Newly Independant States, Europe and Eurasia (was ENIS), Asia |
Monitoring, Condoms, HIV/AIDS, Sex Workers, Monitoring, At-Risk Populations |
The PLACE (Priorities for Local AIDS Control Efforts) protocol was implemented in Karganda, Kazakhstan in 2002 to determine whether there was any overlap in the injecting drug user and sexual netowrks and to identify where HIV prevention efforts should focus to minimize HIV transmission. A follow-up assessment was planned for 2003 to determine to what extent AIDS prevention programs had successfully reached target sites and whether gaps remained in program coverage. This report summarizes the findings of these two assessments. Unfortunately, the interim period between assessments was not sufficient to implement the range of prevention activites anticipated, so the 2003 assessment was essentially a repeat of the 2002 assessments with some additional improvements and objectives. |
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Report of PLACE Assessments in Almaty, Kazakhstan, Central Asia 2002 and 2003
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Zhussupov B, Alimbekova G, Tate J E, Bassett-Hileman S, Weir S S |
2004 |
English |
Asia, Newly Independant States, KAZAKHSTAN, Central Asian Republics, Europe and Eurasia (was ENIS) |
Condoms, HIV/AIDS, Sex Workers, Monitoring, At-Risk Populations |
This in-depth, 236-page report discusses the results of the Priorities for Local AIDS Control Efforts (PLACE) analysis of Almaty, Kazakhstan conducted in 2002 and 2003. PLACE 2002 and PLACE 2003 attempted to identify specific sites within Almaty where HIV transmission was likely to occur and to examine the change in these sites over time. This assessment included questions provided by local intervention groups to help focus and monitor prevention programs, and attempted to collect more information to estimate the size of the most-at-risk populations in Almaty. Community informants identified more than 850 unique sites in 2002 and more than 1,000 unique sites in 2003 as places where people meet new sexual partners, commercial sex workers solicit clients, and injection drug users socialize. Researchers interviewed 2,100 individuals at more than 250 of these sites about their risk behaviors, receptivity to HIV/AIDS prevention efforts. The results of this work, as well as in-depth analysis and recommendations for future HIV/AIDS prevention efforts, are presented in this report. |
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Monitoreo y Evaluacion de las Reformas de Descentralization en los Sectores de Salud de los Paises en Desarrollo
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Hutchinson PL, LaFond AK |
2004 |
Spanish |
Latin America and the Caribbean, Global |
Public Health |
La descentralización de responsabilidades del gobierno central hacia instancias gubernamentales inferiores o instituciones semi autónomas se ha transformado en una estrategia cada vez más generalizada para mejorar los sistemas de salud en los países en desarrollo y, en última instancia, mejorar el estado de salud de los habitantes de dichos países. Ahora bien, los esfuerzos tendientes a monitorear y evaluar la concreción y el funcionamiento de los programas de descentralización se ha visto muchas entorpecido por la escasa y deficiente información, por la falta de diseños acordes de investigación y por el vasto campo de la reforma, que puede englobar todos los aspectos del funcionamiento del sistema de salud. Este trabajo presenta un marco conceptual que permite identificar áreas clave para el monitoreo y la evaluación de los programas y las vías de acción y los posibles obstáculos mediante las cuales la descentralización puede afectar los sistemas de salud. También identifica diferentes maneras de evaluar el impacto de la descentralización en términos del logro de objetivos clave mayor eficiencia, accesibilidad, equidad, participación de la comunidad y estado de salud. En este trabajo se presentan los tipos de datos que pueden reunirse y un conjunto de indicadores en diferentes áreas política, administrativa y fiscal que pueden resultar útiles para efectos de monitoreo y evaluación. La mayoría de los indicadores descritos pueden ser obtenidos a partir de técnicas existentes de recolección de datos, aun cuando hoy por hoy muchos de esos datos no son usualmente recolectados en muchos países. También se describen diferentes herramientas de recolección de datos y diversos tipos de análisis, incluidas las evaluaciones de impacto de la descentralización, que pueden utilizarse con estos datos. Hay un versión de este reportaje en ingles: "Monitoring and Evaluation of Decentralization Reforms in Developing Country Health Sectors |
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Monitoring and Evaluation of Decentralization Reforms in Developing Country Health Sectors
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Hutchinson PL, LaFond AK |
2004 |
English |
Latin America and the Caribbean, Global |
Public Health |
The decentralization of responsibilities from the central government to lower levels of government or semi-autonomous institutions has become an increasingly common strategy for improving the performance of health systems in developing countries and ultimately for improving the health status of developing country populations. However, efforts to monitor and evaluate the implementation and functioning of decentralization programs are often hampered by poor or incompatible data, by the absence of sound research designs, and by the sheer scope of the reform, which can encompass all aspects of health system functioning. This work presents a conceptual framework for identifying key areas for evaluation of decentralization programs and the pathways and potential barriers by which decentralization can affect health systems. It also identifies ways to evaluate the impact of decentralization in achieving key objectives improved efficiency, accessibility, equity, community participation and health status. The work outlines the types of data that can be collected and a detailed set of indicators in several broad areas political, administrative, and fiscal that can be useful for monitoring and evaluation purposes. Most of the indicators described can be collected from existing data collection techniques, although to date, many of these data are not part of routine data collection in many countries. Numerous data collection tools are also described, as are the types of analyses including impact evaluations of decentralization that can be undertaken with that data. A spanish-language version of this technical report, "Monitoreo y Evaluacion de las Reformas de Descentralization en los Sectores de Salud de los Paises en Desarrollo," is also available. |
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Avoiding Unwanted Pregnancy and Sexually Transmitted Infections: A Rural Malawi District Study
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Center for Social Research, Malawi Ministry of Health and Population, Save the Children Federation USA, MEASURE Evaluation |
2004 |
English |
MALAWI, Southern Africa, Africa |
Sexually Transmitted Infections (STIs), Fertility, Maternal Health, HIV/AIDS, Rural Populations |
The Pregnancy and Sexually Transmitted Infection Avoidance Study was conducted in the rural Mangochi district of Malawi from 2000 to 2002 to assess the levels of perceived risk for unwanted pregnancy and STIs and the relationship between perceived risk and sexual activity and avoidance behaviors. This 136-page study presents the following results and also provides implications for future efforts to control the spread of HIV/AIDS and other STIs: Fertility demand remained high, with a reported ideal family size of four children. Roughly one-fifth of couples were using some form of contraception, most often injectable and periodic abstience. Most men and women knew that abstience and condom use are means to avoid HIV infection, but neither men nor women were likely to use either of these methods. For both HIV and other STIs, women and men were most likely to report friends and relatives as their first source of information. Most women and men were likely to cite no barriers to STI and HIV treatment. Men are more aware of STI and HIV risk than women. |
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PLACE in Mexico Focusing AIDS Prevention in Border Towns 2001
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Hileman SB, Bronfman M, Martinez Sanchez C, Negroni Belen M, Ortiz Mondragon R, Rueda Neria C, Vargas Guadarrama G, Weir S |
2004 |
English |
MEXICO, Latin America and the Caribbean |
HIV/AIDS, At-Risk Populations, Monitoring |
In Mexico, HIV/AIDS prevalence is concentrated among men who have sex with men and injecting drug users, but low in the general population. However, these populations and others in Mexico are extremely mobile, and there exists a real possibility that HIV/AIDS will "spill over" into the general population. This project attempted to reduce vulnerability of mobile populations in Mexico to HIV/AIDS. For this project, the PLACE (Priorities for Local AIDS Control Efforts) method was carried out in Chetumal and Ciadad Hidalgo Mexico in 2001. Key informants reported 200 sites where people in these regions meet new sexual partners; researchers then visited these venues and interviewed people their about their sexual behaviors and receptivity to HIV/AIDS prevention efforts. Mobile populations in both areas mix with local residents, and attend these sites to find new sexual partners. Reported condom use at last sex was higher at Cidad Hidalgo than at Chetumal. At both areas, condoms were unavailable at most sites. Utilizing these sexual network sites for AIDS prevention could further focus programs and would complement a strong general-population campaign. Site-based programs would also provide access to hard-to-reach mobile populations with prevention messages. |
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PLACE in Central Asia: A Regional Strategy to Focus AIDS Prevention in Almaty and Karaganda, Kazakhstan; Osh, Kyrgyzstan; Tashkent, Uzbekistan 2002.
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|
2004 |
English |
Europe and Eurasia (was ENIS), Asia, Central Asian Republics, KYRGYZSTAN, KAZAKHSTAN, UZBEKISTAN, Newly Independant States |
At-Risk Populations, HIV/AIDS, Sex Workers, Condoms, Monitoring |
Researchers used the Priorities for Local AIDS Control Efforts (PLACE) method to within the Central-Asian countries of Kazakhstan, Kyrgystan, and Uzbekistan. The PLACE method identifies specific sites where high-risk populations meet to find sexual partners and inject drugs, and then collects behavioral information from the people attending these sites and assesses local HIV/AIDS prevention efforts. HIV surveillance is currently limited in Central Asia, but it suggests that some geographic areas may have high incidences of infection; these incidences could spill over to the general population if effective prevention measures are not made. The cities of Almaty and Karaganda in Kazakhstan, Osh in Kyrgystan, and Tashkent in Uzbekistan were selected as cities for this assessment, which was conducted in 2002. Key informants identified almost 3,000 unique sites where people meet new sexual partners, commercial sex workers solicit clients, or injecting drug users socialize. Researchers visited these venues and interviewed more than 7,500 individuals there about their sexual behaviors, condom use, propensity to share needles, and willingness to attend HIV/AIDS prevention programs. This 254-page report describes and analyzes these data, and offers recommendations on how to target effective and low-cost HIV/AIDS prevention efforts to these groups. |
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PLACE in South Africa: Monitoring AIDS Prevention in a Township in Cape Town, 1999-2002.
|
|
2004 |
English |
Southern Africa, SOUTH AFRICA, Africa |
At-Risk Populations, Sexually Transmitted Infections (STIs), HIV/AIDS, Monitoring, Sex Workers |
Researchers used the Priorities for Local AIDS Control Efforts (PLACE) method in Cape Town, South Africa, from 1999 to 2002. The PLACE method identifies specific sites where high-risk populations meet to find sexual partners and inject drugs. PLACE efforts then collects behavioral information from the people attending these sites and assesses local HIV/AIDS prevention efforts. For this study, 977 people socializing at 40 sites were randomly selected and interviewed in 1999, 2000, and 2002 about their sexual history, condom use, and willingness to attend HIV/AIDS educational programs. |
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PLACE in Jamaica: Monitoring AIDS Prevention at the Parish Level, St. James, 2003.
|
|
2004 |
English |
JAMAICA, Latin America and the Caribbean |
Sexual Behavior, Monitoring, Sex Workers, Jamaica, Condoms, HIV/AIDS, At-Risk Populations |
Researchers used the Priorities for Local AIDS Control Efforts (PLACE) method to collect information about high-risk populations in the St. James parish of Jamaica. About 1.5% of the adult population in Jamaica is infected with HIV, and the parish of St. James has a cumulative AIDS case rate that is two-and-a-half times higher than the national average. In 2003, community informants identified almost 500 local sites where Jamaicans meet to find new sexual partners and inject drugs; researchers then visited these sites, interviewed attendants about their sexual behaviors, and assessed sites for their capacity to house HIV/AIDS prevention efforts. Findings from this study suggest that focusing interventions at sexual network sites could reach people with high rates of new partner acquisition with condoms and prevention messages to decrease their risk of acquiring HIV and other STIs. A site-based approach is also likely to be a cost-effective way of reaching these people, who are most in need of prevention efforts. |
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PLACE in South Africa: Evaluation of a Successful Community-Based AIDS Prevention Program, East London, 2000-2003.
|
|
2004 |
English |
SOUTH AFRICA, Southern Africa, Africa |
HIV/AIDS, At-Risk Populations, Monitoring |
Two waves of the Priorities for Local AIDS Control Efforts (PLACE) assessments were conducted in East London, South Africa between 2000 and 2003. The first assessment attempted to identify and characterize sites where HIV transmission was likely to occur, and to use that information to develop an HIV/AIDS prevention program for the community. The second assessment attempted to evaluate the impact of the intervention on site characteristics and on the behaviors of those socializing at them, and to use the data to improve the intervention strategy. This 160-page report presents the results of these assessments, in which key informants identified sites where groups at high risk for HIV met to socialize and meet new sexual partners; researchers then visited these sites to interview people there about their sexual and injecting-drug-use behaviors and attitudes, as well as their receptivity to HIV-prevention efforts. The PLACE efforts identified major gaps in AIDS prevention activities and condom availability at baseline, but intervention efforts resulted in a higher percentage of sites that hosted AIDS educational activities and distributed condoms. Additionally, this report provides recommendations for future HIV/AIDS prevention efforts. |
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PLACE in Russia: Identifying Gaps in HIV Prevention in St. Petersburg, 2002.
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|
2004 |
English |
Europe and Eurasia (was ENIS), RUSSIAN FEDERATION, Asia, Eastern Europe |
HIV/AIDS, At-Risk Populations, Monitoring, Sexually Transmitted Infections (STIs), Sexual Behavior, Condoms, Sex Workers |
Researchers used the Priorities for Local AIDS Control Efforts (PLACE) method to identify specific sites within St. Petersburg, Russia, where people meet to find sexual partners and to inject drugs. Russia has one of the highest HIV incidence rates in the world, and the current HIV/AIDS epidemic is strongly concentrated among injecting-drug users. The PLACE method was implemented in three areas of St. Petersburg from April to August, 2002. Community informants identified 350 sites in venues where people met to inject drugs and meet new sexual partners. Researchers then interviewed people and assessed HIV/AIDS prevention capabilities at these sites. This 105-page report presents the results of this research and offers recommendations on how to target St. Petersburgs high-risk populations in an effective and cost-efficient manner. |
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Zambia Sexual Behaviour Survey 2003
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2004 |
English |
ZAMBIA, Southern Africa, Africa |
Sexually Transmitted Infections (STIs), Condoms, HIV/AIDS |
The 2003 Zambia Sexual Behavior Study (ZSBS) is the third in an ongoing series of surveys designed to monitor the effectiveness of HIV-reduction programs. The main objective of the 2003 ZSBS was to obtain national estimates of key indicators for the National HIV/AIDS/STD program monitoring process, including indicators on HIV/AIDS-related knowledge, attitudes, and sexual and health-seeking behaviors. |
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1998 South Africa Demographic and Health Survey Report for Eastern Cape Province, Summary Report with Results from Impact Evaluation.
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MEASURE Evaluation, The Equity Project |
2004 |
English |
Southern Africa, Africa, SOUTH AFRICA |
Child Mortality, HIV/AIDS, Public Health |
This 30-page report briefly summarizes the most important findings of the 1998 South Africa Demographic and Health Survey (SADHS), with further analysis after an impact evaluation of government health services on the health of the local population. The information and findings presented in these pages represent a summary of a more extensive report, which is also available on the MEASURE Evaluation Web site. This report includes analyses not present in that larger report, including socio-economic status analyses, regional analyses, survival analyses, adult health analyes, and impact evaluation analyses. |
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1998 South Africa Demographic and Health Survey Report for Eastern Cape Province
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MEASURE Evaluation, The Equity Project |
2004 |
English |
Africa, SOUTH AFRICA, Southern Africa |
HIV/AIDS, Child Mortality, Maternal Health, Fertility, Child Health, Public Health |
This 217-page report summarizes the analysis of the 1998 South Africa Demographic and Health Survey (SADHS). SADHS data confirm and quantify the large inequities that exist between the Eastern Cape Province and other South African provinces, as well as the inequities between populations in the Eastern Cape Province. The 1998 SADHS data are augmented here by data on government health facilities that serve the population of the Eastern Cape. This report details key findings in child mortality, fertility and family planning, maternal and child health, AIDS knowledge and behavior, adolescent health, adult health, and impact of facility quality. |
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Evaluando Proyectos de Prevencion VIH/SIDA: Un Manual con Enfoque en las ONG
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Bertrand JT, Solis M |
2004 |
Spanish |
Global, Latin America and the Caribbean |
HIV/AIDS |
El proposito de este manual es demitificar los procesos de evaluacion, sobre todo para el personal que no es especialista en las tecnicas de evaluacion. Nuestra meta es que este manual sirva de guia en el diseño y realizacion de evaluaciones de programas/proyectos de prevencion del VIH/SIDA. Ademas, se incluye alguna informacion pertinente a los programas/proyectos de atencion pertinente a los programas/proyectos de atencion a usarios de los servicios clinicos de atencion de VIH/SIDA. |
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The Reach and Impact of Social Marketing and Reproductive Health Communication Campaigns in Tanzania
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Meekers D, Silva M |
2003 |
English |
TANZANIA, East Africa, Africa, Southern Africa |
HIV/AIDS, Reproductive Health |
Objectives: In Tanzania, governmental and non-governmental organizations are increasingly relying on health education and communications to provide information about reproductive health and HIV/AIDS prevention and to promote healthy behavior, including condom use, abstinence, and partner reductions. This paper studies the reach of the Green Star family planning program, six different radio drama series, and the Salama condom social marketing campaign in Tanzania. In addition, it assesses the impact these programs have on discussion of family planning and condom use. Data: The 1999 Tanzania Reproductive and Child Health Survey containing a sample of 4,029 women (age 15-49) and 3,542 men (age 15-59) was used for this analysis. Results: Results show that 42% of women and 53% of men were exposed to both the social marketing and other reproductive health communication campaigns. For both genders the likelihood of being exposed to campaigns was higher among educated urban dwellers with access to the media. Estimates of the impact of campaign exposure show that for both men and women exposure to the Salama campaign, the reproductive health dramas, and the Green Star program had a significant positive effect on discussion of family planning and ever-use of condoms. Exposure to any of the campaigns also had a positive effect on the likelihood of having used a condom in the last sex act for men (OR=1.1 for drama exposure, OR=1.3 for Salama exposure, and OR=1.2 for Green Star exposure); however, only the Salama campaign had a significant effect on women's use of condoms at last sex act (OR=1.2). Conclusions: The three types of programs discussed in this paper succeeded in reaching substantial portions of the population. Yet further efforts must be made to reach rural, less educated and low socio-economic status populations. To a large extent the programs reached similar audiences, thereby reinforcing the messages. Exposure to the campaigns had a positive effect on discussion of family planning and condom use. As this effect increased with level of exposure, it is important for future campaigns to increase the number of channels through which they disseminate campaign messages and to increase the frequency of such messages. |
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Determinants of Contraceptive Method Choice in Rural Tanzania Between 1991 and 1999
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Chen S, Guilkey D K |
2003 |
English |
Southern Africa, Africa, TANZANIA, East Africa |
Contraception |
Four pooled Demographic and Health survey data sets are used to examine the determinants of contraceptive method choice in rural Tanzania in the period 1991 to 1999. The individual data is linked to facility surveys conducted in the same communities so that the impact of Tanzania's family planning program can be examined. The very large sample size allows us to disaggregate method choice into five categories, including a separate category for condoms, even though this is a very low prevalence country. In addition, we are able to examine the impact of pharmacies. The focus of the paper is an examination of the impact on method choice of the three major components of Tanzania's program: logistical support, trained providers, and communications programs. The statistical methods employed correct for the potential endogeneity of message recall by joint estimation of an equation explaining contraceptive method choice and equations explaining family planning message recall and recall of having heard a radio drama. Simulations are used to quantify the impact of the important policy variables. |
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HIV and Child Mortality: Evidence from Surveillance Studies in Uganda, Tanzania and Malawi
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Zaba B, Marston M, Nakiyingi J, Whitworth J, Ruberantwari A, Urassa M, Issingo R, Mwaluko G, Crampin A, Floyd S, Nyondo A, Bracher M |
2003 |
English |
MALAWI, UGANDA, Southern Africa, TANZANIA, Africa |
Census, Child Health, HIV/AIDS, Maternal Health, Child Mortality |
The steady decline in child mortality that has been seen in most African countries in the 1960s, 70s and 80s has stalled in many countries in the 1990s, because of the AIDS epidemic. However, the census and household survey data that are generally used to produce estimates of child mortality do not enable the adverse effect of HIV on child mortality to be precisely quantified. This paper uses pooled data from three longitudinal community based studies that classified births by the mother's HIV status to calculate the excess risks of child mortality due to maternal HIV status. The excess risks of child death due to increased mortality among mothers are also estimated, and the joint effects of maternal HIV status and maternal survival are quantified using multivariate techniques in a survival analysis. The analysis shows that the excess risk of death associated with having an HIV positive mother is 3.2, and this effect lasts throughout childhood ages. The excess risk associated with a maternal death is 3.6 in the two year period centered on the mother's death, with children of both infected and uninfected mothers experiencing elevated mortality risks at this time. |
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The Social Side of Service Accessibility
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Entwistle B, Weinberg A, Rindfuss R R, Faust K |
2003 |
English |
THAILAND, Asia, South Asia, East Asia |
Child Health, Public Health, Health Facilities, Maternal Health, HIV/AIDS |
This methodological project relates both to the conceptualization and measurement of potential program effects. The starting point is the hypothesis that the social side of service accessibility--i.e., social network characteristics that affect access to information and redundancy in the information obtained--is important to an understanding of accessibility and its effects. Our results suggest that this is true. Using a unique survey data set for Nang Rong, Thailand, we formalize social network concepts at the individual and village level, and then examine effects on contraceptive choice--method and source--in the context of models that also take into account physical proximity. To quickly summarize our results: Proximity to family planning outlets affected contraceptive choices, especially source choices. Women living further away from a local health center were less likely to choose a local health center, and women living further away from a hospital were less likely to choose a hospital. Proximity mattered less, however, for women living in households directly linked by sibling ties to other households in the village and to siblings living in other places. Results inform the design and interpretation of evaluation efforts in a variety of settings, and the potential role of social networks in bringing about program effects. While the specific focus is the provision of family planning services, the idea extends to the provision of STD or maternal and child health services as well. |
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The Effects of Education and Family Planning Programs on Fertility in Indonesia.
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Angeles G, Guilkey D K, Mroz T A |
2003 |
English |
East Asia, Asia, South Asia |
Fertility |
Numerous studies indicate that female education is a major determinant of completed family size and the length of the interval between births. The estimated reductions of fertility rates due to increases in education typically dwarf the effects of most other variables, including variables included to measure the availability of family planning programs. Based on such estimates, some analysts have concluded that programs to increase women's educational attainments might be the most effective way to stimulate reductions in fertility in developing countries. There are, however, two serious deficiencies in the research relating educational attainment to fertility that could give rise to invalid inferences about the causal impacts of education. First, many public programs, including health and family planning programs, may influence a woman's decisions about education, and these indirect programmatic effects might be large. Second, nearly all existing studies of the impacts of education on fertility assume that a woman's educational attainment is unrelated to other unobserved determinants of these outcomes. Education could be serving as a proxy for such unobservable determinants as ability, motivation, and parental background, as these factors most likely are important determinants of a woman's educational attainment. The estimated impact of education on fertility most likely includes the impacts of these unobserved factors as well as the true education effect. In our empirical work, we use the 1993 Indonesian Family Life Survey (IFLS). We compare the estimated impacts of education on fertility from a simple model that assumes the exogeneity of education and an unobserved factor model that allows for endogeneity of schooling. Our empirical results provide key evidence that the importance of female education as means of reducing fertility would be overstated for Indonesia if one uses a naive empirical model that does not control for endogeneity due to the self-selection of a woman's educational status. |
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Understanding Perceptions of HIV Risk among Adolescents in KwaZulu-Natal.
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Macintyre K, Rutenberg N, Brown L, Karim A |
2003 |
English |
Africa, SOUTH AFRICA, Southern Africa |
HIV/AIDS |
Risk perception has been theorized to be an important antecedent for adopting protective behavior. It is a key construct of research applying the Health Belief Model and other behavior change models. In relation to HIV, risk perception is an indicator of perceived susceptibility to infection, a measure of one's understanding of AIDS transmission as well as willingness to consider behavioral changes. However, there remains much we do not know about what drives risk perception, especially among youth. This study identifies factors that influence the calculation of HIV risk perception among a group of adolescents in South Africa. Data, collected in 1999 from 2,716 adolescents aged 14-22, are used to explore factors predicting risk perception. Logistic regression models suggest connectedness to parents and community for males and females, self-efficacy to use a condom among males and living in a household with a chronically ill member for females are associated with HIV risk perception. We conclude that a greater understanding of the connection of adolescents to their communities and adults in their lives is needed, and ways in which programs can alter the environments in which adolescents form opinions, make choices, and act should be incorporated into program design. |
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Contrasting Primary School Outcomes of Paternal and Maternal Orphans in Manicaland, Zimbabwe: HIV/AIDS and Weaknesses in the Extended Family System
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Nyamukapa C, Gregson S |
2003 |
English |
Southern Africa, Africa, ZIMBABWE |
Child Health, Orphans and Vulnerable Children, Child Mortality |
Fewer orphans are enrolled in school than other children but the extent of disadvantage-after allowing for their older average age- is small in most countries. Cross country analyses show variation in the size and strength of associations between orphanhood and education according to the form of parental loss experienced. However, maternal death is usually more detrimental to children's education chances than paternal death and double orphans are typically the least likely to be in school. These differences are not fully accounted for by differences in household socio-economic circumstances. In a case study in Manicaland, Zimbabwe, we found that children who had lost their mothers at an early age were less likely to have completed primary school than other children but that the reverse was true for paternal orphans. These results remained valid even after controlling for other factors that influence primary school completion, including child's sex and age, economic status of household, and characteristics of household head. In an in-depth study of the extended family system in Manicaland, we identified factors that support the education of paternal orphans and reduce the school chances of maternal orphans. The former include the increased role and greater motivation of surviving mothers and more extensive involvement of relatives. The latter include low priority given by surviving fathers and step-mothers to the child's education and more frequent residence with more distant relatives. The extended family and Government and NGO programmes are less likely to provide support when the natural father is still alive. The extended family system provides the most conducive and sustainable context for orphans' upbringing but is becoming seriously fragmented. Care is needed to ensure that initiatives intended to assist orphans support and build upon rather than undermine extended family arrangements. |
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The Impacts of Decentralization on Health Behaviors in Uganda
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Hutchinson P, Akin J, Ssengooba F |
2003 |
English |
Africa, Southern Africa, UGANDA |
Public Health |
This paper examines the impacts of a public sector decentralization program on the demand for health care in Uganda in the 1990s. This work is an extension of a previous paper, which provided evidence of a shifting of priorities by local governments in Uganda's decentralized health system away from provision of primary health care, in particular the provision of public goods or goods with substantial consumption externalities, and toward provision of private health goods such as curative care. This work furthers that analysis by examining how local planners allocation decisions among these different types of primary health care and curative care services affect individual-level health behaviors. This analysis finds that, while the country has been undergoing a multitude of changes in recent years, decentralization appears to have led to increases in the use of curative services with exclusively private benefits, perhaps at the expense of use of primary health care services and services with consumption externalities. A longer period of analysis is required to determine the persistence of these effects. |
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How and When Should One Control for Endogenity Biases? Part I: The Impact of a Possibly Endogenous Explanatory Variable on a Continuous Outcome
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Angeles G, Guilkey D K, Mroz T A |
2003 |
English |
|
Public Health |
The interpretation of coefficients estimates from ordinary least square regressions and other statistical models depends crucially on whether any explanatory variable in the statistical model is correlated with the ôerror termö influencing the outcome of interest. If there is a relationship between any explanatory variable and the unmeasured determinants of an outcome, then one usually cannot interpret any of the estimated coefficients as the impact of the corresponding covariate on the outcome of interest. In the medical and public health literature, this is often called the problem of confounding effects. In economics and sociology, one typically calls this the problem of endogenous regressors. Regardless of the label chosen for this relationship, the presence of a correlation between the measured and unmeasured determinants of an outcome results in biased estimators of the impacts of all covariates. In this paper we explore the severity of the possible biases that can arise when such correlations are present, and we examine the performance of some simple estimators that have been developed to reduce the bias. We start out by examining ordinary least square models with continuous outcomes and continuous regressors because most of the intuition about the problems and the solutions can be developed simply in that context. We then examine endogeneity problems and solutions for three other sets of models that researchers often encounter in practice: a continuous outcome influenced by an endogenous binary regressor; a binary (discrete) outcome determined by an endogenous continuous regressor; and a binary outcome being influenced by an endogenous binary regressor. In nearly all instances we focus on the estimation of the impact of the possibly endogenous regressor on the outcome of interest, but it is important to recognize that estimators for all effects in a model, not just those for the endogenous variables, usually are biased when any explanatory variable is endogenous. We also examine the performance of estimators in situations where the researcher cares about more than just the bias of the estimator. |
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The Role of User Charges and Structural Attributes of Quality On the Use of Maternal Health Services in Morocco
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Hotchkiss D R, Krasovec K, El-Idrissi M D Z, Eckert E, Karim A M |
2003 |
English |
West Africa, MOROCCO, Africa |
Maternal Health |
This study examines the role of household out-of-pocket costs and structural attributes of quality on the use of maternity care in Morocco using empirical data collected from both households and health care facilities. The study uses a nested mixed multinomial logit model to estimate the effects of structural attributes of quality, price, distance, and individual characteristics of women on the utilization of skilled and unskilled delivery assistance. The availability of a special DHS supplement on household out-of-pocket health care expenditures, as well as individual-, household-, and facility-specific information, makes this the first study of the demand for maternity care based on DHS data. The Moroccan setting provides substantial variation in the types of assistance available to women, ranging from home delivery aided only by friends and relatives at one extreme, to modern private hospitals at the other end of the spectrum. The reduced-form model specifications contains price, travel time, and different combinations of structural attributes of quality, including the availability of medical equipment, drugs, and infrastructure, the numbers and types of practitioners in the facility, and the availability various types of maternity services, and the interaction of these variables with individual characteristics of Moroccan women. The coefficient estimates are used to carry out policy simulations of the impact of changes in the level of out-of-pocket fees on utilization patterns for maternity care in Morocco. As of 1995, the majority of Moroccan women still gave birth at home, without the assistance of a skilled birth attendant (55.9 percent). Rural women were five times as likely as urban women to have home births without skilled assistance (78.7 percent vs. 18.8 percent). All forms of maternity care were more economically and geographically accessible to urban compared to rural women. The public sector was the most common source of facility based care (34 percent), as well as a more important source of care for urban (58 percent) than rural (19 percent) women. Rural women from richer households were considerably more likely than poor women to use public providers; while in urban areas, where there is better availability of private practitioners, wealthier women were slightly less likely to use public providers. Facility-based private health care providers assisted 16 percent of urban deliveries, but fewer than one percent of rural deliveries. On the whole, quality of care measures, such as the availability of drugs, equipment and infrastructure, were not substantially better in private facilities than in public facilities. Our policy simulations showed that increases in out-of-pocket costs for public facilities would be expected to have very little impact on women living in better-off households, but would have a substantial and detrimental effect on the poor. Health reform strategies that involve increases in out-of-pocket payments in the form of co-payments could be implemented without untoward effects on appropriate use of maternity care for better-off women, but would be contra-indicated for poorer and rural households. Among wealthier households, the positive effect of quality improvements was greater than the dampening effect of user fee increases, even if out-of-pocket costs of using public facilities were to be doubled. However, among the poor, the net effect of any strategy that involved increases of more than ten percent in out-of-pocket costs would have a detrimental influence on utilization rates, regardless of quality improvements. Our findings suggest that in Morocco, unlike countries with stronger traditions of skilled and mobile midwifery services, maternity continues to be a risky proposition, particularly for poor and rural women. The Moroccan government's emphasis on expanding social health insurance to improve financial access to public sector maternity services for the poor and for rural populations is clearly an urgent priority. |
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PLACE in Uganda: Monitoring AIDS-Prevention Programs in Kampala, Uganda Using the PLACE Method.
|
|
2003 |
English |
Southern Africa, UGANDA, Africa |
At-Risk Populations, HIV/AIDS, Sex Workers, Condoms, Monitoring |
This 81-page report details the efforts of the PLACE (Priorities for Local AIDS Control Efforts) method to identify areas in the Kawempe division in Kampala, Uganda, with a higer incidence of infection and to identify specific sites where AIDS prevention programs should be targeted. Trained inteviewers talked with key informants, who identified 227 places where people from Kawempe go to meet new sexual partners. Interviewers then visited these sites and asked attendants about their sexual and injecting drug use behavior and prevention knowledge. This report presents the folowing key findings: Most sites identified were bars and nightclubs; sex work at these locations were uncommon. Three-quarters of individuals socialing at these sites report having met a new sexual partner there. More than two-thirds of men reported using condoms with new sexual partners; condom use was higher if condoms were available on-site. AIDS prevention activities and condoms, however, generally do not reach network sites. The assessment strongly suuggests that interventions need to be further focuses at the sites where new partners are met, while maintaining a strong general population prevention program. |
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Association of mass media exposure on family planning attitudes and practices in Uganda
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Gupta N, Katende C, Bessinger R |
2003 |
English |
Southern Africa, UGANDA, Africa |
|
This paper examined the influences of multi-media Behavior Change Communication campaigns on women's and men's use of and intentions to use contraception in target areas of Uganda. Data were primarily drawn from the 1997 and 1999 Delivery of Improved Services for Health evaluation surveys, which collected information from representative samples of women and men of reproductive age in the districts served by the DISH project. Additional time-trend analyses relied on data from the 1995 Demographic and Health Survey. Logistic regressions were used to assess the associations between BCC exposure and family planning attitudes and practices, controlling for individuals' background characteristics. To minimize the biases of self-reported exposure, the analyses also considered cluster-level indices of the penetration of BCC messages in the community. Results indicated that exposure to BCC messages was associated with higher contraceptive intentions and use. While there was some evidence of bias of self-report, the pathways to behavior change appeared different for women and men. |
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Multi-media campaign exposure effects on knowledge and use of condoms for STI and HIV/AIDS prevention in Uganda
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Bessinger R, Katende C, Gupta N |
2003 |
English |
UGANDA, Southern Africa, Africa |
HIV/AIDS |
This paper evaluated the influences of multi-media Behavior Change Communication campaigns on knowledge and use of condoms for prevention of HIV/AIDS and other sexually transmitted infections in target areas of Uganda. Data were drawn from the 1997 and 1999 Delivery of Improved Services for Health Evaluation Surveys, which collected information from representative samples of women and men of reproductive age in the districts served by the DISH project. Logistic regressions were used to assess the associations between BCC exposure and condom knowledge and use, controlling for individuals' background characteristics. While there was some evidence of bias of self-report, results indicated that exposure to BCC messages, especially via radio, was strongly associated with higher condom knowledge and use. A dose-response effect between the number of media channels and condom knowledge was observed. Certain gender differences were also found, with message content seemingly more important in terms of instilling safer sex practices. |
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Assessment of a Capture-Recapture Method for Estimating the Size of the Female Sex Worker Population in Bulawayo, Zimbabwe
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Weir S S, Wilson D, Smith P J, Schoenbach V J, Thomas J C, Lamptey P R, Boerma J T |
2003 |
English |
ZIMBABWE, Africa, Southern Africa |
HIV/AIDS, Public Health |
Purpose: To assess the use of capture-recapture methods for estimating the size of sex worker populations in sub-Saharan Africa. Methods: We used a capture-mark-recapture method to estimate the size of the bar-based female sex worker population in Bulawayo, Zimbabwe and compared this estimate with an estimate obtained by counting sex workers. Results: Enumerators counted 6,997 women entering 56 bars known for sex worker activity. For the capture-recapture estimate, we interviewed 1,381 sex workers at 15 bars one Saturday night and 1,469 sex workers at the same bars a week later. Of these 1,469 women, 521 reported being interviewed the previous Saturday. The capture-recapture estimate of 3,894 (1381 x 1469 / 521) was considerably lower than the number counted. When we assumed that half the women returned to the same bar (rather than randomly mix among bars) and based the estimate on bars where the proportion recaptured was more than 20 percent, the estimate (7,855) of the 56-bar population was closer to the estimate obtained by counting. Conclusions: Estimating the size of populations at risk for transmitting HIV is critical for AIDS prevention. The capture-recapture method may prove useful but requires collecting data to assess the direction and extent of bias in estimates. Key Words: AIDS, population size, population surveys, epidemiological methods, prostitution, Africa, sampling |
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Comparative Analysis of Program Effort for Family Planning, Maternal Health, and HIV/AIDS, 30 Developing Countries
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Ross J A |
2003 |
English |
Asia, Africa, Global |
Maternal Health, HIV/AIDS |
CONTEXT: Many developing countries have mounted national programs for family planning, for maternal health, or for HIV/AIDS, but rather little is known about how closely these three programs parallel or support each other. Measures of program effort are now available for all three activities, collected in the 1999-2000 period, with common data on 30 countries that contain half of the developing world's population. METHODS: All three studies used questionnaires completed by expert observers for each country. Experts from a variety of backgrounds and institutional affiliations were identified, with a different set of persons for each study since the field operations were entirely separate and done at different times. Each program was rated on a large number of features, and the ratings were all quantified as the percent of the maximum possible scores. RESULTS: As an average, the strength of effort of these three programs is similar across the 30 countries, at slightly over half of the maximum scores. However the averages conceal sharp variations. In some countries the total scores are close for two or even all three of the programs, but in others there are large disparities. In addition, there is no correspondence across countries in the strength of the family planning and the HIV/AIDS programs, although both correlate appreciably with the maternal health programs. Policy scores are relatively high and vary rather little across the regions, but access to services shows substantial differences from one program to another; moreover Sub-Saharan Africa scores low on family planning and maternal health, but about as well on HIV/AIDS as do the other regions. Over time, countries with the weakest efforts have improved their scores more than countries with the strongest efforts have. |
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Costs and Results of Information Systems in Tanzania
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|
2003 |
English |
Southern Africa, TANZANIA, East Africa, Africa |
Workshop |
This 93-page report presents findings from a participatory assessment of the costs and results of information systems in Tanzania that were carried out in 2002 and 2003. Findings were based on cost and output data provided by 11 information systems in four government ministries, offices, and executive agencies. Data were collected using questionnaires, interviews with system managers, and field visits. Results were assessed against a composite list of 38 health, demographic and poverty indicators. Finding were fed back to participants at a workshop, and revisions to the assessments were made. In this report, authors report findings in coverage of health and poverty indicators, comparative costs, and the relationship between cost, coverage, and quality assurance. |
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Royaume du Maroc: Programmes de sante reproductive et infantile
|
|
2003 |
French |
MOROCCO, West Africa, Africa |
HIV/AIDS, Maternal Health, Reproductive Health, Sexually Transmitted Infections (STIs), Child Health |
This French-language report is a synthesis of a series of four reports which documented the joint efforts of these two organizations from 1971 to 2000. This document provides a model for USAID in developing health partnerships in other countries, as well as a model for Morocco both within its own health care system and in its exchanges with developing countries eager to achieve similar successes in maternal and child health. There are ten sections of this 72-page report: an introduction, USAID/Ministry of Health projects, the Family Planning program, the Child Health program, the Safe Motherhood program, the Safe Motherhood Program, the Fight Against STI/HIV/AIDS, results of collaboration between USAID and the Moroccan Ministry of Health, factors contributing to the success of the USAID/MOH collaboration, actions promoting program sustainability, and future challenges for reproductive and child health in Morocco. An English version of this document, Morocco: Reproductive and Child Health Programs [sr-03-23-en] is also available on the MEASURE Evaluation Web site. |
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Morocco: Reproductive and Child Health Programs
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|
2003 |
English |
MOROCCO, West Africa, Africa |
HIV/AIDS, Maternal Health, Reproductive Health, Sexually Transmitted Infections (STIs), Child Health |
This document is a synthesis of a series of four reports, which were originally titled "Morocco: 30 Years of Collaboration between USAID and the Ministry of Health, a Retrospective Analysis." This series documented the joint efforts of these two organizations from 1971 to 2000. This document provides a model for USAID in developing health partnerships in other countries, as well as a model for Morocco both within its own health care system and in its exchanges with developing countries eager to achieve similar successes in maternal and child health. There are ten sections of this 72-page report: an introduction, USAID/Ministry of Health projects, the Family Planning program, the Child Health program, the Safe Motherhood program, the Safe Motherhood Program, the Fight Against STI/HIV/AIDS, results of collaboration between USAID and the Moroccan Ministry of Health, factors contributing to the success of the USAID/MOH collaboration, actions promoting program sustainability, and future challenges for reproductive and child health in Morocco. A French-language version of this report, Royaume du Maroc: Programmes de sante reproductive et infantile, is also available. |
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Use of Maternity Register Data in Benin
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2003 |
English |
West Africa, Southern Africa, BENIN, Africa |
Maternal Health, Maternal Mortality |
This report describes a study of the content and the use of routinely collected data from maternity registers for the purposes of monitoring maternal and newborn health at the health facility level in departments in Atlantique and Zou, Benin. The Benin Maternity Register Study was designed to assess the current and potential use of data routinely collected from registers and logbooks. The results suggest that a broad range of data is routinely collected, though there is little standardization in the content or format of these data. In general, public health facilities are more likely than private ones to maintain the four registers pertaining to childbirth that were of interest to the study. In all three categories of maternity included in the sample, data were remarkably complete for data items specified in the registers. Results from the qualitative study suggest that midwives, nurses, and nurses' aides see value in the data collection process. |
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Sexual Behavior, HIV and Fertility Trends: A Comparative Analysis of Six Countries: Phase I of the ABC Study (Full Report)
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Ruth Bessinger, Priscilla Akwara, Daniel Halperin |
2003 |
English |
Africa, East Africa, West Africa, Southern Africa, KENYA, THAILAND, UGANDA, ZAMBIA, ZIMBABWE, CAMEROON, Asia |
Fertility, Sexual Behavior, HIV/AIDS |
The USAID-supported ABC (Abstinence, Being faithful, and Condom use) Study examines how prevention barriers may have affected HIV prevalence as well as fertility patterns in Uganda, Zambia, and Thailand, where HIV prevalence declined during the 1990s, and Cameroon, Kenya, and Zimbabwe, where it appears not to have declined. This Phase I report compares levels and trends of behavioral indicators such as abstinence, age of sexual debut among youth, faithfulness in sexual relationships, reduction in multiple sexual partners, and condom use. Among the declining prevalence countries, the most dramatic reduction occured in Uganda, where prevalence among women in the capital city of Kampala fell from 30% in 1992 to about 10% by the end of the declade. Thailand and Zambia so experienced a significant decrease in HIV prevalence, especially among high risk groups and youth, respectively. Cameroon, Kenya, and Zimbabwe all experienced large increases of HIV prevalence in the 1990s, though prevalence varied considerably among the three countries. |
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Sexual Behavior, HIV and Fertility Trends: A Comparative Analysis of Six Countries: Phase I of the ABC Study (Summary)
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Ruth Bessinger, Priscilla Akwara, Daniel Halperin |
2003 |
English |
CAMEROON, West Africa, Asia, Africa, Southern Africa, East Asia, South Asia, KENYA, THAILAND, UGANDA, ZAMBIA, ZIMBABWE |
Sexual Behavior, HIV/AIDS |
This four-page document is an executive summary of the Phase I report of the ABC Study, which is also available on the MEASURE Evaluation Web site. The USAID-supported ABC (Abstinence, Being faithful, and Condom use) Study examines how prevention barriers may have affected HIB prevalence as well as fertility patterns in Uganda, Zambia, and Thailand, where HIV prevalence declined during the 1990s, and Cameroon, Kenya, and Zimbabwe, where it appears not to have declined. The Phase I report compares levels and trends of behavioral indicators such as abstinence, age of sexual debut among youth, faithfulness in sexual relationships, reduction in multiple sexual partners, and condom use. |
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AIDS in Africa During the Nineties: Uganda
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2003 |
English |
UGANDA, Africa, Southern Africa |
Africa, HIV/AIDS |
This 67-page report is based on analysis and review of existing data in Uganda, the only country in sub-Saharan Africa to experience signficant declines in HIV prevalence during the 1990s. This report examines trends and knowledge and behaviors based on Ugandan demographic health surveys conducted in 1988/1989, 1995, and 2000/2001. Chapter 1 of this report provides an introduction to the history of HIV/AIDS in Uganda. Chapter 2 discusses the national and international responses to the epidemic. Chapter 3 presents information on the spread of HIV using data from the national surveillance system and from research studies. Chapters 4, 5, and 6 present trends in knowledge and attitudes about HIV, sexual behavior, and the use of condoms in the 1990s. Finally, chapter 7 presents information on the impact of the epidemic from other surveys and research studies. |
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Encuesta Nicaraguense de Servicios de la Comunidad ENCO 2001
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2003 |
Spanish |
NICARAGUA, Latin America and the Caribbean |
Maternal Health, Child Health |
|
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AIDS in Africa During the Nineties: Ghana
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|
2003 |
English |
West Africa, GHANA, Africa |
HIV/AIDS |
This report focuses on trends in the spread of HIV infection and in AIDS-related knowledge, attitudes and sexual behavior among men and women in Ghana. Chapter 1 provides information about the history of HIV in Ghana and details previous studies of HIV in the region. Chapter 2 examines information about the spread of HIV/AIDS in Ghana by geographic area. Chapter 3 looks at trends in knowledge about what HIV is and how it is spread. Chapter 4 examines sexual behavior of men and women in Ghana. Chapter 5 details knowledge about and use of condoms. Chapter 6 examines the socio-demographic characteristics, contraceptive use, HIV-related knowledge and sexual behaviors of adolescents in Ghana. |
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AIDS in Africa During the Nineties: Young People in Kenya
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2003 |
English |
Southern Africa, Africa, East Africa, KENYA |
Contraception, HIV/AIDS |
This summary report examines existing information about adolescent sex in Kenya during the 1990s. Overall, living conditions for adolescent Kenyans changed little during this decade, though access to the media rose, employment opportunities fell and populations become more mobile. In terms of sexual behavior, data clearly indicate that abstinence until marriage remains the exception rather than the rule for both sexes. The majority of young Kenyans of both sexes have sex before marriage and more than one premarital partner also appears to be the norm. The biggest change observed was in condom use. Condom use rose significantly among both men and women, though the risk was most striking among men. HIV prevalence among adults in Kenya was estimated at 5% in 1990, but by 1998 this number had jumped to 14%. However, this increased risk appears not to have found its way into young people's thinking. |
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Evaluacion de los Programas de Planificacion Familiar: Dos Casos en Hospitales Peruanos (Evaluation of adolescent programs in two hospitals in Peru)
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2003 |
Spanish |
PERU, Latin America and the Caribbean |
Public Health |
|
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Using Data to Improve Service Delivery: A Self-Evaluation Approach
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LaFond A, Kleinau E, Shafritz L, Prysor-Jones S, Mbodj F, Traore B, Dembele E, Gueye M, Bouare M, Snow C |
2003 |
English |
Africa |
Maternal Health |
This guide will help frontline health workers use the data collected at health facilities to solve common problems in service delivery and improve their response to community needs. It is intended for doctors, nurses, and midwives in community-based health centers. The overall aim of the guide is to promote greater use of existing service data to improve health services, as part of good data demand and use (DDU or DDIU) practices. The guide does not require health workers to collect any additional data. |
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A Guide to Monitoring and Evaluation of Capacity-Building Interventions in the Health Sector in Developing Countries
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LaFond AK, Brown L |
2003 |
English |
Global |
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Number 7 in the MEASURE Evaluation Manual Series has the purpose of assisting health planners and evaluators to: gain a clear understanding of the concepts of capacity and capacity building; critically evaluate the strengths and limitations of current approaches to capacity measurement; and design a capacity-building M&E plan that outlines a systematic approach to measuring capacity and assessing the results of the capacity-building interventions in the health sector. Sources for this 110-page guide include a review of the state of the art of capacity measurement, a review of capacity-building measurement tools and indicators, formal and informal consultations with practitioners, and an in-depth exploration of four different capacity measurement experiences. The Guide also draws on lessons learned about capacity-building M&E in other sectors, such as agriculture and housing, and on new evaluation approaches designed to support learning in development programming. |
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Determinants of contraceptive method choice in rural Tanzania between 1991 and 1999
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Chen S, Guilkey DK |
2003 |
English |
Africa, TANZANIA, Southern Africa |
Contraception, Rural Populations |
Four pooled Demographic and Health Survey data sets are used to examine the determinants of contraceptive method choice in rural Tanzania for the period from 1991 to 1999. The individual data are linked to facility surveys conducted in the same communities so that the impact of Tanzania's family planning program can be examined. The focus of the study is an examination of the effect on method choice of the three major components of Tanzania's family planning program: logistical support, trained providers, and communications programs. The statistical methods employed correct for the potential endogeneity of family planning message recall. Simulations are used to quantify the impact of the important policy variables. All three components of the program are shown to have had an impact on modern method choice. |
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Identificacion de sitios de encuentro de parejas sexuales en dos ciudades de la frontera sur de Mexico
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Negroni-Belen M, Vargas-Guadarrama G, Rueda-Neria CM, Bassett-Hileman S, Weir S, Bronfman M |
2003 |
Spanish |
MEXICO, Latin America and the Caribbean |
Monitoring, Condoms, HIV/AIDS, Sex Workers, At-Risk Populations |
Objetivo. Identificar sitios de encuentro de nuevas parejas sexuales en dos ciudades de la frontera sur de México. Material y métodos. En un estudio epidemiológico descriptivo se encuestó, en mayo de 2001, a informantes clave de la comunidad en dos ciudades fronterizas del sur de México para identificar sitios de encuentro de nuevas parejas. Se visitó cada sitio reportado y se encuestó a una persona del lugar. De una submuestra de sitios, se encuestó a personas que socializaban en los mismos. Resultados. Los informantes clave de la comunidad reportaron 134 sitios en Chetumal y 111 en Ciudad Hidalgo. Se obtuvo información de las características de 89 sitios en Chetumal y 42 en Ciudad Hidalgo, ambos con escasas actividades preventivas del VIH/ SIDA. Cerca de 21% de usuarios encuestados reportaron haber conocido una nueva pareja en los sitios en las últimas cuatro semanas. Conclusiones. Son necesarias acciones de prevención en los sitios de encuentro de nuevas parejas sexuales. Este método puede proveer información para planificar futuras intervenciones. OBJECTIVE: To identify the meeting sites of new sexual partners in two Southern border cities in Mexico. MATERIAL AND METHODS: A descriptive epidemiologic study was carried out in May 2001, by surveying key informants in two border cities. Each reported site was visited to interview a resident subject. Subjects socializing in a subsample of sites were also interviewed. RESULTS: The key informants of the community reported 134 meeting sites in Chetumal and 111 in Ciudad Hidalgo. Both sites had scarce HIV/AIDS prevention activities. Characteristics were obtained for 89 sites in Chetumal and 42 in Ciudad Hidalgo. Almost 21% of interviewees reportedly met a new sexual partner in these sites in the past four weeks. CONCLUSIONS: Preventive actions are needed in meeting sites of new sexual partners. This method may provide information to plan for future interventions.
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Estimating the needs for artesunate-based combination therapy for malaria case-management in Africa
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Snow RW, Eckert E, Teklehaimot A |
2003 |
English |
East Africa, West Africa, Africa, Southern Africa |
Malaria, Public Health |
Because of inadequacies in national health information systems, the volumes of drugs required to support an effective policy transition toward artesunate-based combination therapy (ACT) are unknown for most African countries. A series of national surveys and population projections have been used to estimate the age-structured fever burden among 41 malaria endemic countries in Africa. Under present fever-management guidelines, commodity costs and internationally agreed coverage targets, the financial resources to meet the needs of ACT in most African countries are huge. Between US$1.6 billion and US$3.4 billion per annum must be found to give Africa the chance to consider a drug policy based on ACT. Substantial reductions in these costs would be achieved through more effective targeting of resources--only 20% of drugs would be required to manage fevers among the most at-risk pediatric patient populations. Better diagnostics would also be an important consideration for a new ACT policy in Africa. |
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Trends and determinants of contraceptive method choice in Kenya
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Magadi M, Curtis SL |
2003 |
English |
KENYA, Southern Africa, East Africa, Africa |
Rural Populations, HIV/AIDS, Contraception |
This study uses data from the 1989, 1993, and 1998 Kenya Demographic and Health Surveys to examine trends and determinants of contraceptive method choice in Kenya. The analysis, based on two-level multinomial regression models, shows that, over time, the use of modern contraceptive methods, especially long-term methods, is higher in urban than in rural areas, whereas the pattern is reversed for traditional methods. Use of barrier methods among unmarried women is steadily rising, but the levels remain disappointingly low, particularly in view of the HIV/AIDS epidemic in Kenya. One striking result from this analysis is the dramatic rise in the use of HIV/AIDS. Of particular program relevance is the notably higher levels of use of injectables among rural women, women whose partners disapprove of family planning, uneducated women, and those less frequently exposed to family planning media messages, compared with their counterparts who have better access to services and greater exposure to family planning information. |
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Facility-level reproductive health interventions and contraceptive use in Uganda
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Katende C, Gupta N, Bessinger R |
2003 |
English |
Africa, UGANDA, Southern Africa |
Condoms, Contraception |
CONTEXT: In Uganda, modern has recently increased in areas served by the Delivery of Improved Services for Health (DISH) project. Whether these increases are associated with facility-level factors is unknown, however. METHODS: Data from the 1999 DISH Evaluation Surveys were used in multivariate logistic regressions to assess the independent relationships of five indicators of the family planning service environment with individual-level use of a modern contraceptive in rural and urban areas. The surveys consisted of a household questionnaire of 1,766 women of reproductive age and a facility module implemented in all health facilities that serve the sampled population. RESULTS: After womens social and demographic characteristics were controlled for, none of the service environment factors was independently associated with current use of a modern method in rural areas. By contrast, in urban areas, the proximity of a private health facility (which likely reflects an increased availability of methods) was positively associated with current use (odds ratio, 2.1), as was the presence of a higher number (three or more) of DISHtrained service providers (1.7). CONCLUSIONS: The presence of private health facilities was the factor most strongly associated with contraceptive use in urban areas, perhaps because they improved the availability of methods. Few other facility-level program inputs had significant effects. |
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Perception of risk of HIV/AIDS and sexual behavior in Kenya
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Akwara PA, Madise NJ, Hinde A |
2003 |
English |
Southern Africa, KENYA, Africa |
HIV/AIDS |
The association between risk of HIV infection and sexual behavior remains poorly understood, though perception of risk is considered to be the first stage towards behavioral change from risk-taking to safer behavior. Authors used data from the 1998 Kenya Demographic and Health Survey to examine the direction and strength of the association between perceived risk of HIV/AIDS and risky sexual behavior in the 12 months before the survey. The findings indicate a strong positive association between perceived risk of HIV/AIDS and risky sexual behavior for both men and women. Controlling for sociodemographic, sexual exposure and knowledge factors such as age, marital status, education, work status, residence, ethnicity, source of AIDS information, specific knowledge of AIDS and condom use did not chnge the direction of the association. Young and unmarried men and women were more likely than older and married ones to report risky sexual behavior. Ethnicity was significantly associated with risky sexual behavior, suggesting a need to identify the contextual and social factors that influence behavior among Kenyan people. |
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Utilization of care during pregnancy in rural Guatemala: does obstetrical need matter?
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Glei DA, Goldman N, Rodriguez G |
2003 |
English |
Latin America and the Caribbean, GUATEMALA |
Maternal Health, Rural Populations, Pregnancy |
This study examines factors associated with the use of biomedical care during pregnancy in Guatemala, focusing on the extent to which complications in an ongoing or previous pregnancy affect a woman's decisions to seek care. The findings, based on multilevel models, suggest that obstetrical need, as well as demographic, social, and cultural factors, are important predictors of pregnancy care. In contrast, measures of availability and access to health services have modest effects. The results also suggest the importance of unobserved variablessuch as quality of carein explaining women's decisions about pregnancy care. These results imply that improving proximity to biomedical services is unlikely to have a dramatic impact on utilization in the absence of additional changes that improve the quality of care or reduce barriers to access. Moreover, current efforts aimed at incorporating midwives into the formal health-care system may need to extend their focus beyond the modification of midwife practices to consider the provision of culturally appropriate, high-quality services by traditional and biomedical providers alike. |
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Contraceptive use in a changing service environment: evidence from Indonesia during the economic crisis
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Frankenberg E, Sikoki B, Suriastini W |
2003 |
English |
East Africa, Asia, South Asia |
Contraception |
In the late 1990s, most Southeast Asian countries experienced substantial economic downturns that reduced social-sector spending and decreased individuals' spending power. Data from Indonesia were collected in 1997 (just before the crisis) and in 1998 (during the crisis) that are used in this study to examine changes in the contraceptive supply environment and in women's choices regarding contraceptive use. Despite substantial changes in providers' characteristics during the first year of the crisis, no statistically significant differences are found between 1997 and 1998 in overall levels of prevalence, in unmet need, or in method mix. Women's choices regarding source of contraceptive supplies, however, changed considerably over the period. Changes in the contraceptive supply environment are linked here to changes in women's choice of source of supply, and a number of providers' characteristics are found to be significantly associated with women's choices in this regard. |
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From people to places: focusing AIDS prevention efforts where it matters most
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Weir SS, Pailman C, Mahlalela X, Coetzee N, Meidany F, Boerma JT |
2003 |
English |
SOUTH AFRICA, Southern Africa, Africa |
Monitoring, Condoms, Sex Workers, Monitoring, HIV/AIDS, Sexual Behavior, At-Risk Populations |
Objectives: To develop and implement a method to identify and characterize places where people meet new sexual partners and to assess HIV prevention program coverage in those places. Methods: In three townships (populations 60 000-100 000 each) and one business district (population < 20 000) in South Africa, interviewers asked over 250 informants per area to identify public sites where people meet new sexual partners. All reported sites were visited and mapped. A knowledgeable person onsite was interviewed about the site and its patrons. Individuals socializing at sites were interviewed about their sexual behavior. Results: More than 200 sites in each township and 64 sites in the central business district were identified and visited. The male to female ratio among site patrons was approximately 2:1. In each area, men and women socializing at sites reported high rates of new sexual partner acquisition and low condom use. Almost half of the 3085 men and 1564 women interviewed while socializing reported having a new sexual partner in the last 4 weeks. A third reported meeting a new partner at the site of the interview. Commercial sex was rare in the townships but available at 31% of central business district sites. Fewer than 15% of township and only 20% of business district sites had condoms. Conclusion: The PLACE method successfully identified sites where people with high rates of new sexual partnerships can be reached for prevention programs. Sexual networks in these areas are extensive, diffuse, and characterized by high rates of new partnership formation and concurrency with little acknowledged commercial sex. |
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HIV impact on mother and child mortality in rural Tanzania
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Ng weshemi J, Urassa M, Isingo R, Mwaluko G, Ngalula J, Boerma T, Marston M, Zaba B |
2003 |
English |
TANZANIA, Southern Africa, Africa |
Child Health, HIV/AIDS, Maternal Health, Child Mortality |
Child mortality in Tanzania rose from 137 per 1000 in 1992-1996 to 147 per 1000 in 1995-1999. Impact of HIV on child mortality is analyzed in a longitudinal community-based study in Kisesa ward, Mwanza region. HIV data on 4273 mothers from 3 rounds of serologic testing are linked to survival information for 6049 children born between 1994 and 2001, contributing 10,002 person-years of observation and 584 child deaths. Impacts of maternal survival and HIV status on child mortality are assessed using hazard analysis. Infant mortality for children of HIV-positive mothers was 158 per 1000 live births compared with 79 per 1000 for children of uninfected mothers; by age 5, child mortality risks were 270 per 1000 live births and 135 per 1000, respectively. Fifty-one deaths were observed among child-bearing women, 14 to HIV-positive mothers. Infant mortality among children whose mothers died was 489 per 1000 live births compared with 84 per 1000 for children of surviving mothers. Maternal death effects were statistically independent of HIV status. Allowing for age, sex, twinning, birth interval, maternal education, and residence, the child death hazard ratio for maternal HIV infection was 2.3 (1.7-3.3); hazard ratio associated with maternal death was 4.8 (2.7-8.4). The HIV-attributable fraction of infant mortality is 8.3% in a population in which prevalence among women giving birth is around 6.2%. |
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Evaluation of midwifery care: results from a survey in rural Guatemala
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Goldman N, Glei DA |
2003 |
English |
GUATEMALA |
Rural Populations, Maternal Health, Pregnancy |
In an effort to reduce infant and maternal morbidity and mortality in developing countries, the World Health Organization has promoted the training of traditional birth attendants (midwives) and their incorporation into the formal health care system. In this paper, we examine several aspects of the integration of traditional and biomedical maternity care that are likely to reflect the quality of care received by Guatemalan women. Specifically, we examine the extent to which women combine traditional and biomedical pregnancy care, the frequency with which midwives refer women to biomedical providers, the content and quality of care offered by midwives, and the effects of midwife training programs on referral practices and quality of care. The analysis is based on data from the 1995 Guatemalan Survey of Family Health. The results offer a mixed assessment of the efficacy of midwife training programs. For example, although trained midwives are much more likely than other midwives to refer their clients to biomedical providers, most pregnant women do not see a biomedical provider, and the quality of midwife care, as defined and measured in this study, is similar between trained and untrained midwives. |
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Associations of mass media exposure with family planning attitudes and practices in Uganda
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Gupta N, Katende C, Bessinger R |
2003 |
English |
Southern Africa, Africa, UGANDA |
Contraception |
This study examines the associations between multimedia behavior change communication (BCC) campaigns and women's and men's use of and intention to use modern contraceptive methods in target areas of Uganda. Data are drawn primarily from the 1997 and 1999 Delivery of Improved Services for Health (DISH) evaluation surveys, which collected information from representative samples of women and men of reproductive age in the districts served by the DISH project. Additional time-trend analyses rely on data from the 1995 Uganda Demographic and Health Survey. Logistic regressions are used to assess the associations between BCC exposure and family planning attitudes and practices, controlling for individuals' background characteristics. To minimize the biases of self-reported exposure, the analyses also explore cluster-level indexes of the penetration of BCC messages in the community. Results indicate that exposure to BCC messages was associated with increased contraceptive use and intention to use. Some evidence of self-reported bias is found, and the pathways to fertility-related behavioral change appear different for women and men. |
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Inequality and changes in women's use of maternal health-care services in Tajikistan
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Falkingham J |
2003 |
English |
Asia, TAJIKISTAN, Central Asian Republics, Europe and Eurasia (was ENIS), Newly Independant States |
Maternal Health, Poverty |
Using recently available survey data for Tajikistan, this study explores changes in the pattern of maternal health care during the last decade and the extent to which health care in access to that care have emerged. In particular, the links between poverty and women's educational status and the use of maternal health-care services are investigated. The survey findings demonstrate a significant decline in the use of maternal health-care services in Tajikistan since the country gained independence from the Soviet Union in 1991. They show changes in the location of delivery and the person providing assistance, with a clear shift away from giving birth in a medical facility toward giving birth at home. More than two-fifths of all women who gave birth in the year prior to the survey delivered their baby at home. Women from the poorest quintile are three times more likely than women from the richest quintile to undergo a home delivery without a trained assistant. |
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Contraceptive dynamics in Guatemala: 1978-1998
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Bertrand JT, Seiber E, Escudero G |
2003 |
English |
GUATEMALA, Latin America and the Caribbean |
Contraception, Fertility |
Guatemala lags far behind other Central American countries in contraceptive prevalence, and levels of use differ markedly between Mayans and ladinos, the two main ethnic groups. Understanding the factors that influence contraceptive use is critical to program efforts to increase prevalence. Authors analyzed data from four national-level surveys to examine trends in contraceptive use between 1978 and 1998. Results of multivariate analyses show the extent to which various factors, particularly ethnicity and access, influence contraceptive dynamics. Between 1978 and 1998, the proportion of women using any contraceptive rose from 28% to 50% among ladinos, but only from 4% to 13% among Mayans. Female sterilization, the pill and rhythm have been the most widely used methods, though as of 1998, the injectable replaced the pill as the third most popular method among Mayans. The source of methods has shifted over time, but Mayans and ladinos have used similar sources at each survey. Dramatic changes in socioeconomic conditions among both ladinos and Mayans over these 20 years have been key determinants of contraceptive use; access to services is also a significant correlate of use among Mayans, once socioeconomic factors are controlled for. Mayans are a "hard to reach" population, but evidence suggests they are becoming more open to adopting family planning when services are accessible and provided in a culturally acceptable manner. |
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Access as a factor in differential contraceptive use between Mayans and Ladinos in Guatemala
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Seiber EE, Bertrand JT |
2003 |
English |
GUATEMALA, Central American Project, Latin America and the Caribbean |
Health Facilities |
Previous studies have demonstrated consistently that the Mayan women of Guatemala have a far lower level of contraceptive use than their ladino counterparts (e.g. 50% versus 13% in the 1998 Demographic and Health Survey DHS). Most researchers and practitioners have attributed this to social, economic and cultural differences between the two groups that result in Mayans having a far lower demand for family planning than ladinos. This paper tests an alternative hypothesis: that the contraceptive supply environment may be more limited for Mayans than ladinos. This analysis uses an innovative approach of linking household level data from the 1995/6 Guatemala DHS and with facility-level data from the 1997 Providers Census for four highland departments in which the latter was conducted. On average, married women of reproductive age in the four departments lived 2 km from a facility that provided some type of contraception. Mayans and ladinos did not differ significantly in terms of (1) mean distance to the closest facility offering family planning services, or (2) mean distance to a facility providing each specific method (except injectables). Mayans were more likely to live closer to an APROFAM clinic, whereas ladinos were closer to a facility that offered access to injectables. Otherwise, the family planning supply environment differed little for the two groups. However, access may not be the determining factor in contraceptive use, given that less than 8% of users got their (last) contraceptive from the nearest facility. Moreover, APROFAM which was the nearest facility for only 7% of the respondents in this study was the source of supply for 48% of users. Although this study does not directly measure quality, the characteristics that differentiate APROFAM from other service providers point to quality as more important than physical access or cost in source of contraception among this group of users. |
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Appropriate methods for analyzing the effect of method choice on contraceptive discontinuation
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Steele F, Curtis S |
2003 |
English |
East Asia, Asia, South Asia |
Contraception |
The contraceptive method chosen is an important determinant of contraceptive discontinuation. However, method choice is endogenous to contraceptive discontinuation. Using data from the 1997 Indonesia Demographic and Health Survey, we apply a multilevel multiprocess model to examine the impact of method choice on three types of contraceptive discontinuation. We confirm that method choice is endogenous to the processes of contraceptive abandonment and method switching, but not failure. Ignoring the endogeneity of contraceptive choice leads to various biases in the magnitude of estimated effects of method choice on abandonment and method switching, but the general conclusions are robust to these biases. |
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Demographic and Health Surveys: caesarean section rates in sub-Saharan Africa
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Buekens P, Curtis S, Alayon S |
2003 |
English |
ZAMBIA, East Africa, Africa, West Africa, Southern Africa, NIGER, MADAGASCAR, BURKINA FASO |
Child Health, Maternal Health, Sub-Saharan Africa |
Study authors analysed Demographic and Health Surveys performed at two different times in eight sub-Saharan African countries--Burkina Faso, Cameroon, Ghana, Kenya, Madagascar, Niger, Tanzania, and Zambia. Authors calcullated caesarean section rates for singleton live births according to residence (rural or urban) for mothers, as well as the proportion delivered in health facilities. Cesarean section rates were lower than 5% in all countries except Kenya, and rates were lower than 2% in Burkina Faso, Madagascar, Niger and Zambia. Data analysis show that access to caesarean section is not improving in sub-Saharan Africa and that it might be worsening. |
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Bulletin 6: Evaluation of the Impact of Population and Health Programs.
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2003 |
English |
South Asia, Asia, Africa, Latin America and the Caribbean, TANZANIA |
Reproductive Health, Rural Populations, Health Services |
The sixth issue of the MEASURE Evaluation Bulletin contains the following stories: A comparative multi-level analysis of health program effects on individual use of reproductive sexual health services; changes in use of health services during Indonesia's economic crisis; health facility charactersitics and the decision to seek care; determinants of fertility in rural Peru: program effects in the early years of the National Family Planning Program; determinants of contraceptive mehtod choice in rural Tanzania between 1991 and 1999; the impact of reproductive health project interventions on contraceptive use in Uganda; and an evaluation of the rural service delivery partnership (RSDP) in Bangladesh. |
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Bulletin 5: Investing in Population, Health and Nutrition Monitoring and Evaluation: Lessons Learned.
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2003 |
English |
TANZANIA, Africa, Southern Africa, Latin America and the Caribbean, Middle East, Central American Project, TURKEY, UGANDA |
Monitoring, Evaluation |
The November 5, 2003 issue of the MEASURE Evaluation Bulletin contains the following stories: Challenges in Monitoring and Evaluation of Population, Health, and Nutrition Programs; Performance Monitoring Plans and R4s: Field Practices and Lesons Learned; Monitoring Area-Based Programs Through Surveys: The Uganda DISH experience; Monitoring and Evaluation Practices of the USAID/Turkey Popluation Program; Investing in National Surveys for Monitoring and Evaluation: USAID in Tanzania in the 1990s; and Monitoring Complex Projects with Results Frameworks: The Central American HIV/AIDS Prevention Activity. |
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PLACE in Burkina Faso: Combating AIDS at the District Level
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2003 |
English |
Southern Africa, West Africa, Africa, BURKINA FASO |
Monitoring, At-Risk Populations, HIV/AIDS, Condoms, Sexual Behavior, Sex Workers, Monitoring |
Health districts in Burkina Faso have the formidable task of providing care for 300,000 to 400,000 people per district with severely limited resources for HIV/AIDS prevention. In June through October 2001, health officials in Burkina Faso adapted and pilot tested the PLACE method for planning HIV/AIDS interventions. This study presents the results of that effort. Key informants identified more than 400 sites where high-risk populations met to socialize and meet new sexual partners; individuals attending these venues were then interviewed about their knowledge and risk behaviors. |
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Nigeria (Bauchi, Enugu, Oyo) Family Planning and Reproductive Health Survey 2002: Health Facility Survey Results.
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Agha S, Escudero G, Keating J, Meekers D |
2003 |
English |
West Africa, Southern Africa, NIGERIA, Africa |
Health Services, HIV/AIDS |
This report presents findings from a health facility survey conducted by MEASURE Evaluation as part of the evaluation of the USAID-supported VISION project. As part of an effort to increase the capacity and quality of family planning services in the Nigerian state sof Bauci, Enugu, and Oyo, this report presents data that will be used as a baseline to measure VISION Project changes against. There are five chapters to this report. Chapter 1 provides background information on the availability and access to health services in Nigeria, the role of the VISION Project, and the objectives and methodology of the health facility survey. Chapter 2 presents information on the characteristics of families. Chapter 3 provides information on family planning service provision. Chapter 4 describes the provision of STI and HIV/AIDS services at facilities, and chapter 5 presents information on the provision of post-abortion care services. |
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Nigeria (Bauchi, Enugu, Oyo) Family Planning and Reproductive Health Survey 2002.
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Agha S, Escudero G, Keating J, Meekers D |
2003 |
English |
West Africa, Southern Africa, NIGERIA |
Reproductive Health |
This 133-page report presents findings from the 2002 Nigeria Family Planning and Reproductive Health survey. This survey was conducted in selected Local Government Areas (LGAs) in the states of Bauchi, Enugu, and Oyo, where the VISION project operated in five LGAs in each of these three states. The VISION project, initiated in 2002, develops models of high impact, high performing family/planning/reproductive health (FP/RH) service delivery networks in selected LGAs so that these may be replicated in other parts of Nigeria. From a representative sample of men and women in the VISION project areas, the survey team collected information on respondents' exposure to mass media messages pertaining to family planning and AIDS, knowledge of family planning and sexually transmitted infections, sexual behavior, and use of family planning and AIDS prevention strategies. This report presents indicators used by the VISION project and USAID/Nigeria to monitor project performance. Data from the baseline survey were also used to measure changes in family planning and reproducitve health indicators resulting from the VISION project's interventions and in fine-tuning implementation of the VISION project. |
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Bangladesh: Evaluation of Impacts of the Urban Family Health Partnership (UFHP)
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2003 |
English |
East Asia, Asia, BANGLADESH, South Asia |
Maternal Health, Child Health, Public Health |
Data from the 2001 Urban Family Health Partnership (UFHP) Evaluation Survey are used to determine the impact of the project in improving populations' health and health care seeking behaviors. The results here have two main components: 1) a discussion of trends in the use of UFHP services, and 2) multilevel analyses of determinants of health outcomes and health-care seeking behaviors. The evaluation survey presents the following key findings: 1) Since 1998, there have been notable increases in the share of UFHP providers in the supply of antenatal care, contraceptive methods, and childhood immunizations. The project seems to have little impact on children's curative care. 2) Except for antenatal care and modren contraception, there is little statistical difference between the poor and non-poor in many health outcomes and the use of UFHP health providers. 3) Proximity to UHFP providers significantly increases the likelihood that women will use essential UFHP services. The quality of UFHP satellite clinics has a significant impact upon their use. 4)Price has a small effect on use of services. 5) Considerable overlap exists between UFHP and non-UFHP catchment areas. |
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Bangladesh: Evaluation of Impacts of the Rural Service Delivery Partnership (RSDP)
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2003 |
English |
East Asia, Asia, BANGLADESH, South Asia |
Maternal Health, Child Health, Public Health |
Data from the 2001 Rural Service Deilvery Partnership (RSDP) Evaluation Survey indicate that the project has had positive effects on the health and health-care seeking behaviors of the targeted populations. Much of this impact analysis focuses on qualtifying key changes in the use of essential services since the 1998 Baseline Survey and identfying the pathways through which those changes have occured. The following key findings were found: The RSDP program is responsible for substantial increases in antenatal care use. Similations indicate that the project is responsible for an 8.6 percentage point increase in antenatal care, an 8.6 percentage point increase in the number of pregnant women with two or more tetanus toxoid injections, and a 3.3 precentage point increase in the use of modern contraception from 1998 to 2001. For child health outcomes, the impact of the project was smaller. Price generally had a small effect on the use of services at RSDP clinics and depotholders; distance, however, appears to have a larger effect and is likely a significant determinant of overall use of antenatal care and of RSDP providers for antenatal care and modern contraception. Multilevel analyses indicate that RSDP provider characteristics generally do not have significant impacts on the likelihood of their use, with the exceptions of distance, satellite clinic worker experience, and service availability. |
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Bangladesh: 2001 Urban Family Health partnership Evaluation Survey - Facility Survey Report
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2003 |
English |
BANGLADESH, Asia, South Asia, East Asia |
Health Facilities, Maternal Health, Child Health, Public Health |
The 2001 Urban Family Health Partnership (UFHP) Evaluation Survey was designed to evaluate the performance of the UFHP program in delivering an Essential Service Package of primary health care interventions through a network of static clinics and satellite clinics to underserved urban populations of Bangladesh. The faiclity survey had two main goals: 1) to define the service supply environment for populations in the 2001 UFHP Evaluation Survey in order to examine the choices that women make in deciding whether or not to use health services, and 2) to permit comparisons in quality, size, and efficiency among different types of health facilities that are available to the study population. |
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Bangladesh: 2001 Rural Service Delivery Partnership Evaluation Survey - Facility Survey Report
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2003 |
English |
East Asia, Asia, BANGLADESH, South Asia |
Maternal Health, Public Health |
The 2001 Rural Service Delivery Partnership (RSDP) Evaluation Survey was designed to evaluate the performance of the RSDP program in delivering an Essential Service Package of primary health care interventions. These interventions were provided throug a network of static clinics and satellite clinics and depotholders aimed at serving underserved rural populations of Bangladesh. The facility survey had two main goals: 1) to define the service supply environment for populations in the 2001 RSDP Evaluation Survey in order to examine the choices that women make in deciding whether or not to use health services; and 2) to permit comparisons in quality, size, and efficiency among the different types of health facilities that are available to the study population. |
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Bangladesh: 2001 Urban Family Health Partnership Evaluation Survey - Household Survey Report
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2003 |
English |
Asia, South Asia, East Asia, BANGLADESH |
Maternal Health, Child Health, Public Health, Contraception |
The 2001 Urban Family Health Partnership (UFHP) Evaluation Survey was designed to evaluate the progress of the UFHP program in delivering an essential service package of primary health care interventions in underserved urban populations of Bangladesh. Data focus primarily on knowledge and use of services related to family planning, maternal and child health, and awareness and use of UFHP facilities. The survey itself has two main purposes: 1) to collect information relevant to monitoring the progress of the project as specified in USAID's NIPHP Results Framework and 2) to provide data for evaluationg the impact of the UFHP program on improving the health status of the population in UFHP areas and in expanding access to ESP services. This report presents findings from the following topics: contraceptive use, antenatal care, childhood vaccinations, child health, knowledge of health promotion behaviors, fertility, and early childhood mortality. |
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Bangladesh: 2001 Rural Service Delivery Partnership Evaluation Survey - Household Survey Report
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2003 |
English |
BANGLADESH, Asia, South Asia, East Asia |
Maternal Health, Child Health, Public Health, Contraception |
The 2001 Rural Service Delivery Partnership (RSDP) Evaluation Survey was designed to evaluate the rural component of the National Integrated Population and Helath Program, a seven-year USAID health and population project. The survey had two main objectives: 1) to collect information on and monitor changes in the USAID performance indicators since the RSDP Baseline Survey in 1992, and 2) to evaluate the RSDP program's impact on the health of the project's catchment area population by linking data on individual behaviors and health outcomes with data on the health service supply environment. This report presents findings in the following areas, contraceptive use, antenatal care, childhood vaccinations, child health, awareness of RSDP services, knowledge of health promotion behaviors, early childhood mortality, and fertility. |
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Uganda Delivery of Improved Services for Health (DISH) Facility Survey 2002
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2003 |
English |
Southern Africa, UGANDA, Africa |
HIV/AIDS, Child Health, Maternal Health |
The 2002 DISH Facility Survey (DFS) was undertaken as part of a series of DISH Evaluation Surveys designed to measure changes in reproductive, maternal and child health knowledge and behaviors in DISH project districts. Results from these surveys have been used to monitor the progress of DISH activities and to evaluate project impact. Three rounds of population and facility-based surveys were conducted in 1997, 1999, and 2002. This 130-page report details the surveys and their findings in the following areas: trends in facility-based indicators betwteen 1997 and 2002: quality of antenatal care; quality of sick-child care; and basic standards of quality health care services. |
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Compendium d'Indicateurs pour l'Evaluation des Programmes de la Santé de la Reproduction - Volume II
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Bertrand J, Escudero G |
2002 |
French |
Global |
Indicators, Maternal Health, Evaluation, HIV/AIDS |
L'objectif général de ce Compendium est d'inciter l'évaluation de projets et d'améliorer la qualité du travail effectué dans ce domaine. Dans ce but, le Compendium présente une liste exhaustive des indicateurs les plus utilisés dans lévaluation des programmes de santé de la reproduction dans les pays en voie de développement. De plus, les indicateurs ont été organisés en fonction d'une version revue et corrigée du cadre conceptuel qui avait été élaboré initialement sous le projet ÉVALUATION. Ce cadre illustre par quels chemins les programmes atteignent leurs résultats et constitue un cadre logique pour l'élaboration d'un plan d'évaluation avec des indicateurs appropriés. Le cadre original, mis en place pour les programmes de planification familiale, peut être adapté facilement à dautres domaines de la santé de la reproduction. De nombreuses sections du Compendium contiennent des cadres plus détaillés expliquant le chemin effectué pour évaluer les effets propres au domaine dont il est question. |
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Socioeconomic Status, Permanent Income, and Fertility: A Latent Variable Approach
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Bollen K A, Glanville J L, Stecklov G |
2002 |
English |
GHANA, Latin America and the Caribbean, PERU, West Africa, Africa |
Maternal Health, Fertility |
The role of socioeconomic status (SES) is central in sociological studies of almost any outcome, and sociologists have become increasingly interested in the long-term or permanent income aspect of SES. In this paper we examine how the components of SES, including permanent income, relate to fertility in developing countries. Permanent income is an abstract concept that is impossible to measure directly. Therefore, we employ a latent variable approach to studying its impact on fertility. We compare our results to the more common practice of using a proxy variable to measure permanent income and thereby investigate the consequences of not accounting for the measurement error that is inherent in proxies for permanent income. Using micro survey data from Ghana and Peru, we find that permanent income has a large, negative influence on fertility and that research must take the latent nature of permanent income into account in order to uncover that influence. Our results also suggest that when we take into account the measurement error of the proxies for permanent income, the estimates of the effects of some of the control variables are markedly different. Finally, we examine which of the common proxies used to measure permanent income most reliably capture the concept. Though our focus is on childbearing, our results have implications beyond this specific dependent variable, providing researchers with a sense of the sensitivity of microanalyses to the treatment of long-term economic status. |
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The Effect of Facility Characteristics on Choice of Family Planning Facility in Rural Tanzania
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Chen S, Guilkey D K |
2002 |
English |
Southern Africa, Africa, TANZANIA |
Health Facilities, Contraception, Rural Populations |
A major goal of most family planning programs in developing countries is to increase quality and access to family planning facilities. While it has long been hypothesized that contraceptive users are responsive to their supply environment, there is scant evidence showing that access and quality factors, have an effect on family planning use (for recent work on the topic see, for example: Bertrand, Hardee, Magnani and Angle 1995; Cochrane and Guilkey 1995; Frankenberg, Sikoki, Suriastini, and Thomas 2001a and 2001b; Koenig, Hossain, and Whittaker 1997; Steele, Curtis and Choe 2000; and Tsui, Ukwuani, Guilkey and Angeles 2001). Much of the work cited above on the role of the family planning supply environment on influencing contraceptive use has focused on access to care. Using distance and proximity as a measure of access to care, several studies have found that access is an important determinant of contraceptive use. Some studies that have tried to examine the role that quality plays on the use of contraceptives have found that quality is important, though it is hard to uncover significant effects for specific quality indicators (see, for example, Mensch, Arends-Kuening and Jain 1996). One study, Mroz, Bollen, Speizer and Mancini (1999), found that a community's subjective measure of quality had a significant impact on contraceptive prevalence in that community and that the size of the impact was larger than the other community measures such as time, distance and accessibility. In the past, studies that have examined the effect of quality on individual level family planning behavior have often used community level information on family planning service quality. For example, a knowledgeable individual within the community is selected to provide information on the nearest facility or a facility actually within the community. The facility is surveyed or the knowledgeable individual is asked about the type of services available at the facility. If the unit of analysis is the woman, each woman within the community is then assigned information from this facility. There are two problems with this type of analysis. The first is that within a community, each woman has no variation in the quality of family planning facility. Since they all are assigned the same facility, the quality attributes of the facility do not vary within a community. The quality variables are in some sense restricted since by construction, they can now only account for differences in behavior across communities (not within). Since the only other factors in the analysis are demand side factors such as education, these variables may be overstated as they are forced to explain the difference in behavior across all individuals. The second problem is that a woman may not attend the facility assigned to her. She may decide to go outside of her community to obtain family planning or to go to another facility which was not surveyed. This will result in measurement error in the quality attributes of the facility that the woman is purported to attend. Mensch et al (1996) in their study of facility quality used a situation analysis to obtain information on all the family planning facilities within 5 kilometers of each community which, in rural areas, is a better approximation to the market for services that the woman faces. They found that better services were associated with greater contraceptive use. Their measure of quality was however an index made up of a number of quality attributes so that the effect of any one factor is obscured. Even though they had information on the market of facilities that a woman could choose to attend, they were not able to make use of this information in their analysis. Our study represents a departure from the typical question asked in much of the family planning supply literature. Instead of examining the effect of the components of the supply of family planning on contraceptive prevalence or use we ask a more basic question. Among current users of family planning, what quality and access attributes influence a woman's choice of family planning facility? We are able to undertake this analysis because of an unusually rich data set which links rural women in Tanzania with their entire market of family planning facilities surrounding their community. In other words, we have data on all of a woman's options when she is contemplating where to go to receive family planning services. In addition, for 40% of modern contraceptive users in our sample we have information on the actual facility she attended even if it lies outside of the surrounding area. This means that we do not rely on community informants to determine where a woman goes for family planning and we have a more reliable accounting of the attributes of the facility that she attends. To determine the effect of specific facility attributes on facility choice we use McFadden's conditional logit model. In this model, the effect of choice characteristics are used as determinants of individual facility selection. We use distance as our measure of access, and two quality measures: at least one provider trained since 1992 and the number of modern family planning methods seen in stock. Compared to previous studies we have better data on trained providers and distance is more precisely estimated. The distance variable is based on a Global Positioning System (GPS) reading taken at the facility and measured from the center of the community. Our information on trained providers was based on a survey administered to all family planning providers and contained very specific questions on the type of training and the year that training was received. This type of study will help policymakers to identify what quality factors attract a woman to a facility and assist them in targeting their population programs to provide better care to women. After an introductory section, authors describe the data set used and present descriptive statistics. Section III presents the estimation methods and the empirical results. Authors conclude in section IV. |
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A Comparative Multi-Level Analysis of Health Program Effects on Individual Use of Reproductive and Sexual Health Services
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Tsui A O, Ukwuani F, Guilkey D, Angeles G |
2002 |
English |
INDIA, Asia, Africa, Southern Africa, PARAGUAY, TANZANIA, UGANDA |
Public Health, Reproductive Health |
This study assesses the influence of health resource inputs, in the form of facilities, commodities and knowledge, on the likelihood of individual use of family and other reproductive health services in four developing countries. The data analyzed are drawn from multi-stage cluster sample surveys in Paraguay, Uganda, Tanzania, and northern India, which selected health facilities and female populations for interviews. Although previous studies are equivocal about such effects, this study finds health-system factors, such as distance, types of services provided, and exposure to health messages, to influence significantly individual consumption of services for contraception, maternity care, and sexual health services, net of demand factors. A strong distance decay effect is observed on women's use of maternity services. The study also finds, however, that in these low-income settings women's consumption of health services is primarily influenced by household and individual socioeconomic status. |
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Health Facility Characteristics and the Decision to Seek Care
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Jensen E R, Stewart J F |
2002 |
English |
East Asia, South Asia, PHILIPPINES, Asia |
Child Health, Public Health, Health Facilities |
Utilisation of healthcare facilities is low in many developing areas. One possible explanation is that treatment costs, in time or money, are high. Another is that parents perceive treatment benefits to be low. We combine Philippines DHS data with a subsequent facilities survey in order to examine these issues with respect to treatment for respiratory infections and diarrhea in young children. Controlling statistically for the selectivity of the initiating illness, we find that the staffing level of nearby health facilities is a determinant of the probability that parents take their ill children for curative care. |
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HIV impact on mother and child mortality in rural Tanzania
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Ng |
2002 |
English |
TANZANIA, Africa, Southern Africa |
Child Health, HIV/AIDS, Rural Populations, Maternal Health, Child Mortality |
Child mortality in Tanzania rose from 137 per 1,000 in 1992-96 to 147 in 1995-99. HIV affects child mortality directly, due to mother to child transmission, and indirectly, because maternal illness and death has negative consequences for child health. A longitudinal community-based study in Kisesa ward, Mwanza region is used to show the contribution of HIV infection to child mortality. HIV status data of 4,273 mothers, from three rounds of serological testing (1994, 96 and 99) are linked to survival information for 6,049 children born between 1994 and 2001. Impacts of maternal survival and HIV status on child mortality are assessed using hazard analysis with time varying co-variates. 584 child deaths were recorded during 10,002 person-years of observation. Infant mortality among children of HIV positive mothers was 158 per 1,000 compared to 74 for children of HIV negative mothers. By age 5 child mortality risks were 265 and 135 respectively. 51 deaths were observed among women who gave birth, 14 of these were among the 149 mothers known to be HIV positive at parturition. Infant mortality among children whose mothers died was 257 compared to 87 amongst children of surviving mothers. Mortality risks for children whose mother died were as high in the year preceding the mother's death as in the first year of orphanhood. Statistical analysis showed that the effect of maternal death was independent of maternal HIV status, though numbers were too small to study interactions in children over age 3. After allowing for the effects of age, sex, twinning, birth interval, maternal education and residence, the child death hazard ratio for maternal HIV infection was 2.2 (1.6 - 3.1), the hazard ratio associated with maternal death was 4.6 (2.6 - 8.1). In a population in which HIV prevalence among pregnant women is 4.3%, the fraction of infant mortality attributable to maternal HIV infection is 8.1%. |
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Secretive females or swaggering males? An assessment of the quality of sexual partnership reporting in rural Tanzania
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Nnko S, Boerma J T, Urassa M, Mwaluko G, Zaba B |
2002 |
English |
Southern Africa, TANZANIA, Africa |
Rural Populations, Data Quality, HIV/AIDS, Sexual Behavior |
In population-based surveys on sexual behaviour, men consistently report higher numbers of sexual partners than women, which may be associated with male exaggeration or female underreporting or with issues related to sampling, such as exclusion of female sex workers. This paper presents an analysis of data collected in the context of a longitudinal study in rural Tanzania, where a sexual partnership module was applied to all participating men and women in the study population. Since the study design included all men and women of reproductive ages and did not involve sampling, these data provide a unique opportunity to compare the consistency of aggregate measures of sexual behaviour between men and women living in the same villages. The analysis shows that non-marital partnerships are common amongst single people of both sexes -- around 70% of unmarried men and women report at least one sexual partner in the last year. However, 40% of married men also report having non-marital partners, but only 3% of married women do so. Single women report about half as many multiple partnerships in the last year as men, and only one-fifth as many overlapping partnership episodes as are reported by single men. Underreporting of non-marital partnerships was much more common among single women than among married women and men. Furthermore, women were more likely to report longer duration partnerships and partnership with urban men or more educated men than with other men. If a woman reports multiple partners however, biological data indicate that this is true. For men however there is a weak association between numbers of type of partnerships and the risk of HIV, and it cannot be excluded that men, especially single men, exaggerate the number of sexual partners. |
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Understanding the Uneven Spread of HIV within Africa: Comparative Study of Biological, Behavioral and Contextual Factors in Rural Populations in Tanzania and Zimbabwe
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Boerma J T, Nyamukapa C, Urassa M, Gregson S |
2002 |
English |
TANZANIA, Africa, ZIMBABWE, Southern Africa |
Rural Populations, HIV/AIDS, Sexual Behavior |
Objective: To identify factors which explain differences in the spread of HIV between rural sub-Saharan African populations. Methods: Ecological comparison of data from cross-sectional population-based HIV surveys in high and relatively low HIV prevalence rural areas in Zimbabwe (Manicaland) and Tanzania (Kisesa). Results: HIV prevalence in Manicaland and Kisesa was 15.4% (n = 1,624) and 5.3% (n = 2,588) in men aged 17-44 years (odds ratio [OR] 3.3; 95% CI, 2.6-4.1) and 21.1% (n = 2,968) and 8.0% (n = 3,365) in women aged 15-44 years (OR, 3.1; 95% CI, 2.7-5.7). Marriage is later, spatial mobility more common, cohabitation with marital partners less frequent, education levels are higher, and male circumcision is less common in Manicaland. However, adjustment for differences in these factors increased the odds ratios for HIV infection in Manicaland versus Kisesa to 6.9 (95% CI, 4.9-9.8) and 4.8 (95% CI, 3.6-6.3) for men and women, respectively. STI levels were similar but syphilis was only common in Kisesa. Respondents in Kisesa started sex earlier and reported more sexual partners, while age differences between partners were similar. Conclusion: The comparison of data on a wide range of underlying and proximate factors for the rural populations has resulted in few possible reasons for the much more extensive spread of HIV in Zimbabwe. The most important differences between the two populations pertained to underlying socio-demographic variables, such as the much lower levels of spousal cohabitation and the higher levels spatial mobility seen in Manicaland, although these differences did not translate into changes in reported sexual behavior. Key Words: HIV prevalence - Epidemic size - Ecological study - Proximate determinants - Tanzania - Zimbabwe |
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The Determinants of Fertility in Rural Peru: Program Effects in the Early Years of the National Family Planning Program
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Angeles G, Guilkey D K, Mroz T A |
2002 |
English |
Latin America and the Caribbean, PERU |
Rural Populations, Fertility |
After several attempts over a 20-year period, Peru enacted its National Policy on Population in July 1985. Using data from the 1991 Peru Demographic and Health Survey (PDHS91), a linked Peru Situation Analysis (PSA92) community and facility data set collected in 1992, and a unique region-level data set gathered specifically for this analysis, this paper examines the determinants of fertility in rural Peru before and after this important date. Particular attention is paid to assess the effect of family planning services on fertility. The empirical model that is used combines a model of the timing and spacing of births with a model of the timing of the placement of family planning (FP) services in communities. This modeling strategy allows us to control for the non-random placement of FP services that could potentially bias the measures of program impact. An illustration of the potential relationship between fertility and FP services can be seen in Figures 1 and 2. Figure 1 presents age-specific fertility rates (ASFR) for the period 1972-1991 from the fertility histories for women in the rural sample of the PDHS91. For all age groups except the youngest, fertility appears to be declining, and the rate of the decline seems to have accelerated in the 1980's. Figure 2 depicts the expansion of FP services within five kilometers of the rural PDHS communities for different type of providers. Public FP services were virtually non-existent in rural Peru during the 1970's and the expansion in services really started after the passage of the National Policy on Population in 1985. The timing and extent of the fertility decline appear to coincide with the growth of the government provision of FP services. Our data set allows us to estimate the determinants of the annual probability of a birth for every year between 1972 and 1991 and so we completely span this period of marked change. Clearly, any change in FP policy will not have an immediate impact on fertility. One of the goals of this paper will be to measure the lag in program impact if, in fact, there is an impact at all. The next section of this paper presents a brief review of Peru's family planning program. This context will be important in the interpretation of our empirical results. Section III discusses estimation difficulties that arise when programs are not randomly implemented and our estimation strategy that overcomes these difficulties. Section IV presents the data used to estimate the model, and Section V discusses the results. We conclude in Section VI. |
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Measuring Family Planning Sustainability at the Outcome and Program Levels
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Stephenson R, Tsui A O, Knight R |
2002 |
English |
|
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The paper examines the validity of two indices of sustainability: family planning program sustainability (PSI) and outcome sustainability (OSI), developed by Tsui and Knight (1997) by applying their original method to recent data. The indices succeed in identifying the directional path of program and outcome sustainability. Close correlations are found between PSI and OSI predicted values and actual program and outcome values. The indices provide a repeatable method for measuring sustainability, although they are sensitive to data measurement errors. The indices provide a policy tool for funding decisions but should be used with other data sources to judge sustainability. |
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An Assessment of the Quality of National Child Immunization Coverage Estimates in Population-based Surveys
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Brown J, Monasch R, Bicego G, Burton A, Boerma J T |
2002 |
English |
Global |
Child Health |
Background This study aims to assess of the quality of child immunization coverage estimates obtained in 101 national population-based surveys in mostly developing countries. Methods The Demographic and Health Surveys (DHS) and UNICEF's Multiple Indicator Cluster Sample (MICS) surveys provide national immunization coverage estimates for children aged 12-23 months once every three to five years in many developing countries. The data are collected by interview from a nationally representative sample of households. 83 DHS and 18 MICS surveys were included. Findings 85% of mothers reported that they had ever received a health card for their child. 81% still had the card at the time of the interview, and nearly two-thirds of these presented the card to the interviewer. Cards were therefore observed for 55% of children overall. Rural and less educated mothers were less likely to report receiving health cards. Recall of additional immunizations by mothers that presented a card ranged from 1 to 3%. Recall of immunizations by mothers who reported never receiving a card ranged from 9 to 32%. Coverage among those who did not show a card rarely exceeded coverage among those who did, and there was good correlation between DPT and OPV doses received according to health card and recall data. Conclusion Though maternal recall data are known to be less accurate than health card data, we found no major systematic weaknesses in recall and believe that inclusion of recall data yields more accurate coverage estimates. |
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Determinants of Contraceptive Method Choice in Rural Tanzania between 1991 and 1999
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Chen S, Guilkey D K |
2002 |
English |
TANZANIA, Africa, Southern Africa |
Rural Populations |
Four pooled Demographic and Health survey data sets are used to examine the determinants of contraceptive method choice in rural Tanzania in the period 1991 to 1999. The individual data is linked to facility surveys conducted in the same communities so that the impact of Tanzania's family planning program can be examined. The very large sample size allows us to disaggregate method choice into five categories, including a separate category for condoms, even though this is a very low prevalence country. In addition, we are able to examine the impact of pharmacies. The results show that contraceptive use increased dramatically in the early years of the period and then leveled off. The facility information also shows an initial substantial increase in facility quality and then a leveling off and decline. The pharmacy results run counter to this prevailing trend. |
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The Impact of Community Level Variables on Individual Level Outcomes: Theoretical Results and Demographic Applications
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Angeles G, Guilkey D K, Mroz T A |
2002 |
English |
Global |
Contraception |
We study alternative estimators of the impacts of higher level variables in multilevel models. This is important since many of the important variables in demographic research, such as community level access to family planning facilities, prices for services, and media campaigns are higher level factors having impacts on lower level outcomes such as contraceptive use. We present theoretical and Monte Carlo evidence about point estimation and standard error estimation for both two and three level models for continuous dependent variables, and we discuss the extension of these results to models with discrete dependent variables. A major conclusion of the paper is that readily available commercial software can be used to obtain both reliable point estimates and coefficient standard errors in models with two or more levels as long as appropriate corrections are made for possible error correlations at the highest level. |
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The Impact of a Reproductive Health Project Interventions on Contraceptive Use in Uganda
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Katende C, Gupta N, Bessinger R |
2002 |
English |
Southern Africa, UGANDA, Africa |
Maternal Health, Reproductive Health, Contraception |
This study considers whether recent increases in modern contraceptive use in Uganda are likely reflecting the impacts of reproductive health interventions related to health facilities. We employ data from the 1999 Delivery of Improved Services for Health (DISH) Evaluation Surveys, which provide quantitative information on the reproductive health status of individuals and services in the districts served by the DISH project. The surveys consisted of a Household Questionnaire administered to a representative sample of women of reproductive age, and a Facility Questionnaire implemented in all health facilities serving the sampled population. Multivariate logistic regressions were used drawing on both individuals' background characteristics as well as representative characteristics of health facilities to assess the independent impact of the quality of the health service environment on individual-level differences in contraceptive use. After controlling for a number of socio-demographic characteristics, access to a greater choice of family planning supply methods in rural areas remained significantly associated with women's increased usage. A positive association between the number of DISH-trained family planning service providers and contraceptive use was found in urban areas. However unexpected findings of negative associations between certain indicators of programme efforts and actual family planning practices point to the need for a better understanding of any potential targeting of publicly-funded resources. |
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Estimation of levels and trends in age at first sex from surveys using survival analysis
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Zaba B, Boerma T, Pisani E, Baptiste N |
2002 |
English |
Africa, Southern Africa, UGANDA |
HIV/AIDS |
Age at first sex is an important indicator of exposure to the risk of pregnancy and risk of sexually transmitted infections, including HIV, during adolescence. In fertility studies age at first marriage is often used as a proxy measure of the onset of a woman's exposure to pregnancy, but in many societies premarital sexual activity is common, and it has been proposed to use age at first sex as a better proxy (Stover 1998). In the context of the AIDS epidemic, accurate monitoring of trends in age at first sex has become even more important. Interventions target youth and promote postponement of first sex or discourage premarital sexual activity. In several countries, trends in HIV prevalence among pregnant women attending antenatal clinics have shown a decline in the younger age groups, while older women do not show such changes (Bunnell et al. 1999,Kilian et al. 1999). Such changes may be associated with changes in age at first sex, rates of partner change, sexual mixing patterns, and condom use. In Uganda, a rapid increase in age at first sex in urban areas between 1990 and 1995 was considered a major contributing factor in the observed HIV prevalence decline in young pregnant women from about 1993 (Asiimwe Okiror et al. 1997). |
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Community effects on the risk of HIV infection in rural Tanzania
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Bloom S S, Urassa M, Isingo R, Ng |
2002 |
English |
Southern Africa, TANZANIA, Africa |
HIV/AIDS, Rural Populations |
Objectives: To investigate the effect of community characteristics on HIV prevalence and incidence. Methods: Data from an open cohort study with demographic surveillance, epidemiological surveys and qualitative research were used to examine the relationship between individual and community risk factors with HIV prevalence in 1994/95 and incidence between 1994/95 and 1996/97 among men (n=2271) and women (n=2752) living in a rural area in northwest Tanzania. Using subvillages as the unit of analysis, community factors investigated were level of social and economic activity, ratio of bar workers per male population aged 18-59, level of community mobility, and distance to the nearest town. Logistic and Cox regression models were estimated to assess community effects, controlling for multiple individual factors. Results: All four community factors had strong effects on HIV transmission. Men who lived in subvillages with the highest level of social and economic activity had an odds of being HIV positive that was about five times higher (OR=4.71, 95% CI=2.89-6.71) than those in places with low levels of activity; women in these subvillages had an odds that was twice as high (OR=1.92, 95% CI=1.27-2.92). After controlling for community effects, the effects of some individual factors on the risk of HIV education, male circumcision, type of work, and number of household assets changed notably. The association between HIV incidence and community factors was in the expected direction, but did not reach statistical significance (RR=2.07, p=0.10). Conclusions: Results suggest that community characteristics play an important role in the spread of HIV in rural Tanzania. Community effects need to both be considered in individual risk factor analyses and given more attention in intervention programs. |
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Assessment of the Roll Back Malaria Monitoring and Evaluation System
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Macintyre K, Eckert E, Robinson A |
2002 |
English |
Africa, Global |
|
Introduction The Roll Back Malaria (RBM) partnership is currently undergoing an evaluation of its progress after three years of implementation. One objective of the RBM Partnership is to develop an effective monitoring and evaluation (M&E;) system to assess RBM progress towards its objectives and determine whether its goals have been met at the country, regional, and international levels. USAID, as a primary funder of this monitoring and evaluation system, particularly for the Africa region, has requested a specific assessment of the monitoring and evaluation system at the regional and global level. The results of this assessment will feed into the larger external evaluation and will provide recommendations to improve the capacity of RBM to monitor its effectiveness. The methods used here have consisted of document reviews, database reviews, summary analysis of indicators and methodology, and key informant interviews in Harare, Geneva, Atlanta and by phone with nearly all other partners. The consultancy took place between November 2001 and January 2002. WHO/AFRO: 3 staff from RBM and 1 person from integrated disease surveillance WHO/HQ: 5 staff from RBM, 2 from integrated disease surveillance, 2 from TB Interviews and general discussions were also held with most of the individuals involved in or with a close interest in M&E; of RBM, with members of the Partnership, and several malaria experts from RBM itself, and externally. Framework The framework for M&E; for RBM is comprehensive in its coverage of all areas relevant to Roll Back Malaria. It emphasizes local control over data collection efforts by developing standardized approaches and encouraging countries to pick indicators appropriate to its epidemiologic profile. The framework uses minimal new data collection, instead relying on existing mechanisms and tapping into larger survey efforts, such as the DHS, where appropriate. This reliance on on-going data collection efforts while improving existing systems aims is laudable but has potential to increase problems in acquiring the desired data in a timely fashion. The conceptual framework spells out the elements of a malaria program but does not clarify the processes, outputs, and outcomes within each element. In addition, there is no guidance on the appropriate selection of indicators at different levels, except to urge countries to choose one process and one outcome indicator for each element. The 'evaluation' aspect of M&E; is not evident in the framework documents either which could limit efforts to empirically prove the merits and cost-effectiveness of various programs. Databases and Platforms Monitoring and evaluation depends on high-quality valid and reliable data on the target program. Several databases are in use, or being created. However, many challenges remain if these databases are to play a solid role in M&E.; In many cases the databases are not complete and some of the data are of questionable quality. It is of particular concern that the baseline surveys are still not complete. At the country level, various sources of data exist including national health information systems, national surveys such as the Demographic and Health Survey (DHS) or the UNICEF Multi-indicator Cluster Survey (MICS). These sources provide information for program monitoring and impact assessment on a regular basis. WHO/AFRO has also developed a methodology for collecting country baseline data which is currently being implemented in Africa. In addition, RBM has contracted with the INDEPTH network of demographic surveillance sites to collect specific indicators on malaria morbidity and mortality to inform the program on disease trends. Indicators and Sources of Data There is a lack of consistency in indicators and definitions reported across countries and regions within RBM. The biggest issue is a lack of clarity on the definition of the indicators and target population covered. This lack of consistent guidelines and practices is a minor problem within a given country but can create more serious problems when it is aggregated at the regional or international level and compared with data from other countries that use different definitions or data sources. The guidelines require countries to report on the 5 'global' indicators and suggest selecting indicators to cover outcome and process levels as well. However, many countries have difficulty in recognizing the process/outcome/impact hierarchy. RBM (either regional or international) could greatly assist in this effort by providing technical assistance to individual countries to develop their M&E; plans. The RBM M&E; framework suggests many different sources of data for most of the key indicators, including 4 of the 5 global indicators, which leads to confusion as to the most appropriate mechanism to obtain the needed data. A large number of the proposed indicators are population-based, yet the bulk of the data used are derived from routine health information systems or facility-based information and do not use the most accurate denominator estimates. The RBM guidelines currently provide no guidance on the appropriate selection of data sources. Indeed, in AFRO Region, community surveys are being implemented without the rigid sampling methodologies necessary to be representative. This can create confusion and controversy when an indicator derived from one source is not the same as one calculated from another. Finally, there is an inconsistency in definitions of the suggested indicators, particularly the 'global' or 'core' indicators. These inconsistencies lead to confusion and ultimately jeopardize attempts to aggregate data at the regional or international level. Organizational Capacity Many of the shortcomings of the M&E; system of RBM are due to organizational or structural issues within the RBM offices. The M&E; team at HQ is tasked with: a) coordinating an internal M&E; working group; b) developing and implementing a work plan to track progress of RBM at all levels; c) developing a geographical information system for RBM; d) developing and testing tools for malaria M&E; and e) coordinating reporting on RBM and related activities. In addition to the M&E; team at WHO/HQ, individuals within the programmatic components of RBM have M&E; responsibilities. Several individuals working in other units such as Stop TB and Communicable Disease Surveillance are also collaborating on aspects of RBM M&E;, however, the organizational structure of RBM does not clearly define the roles and responsibilities of these individuals vis-à-vis the M&E; team. Likewise, budget allocations for M&E; activities are not clearly defined among the groups. This confusion leads to redundancies in some activities and gaps in others. At WHO/AFRO, the M&E; team is understaffed, consisting of one epidemiologist and one data manager. Both individuals are frequently on other activities within RBM and the larger WHO office. Other regional offices do not have dedicated M&E; staff. This is a serious shortcoming given that all the data for international monitoring must come through the regional offices first. There is no clear delineation of responsibilities between the regional bureaus and WHO/HQ for monitoring and evaluation activities nor is there any formalized chain for reporting or deadlines. RBM is caught between the stated goal of helping countries develop their monitoring systems and the demand to produce accurate, timely tracking for the overall initiative. However, given the constraints mentioned above, this review suggests that technical assistance for the development of monitoring systems should be viewed as a separate, but equally important, activity from the monitoring of international efforts, at least in the early years of the initiative. Recommendations 1. Recommendations for establishing systematic evaluation of RBM 1.1 Establish a strong M&E; Team at the RBM Secretariat and in the Regional Offices. We see this as needing at least three separate initiatives: Increase the number of qualified M&E; staff both at HQ and in the Regional offices, especially AFRO. Streamline the management structure so that there is more authority to drive the evaluation decisions. Establish a reference group to provide periodic consultation on specific technical issues related to monitoring and evaluation. 1.2 Establish and maintain a plan and timeline for RBM M&E; reports at the regional and global levels. Reports that are essential in the near future include: A baseline report for measures (dating from approximately 1998-1999) of impact, outcome, and process indicators from settings where these data exist Progress reports describing specific issues such as evaluation of priority interventions, or monitoring the effect of a major policy change (e.g. change in first line drug policy). A format for annual reporting on progress with specific indicators and a timeframe for reporting must be established. A global report on malaria, produced every few years, like the TB Global Report, would be very helpful at the international level. 1.3 Establish a transparent system for assessing data quality and standardization across countries especially for the core indicators. The current M&E; framework allows for local adaptation of many indicators thus potentially rendering some indicators incomparable. Certain indicators, when established as ""global"" or at least as ""regionally critical,"" must be exempt from country modification. 1.4 Establish methods for documenting sources of data within the specific databases used for M&E; purposes, and the extent to which they are representative of a country situation. Currently, data sources for country indicators are not documented when the data are aggregated to the national or regional level thus confusing interpretation. 1.5 Establish clear guidelines for data collection protocols and sampling strategies used to collect malaria-focused data in countries. For those indicators which can be obtained through standard survey methodologies, these should be used. For other indicators, RBM needs to provide clear and consistent recommendations on how to collect the necessary data and technical assistance in data collection when necessary. 1.6 Establish a complete malaria database at the global level. Currently, no complete database for malaria exists at the global level (although the AFRO Regional office is compiling one for that region). RBM must be pro-active in collecting data and holding countries to reporting requirements and deadlines. 1.7 Develop clear terms of reference for the HQ M&E; unit as a whole. Management needs to clarify how the cross-cutting programs like M&E; should interact with the vertical teams. Current collaboration is based more on personal relations than on a defined structure. |
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Cost and Efficiency of Reproductive Health Service Provision at the Facility Level in Paraguay
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Angeles G, Gaete R, Stewart J F |
2002 |
English |
Latin America and the Caribbean, PERU |
Child Health, Health Facilities, Maternal Health, Reproductive Health |
The cost and efficiency at which maternal, child, and reproductive health care services are provided in developing countries have become increasingly pressing issues over the last decade. A number of factors are driving the concern over cost and efficiency. These include the staggering estimated total cost of providing these services, (1) the scarcity of funds to meet policy objectives, and the resultant pressure from donor countries and agencies for programs to be more accountable for results and cost effectiveness, and for programs to demonstrate the potential for long run sustainability. Furthermore, the analysis of many policy issues of current interest can be informed by detailed information on cost of service. It has long been hypothesized that organizational structure of the health care service provision system may have a substantial impact on the cost of service provision. Analysis of issues such as the effect of decentralizing the health care system or converting from vertical to integrated systems requires large cross sectional data bases of cost information. Existing data obtained at the facility level such as the DHS Service Availability Module and Situation Analysis, while providing much information about the facility's operation, provide essentially none of the information required to make estimates of service provision costs. Any examination of cost and efficiency of the provision of health care services is complicated significantly by the fact that reproductive health involves a large number of different services each with different cost implications. In this paper we develop a methodology for estimating facility level service provision cost disaggregated to the service level that makes use of survey data collected from 52 public health facilities in Paraguay. In addition, a method is developed to calculate facility level measures of staff use utilization rates to provide information on the efficiency of input use in the Paraguayan health care system. The current paper is part of a larger study of health care decentralization in Paraguay. (2) The broader study was designed to measure changes in cost, efficiency, and other attributes of the public heath care system that might be attributed to the change from a centralized system to one where the responsibility for managing basic health care services provided through public facilities is devolved to the municipal governments. The sample was selected to include a census of public health facilities from 20 municipalities in Paraguay, 11 of which were to be subject to decentralization and 9 were to remain under centralized control. The current paper reports the baseline cost and efficiency results. 1. The United Nations Fund for Population Activities (UNFPA) has estimated that worldwide spending on family planning (FP) and reproductive health (RH) will reach 17 billion dollars annually by the year 2000 (UNFPA, 1996). 2. See Angeles, et al., 1999. |
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Decentralization in Tanzania: The View of District Health Management Teams
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Hutchinson P |
2002 |
English |
Southern Africa, TANZANIA, Africa |
Public Health |
A 1999 survey of District Health Management Teams (DHMTs) in Tanzania provides information on the progress of the decentralization process in that country. The objectives of the survey were to monitor the extent of the decentralization process and to collect information on decentralization's achievements and limitations to date. The survey represents a unique source of data since information was collected from the actual "on-the-ground" implementors of the decentralization process. The survey found that while decentralization has been ongoing for over a decade, at least rhetorically, less than half of DHMTs report that decentralization is underway in their districts and the actual transfer of administrative and fiscal responsibilities is still limited for the majority of districts. Most districts are heavily reliant on external funding and report that they have control over only a small proportion of their budgets. For those districts in which decentralization is ongoing, the decentralization process is reported to be associated with improvements in a variety of areas: availability of district funds, coordination with donors, ability to attract and retain staff, and use of government health services. |
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Decentralization, Allocative Efficiency and Health Service Outcomes in the Philippines
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Schwartz J B, Guilkey D K, Racelis R |
2002 |
English |
East Asia, South Asia, PHILIPPINES, Asia |
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Many developing countries have decentralized the public health care system in the last twenty years, but little empirical research has been conducted on the effects of these fiscal changes. Important policy questions are whether decentralization leads to more or less health care provision, whether more or less public good types of health care are provided, and whether local governments are effective in the provision of health care services. This paper systematically examines these questions using a unique data set on audited annual expenditures combined with secondary census and demographic survey data for nearly 1600 local governments before and after decentralization in the Philippines. Our statistical methods correct for the potentially endogenous allocation of funds to the provision of health care by local governments. The results show that although local health expenditures and the share of resources allocated to health increased after decentralization, local governments decreased the share of public good types of health care services. In addition, we find that city/municipality public health expenditures are endogenous and that simple methods that do not correct for this endogeneity can be seriously misleading. Finally, we find that local expenditures are found to increase the use of public health services and the impact of these expenditures on health related outcomes is substantial. |
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Proceedings from the RHINO Workshop on Issues and Innovation in Routine Health Information in Developing Countries, March 14-16, 2001
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2002 |
English |
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MEASURE Evaluation, JSI, the World Bank, and WHO hosted an international workshop, "Issues and Innovation in Routine Health Information in Developing Countries" from March 14-16, 2001. This HTML document provides an in-depth discussion of that workshop's proceedings. This html document contains links that discuss the workshop agenda, presentations and papers, facilitators and presenters, a list of participants, working groups, and a .PDF document summarizing workshop proceedings. |
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Declaration de Potomac sur l’investissement dans l’information sanitaire de routine dans le monde en voie de développement
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2002 |
French |
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MEASURE Evaluation, JSI, the World Bank, and the World Health Organization hosted an international workshop on Issues and Innovation in Routine Health Information in Developing Countries on March 14-16, 2001, in Potomac, Maryland. This html document, written in French, describes the workshop and the issues discussed there. This document includes the workshop agenda, presentations and papers, facilitators and presenters, a list of participants, working groups, and a 224-page .pdf document of the workshop proceedings. |
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The Potomac Statement on Investment in Routine Health Information in Developing Countries
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2002 |
English |
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Knowledge Management |
MEASURE Evaluation, JSI, the World Bank, and the World Health Organization hosted an international workshop on Issues and Innovation in Routine Health Information in Developing Countries on March 14-16, 2001, in Potomac, Maryland. This html document describes the workshop and the issues discussed there. This document includes the workshop agenda, presentations and papers, facilitators and presenters, a list of participants, working groups, and a 224-page .pdf document of the workshop proceedings. A French-language version of this document, Declaration de Potomac, is also available. |
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AIDS in Africa During the Nineties: Zimbabwe
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2002 |
English |
Africa |
HIV/AIDS |
This report presents and discusses available information about the AIDS-related knowledge, attitudes, behaviors, and practices of Zimbabweans during the 1990s. To provide an epidemilogical context to the report, a summary of Zimbabwe's national HIV surveillance data is presented. This 51-page document is divided into six sections. After a first introductory section, the second section details the spread of the AIDS epidemic in the country. The third section details HIV/AIDS related knowledge of Zimbabweans. The fourth summarizes Zimbabweans' sexual behavior. The fifth section discusses condom use and awareness, and the final section discusses the demographic impact of the HIV/AIDS epidemic in terms of mortality and orphanhood. |
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Trends in Reproductive Health Knowledge, Attitudes, and Practices in the CREHP Districts of Uganda, 1995-2000.
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2002 |
English |
Africa |
Contraception, Maternal Health |
This report presents findings from the 2000 Uganda Demographic and Health Survey (UDHS) for districts served by the Community Reproductive Health Project (CREHP). Where possible, trends in family planning, maternal and child health, and knowledge and behavior among adults of reproductive age are compared to findings from the 1995 UDHS. After a brief introduction, this report presents a demographic description of survey respondants. Following these, the report presents indicators of family planning, of maternal and child health, and finally of STDs and HIV/AIDS. While the trends in some indicators are encouraging, they are associated with unchanging and declining trends in others. |
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Evaluacion de la Calidad de Registros de Nacimientos en Establecimientos de Salud en Guatemala
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2002 |
Spanish |
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Guatemala, Maternal Health |
This Spanish language report presents the findings of an in-depth case study carried out in facilities in three departamentos of Guatemala (Quiche, San Marcos, and Totonicapan) to determine whether routine data in maternity registers can be used to monitor and evaluate maternal and neonatal health at the departamento level, and if so, in what ways the register might best be used. An English-language version of the report is also available on the MEASURE Evaluation's publication Web site. |
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Assessment of the Quality of Maternity Registers in Guatemala
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2002 |
English |
Central American Project, GUATEMALA, Latin America and the Caribbean |
Maternal Health, Child Health |
Better tools and methods are required for monitoring maternal health. Deriving key process indicators from birth register data has been proposed as a method, but experience to date is limited and there is ongoing debate as to whether this approach is feasible or sustainable. Although maternity register data are collected in most facilities, there is little evidence that they are used effectively for monitoring, even in many developed countries. This report presents the findings of an in-depth case study carried out in facilities in three departamentos of Guatemala (Quiche, San Marcos, and Totonicapan) to determine whether routine data in maternity registers can be used to monitor and evaluate maternal and neonatal health at the departamento level, and if so, in what ways the register might best be used. |
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Compendium of Maternal and Newborn Health Tools
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2002 |
English |
Global |
Child Health, Maternal Health |
The monitoring and evaluation of maternal and newborn health programs present serious challenges to the areas of program managment. In order to help a wider audience gain experience in the monitoring and evaluation of maternal and newborn health status, MEASURE Evaluation brought together more than 20 tools, collected in this compendium. This compendium includes population- and facility-based assessment tools that use qualitative and quantitative approaches and that can be used at different levels of the health system. Each tool meets the following four criteria: 1) It is principally concerned with monitoring or evaluating maternal or newborn health status; 2) It is appropriate for use in developing country settings; 3) It is current; and 4) It has been field-tested. Each of the abstracts included here is linked to an electronic version of the tool that can be downloaded. |
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Compendium d'Indicateurs pour l'Evaluation des Programmes de la Santé de la Reproduction - Volume I
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Bertrand J, Escudero G |
2002 |
French |
Global |
HIV/AIDS, Indicators, Maternal Health, Child Health, Evaluation |
Lobjectif général de ce Compendium est dinciter lévaluation de projets et daméliorer la qualité du travail effectué dans ce domaine. Dans ce but, le Compendium présente une liste exhaustive des indicateurs les plus utilisés dans lévaluation des programmes de santé de la reproduction dans les pays en voie de développement. De plus, les indicateurs ont été organisés en fonction dune version revue et corrigée du cadre conceptuel qui avait été élaboré initialement sous le projet ÉVALUATION. Ce cadre illustre par quels chemins les programmes atteignent leurs résultats et constitue un cadre logique pour lélaboration dun plan dévaluation avec des indicateurs appropriés. Le cadre original, mis en place pour les programmes de planification familiale, peut être adapté facilement à dautres domaines de la santé de la reproduction. De nombreuses sections du Compendium contiennent des cadres plus détaillés expliquant le chemin effectué pour évaluer les effets propres au domaine dont il est question. |
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Compendio de Indicadores para Evaluar Programas de Salud Reproductiva
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2002 |
Spanish |
Latin America and the Caribbean |
Child Health, Indicators |
This Spanish-language Compendium provides a comprehensive listing of the most widely used indicators for evaluating reproductive health programs in developing countries. Indicators are organized according to a revised version of the conceptual framework originally developed by MEASURE Evaluation. This framework maps the pathways through which programs achieve results, and it constitutes a logical framework for developing an evaluation plan with appropriate indicators. Many sections of this Compendium contain more detailed frameworks that explain the pathways for program effects specific to the topic area in question. A version of this Compendium written in English, "Compendium of Indicators for Evaluating Reproductive Health Programs," is also available on the MEASURE Evaluation Web site. |
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Compendium of Indicators for Evaluating Reproductive Health Programs
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Bertrand J, Escudero G |
2002 |
English |
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Indicators, Reproductive Health, Child Health |
In June 2011 an updated version of this Compendium was released. Please refer to the online Family Planning and Reproductive Health Indicators Database.
This Compendium provides a comprehensive listing of widely used indicators for evaluating reproductive health programs in developing countries. Indicators are organized according to a revised version of the conceptual framework originally developed by MEASURE Evaluation. This framework maps the pathways through which programs achieve results, and it constitutes a logical framework for developing an evaluation plan with appropriate indicators. Many sections of this Compendium contain more detailed frameworks that explain the pathways for program effects specific to the topic area in question.
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A Trainers Guide to the Fundamentals of M&E for Population, Health and Nutrition Programs
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2002 |
English |
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Public Health |
This HTML document is a training manual intended to help trainers teach program managers, staff, and other decision-makers the fundamental elements and techniques of monitoring and evaluation with a focus on population and health programs. The manual is divided into three modules: an introduction to M&E, developing plans for M&E frameworks; and developing plans for M&E indicators and data systems. Each module consists of a set of slides accompanied by discussions and activities that cover basic theoretical and practical approaches to M&E in terms suitable for a variety of population and health interventions. Group exercises are an important part of the training modules and provide participants with hands-on experience in M&E planning, design, and decision-making. The aim of these modules is to provide a comprehensive curriculum for training others in improving the design and implementation of their own M&E activities. |
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Community effects on the risk of HIV infection in rural Tanzania.
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Bloom SS, Urassa M, Ng'weshemi J, Boerma JT |
2002 |
English |
TANZANIA, Africa, East Africa, Southern Africa |
HIV/AIDS, Rural Populations |
This study investigated the effect of community characteristics on HIV prevalence and incidence. Data from an open cohort study with demographic surveillance, epidemiological surveys and qualitative research were used to examine the association between individual and community risk factors with HIV prevalence in 1994-5 and incidence between 1994-5 and 1996-7 among men and women living in a rural area in Northwest Tanzania. Authors investigated the following community factors: level of social and economic activity, ratio of bar workers per male population aged 18-59, level of community mobility, and distance to the nearest town. All four community factors had strong effects on HIV transmission. Men living in subvillages with the highest level of social and economic activity were about five times more likely to have HIV than those in places of low levels of activity. Women in these subvillages were about twice as likely. After controlling for community effects, the effects of some individual factors on the risk of HIV--education, male circumcision, type of work, and number of household assets--changed notably. Results suggest that community characteristics play an important part in the spread of HIV in rural Tanzania. Community effects need both to be considered in individual risk factor analyses and be given more attention in intervention programs. |
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Monitoring contraceptive continuation: links to fertility outcomes and quality of care
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Blanc AK, Curtis SL, Croft TN |
2002 |
English |
Africa, Global, Asia |
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This study examines the fertility consequences of contraceptive discontinuation, describes cross-national variation in continuation rates, and assesses the usefulness of the contraceptive discontinuation rate as a summary outcome indicator of quality of care. In the 15 countries included in this analysis, the total fertility rate would be between 28 and 64 percent lower if the births following discontinuations that were not the result of a desire to become pregnant had not occurred. The all-method discontinuation rate for quality-related reasons emerges as the most likely candidate for a summary measure of quality of care. Within a year of starting use of a method, between 7 and 27 percent of women cease to practice contraception for reasons related to the quality of the service environment. The results imply that as fertility declines, family planning programs would profit from a shift in emphasis from providing methods to new clients toward providing services to reduce discontinuation rates. |
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Mapping capacity in the health sector: a conceptual framework
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LaFond AK, Brown L, Macintyre K |
2002 |
English |
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Capacity improvement has become central to strategies used to develop health systems in developing countries. However, despite the growing interest in capacity improvement, there has been little consensus among practitioners and academics on definitions of "capacity building" and how to evaluate it. This paper reviews current knowledge and experiences from ongoing efforts to monitor and evaluate capacity building interventions in the health sector in developing countries. It draws on a wide range of sources to develop a definition of capacity building and a conceptual framework for mapping capacity and measuring the effects of capacity building interventiosn. Mapping is the initial step in the design of capacity building interventions and provides a framework for monitoring and evaluating their effectiveness. Capacity building is useful to planners because it makes explicit the assumptions underlying the relationship between capacity and health system performance and provides a framework for testing those assumptions. |
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The effect of AIDS on maternal mortality in Malawi and Zimbabwe
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Bicego G, Boerma J T, Ronsmans C |
2002 |
English |
Africa, Southern Africa, ZIMBABWE, MALAWI |
HIV/AIDS, Maternal Health, Maternal Mortality |
In this collection of research letters from issue 16 of the journal AIDS, year 2002, authors discusses the significant impact the AIDS epidemic has had on pregnancy-related mortality levels in Malawi and Zimbabwe. In these two countries, pregnancy-related mortality risks have increased 1.9 and 2.5 times respectively, during the past decade, concomitant with a nearly 10-fold increase in the prevalence of HIV among pregnant women. The increase is even more pronounced in urban populations. These observations have important implications, authors note, for intervention strategies and monitoring in the context of safe motherhood programs. |
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Pilot study of a rapid assessment method to identify places for AIDS prevention in Cape Town, South Africa
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Weir SS, Morroni C, Coetzee N, Spencer J, Boerma JT |
2002 |
English |
Southern Africa, SOUTH AFRICA, Africa |
Monitoring, HIV/AIDS, Monitoring |
This journal article discusses a pilot study of the PLACE (Priorites for Local AIDS Control Efforts) method conducted in Cape Town, South Africa, in 1998. Researchers spoke with key informants, who identified 363 sites where locals meet to find sexual partners and to inject drugs. Of the 363 sites, 310 were verified and visited; researchers recorded characteristics of these locations and asked people there about their behaviors, demographic characteristics, and knowledge about HIV/AIDS. Results of this rapid assessment suggest that prevention programs and HIV/AIDS awareness campaigns should be targeted to bars and shebeens, which serve as networks for transmission. |
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Sociodemographic context of the AIDS epidemic in a rural area in Tanzania with a focus on people
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Boerma J T, Urassa M, Nnko S, Ng |
2002 |
English |
TANZANIA, Africa, Southern Africa, East Africa |
HIV/AIDS, Rural Populations, Poverty |
This analysis focuses on how sociocultural and economic characteristics of a poor semi-urban and rural population in northwest Tanzania may directly and indircetly affect the epidemiology of HIV and other sexually transmitted infections (STIs). Poverty and sociocultural changes may contribute to the observed high levels of martial instability and high levels of short- and long-term migration in Kisesa, especially among younger adults. Marriage and migration patterns are important underlying factors affecting the spread of HIV. The most cost-effective intervention strategy may be to focus on the trading centre in which mobility is higher, bars were more common, and HIV prevalence and incidence were considerably higher than in nearby rural villages. If resources suffice, additional work can be undertaken in the rural villages, though it is not clear to what extent the rural epidemic would be self-sustaining if the interventions in the trading centre were effective. |
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Bulletin 4: A New Tool to Focus and Monitor AIDS Prevention Efforts: The PLACE Method.
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2002 |
English |
BURKINA FASO, UGANDA, Southern Africa, West Africa, Asia, Africa, TANZANIA, INDIA |
Condoms, Monitoring, HIV/AIDS, Sexual Behavior, At-Risk Populations |
This issue of the MEASURE Evaluation Bulletin introduces the PLACE (Priorities for Local AIDS Control Efforts) method; describes the results from PLACE studies in South Africa, India, Burkina Faso, Uganda, and Tanzania; and provides lessons learned from its early use. MEASURE Evaluation's fourth bulletin contains the following articles: "From People to Places: An 0verview of the PLACE Method and Lessons Learned"; "Application of the PLACE Method for Facilitation of AIDS Prevention in a City in India"; "Diversity in Sites of Sexual Encounter Revealed by the PLACE Method in Two Burkina Faso Health Districts"; "Assessing the Stability of Sites Where People Meet New Sexual Partners: A PLACE Follow-Up Stude in Cape Town, South Africa"; "Three PLACE Studies in the Eastern Cape Province of South Africa"; "Assessment of Sexual Mixing Among Mobile and Resident Populations Using the PLACE Method in Two Mexican Border Towns"; "Using the PLACE Method to Reveal Gaps in Kampala's AIDS Prevention Program"; and "Using the PLACE Method to Monitor AIDS Prevention Programs at the District Level in Tanzania. |
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Evaluating the Impact of Communication Programs
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2002 |
English |
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Indicators |
This document summarizes an expert meeting organized by MEASURE Evaluation and the Population Communication Services Project held October 4-5, 2001, in Elkridge, MD. At the meeting, experts discussed methodological issues regarding the evaluation of large-scale communication programs. The overall objective of the meeting was to agree on the preferred methodologies for evaluating the impact of communication programs conducted as part of wide-scale health interventions. The specific objectives of the meeting were to: 1) identify the major methodological challenges to evaluating the impat of full-coverage communication programs for behavior change; 2) To review study designs that leading researchers have used to address the threats to validity in the context of evaluating communication programs; 3) To identify means to further improve on existing methodological approaches and appropriate indicators for impact assessment; and 4) To strengthen the network of researchers and evaluatiors involved in evaluating communication programs. |
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Strengthening Monitoring and Evaluation of National AIDS Programmes in the Context of the Expanded Response, February 2002, Senegal Workshop.
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2002 |
English |
SENEGAL, Africa, Southern Africa |
HIV/AIDS |
This report, written in both English and French in a side-by-side format, summarizes the main themes and action plans country teams of participants developed at a workshop on monitoring and evaluation (M&E) of national AIDS programs, held in Dakar, Sengal, from February 4 to 6, 2002. The workshop brought together participants from 18 countries, and National AIDS programs, research institutions and program implementors were all represented as were headquarters and country staff from UNAIDS, USAID, CDC, WHO-Geneva, WHO_-AFRO, and the World Bank. The workshop's primary goal was to help countries develop a short-term action plan to strengthen M&E. |
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Encuesta de Establecimientos de Salud Nicaragua 2001
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Angeles G, Urbina Aguilera JE, Talavera Rocha MS, Gutter SM/Urdapilleta O, Mobius S |
2002 |
Spanish |
Latin America and the Caribbean, NICARAGUA, Central American Project |
Maternal Health, Child Health |
Este informe presenta los resultados principales de la encuesta de establecimientos de salud llavada a cabo en los diecisiete SILAIS de Nicaragua durante los meses de agosto a octubre del 2001. El objetivo principal de la ecuesta fue obtener informacion sobre la capacidad operative de los estableciimientos que brindan servicios basicos de salud, en particular servicios materno-infantil, y las caractreisticas del personal de los establecimientos publicos. Los resultados de la encuestra describen las caracteristicas basicas de un componente importante de la oferta de servicios de ssalud de Nicaragua existentes al momento de la encuestra. Tambien hay un version de este reportaje en ingles, que se llama "Health Facility Survey Nicaragua 2001. |
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Health Facility Survey Nicaragua 2001
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2002 |
English |
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Health Facilities, Health Services, Nicaragua |
This report presents the principal results from the survey of health facilities carried out between August and October 2001 in Nicaragua's 17 Local Systems of Integrated Health Care (SILIAS). This survey obtained information about the operating capacity of the health care facilities that offer basic health services to the population, with special attention to maternal and child health services, and the characteristics of health facility staff. The survey collected information from all of public health facilities of the Ministry of Health (MINSA), as well as from a significant number of private facilities. The results of the survey describe the basic characteristics of an important component of the supply of health services in Nicaragua at the time that the survey was conducted. Additionally, this survey permits examination of changes in conditions of public health facilities that have take place in the nine SILAIS in which the 2000 Health Facility Survey Nicaragua was carried out. A Spanish-language version of this document, Encuesta de Establecimientos de Salud Nicaragua 2001, is also available. |
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Zambia Sexual Behaviour Survey 2000
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2002 |
English |
Southern Africa, Africa, ZAMBIA |
Sexually Transmitted Infections (STIs), HIV/AIDS |
In 1998 the first Zambia Sexual Behavior Survey (ZSBS) was carried out to assess Zambian individuals, families, and communities' knowledge, attitudes, practices and behaviors related to HIV/AIDS. The 2000 ZBS is the second of these surveys, which are scheduled for every two years to enable assessing changes over time. The knowledge section of the ZSBS assessed whether or not Zambians had heard of HIV/AIDS if they knew how and how it is not transmitted, if they knew how to prevent infection, and if they had been tested. The attitude section of the ZSBS asked respondents about their attitudes towards an HIV-infected individual: whether they should allowed to work, whether respondents would share a meal with or buy goods from such an individual, and whether a respondent would want a family member's HIV+ status kept secret. The practice section of the ZSBS asked respondents aobut their own high-risk practices: sex with a non-regular partner, having sex with an extra-marital partner, and their prevalences of other sexually transmitted infections. |
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Guinea Health Facility Survey 2001
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2002 |
English |
Africa, GUINEA, West Africa |
HIV/AIDS, Maternal Health, Reproductive Health, Child Health, Public Health, Sexually Transmitted Infections (STIs) |
The 2001 Guniea Health Facility Survey was designed to collect information on the availability and quality of services in reproductive, maternal and child health in two regions of the country. The survey gathered information from 158 public health clinics and maternity centers funded by USAID. Chapter 1 of this report provides an introduction and description of USAID and PRISM activities in Guinea. In Chapter 2, authors discuss the main characteristics of health centers sampled in the survey, and in chapter 3 they discuss the availability of equipment and supplies. Chapters 4, 5, 6, and 7, respectively, provide an assessment of the quality of care in family planning, sexually transmitted infections and HIV/AIDS, prenatal care, and child health care. Chapter 8 concludes the report with a discussion of findings. |
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PLACE: Priorities for Local AIDS Control Efforts: A Pilot Study of the PLACE Method in a Township in Cape Town, South Africa.
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|
2002 |
English |
Africa, SOUTH AFRICA, Southern Africa |
Monitoring, Sex Workers, Condoms, HIV/AIDS, Sexually Transmitted Infections (STIs), At-Risk Populations |
MEASURE Evaluation pilot-tested the PLACE (Priorities for Local AIDS-Control Efforts) Method to locate and describe areas in Cape Town, South Africa, with the aim of determining if the PLACE method could accurately locate and classify sites where individuals at high risk for HIV infection go to meet new sex partners. Key informants identified potential venues where people went to meet sexual partners; researchers then visited these locations and recorded information about the locations and about patrons' sexual behaviors, knowledge, and receptivity to prevention messages. Authors conclude that the PLACE method appears promising for focusing interventions in Cape Town and the developing world. |
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Dinamica de la anticoncepcion en Guatemala: 1978-1998
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Escudero G, Bertrand J, Seiber E |
2002 |
Spanish |
GUATEMALA, Latin America and the Caribbean |
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CONTEXTO: Guatemala se encuentra mucho mas atrasada que los demas paises centroamericanos con respecto a la prevalencia del uso de anticonceptivos, y existe una marcada diferencia en la practica anticonceptiva entre los dos gruops etnicos principales--los mayas y los ladinos. Un mejor conocimiento de los factores que afectan esta practica es esencial para realizar esfuerzos que fomenten el incremento de la prevalencia de anticonceptivos. METODOS: Se utilizaron los datos correspondientes a cuatros encuestas nacionales para examinar las tendencias del uso anticonceptivo durante el periodo comprendido entre 1978 y 1998. Los resultados de los analisis multivariados indican el alcance que varios factores, particularmente el origen etnico y el acceso a los servicios, tienen para influir enl la dinamica de la anticoncepcion. RESULTADOS: Desde 1978 a 1998, el porcentaje de mujeres que usaban algun metodo aumento de 28% al 50% entre las ladinas, y del 4% al 13% entre la poblacion maya. Los metodos mas utilizados fueron la esterilizacion femenina, el ritmo y la pildora, aunque en 1998, la injeccion reemplazo el uso de la pildora, convirtiendose en el tercer metodo anticonceptivo mas popular entre las mayas. Aunque la fuente de los metodos ha ido cambiando a traves del tiempo, cada encuesta revelo que las mujeres mayas y ladinas recurrian a fuentes similares. Los cambios dramaticos ocurridos con respecto a las condiciones socioeconomicas durante este periodo de 20 años, fueron un factor determinante en el uso de anticonceptivos: el acceso a los servicios tambien presenta correlacion con el nivel de uso entre las mayas, una ves controlados los factores socioeconomicos. CONCLUSIONES: La poblacion maya es de "dificil acceso"; sin embargo, este grupo esta cada vez mas proclive a adoptar los servicios de planificacion familiar, cuando estos son accesibles y se presentan en una forma que resulta culturalmente aceptable. |
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Changes in Use of Health Services During Indonesia
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Frankenberg E, Sikoki B, Suriastini W, Thomas D |
2001 |
English |
East Asia, South Asia, Asia |
Child Health, Public Health, Health Facilities |
This paper uses panel data from the 1997 and 1998 rounds of the Indonesian Family Life Survey to examine changes in the health sector in Indonesia during the first year of the economic crisis. Changes in the characteristics of health facilities themselves were substantial. Prices rose at public and private sector sources of care, while public facilities experienced drug stock outages with increasing frequency. Community health posts also experienced changes for the worse, particularly with respect to the availability of supplies and supplementary food. These changes are related to use of care by adults and children, which generally declined between 1997 and 1998. Declines in use are also related to characteristics of the individuals themselves, such as age, and to socioeconomic characteristics of the households. |
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Contraceptive Use in a Changing Service Environment: Evidence from the First Year of Indonesia
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Frankenberg E, Sikoki B, Suriastini W, Thomas D |
2001 |
English |
South Asia, Asia, East Asia |
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Since the 1970s many developing countries have launched large-scale efforts to provide couples with family planning services. The nature of these programs and the rhetoric that accompanies them has changed over time, reflecting available resources, perceptions of the most relevant population and program issues, levels and emphasis of overseas assistance, innovations in contraceptive technology, and research findings on program effectiveness. In some countries the private sector has emerged to complement or substitute for the government as an important source of contraceptive services. Two important research topics on the links between family planning use and supply-side factors are how contraceptive use patterns respond to the price of contraceptive services and to the quality and availability of services (see for example Jain, 1989; Mensch et al., 1996; Koenig et al., 1997; Mroz et al., 1999). Analysis of these topics is limited by the lack of available data on characteristics of the contraceptive service environment linked to women's choices regarding use (Mensch et al., 1996). We address these topics, using unusual longitudinal data from providers and individuals collected in Indonesia (as part of the Indonesia Family Life Survey) before and during the economic crisis of the late 1990s. Though the crisis affected many Asian countries, Indonesia has been the country most hard hit (Stalker, 2000). Because the data straddle a period of economic downturn, the service environment at the second observation (1998) differs drastically from the service environment at the first observation (1997). In Indonesia most health and family planning supplies are imported, so a large-scale currency depreciation has major implications for services (UNFPA 1998). These changes give us purchase on identifying the relationship between the service environment and patterns on contraceptive use. We first consider the question from the user's perspective by documenting for each year levels of use, reasons for non-use, and method mix. We then consider patterns of use by various background characteristics of a user and her household. We also examine choice of providers and satisfaction with source of supply in 1998. Next we turn to the supply side. Because we have data from public, private, and community providers of contraceptive services in both years, we are able to consider, from the perspective of providers, how the quality and price of services changed during the first year of the crisis. To bring these two perspectives together, we construct community-level measures of the family planning service environment before and during the economic crisis from the information from the provider. We then use multinomial logistic regression methods to relate these measures to individual women's choice of provider, controlling for individual and household characteristics. |
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Access as a Factor in Differential Contraceptive Use between Mayans and Ladinos in Guatemala
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Seiber E, Bertrand J T |
2001 |
English |
GUATEMALA, Latin America and the Caribbean, Central American Project |
Contraception |
Previous studies consistently have demonstrated that the Mayan women of Guatemala have a far lower level of contraceptive use than their ladrino counterparts (e.g., 50 percent versus 13 percent in the 1998 DHS). Most researchers and practitioners have attributed this to social, economic, and cultural differences between the two groups that result in Mayans having a far lower demand for family planning than ladinos. This paper tests an alternative hypothesis: that the contraceptive supply environment may be more limited for Mayans than ladinos. This analysis uses an innovative approach of linking household level data from the 1995/6 Guatemala DHS and with facility-level data from the 1997 Providers Census for four highland departments in which the latter was conducted. On average, married women of reproductive age in the four departments lived 2 kilometers from a facility that provided some type of contraception. Mayans and ladinos did not differ significantly in terms of (1) mean distance to the closest facility offering FP services, or (2) mean distance to a facility providing each specific method (except injectables). Mayans were more likely to live closer to an APROFAM clinic, whereas ladinos were closer to a facility that offered access to the injectable. Otherwise, the FP supply environment differed little for the two groups. However, access may not be the determining factor in contraceptive use, given that less than 8 percent of users got their (last) contraceptive from the nearest facility. Moreover, APROFAM -- which was the nearest facility for only 7 percent of the respondents in this study -- was the source of supply for 48 percent of users. Although this study does not directly measure quality, the characteristics that differentiate APROFAM from other service providers point to quality as more important than physical access or cost in source of contraception among this group of users. |
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Dimensions of Ratings of Maternal and Neonatal Health Services: A Factor Analysis
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Bulatao R A, Ross J A |
2001 |
English |
Global |
Maternal Health, Child Health |
Ratings of the adequacy of national maternal and neonatal health programs, for 48 developing countries, are factor analyzed to determine the dimensions along which expert raters made their judgments. Up to 17 factors could be identified, largely paralleling the grouping of the 81 items in the questionnaire. Further analysis identified larger blocks of items, representing the capacity of health facilities, the extent of women's access to services, the care women receive, and policy and support services, plus a miscellaneous factor covering relatively rare service items. The various factor results were mostly interpretable and suggest that raters made careful judgments. |
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Do Health Services Reduce Maternal Mortality? Evidence from Ratings of Maternal Health Programs
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Bulatao R A, Ross J A |
2001 |
English |
Global |
Health Services, Maternal Health, Maternal Mortality |
Objectives. The study investigates whether maternal mortality ratios in developing countries are related to health service adequacy. Methods. Service ratings were obtained from an average of 17 experts in each of 49 developing countries and used in cross-national regressions for alternative measures of maternal mortality. Results. The rated adequacy of access to services was one of two significant predictors, the other being national per capita income. Among services, those involving emergency treatment and avoidance of births (abortion and family planning) had stronger relationships with maternal mortality than those involving prevention (antenatal care) and risk identification (general delivery care). Conclusions. Besides socioeconomic development, health services can contribute to lower maternal mortality, and more narrowly targeted services have a greater statistical effect. |
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Economic Status Proxies in Studies of Fertility in Developing Countries: Does the Measure Matter?
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Bollen K A, Glanville J L, Stecklov G |
2001 |
English |
PERU, Latin America and the Caribbean, West Africa, GHANA, Africa |
Maternal Health, Fertility |
Practically every empirical study of fertility in developing countries includes economic variables as either a primary focus variable or as an important control variable. Yet economic status variables are included in various ways, and researchers have little guidance as to the implications of alternative approaches. This paper investigates the consequences of using different economic status proxies on the estimated impact of economic status and other determinants of fertility. Using micro survey data from Ghana and Peru and techniques for comparing non-nested models, we find that the proxies for income that best predict fertility are a principal components score of various consumer durable goods and an index that is constructed by summing ownership of those durable goods. The choice of the proxy used influences the predicted effects of some of the control variables, but overall the substantive conclusions are quite consistent. We also compare the results from using a restricted set of proxies such as those typically available in the Demographic and Health Surveys to the results obtained when we have a lengthier set of proxies. Though our focus is on childbearing, our results suggest implications beyond this specific dependent variable, providing researchers with an awareness of the sensitivity of microanalyses to the treatment of economic status. Our results also suggest practical recommendations for survey data collection. |
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A Pilot Study of a Rapid Assessment Method to Identify Areas for AIDS Prevention in Cape Town, South Africa
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Weir S S, Morroni C, Coetzee N, Spencer J, Boerma J T |
2001 |
English |
Southern Africa, SOUTH AFRICA, Africa |
Monitoring, Monitoring, HIV/AIDS |
We developed the rapid method described in this paper and pilot tested in a township in Cape Town to determine whether a place-focus rather than an individual focus could take advantage of geographical clustering of STD/HIV transmission and maximize utility for fielding interventions. The following principles guided our approach: A synthesis of available demographic and epidemiologic contextual data could provide sufficient information to identify areas most likely to have partnership formation patterns capable of spreading and maintaining infection; Within these HTAs, a primary focus should be among those with highest rates of new partnership formation because they have a disproportionate role in the epidemic; To minimize bias, the method should not primarily rely on self-reported behavior, contact tracing, or naming of sexual partners. Nor should it require information about self-reported behavior, except to validate information obtained in other ways; The method should be feasibly implemented in a short period of time without on-site involvement of outside technical experts; and The method should provide program indicators useful for intervention monitoring. Based on these principles, we developed a rapid assessment method to identify and describe a high transmission area and indicators useful for AIDS prevention programming. |
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Decentralization and Government Provision of Public Goods: The Public Health Sector in Uganda (Draft)
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Akin J, Hutchinson P, Strumpf K |
2001 |
English |
Southern Africa, UGANDA, Africa |
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While many developing countries have devolved health care responsibilities to local governments in recent years, no study has examined whether decentralization actually leads to greater health sector allocative efficiency. This paper approaches this question by modeling local government budgeting decisions under decentralization. The model leads to conclusions not all favorable to decentralization and produces several testable hypotheses concerning local government spending choices. For a brief empirical test of the model we look at data from Uganda. The data are of a type seldom available to researchers -- actual health budgets for the health sector in a developing country. The health budgets are disaggregated into specific types of activities based on a subjective characterization of each activity's "publicness." The empirical results provide preliminary evidence that district planners are allocating declining proportions of their budgets to public goods activities. They also provide strong support for the hypothesis that spillover effects cause spending on public goods in one district to reduce spending on public goods in neighboring districts. |
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Appropriate Methods for Analyzing the Effect of Method Choice on Contraceptive Discontinuation
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Steele F, Curtis Sian L |
2001 |
English |
Asia, Middle East, TURKEY |
|
Contraceptive discontinuation is a topic that has received increasing attention in recent years for several reasons. First, increased attention to the quality of family planning services has lead to interest in outcomes that might be associated with the quality of services. Jain (1989) argues that the quality of services increases contraceptive prevalence through increased adoption of contraceptives but more significantly through improved continuity of use. Although there is relatively little empirical evidence to date to support the theoretical link between the quality of services and contraceptive discontinuation, the interest in contraceptive discontinuation as an outcome associated with the quality of services remains. Second, as contraceptive use rises throughout the world, contraceptive continuation becomes an increasingly important determinant of contraceptive prevalence and unwanted fertility. For example, Blanc and Curtis (1999) find that in 15 countries with Demographic and Health Surveys (DHS) total unwanted fertility rates would be between 44 percent and 81 percent lower in the absence of contraceptive discontinuation and failure. Similarly, in Turkey 78 percent of induced abortions in the three years preceding the 1998 DHS survey were preceded by a contraceptive failure or discontinuation (Senlet et al. 2001). Finally, the increasing availability of contraceptive history data, such as that collected through the DHS program, has provided increased opportunities to study contraceptive discontinuation in more depth and across more countries. Studies of contraceptive discontinuation consistently show contraceptive discontinuation rates vary substantially by method used. Typically, method-specific discontinuation rates are lowest among IUD users and highest among users of condoms and, to a lesser extent, injectables (Ali and Cleland 1995; Blanc and Curtis 1999). Reasons for discontinuation also vary substantially by method; DHS surveys typically find side effects and health concerns are the main reasons for discontinuing hormonal methods and IUDs, inconvenience and partner's disapproval are the main reasons for discontinuing condom use, and contraceptive failure and desire for a more effective method are the main reasons for discontinuing traditional methods. Multivariate analyses of the determinants of contraceptive discontinuation find that the method used is strongly associated with contraceptive discontinuation after controlling for other factors (Curtis and Blanc 1997; Koenig et al. 1997; Steele, Diamond and Wang 1996; Steele and Diamond 1999), although the pattern by method depends on the type of discontinuation being studied. However, as Curtis and Blanc (1997) note, the relationship between the method used and contraceptive discontinuation is complicated by the fact that method choice is determined by women's balancing of a number of factors including ease of continuation, risk of failure, intended length of use, and other characteristics of the woman that might also affect her risk of discontinuing use. These factors could lead to selection of women at high risk of discontinuation to use certain methods, which in turn would lead to bias in the determinants of contraceptive discontinuation. In other words, method choice is potentially an endogenous variable. The direction of the selection effects resulting from method choice is difficult to predict. For example, a woman may choose to use the IUD because she intends to use for a long time and believes the IUD to be an easy method for long-term use because it requires no ongoing action on her part once it is inserted. Such selection may overstate the difference between the discontinuation rates of IUD and other methods. Alternatively, women who have difficulty continuing use of methods may choose the IUD again because of the lack of ongoing action required to continue use. Such selection would lead to understatement of the contraceptive method differentials. We are aware of no studies to date that have explicitly addressed the issue of the potential endogeneity of method choice in the discontinuation process. Most authors have either ignored the problem and used conventional modelling techniques (Curtis and Blanc 1997; Koenig et al. 1997; Pariani et al. 1991; Steele et al. 1996; Steele and Diamond 1999) or have fitted method-specific models (Ali and Cleland 1999; Ping 1995; Steele et al. 1999). The objective of this paper is to explore whether method choice is endogenous in the discontinuation process, and if so, to explore what effect that has on the estimates of method effects on discontinuation. To do this, we utilize multilevel multiprocess models to simultaneously model the processes of contraceptive method choice and contraceptive discontinuation using data from the 1997 Indonesia DHS. We focus on one particular type of contraceptive discontinuation, abandonment of contraceptive use while in need of contraception. |
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A Guide to Using Multilevel Models for the Evaluation of Program Impacts
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Angeles G, Mroz T A |
2001 |
English |
|
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The purpose of this essay is to help researchers investigating the impacts of health, family planning, and nutrition programs understand the importance and relevance of using multilevel analysis in their empirical evaluations of the programs' impacts. The discussion first defines what it means to have a multilevel model, and it then turns to an examination of the statistical properties of estimators when one has a hierarchical structure. Throughout the essay we illustrate the basic points through the use of Monte Carlo experiments, where we simulate data and outcomes according to known and exact rules. After simulating data, we use a variety of estimation approaches to estimate the underlying relationships in the simulated data. Since we know the "true" way the "world" operates in these experimental settings, these Monte Carlo experiments allow us to evaluate how well particular statistical procedures can uncover the "true" form of the statistical relationship. Based on these Monte Carlo experiments and some direct comparisons of the statistical properties of the various estimators that we consider, we present a set of recommended approaches for using multilevel data to assess the overall effectiveness of programs. We focus our analysis on simple multilevel models where the effects of observed covariates are fixed and do not vary across units of the hierarchical structure. The residual term in a linear regression model possibly has a simple hierarchical structure. Our primary concern is how well various estimators measure the impacts of observed covariates on outcomes of interest. We focus on unbiasedness of the point estimators, precision of the estimators, and the ability of the point and standard error estimators to provide unbiased hypothesis tests. For our evaluations we focus on only simple linear regression models with continuous outcomes estimated by ordinary least squares (OLS) and on simple, two-level maximum likelihood estimation models. Given this scope, the essay reaches three main conclusions. First, if the data do have a multilevel error structure and one fails to account for this in the estimation of standard errors of estimates, one can dramatically overstate the significance of the estimated statistical relationships. In particular, a researcher who fails to use procedures that adjust estimated standard errors for the multilevel error structure would "uncover" statistically significant relationships when they do not exist. To obtain correct statistical inferences, one need not use complete multilevel modeling approaches. Instead, statistical procedures that ex post account for the clustering in the data when calculating standard errors will provide correct standard errors. Second, there typically is little efficiency loss in the estimation of the impact of a community-level variable on individual-level outcomes if one ignores the multilevel error structure and uses Ordinary Least Squares procedures to estimate the impacts of covariates on the outcome of interest. There can, however, be sizable increases in efficiency for estimators of the impacts of the individual-level variables, but these effects are typically of less interest in program evaluation studies. The third conclusion is more tentative than the first two. It deals with problems that one can encounter with multilevel models when one incorrectly assumes a simple linear relationship when the true relationship is nonlinear. In particular, if one imposes incorrectly a simple linear specification for the observed regressors when there really is a more complex function describing mean effects, then it is possible to incorrectly "uncover" a multilevel error structure when one does not exist. Taken as a whole these conclusions suggest that a fruitful estimation approach in practice would be to rely on simple estimation procedures like ordinary least squares, adjust the estimated standard errors to account for the possible multilevel error structures, and examine whether nonlinear relationships might better describe the data than simple linear effects. After a thorough examination of the empirical relationship with simple models and adjusted standard errors, one could then use more detailed multilevel models to obtain more precise estimators. |
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The Effect of Structural Characteristics on Family Planning Program Performance in Cote d'Ivoire and Nigeria
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Mancini D J, Stecklov G, Stewart J F |
2001 |
English |
NIGERIA, COTE D'IVOIRE, Africa, West Africa |
Contraception |
This paper examines, using Côte d'Ivoire and Nigeria survey data, how structural and demographic factors influence family planning provision and cost. The model explains provision well, but poorly explains cost. We show that size and specialization matter. In both countries, vertical (exclusive family planning) facilities provide significantly more contraception than integrated medical establishments. In Nigeria, larger facilities also offer services at lower average cost. Since vertical facilities tend to be large, they at most incur no higher unit costs than integrated facilities. Model results and cost recovery information point to the relative efficiency of the International Planned Parenthood Federation, which operates large, mostly vertical facilities. |
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Socio-Demographic Context of the AIDS Epidemic in a Rural Area in Tanzania with a Focus on People
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Boerma J T, et al |
2001 |
English |
Southern Africa, TANZANIA, Africa |
Rural Populations, Sexual Behavior, HIV/AIDS |
This paper describes the context of the AIDS epidemic in a small rural area in Tanzania, where a population of about 20,000 people has been followed since 1994. The current analysis includes the period 1994-1998 and focuses on population characteristics rather than individual risk factors. Special attention is given to people's mobility and marriage patterns and how these relate to sexual behavior and HIV infection at the community level. It is shown that mobility and marriage are critical contextual factors in this population, and sexual mixing is dynamic and diffuse. It does not appear to be possible to identify and target spread or maintenance networks. In terms of interventions, this does not mean that focusing interventions is not possible. However, an area-based strategy seems more feasible and more suitable than an approach aimed at high-risk networks. |
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A Meta-analysis of the Impact of Family Planning Programs on Fertility Preferences, Contraceptive Method Choice and Fertility
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Angeles G, et al |
2001 |
English |
KENYA, INDIA, CHINA, BOLIVIA, ZIMBABWE, South Asia, East Asia, Latin America and the Caribbean, Southern Africa, West Africa, Asia, Africa, TUNISIA, TANZANIA, MOROCCO |
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This paper presents a meta-analysis of the results of Angeles, et. al. (1996). The purpose of the original paper was to examine the evidence of the impact of family planning programs on three key sets of outcome variables: fertility preferences, contraceptive method choice, and fertility. The results from multivariate models for these outcome variables using Demographic and Health Survey (DHS) data or comparable cross-sectional data sets with family planning program variables included in the set of explanatory variables are summarized below with detailed results available in Angeles, et. al. (1996). The countries included in this paper constitute a broad geographical representation and cover countries with large population size. The specific countries are Kenya, Morocco, Tanzania, Tunisia, Zimbabwe, Bolivia, Peru, Indonesia, the Philippines, China and India. |
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Utilisation des donnees sanitaires pour ameliorer les presentations de services
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LaFond A, Traore B, Kleinau E, Dembele E, Shafritz L, Gueye M, et al |
2001 |
French |
|
Maternal Health, Public Health |
Ce Guide aidera le personnel de sante du niveau peripherique a utiliser les donnees collectees dans la formation sanitaire en vue de: resoudre les problemes courants au niveau de la prestation de services; et ameliorer leur reponse aux besoins communautaires. Il est destiné aux prestataires de services (médecins, infirmiers(ères), sages-femmes) intervenant dans les centres de santé communautaire (au niveau périphérique). Le but général de ce Guide est de promouvoir une plus grande utilisation des données de services existantes pour améliorer les services sanitaires. Ainsi, les agents de santé n'ont pas besoin de collecter des données supplémentaires. |
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Best Practices in Monitoring and Evaluation: Lessons from the USAID Turkey Population Program
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|
2001 |
English |
Asia, TURKEY, Middle East |
Monitoring |
This 45-page document contains best practices drawn from the USAID Turkey monitoring and evaluation (M&E) plan. Best practices from this report include: linking M&E to strategic plans and workplans; focusing on efficiency and cost-effectiveness; employing a participatory approach to monitoring progress, utilizing both international and local expertise, disseminative results widely; using data from multiple sources; and facilitating data use for program improvement. The conclusions emerging from the USAID Turkey M&E experience are that: 1) M&E is a program asset, not a burden; 2) Local ownership is fundamental to increased utilization and sustainability; and 3) leadership continuation and commitment is necessary. |
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Contraceptive Use Dynamics in Kenya: Further Analysis of Demographic and Health (DHS) Data
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|
2001 |
English |
East Africa, Southern Africa, KENYA, Africa |
HIV/AIDS |
Further Analysis of Contraceptive Use Dynamics analyzes data from the three waves of the Kenya Demographic and Health Surveys (KDHS) conducted in 1989, 1993, and 1998. This 144-page report is broken up into chapters which examine the following topics: the evolution of family planning programs in Kenya; the quality of data on contraceptive use in the three KDHS surveys; non users of family planning in Kenya; first use of contraception; trends and determinants of current method choice; and contraceptive discontinuation, switching and method failure. |
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Monitoring the response to the AIDS epidemic using print media in Kenya, Tanzania, and Zimbabwe, 2001
|
|
2001 |
English |
KENYA, Africa, East Africa, Southern Africa, TANZANIA, ZIMBABWE |
HIV/AIDS |
For this MEASURE Evaluation special report, researchers collected about 3,400 AIDS related articles from major newspapers in Kenya, Tanzania, and Zimbabwe from between May and July, 1999, and analyzed how and how often newspaper articles discussed topics such as condom use, government interventions, a potential cure, and sexual and non-sexual transmission. Analysis of newspaper titles and articles indicated an increase in positive responses to the AIDS epidemic in Kenya, Tanzania, and Zimbabwe during the 1990s, including an increased emphasis on AIDS awareness and action initiatives. Reporting on AIDS awareness was the most common topic; strong reporting of AIDS initiatives was also observed in all countries. |
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Sexual Behavior and Condom Use in the Context of HIV Prevention in Kenya.
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|
2001 |
English |
Africa |
Sexual Behavior, HIV/AIDS |
This report presents a further analysis of data on sexual behavior, condom knowledge, and condom use from the 1998 Kenya Demographic and Health Survey (KDHS), supplemented with data from the Ministry of Health and PSI's social marketing program on the number of condoms distributed annualy and with data on condom promotion and availability at health facilities from the 1999 Kenya Service Provision Assessment. This 42-page report presents trends and patterns in the Kenyan population's sexual behavior, condom use and knowledge, condom availability, and condom promotion in the mass media. |
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AIDS in Africa During the Nineties: Tanzania
|
|
2001 |
English |
Southern Africa, TANZANIA, Africa |
Sexual Behavior, Condoms, HIV/AIDS |
This report focuses on trends in the AIDS epidemic and AIDS-related knowledge, attitudes, and sexual behavior among Tanzanian men and women during the 1990s. The man data sources on the spread of HIV in Tanzania come from antenatal clinic surveillance. After an introductory chapter, chapter 2 of this 62-page report discusses the spread of HIV in Tanzania. Subsequent chapters, respectively, focus on AIDS related knowledge and attitudes; sexual behavior; condom knowledge and use; and the demographic impact of the epidemic. Trend analysis is based on five cross-sectional surveys conducted on nationally representative samples of adults of reproductive age. |
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Measuring Capacity Building, 2001
|
|
2001 |
English |
|
|
Written for USAID program managers and project designers, this report aims to spread current knowledge and practices regarding the measurement of capacity-building activities in developing country health systems. Sources for this document include the published literature, unpublished documents, and informal discussions with practitioners in the field. This report was also informed by a two-day meeting on Measuring Capacity Building in Health and Population Programs. Within this document are: definitions for capacity and capacity-building; discussions of donor organizations' recent focus on supporting sustainable health systems; a conceptual framework for mapping capacity; methodological challenges to measuring capacity and capacity building; and existing indicators and tools to measure capacity and capacity-assessment. |
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Workshop Report - Nairobi, Kenya M&E of HIV/AIDS.
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|
2001 |
English |
Africa, Asia, Global, East Africa, West Africa, Southern Africa, Latin America and the Caribbean, East Asia, South Asia, Middle East, BURKINA FASO, ETHIOPIA, JAMAICA, KENYA, MEXICO, ROMANIA, RUSSIAN FEDERATION, SENEGAL, TANZANIA, THAILAND, UGANDA, ZIMBABWE, BRAZIL |
HIV/AIDS |
This html document presents the results from the "Towards Improved Monitoring and Evaluation of HIV Prevention, AIDS Care, and STD Control Programs" workshop, which was held from November 17-20, 1999, in Nairobi, Kenya. Participants from 13 developing countries and many international and donor organizations analyzed country-level M&E; experiences in national HIV/AIDS/STD programs, reviewed the components of national M&E; system, and discussed indicator improvement and development. Within this document are country reports and abstracts on the state of M&E; of HIV prevention, AIDS care, and STD-control programs in the following countries: Brazil, Burkina Faso, Ethiopia, Jamaica, Kenya, Mexico, Romania, Russia, Senegal, Tanzania, Thailand, Uganda, and Zambia. |
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Mesurer la mortalité maternelle à partir du recensement: Guide pour les utilisateurs potentiels
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Hill K, Stanton C, Gupta N |
2001 |
French |
Global |
Maternal Health |
La mortalité maternelle est un des indicateurs de santé qui reflète le plus les disparités entre les paysriches et les pays pauvres. À la Conférence mondiale sur la maternité sans risque tenue en 1987, àNairobi, au Kenya, l’attention a été portée sur le fait que les rapports de mortalité maternelle dans lemonde en voie de développement étaient souvent 100 fois plus élevés que ceux généralement trouvésdans les pays développés. Par la suite, le Rapport sur le développement mondial de 1993 de la Banquemondiale a montré que la mortalité et la morbidité maternelles étaient les causes principales de la perte dela vie en bonne santé chez les femmes en âge de procréer dans les pays en développement. Au cours de ladernière décennie, un certain nombre de forums internationaux (le Sommet mondial sur les enfants de1990, la Conférence internationale sur la population et le développement de 1994, la Conférencemondiale sur les femmes de 1995 et le Sommet du millénaire de 2000) se sont notamment fixés pourobjectif la réduction de la mortalité maternelle.En novembre 1998, MEASURE Evaluation a tenu un atelier à Nairobi afin d'évaluerl'utilisation des recensements pour mesurer la mortalité maternelle. Les participants étaient desspécialistes de la collecte de données et de l’analyse comparative de données démographiques. Parmi eux,figuraient les représentants du recensement des cinq pays déjà mentionnés ainsi que du Bureau central destatistique du Kenya, et des conseillers techniques de l'université Johns Hopkins, de la London School ofEconomics et de la London School of Hygiene and Tropical Medicine.Cette publication est un produit de cet atelier. Ses objectifs sont de documenter et d’évaluer les tentativesfaites dans des pays en développement pour mesurer la mortalité maternelle à partir des recensementsrécents, d’encourager les pays à bâtir sur ces expériences, et d’adresser des recommandations auxBureaux nationaux de statistique qui comptent utiliser les recensements pour évaluer la mortalitématernelle. L'Organisation mondiale de la santé approuve ce document, qui doit être vu comme un travaildynamique, susceptible de donner une meilleure compréhension du sujet et de contribuer de manièresignificative aux méthodologies de plus en plus nombreuses conçues pour relever les défis qui consistentà mesurer et en fin de compte, à réduire la mortalité maternelle. |
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Medicion de la Mortalidad Materna a partir de un Censo: Instrucciones para los Usuarios
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Hill K, Stanton C, Gupta N |
2001 |
Spanish |
Global |
Maternal Health |
La mortalidad materna está entre los indicadores de salud que reflejan las diferencias más grandes entre lospaíses ricos y los pobres. En la Conferencia Mundial por una Maternidad sin Riesgo de 1987 en Nairobi, Kenia,se llamó la atención al hecho de que las razones de mortalidad materna en los países en vías de desarrollo confrecuencia eran cien veces mayores que las de los países desarrollados. Posteriormente, el Informe sobreDesarrollo Mundial de 1993 del Banco Mundial demostró que la mortalidad y morbilidad materna es la mayorcausa de pérdida de vida saludable entre mujeres de edad reproductiva en países en vías de desarrollo. Duranteel decenio pasado varios foros internacionales han declarado el reducir la mortalidad materna como una de susmetas, incluyendo la Cumbre Mundial en Favor de la Infancia de 1990, la Conferencia Internacional sobre laPoblación y el Desarrollo de 1994, la Conferencia Mundial sobre la Mujer de 1995 y la Cumbre del Milenio de2000.En noviembre de 1998, MEASURE Evaluation realizó un taller en Nairobi paraanalizar el uso del censo para la medición de mortalidad materna. Participando se encontraron expertos quieneshabían participado en la recolección de datos y otros quienes tienen experiencia con el análisis comparativo dedatos de demografía. Entre ellos se encontraron representantes de censo de los cinco países nombrados arriba yde la Oficina Central de Estadística de Kenia, así como asesores técnicos de Johns Hopkins University, LondonSchool of Economics y London School of Hygiene and Tropical Medicine.Esta publicación es el resultado del dicho taller. Sus objetivos son documentar y evaluar las experiencias de lamedición de mortalidad materna por medio de un censo reciente en países en vías de desarrollo, alentar a paísesa que aumenten a estas experiencias y recopilar recomendaciones para las Oficinas de Estadísticas que esténconsiderando el uso de la metodología de censo para obtener estimaciones de mortalidad materna. LaOrganización Mundial de Salud acoge a este documento, el cual se debe tomar como un trabajo en progreso queresultará en un mejor conocimiento y contribuirá considerablemente al cuerpo creciente de metodologíasdiseñadas para dirigirse a el desafío de medir y, finalmente, reducir la mortalidad materna. |
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Measuring Maternal Mortality from a Census: Guidelines for Potential Users
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Hill K, Stanton C, Gupta N |
2001 |
English |
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Maternal Health, Maternal Mortality |
The fourth entry in MEASURE Evaluation's Manual Series provides guidelines for users who want or need to measure maternal mortality from a census. Chapter 1 of this 53-page document offers an introduction to the problem. Chapter 2 discusses indicators and data sources for measuring maternal mortality. Chapter 3 discusses data collection and tabulation procedures, including questionnaire design and field-staff training. In Chapter 4, authors discuss methods for data evaluation and adjustment. The fifth and final chapter provides a summary of data dissemination and use. A French-language version of this document, "Mesurer la mortalite maternelle a partir du recensement: Guide pour les utilisateurs potentiels," as well as a Spanish-language version, "Medicion de la Mortalidad Materna a partir de un Censo: Instrucciones para los Usuarios" are also available. |
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Sampling Manual for Facility Surveys for Population, Maternal Health, Child Health and STD Programs in Developing Countries, July 2001
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Turner AG, Angeles G, Tsui AO, Wilkinson M, Magnani R |
2001 |
English |
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HIV/AIDS, Maternal Health, Child Health |
This manual presents a sampling methodology which can generate estimates of health facilities and their characteristics. It can also be used to tie characteristics of the sampled facilities to those of the serviced population. This manual proposes and recommends two sampling designs. The first is for a stand-alone health facility survey, and the second is for a health facility survey linked to a household survey. Both recommended sampling designs provide unbiased estimates of facilities and their characteristics. However, the linked sampling design provides additional information on the health service environment for resident populations in the household survey sample areas. |
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Socioeconomic status and class in studies of fertility and health in developing countries
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Bollen KA, Glanville JL, Stecklov G |
2001 |
English |
Global |
Child Health, Maternal Health, Fertility |
The concepts of socioeconomic status (SES) and class are pervasive in sociological studies, yet an examination of the sociological and social science literature suggests a lack of consensus on their conceptual meaning and measurement. Our review focuses on the use of SES and class in a specific substantive field, studies of child health and fertility in developing countries. We discuss the mechanisms that underlie the relationship between SES and fertility and child health and the divergent results found in this field. We then provide a brief review of the theoretical literature on SES and class, contrasting unitary and component views. Following this is a section on the use of SES and class in empirical studies of child health and fertility in developing countries. We investigate the relationship between the conceptual and empirical literature, highlighting the inconsistencies we find. In addition, we discuss the variety of meanings and measures of SES that researchers use in these studies. Next, we address a series of methodological issues that arise from the review. Finally, we make recommendations for the treatment of SES and class in these and related areas. |
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Is estimating maternal mortality useful?
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Buekens P |
2001 |
English |
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Maternal Health, Maternal Mortality |
This editorial by UNC-Chapel Hill professor Pierre Buekens accompanies new estimates of maternal mortality for 1995 published in a 2001 WHO Bulletin. The author discussions limitations in data collection that lead to estimates underreporting the extent of maternal mortality in both developed and developing countries. Buekens concludes, however, that even imprecise estimates are useful for noticing and ultimately responding to macro-level trends and disparities, and that measuring maternal mortality is the only way to ensure that its reduction remains a top priority. |
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The impact of HIV/AIDS on mortality and household mobility in rural Tanzania
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Urassa M, Boerma JT, Isingo R, Ngalula J, Ng weshemi J, Mwaluko G, Zaba B |
2001 |
English |
Africa, Southern Africa, TANZANIA |
Rural Populations, Public Health, HIV/AIDS |
Objective: The impact of early-untreated HIV infection on chronic hepatitis C was determined in a case-control study, aimed at limiting factors associated with the progression of immunodeficiency. Methods: HIV-infected patients attending for a medical examination during 1995-1996 were systematically screened for: previous intravenous drug use without other HIV or Hepatitis C virus (HCV) risk factor, CD4 cell count > 200/[mu]l, no AIDS, no antiretroviral treatment, positive anti-HCV antibody, negative hepatitis B surface antigen, abnormal aminotransferase activity. Thirty-eight consecutive eligible HIV-infected patients (cases) were included. Thirty-eight HCV-infected patients without HIV infection whose unique risk factor was intravenous drug use (controls) were paired to cases according to age, sex, and duration of HCV infection. Results: Cases and controls had similar ages, sex ratios, duration of HCV infection, and alcohol intake. They were infected predominantly by genotypes 1 and 3. Viraemia was higher in cases than in controls. METAVIR histological scores of activity and fibrosis in cases versus controls were 2.2 +/- 0.8 versus 1.6 +/- 0.7 (P = 0.0008) and 1.8 +/- 1 versus 1.5 +/- 0.8 (P = 0.06), respectively. The percentage of cirrhosis was higher in cases, without reaching statistical difference. The progression rate of fibrosis was higher in cases. Age at contamination and METAVIR activity score were significantly associated with the progression of fibrosis in cases. Conclusion: Early-untreated HIV infection is associated with higher HCV viraemia and more severe liver injury in intravenous drug users with chronic hepatitis C. |
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Every death counts: measurement of maternal mortality via a census
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Stanton C, Hobcraft J, Hill K, Kodjogbe N, Mapeta WT, Munene F, Naghavi M, Rabeza V, Sisouphantong B, Campbell O |
2001 |
English |
Africa, East Africa, Southern Africa, East Asia, South Asia, Middle East, IRAN, ISLAMIC REPUBLIC OF, LAOS, MADAGASCAR, ZIMBABWE, BENIN, Asia |
Maternal Health, Census, Maternal Mortality, Evaluation |
Methods for measuring maternal mortality at national and subnational levels in the developing world lag far behind the demand for estimates. Authors evaluated use of the national population census as a means of measuring maternal mortality by assessing data from Benin, Iran, Laos, Madagascar, and Zimbabwe, who identified maternal deaths in their censuses. Standard demographic methods were used to evaluate the completeness of reporting adult female deaths and births in the year prior to the census. Authors used the results from these exercises to adjust data. In four countries, the number of adult female deaths needed to be increased; three countries required upward adjustment for the numbers of recent births. The number of maternal deaths was increased by the same factor as that used for female adult deaths on the assumption that the proportion of adult female deaths due to maternal causes was correct. Age patterns of the various maternal mortality indicaotrs were plausible and consistent with external data sources for other populations. Data from this study suggest that, under favorable conditions, a national census is a feasible and promising approach for the measurement of maternal mortality. Moreover, use of the census circumvents several of the weaknesses of methods currently in use. Authors recommend that developing country governments learn from the experience of these five countries and place maternal mortality estimation in the hands of statistical agencies. |
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Measurement of biomarkers in surveys in developing countries: opportunities and problems
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Boerma JT, Holt E, Black R |
2001 |
English |
Global, Asia, Africa |
Public Health |
Reliable and comprehensive data on disease levels, patterns, and trends in populations are required to monitor global and local epidemics and to assess the effectiveness of public health approaches to disease and injury prevention and control. For most developing countries, little is reliably known about causes of mortality or about disease incidence, prevalence, and duration. Advances in technology offer the opportunity to collect biomarkers-biological and clinical data-in existing large-scale, national sample surveys. Such data on biomarkers could result in significantly better insight into public health problems and more rational and equitable policies leading to improved health. The combination of traditionally collected behavioral data with biological and clinical data affords many possibilities to better assess health problems and to develop the most cost-effective set of interventions. Careful assessment and discussion of the potential public health benefits, ethical issues, and logistical challenges should guide the application of technological advances in population-based surveys. |
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The role of changes in contraceptive use in the decline of induced abortion in Turkey
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Senlet P, Curtis SL, Mathis J, Raggers H |
2001 |
English |
TURKEY, Middle East, Asia |
|
The induced abortion rate in Turkey declined from a peak of 4.5 abortions per 100 women in 1988 to 2.4 in 1998. This study examines the extent to which the decline in abortion in Turkey can be attributed to increased use of modern contraceptives. Trends in induced abortion rates and in contraceptive use are examined among Turkish women together with fertility preferences, changes in the contraceptive behavior associated with abortion, and changes in the propensity to abort unwanted pregnancies. The analysis includes a number of simulations that examine what abortion levels might be in different contraceptive-use scenarios. Results indicate that the decline in abortion is due to a decrease in the number of abortions associated with traditional method failure. This decrease is related to three factors: a shift from traditional method use to modern method use, a decline in the traditional method failure rate, and a decline in the proportion of pregnancies resulting from traditional method failures that are aborted. |
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Bulletin 3: Monitoring National Progress with Composite Indices.
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2001 |
English |
Global |
HIV/AIDS, Maternal Health |
The third issue of the MEASURE Evaluation Bulletin focuses on monitoring program and health program efforts with composite indices. The following articles are in this bulletin: "Monitoring National Progress with Composite Indices"; "Three Decades of Tracking National Family Planning Programs through the Family Planning Effort Index"; "Rating Maternal and Neonatal Health Programs in Developing Countries"; and "Monitoring Political Commitment and Program Effort in HIV Prevention and AIDS Care: The AIDS Program Effort Index. |
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Bulletin 2: Indicators for Monitoring and Evaluation of AIDS Programs.
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2001 |
English |
Global |
HIV/AIDS, Sex Workers |
This second issue of the MEASURE Evaluation Bulletin focuses on Indicators for Monitoring and Evaluation of AIDS Programs. This bulletin contains the following articles: "Developing survey-based indicators for National AIDS programs"; "How much do people really know about HIV?"; "Measuring risky sex and condom use"; "The hidden truth: trying to measure HIV-related stigma"; "Estimating the number of sex workers in a city: an experiment with the 'capture-recapture' method"; "HIV prevalence trend among young antenatal women are a good indicator of recent trends in the AIDS epidemic"; and "Monitoring the response to the AIDS epidemic using print media. |
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Bulletin 1: Monitoring the Quality of Care in Family Planning.
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2001 |
English |
TURKEY, Asia, Africa, Southern Africa, Global, Middle East, UGANDA, ZIMBABWE |
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The first issue of the MEASURE Evaluation Bulliten focuses on monitoring the quality of care in family planning. Specific articles in this issue include: "Quick Investgaiton of Quality: Monitoring Quality of Care in Clinic-Based Family Planning Programs"; "Assessing the Quality of Care of NGO Family Planning Services in Ecuador"; "Quick Investigation of Quality Provides Data for Family Planning and Reproductive Health Program Monitoring in Turkey"; "The Quality of Family Planning and Antenatal Care Services in DISH and Comparison Districts in Uganda"; "Quick Investigation of Quality in SEATS-Supported Family Planning Clinics in Zimbabwe"; and "Does Contraceptive Discontinuation Matter?" |
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Medicion de la Mortalidad Materna a partir de un Censo: Usos Potenciales en Paises de America Latina
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2001 |
Spanish |
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Maternal Health |
This Spanish-language document presents the results of a meeting that MEASURE Evaluation and the Maternal and Neonatal Health (MNH) Project held in Lima, Peru, on October 5-6, 2000 to promote dissemination of the census methodology in Latin America and to discuss its potential use in measuring maternal mortality. The objectives of the meeting were to: 1) disseminate information on the methodology required for maternal mortality measurement from a census; 2) openly discuss the advantages and disadvantages of the methodology based on previous experiences in other countries; and 3) to promote discussion and collaboration between Census Bureaus and Ministries of Health on the issue of maternal mortality. An English-language version of this document, "Measuring Maternal Mortality from a Census: Potential uses in Latin American Countries," is also available. |
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Measuring Maternal Mortality from a Census: Potential Uses in Latin American Countries
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|
2001 |
English |
Latin America and the Caribbean, PERU |
Maternal Health, Maternal Mortality, Child Health, Census |
MEASURE Evaluation and the Maternal and Neonatal Health (MNH) Project organized a meeting held in Lima, Peru, on October 5-6, 2000 to promote dissemination of the census methodology in Latin America and to discuss its potential use in measuring maternal mortality. The objectives of the meeting were to: 1) disseminate information on the methodology required for maternal mortality measurement from a census; 2) openly discuss the advantages and disadvantages of the methodology based on previous experiences in other countries; and 3) promote discussion and collaboration between Census Bureaus and Ministries of Health on the issue of maternal mortality. |
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Strengthening Monitoring and Evaluation of National AIDS Programmes in the Context of the Expanded Response, April 2001, Entebbe Workshop.
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2001 |
English |
Southern Africa, UGANDA, Africa |
HIV/AIDS |
This report summarizes the results of a workshop on the monitoring and evaluation (M&E) of national AIDS programs. The workshop, held in Entebbe, Uganda, from April 23 to 26, 2001, focused on recent changes in the landscape of HIV prevention and care: rising infection and death rates are eroding the denial associated with HIV epidemics in African nations and arousing a larger and organized response from the international community. These renewed efforts have brought new challenges to M&E efforts, yet at the same time, have made them more critical than ever. |
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Maternity Care: A Comparative Report on the Availability and Use of Maternity Services.
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2001 |
English |
Africa, Asia |
Maternal Mortality, Maternal Health |
This 94-page report describes women's access to antenatal care, delivery care, emergency care, and family planning services in ten coountries in Africa, Asia, and Latin America and the Caribbean (LAC). Data were obtained from the Services Availability Module and women's questionnarie from the DHS III surveys implemented between 1993 and 1996/7. This report provides a comparative assessment of the availability and use of maternal health services and shows how service availabilty influences use. Analysis of this report found differing patterns, both in the provision and use of services between the African, Asian and LAC regions. In Africa women are more likely to use services and deliver with a skilled attendant than in other countries. In Asia, fewer women deliver with a skilled attendant and many more deliver at home, despite the fact that women in Asia and LAC countries live closer to services. Additionally, this report shows that the availability of maternal health services is consistently associated with greater use in every type of service considered. Rural women who live nearer health services are more likely to seek antenatal care earlier and more frequently than those who live farther from health services, and they are also more likely to use a skilled attendant and use a modern contraceptive method. |
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Encuesta de Establecimientos de Salud Nicaragua 2000.
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Angeles G, Urbina Aguilera J, Fishel J, Paz Soldan V |
2001 |
Spanish |
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En respuesta a la devestacion causada por el huracan Mitch, la mision de USAID en Nicaragua ha puesto en marcha el Programa de Reconstruccion y Recuperacion Post-Huracan Mitch. El proyecto MEASURE colabora con USAID/Nicragua en el monitoreo y evaluaction del programa de salud publica. El objecto de la encuesta fue recolectar informacion sobre las caracteristicas basicas de los establicimientos publicos de salud en los SILAIS afectados por el huracan Mitch, sobre los daños causados por este y sobre su ubicacion geografica. La encuesta tuvo como objecivo incluir todos los establecimientos publicos de salud de los SILAIS de Chinandega, Leon, Nueva Segovia, Madriz, Esteli, Chontales, Boacao, Matagalpa, y Jinotega. Por tanto, la muestra objetivo estuvo constituida por todos los hospitales departamentales, centros de salud con camas, centros de salud sin camas, y puestos de salud de estos nueve SILAIS. |
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Evaluation of Midwifery Care: A Case Study of Rural Guatemala
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Goldman N, Glei D A |
2001 |
English |
Latin America and the Caribbean, GUATEMALA |
Pregnancy, Maternal Health |
The objective of the present analysis is to describe and evaluate several aspects of pregnancy-related care in Guatemala, based on a large-scale sample survey -- the 1995 Encuesta Guatemalteca de Salud Familiar (EGSF), or the Guatemalan Survey of Family Health. As described in more detail below, these data are derived from structured interviews with women of reproductive age and with traditional and biomedical providers in 60 rural communities in Guatemala. This survey was not designed for an evaluation of midwife training programs or for an assessment of changes in treatment behavior over time. Nevertheless, the availability of data from randomly selected samples of women and providers in diverse geographic areas of Guatemala permits us to quantify several important dimensions of the integration of traditional and biomedical services and to move beyond existing studies in an effort to evaluate the quality of pregnancy-related care. In the next section of the paper, we briefly describe the social context, the nature of the health care system, and the content of midwife training programs in Guatemala. Subsequently, we discuss the detailed objectives of the analysis. Next, we describe the data collected as part of the EGSF, explore the availability of different providers who offer care during pregnancy and the characteristics of midwives, and discuss our analytical procedures. In the final two sections, we present the results and consider the implications of our findings. |
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Decentralization and Local Government Health Expenditures in the Philippines
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Schwartz J B, Racelis R, Guilkey D K |
2001 |
English |
East Asia, South Asia, PHILIPPINES, Asia |
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This paper examines allocative efficiency changes in government health expenditures in the Philippines before and after its devolution (decentralization) became effective in 1993. Previous studies typically have focused on the choices made by local governments following decentralization, but it is also important to include expenditure choices made by the central level in countries like the Philippines where the central health agency retains a significant role in the provision of health care goods and services. Central level changes in expenditures on public and private health care in response to decentralization can have significant overall allocative efficiency consequences in these countries. In addition, in the Philippines there are two levels of local government below the central level for which substantial responsibility for the provision of health services was decentralized, namely, provinces and city/municipalities. Each level was given specific, and very different, responsibilities and the choices made at each level are important in the overall assessment of changes in allocative efficiency following devolution. Specifically, the paper addresses three issues: changes in the level and composition of health care expenditures by central and local governments on a total and per capita basis; changes in the share of total local government resources allocated to health by level of local government; and changes in the share of local government health resources allocated to public good types of health by level of local government. The study uses data collected to examine these questions including: i) government audited annual expenditure reports from nearly 1600 local governments for pre- and post devolution years (1992, 1993, 1995 and 1998) collected and encoded for the purposes of this study and never before used to examine these questions; ii) the Philippines National Health Accounts, 1991-1997, which provide annual aggregate pre- and post devolution health expenditures for central and local governments; iii) the 1990 Philippines Census and 1995 Philippines Inter-Censual data which provide indicator variables of population characteristics at the local level for use in multivariate estimations; iv) the 1993 Philippines National Demographic Survey and 1998 Philippines National Demographic and Health Survey which provide an indicator of wealth differences at the local level; and iv) Philippines Statistical Yearbooks which provide additional indicator variables for characteristics of local governments. |
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Effort Scores for Family Planning Programs: An Alternative Approach
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Ross J A, Cooper-Arnold K |
2001 |
English |
Global |
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In the 1999 cycle of the Family Planning Program Effort Scores the standard questionnaire was used as before to produce 30 indices of effort. However a shorter form was also included, which asked the respondent to rate each of the 30 indices directly on a 1-10 scale. Overall the total short score averaged about 8 percent below the total long score, consistently across 88 countries, geographic regions, and among score components. The different score levels appear to arise not from those sources but rather from differences in the two instruments. The long form produces the 30 indices from about 125 questions, using various questions and coding rules to create each score, whereas the short form described each index in brief phrases and used a simple scale for each one. Most differences were in fact relatively small, and especially so where the two forms were most similar. For a consistent time trend for each score in each country it will be useful to retain the long form, but for the total score and the component scores the short form could now be used at less cost and perhaps more frequently to gauge program effort. |
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Monitoring Quality of Care in Family Planning Programs: a Comparison of Observation and Client Exit Interviews
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Bessinger R E, Bertrand J T |
2000 |
English |
Southern Africa, Latin America and the Caribbean, UGANDA, ZIMBABWE, ECUADOR, Africa |
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As part of an ongoing initiative to identify efficient, reliable methods of monitoring quality of care in family planning programs, the Quick Investigation of Quality (QIQ) was developed and field-tested in multiple countries in 1998-99. The current analysis examines the comparability of results between observations and exit interviews on selected indicators using data from three countries (Ecuador, Uganda, and Zimbabwe). These two instruments differ somewhat in the type of information collected, yet there is considerable overlap. For example, observation is better at measuring accuracy of information during counseling and technical competence of the provider, whereas exit interviews provide the client's perspective on the services received. However, the two converge when clients report on the providers' actions during counseling and clinical examination. The researchers compared frequencies on selected indicators available from both instruments and calculated Kappa coefficients for agreement after linking data from observation and exit interviews for the same client. Although levels would vary across countries for a given indicator, within a country results were consistent between instruments. Agreement was good to excellent on many of the indicators. These data provide evidence that the QIQ is a reliable means of monitoring QC in family planning programs. Moreover, a number of the QC indicators can be obtained from either data collection method, raising the question of whether full implementation of both instruments is always needed. Although some programs may opt for one instrument over the other due to resource constraints, the combination provides a fuller assessment of QC. |
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Rating Maternal and Neonatal Health Programs in Developing Countries
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Bulatao R A, Ross J A |
2000 |
English |
Global |
Child Health, Maternal Health |
Maternal and neonatal health services in 49 developing countries are compared, using national ratings provided by 10-25 experts per country on a variety of dimensions. These expert ratings cover both routine and emergency services at health facilities, access to these services for both rural and urban women, the likelihood that women receive particular forms of antenatal and delivery care, and such essential program elements as appropriate policy, health promotion, and training. Programs receive low ratings, but great variation exists across countries, especially with regard to access to services in rural areas. The ratings appear to confirm some aspects of the conventional wisdom about the quality of services. For instance, immunization services receive good ratings, while care for sexually transmitted infections receives abysmal ratings. However, some results are not quite as expected. Where comparisons are possible, the ratings are generally consistent with Demographic and Health survey data. |
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Abortion and Contraceptive Use in Turkey
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Senlet P, Mathis J, Curtis S L, Raggers H |
2000 |
English |
Asia, TURKEY, Middle East |
Contraception, Maternal Health |
The abortion rate in Turkey declined from a peak of 4.5 abortions per 100 women in 1988 to 2.4 in 1998. This paper examines the extent to which the decline in abortion in Turkey can be attributed to increased use of modern contraception. Trends in abortion ratios and rates and in contraceptive use are examined among subgroups of Turkish women. The study then examines changes in the contraceptive behavior associated with abortion, changes in fertility preferences and demand for contraception, and changes in the propensity to abort unwanted pregnancies. Finally, the analysis includes a number of simulations that examine what abortion levels might be under different contraceptive use scenarios. Results indicate that the decline in abortion is associated with a decline in traditional method failure. The decline in traditional method failure is related to three factors: a shift from traditional method use to modern method use, a decline in the traditional method failure rate, and a decline in the proportion of traditional method failures that are aborted. |
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Contraceptive Dynamics among the Mayan Population of Guatemala: 1978-1998
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Bertrand J T, Seiber E, Escudero G |
2000 |
English |
Central American Project, Latin America and the Caribbean, GUATEMALA |
Guatemala |
Guatemala lags far behind its neighboring countries in Central America in contraceptive prevalence. This paper traces the marked differences in family planning between the two main ethnic groups--the Mayans and ladinos--over a 20-year period, based on four national level surveys. Whereas prevalence (all methods) among ladinos increased from 27 percent in 1978 to 50 percent in 1998, the level among Mayans increased from 4 to only 13 percent. Female sterilization, the pill and rhythm have been the most widely used methods, although as of 1998 Depoprovera replaced the pill as the third most popular method among Mayans. The source of methods has shifted over time, but Mayans and ladinos have used similar sources at each survey. Three separate multivariate analyses were used to test the determinants of contraceptive use: among all women of reproductive age over this 20-year period, among Mayan women only in 1995/96 (to examine inter-group differences), and among all women in four departamentos in which it was possible to incorporate access to services in the model. The dramatic changes in socio-economic conditions among both ladinos and Mayans over these 20 years were key determinants of contraceptive use, although as of 1998 there was evidence of other factors as well (conceivably the effect of the program). After controlling for socio-demographic factors, access to services emerged as a significant correlate of contraceptive use among Mayans. The authors discuss the programmatic implications of these findings. |
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Skewed Method Mix: A Measure of Quality in Family Planning Programs
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Bertrand J T, Rice J, Sullivan T M, Shelton J |
2000 |
English |
ALGERIA, West Africa, Asia, Africa, Latin America and the Caribbean, East Asia, South Asia, Middle East, CUBA, EGYPT, JORDAN, KUWAIT, MOROCCO, VIET NAM, ZIMBABWE |
Contraception |
While contraceptive prevalence has been a central to family planning research over the past few decades, there has been surprisingly little consideration of method mix, an important aspect of quality of care. There is no "ideal" method mix recognized by the international community; however, there is reason for concern when one or two methods predominate in a given country resulting in "method skew." In this article method skew is measured using a modified index of dissimilarity. Of the 25 countries with the highest method skew three groups emerge: (1) a first group comprised of half of the high skew countries, all of which (except Turkey) are Sub-Saharan nations where traditional methods predominate; (2) a second group consists of four countries in which female sterilization predominates (China, India, Dominican Republic, and El Salvador); and (3) a third group is made up of nations that rely on a single reversible method (the pill in Algeria, Kuwait, Morocco, and Zimbabwe and the IUD in Cuba, Egypt, Jordan, and Vietnam). Possible explanations for these patterns of method skew are explored through a review of the literature. Of the five variables tested using linear regression (access, physicians per inhabitant, religion, GNP, and region) two correlates of method skew emerge: access and region. Method skew is lower in high access areas and in Latin America as compared to Asia or Africa. This article demonstrates the utility of the index of dissimilarity as a macro-level measure that may be used to monitor method skew in family planning programs worldwide. |
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The Impact of Health Facilities on Child Health
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Jensen E R, Stewart J F |
2000 |
English |
PHILIPPINES, Asia, South Asia, East Asia |
Health Facilities, Child Health |
Within-family resource allocation plays an important role in child health. Nutrition and other preventive activities make demands on scarce resources, as does the obtaining of curative care when children become ill. While previous work has found impacts of within-household resource allocation on child illness, little effect of such variables on subsequent treatment has been found, and utilization of treatment facilities is low in many developing areas. One possible reason is that treatment costs or quality vary, and these variations are not observable in respondent-based survey data. We combine the 1993 Philippines DHS data with a facilities survey subsequently conducted for selected survey clusters in order to address in some detail the question of how facility characteristics, including their distance, density, and quality, affect the probability that children receive treatment for respiratory infections and diarrhea. Controlling statistically for the relationship between the initiating illness and subsequent treatment (or lack of it), we find that spending on secondary health facilities, such as hospitals and rural health units, is an important determinant of the probability that ill children receive curative care. Access, measured by respondents' travel times, also plays a role in obtaining treatment |
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Effort Indices for National Family Planning Programs, 1999 Cycle
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Ross J, Stover J |
2000 |
English |
Global |
Contraception |
Since 1972 indices to measure effort by large-scale family planning programs have been measured periodically. The fifth cycle, in 1999, found a higher average score for all countries than five years ago, at the time of the Cairo conference. Countries with initially low scores have improved considerably more than others and have moved sharply upward over the years to approach these with initially high scores. The profiles of effort over 30 program features differ sharply between strong and weak programs; the latter fall below the former on every score. All countries, regardless of their average score, are selective in the features they stress, but weak programs are more erratic in their selectivity than strong programs. The strongest programs have stabilized at about 80 percent of the maximum score; the all-country average is about two-thirds of that standard. In addition, the international picture is more favorable when country scores are weighted by population size: over two-thirds of people in the developing world live in countries with relatively high scores. Nevertheless, a substantial gap persists between the performance of most individual programs and the 80 percent level. Prevalence of contraceptive use continues to be highest under the combination of favorable social settings and strong programs. |
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Evaluating Malaria Interventions in Africa: A Review and Assessment of Recent Research.
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Eisele T, Macintyre K, Eckert E, Beier J, Killeen G |
2000 |
English |
East Africa, Southern Africa, Africa, West Africa |
Africa |
This paper reviews the literature of malaria intervention studies in Africa over the last ten years, and specifically assesses the state of the art of evaluation of those interventions. Five primary types of malaria intervention studies were found: (1) vector control evaluation studies, (2) vaccine trial evaluation studies, (3) case management evaluation studies (includes chemoprophylaxis and malaria treatment trials), (4) diagnostic evaluation studies (trials of new quick and easy methods of diagnosing malaria) and, (5) cost-effectiveness evaluation studies. Methodological criteria used to identify the evaluation studies included outcomes measured at the community level, use of a rigorous design - experimental, quasi-experimental or pre/post intervention evaluation, and a minimum sample size of 100. The bulk of the literature (ten studies) focused on vector control evaluation studies. In addition, three vaccine trial evaluation studies, three case management evaluation studies, three diagnostic evaluation studies and three cost-effectiveness studies are included. There are several studies that did not stand up to the methodological criteria, but that we considered important from a methodological point of view and were included in our discussion. This review presents four major findings. First, the usefulness of existing studies is limited by their methodological shortcomings, particularly by the lack of standardized indicators. Second, due to the lack of standardized outcome indicators, between-study comparisons are extremely limited which essentially affects everything we can do in terms of evaluating malaria programs or interventions. Third, there is a paucity of evaluation studies on the (possible) synergistic effect of using more than one type of intervention to combat malaria. Fourth, due to the nature of malaria transmission, which can vary seasonally and spatially, it is difficult to generalize study results to other areas and years. In terms of the evaluation designs used, the randomized controlled clinical trial (RCT) is clearly the preferred gold standard in malaria intervention studies. However, because of the nature of malaria transmission and disease, and because of the lack of standard indicators, the majority of results from the studies have severely limited generalizability. Given the human and financial toll malaria is taking on societies throughout the world, continued research on ways to prevent and treat malaria is essential. In order for health professionals to be able to implement effective, large-scale programs to control malaria, at the national or sub-national level, more systematic evaluation protocols are needed. These evaluations should focus on essential program elements using standardized indicators in a wide variety of locations. |
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Monitoring the AIDS epidemic using HIV prevalence data among young women attending antenatal clinics: prospects and problems.
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Basia Z, Boerma T, White R |
2000 |
English |
Global |
Maternal Health, HIV/AIDS |
Objective: to assess the potential of antenatal surveillance data on HIV prevalence in young women as an indicator of trends in HIV incidence. Design: Review of empirical data and problems encountered with surveillance systems, followed by modelling using cohort-component projections and micro-simulation. Methods: Projection models are used to illustrate dynamic relationship between changes in HIV incidence and prevalence in young pregnant women. Incidence changes due to change in risk among sexually active and change in pattern of sexual debut are explored separately, and the prevalence trends in pregnant women under age 25 and those expecting first two births are described. Micro-simulation models are used to explore effect on steady-state prevalence of co-factors which affect both fertility and HIV incidence. Results: HIV prevalence levels in young pregnant women categorized by age and by parity have different relationships to incidence levels. Age categorized prevalence data provide a reasonable indication of incidence under stable conditions, but may be very misleading if age pattern of sexual debut changes. Prevalence levels categorized by parity are a reliable guide to incidence in the sexually active, but not necessarily to incidence in the community as a whole. Conclusions: Ante-natal surveillance systems should categorize prevalence data by both age and parity to aid in the interpretation of underlying incidence levels. |
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An Assessment of Trends in Child Mortality Estimates in Tanzania During the Nineties: A Summary
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2000 |
English |
Southern Africa, TANZANIA, Africa |
HIV/AIDS, Child Health |
This two-page brief summarizes the results of an analysis that compared differences in child mortality between surveys conducted in Tanzania in 1999 and 1996. Focusing on the most recent period estimate of each survey, this report concludes that under-five mortality in Tanzania has been at nearly the same level of 140 per 1,000 live births since the mid-1980s. However, HIV/AIDS in recent years is likely to have become a more significant cause of death and may have contributed to a modest increase or neutralization of a decline in child mortality. |
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Ministry of Health, Tanzania: Guidelines for Monitoring and Evaluation During Mid-Term Plan II 2000-2002.
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2000 |
English |
Southern Africa, TANZANIA, Africa |
HIV/AIDS |
The National AIDS Control Program (NACP) in Tanzania uses Medium-Term Plans (MTP) to outline its program-implementation strategy every five years. This third and most recent plan includes the priority program areas for M&E; and covers the period from 1998 to 2002. The national M&E; plan presented in this document focuses on strengthening existing surveillance and M&E; in Tanzania. In outlining the main elements of a national M&E; strategy for MTP III, these guidelines build as much as possible upon existing M&E; efforts in Tanzania and expand these efforts in important ways. The overall M&E; objective of the MTP III M&E; and surveillance strategy is to monitor the implementation of AIDS prevention and control activites in Tanzania and assess the effect of these activities. |
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Estimacion de la Mortalidad Materna en Guatemala Periodo 1996 - 1998
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2000 |
Spanish |
Latin America and the Caribbean, Central American Project, GUATEMALA |
Maternal Health |
For this study, written in Spanish, a methodology proposed by MEASURE Evaluation was used to estimate maternal mortality in Guatemala for the years 1996 to 1998. The report's estimate is 184 maternal deaths per 100,000 live births. Unadjusted official figures for the same period, range from 87 to 111 during this same period. These official statistics reflect the high level of underreporting of maternal deaths documented in previous studies. All the data sources analyzed for the preparation of this report confirm that maternal mortality levls have remained stable during the last decade. The estimation procedure described in this report, developed by MEASURE Evaluation at Macro International, was based on the application of a national adjustment factor to SIGSA and MSPAS's recent official figures. An English-language version of this report, Estimates of Maternal Mortality in Guatemala 1996 - 1998, is also available. |
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Estimates of Maternal Mortality in Guatemala 1996 - 1998
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2000 |
English |
Latin America and the Caribbean, Central American Project, GUATEMALA |
Maternal Health, Maternal Mortality |
In this study a methodology proposed by MEASURE Evaluation was used to estimate maternal mortality in Guatemala for the years 1996 to 1998. The report's estimate is 184 maternal deaths per 100,000 live births. Unadjusted official figures for the same period, range from 87 to 111 during this same period. These official statistics reflect the high level of underreporting of maternal deaths documented in previous studies. All the data sources analyzed for the preparation of this report confirm that maternal mortality levls have remained stable during the last decade. The estimation procedure described in this report, developed by MEASURE Evaluation at Macro International, was based on the application of a national adjustment factor to SIGSA and MSPAS's recent official figures. This version of the report is in English, a Spanish-language version, Estimacion de la Mortalidad Materna en Guatemala Periodo 1996 - 1998, is also available. |
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National AIDS Programmes: A Guide to Monitoring and Evaluation
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2000 |
English |
|
HIV/AIDS |
This html document contains a complete guide to the monitoring and evaluation of HIV prevention and AIDS care programs in English, French and Spanish. An introduction to the guide outlines the content of the toolkit and gives an overview of the different functions of surveillance, monitoring, and evaluation. The second section describes the main features of a sound M&E system. A third section proposes indicators for key areas of HIV prevention, AIDS care and STI-control programs. Finally, this document contains a link to a list of tools developed by MEASURE Evaluation, some of which are in draft form. |
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Compendium of Child Survival Monitoring and Evaluation Tools
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2000 |
English |
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Child Health, Child Mortality, Indicators |
This HTML-based compendium includes a variety of population- and facility-based assessment tools which can be used at different levels of the health system. This document was intented to funciton as an archive for all Monitoring and Evaluation (M&E) tools developed by the BASICS I and OMNI projects, which focused on child health and micronutrients, respectively. There are a total of 24 child survival M&E tools. |
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Understanding ethnic variation in pregancy-related behaviors, health care and birth outcomes in rural Guatemala
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Glei DA, Goldman N |
2000 |
English |
GUATEMALA, Central American Project, Latin America and the Caribbean |
Child Health, Rural Populations, Maternal Health |
Objectives. This study examines the relatively low use of modern pregnancy-related care in Guatemala, especially among indigenous women, and explores the role of socioeconomic status, social and cultural variables, and access to biomedical health facilities in accounting for ethnic differences in care. Methods. The data for the analysis come from the Guatemalan Survey of Family Health--a population-based survey of rural women that contains detailed data on care received during pregnancy and delivery along with extensive background information. Binomial and multinomial logit models are used to identify the variables that affect the likelihood of receiving different types of care during pregnancy and delivering in a medical facility and the extent to which sociocultural factors and measures of access account for the observed ethnic differences. Results: The estimates not only confirm previous findings of a large ethnic difference in the use of modern pregnancy-related care, but also extend them by identifying a gradient within the indigenous population. The analysis demonstrates that, in general, sociocultural variables are more strongly associated with modern pregnancy-related care than are measures of access and that the former variables explain more of the ethnic variation in care than the latter. The results also demonstrate that pregnant women, especially indigenous women, are more likely to seek biomedical care in conjunction with traditional midwifery care rather than to rely solely on the former. Conclusion. The findings suggest that midwives are likely to continue to be key providers of pregnancy-related care in the future, even as access to modern health facilities improves. Current efforts directed toward the training and integration of midwives into the formal health system are likely to be much more effective at improving pregnancy-related care than the replacement of midwives with biomedical providers. |
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What husbands in northern India know about reproductive health: correlates of knowledge about pregnancy and maternal and sexual health
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Bloom SS, Tsui AO, Plotkin M, Bassett S |
2000 |
English |
INDIA, Asia |
Maternal Health, Reproductive Health, HIV/AIDS |
Women in India suffer from a high incidence of reproductive disease, disability and death. Very little work has been done on men, but a much higher incidence of sexual experience outside marriage and sexually transmitted diseases (STDs) among males than previously expected for this population is now being documented. In north India, women are dependent on their husbands and other family members for health-related decisions. Therefore, the behaviour, knowledge and attitudes of men are integral to the reproductive health status of couples there. This study explores knowledge about three distinct areas of reproductive health among 6549 married men in five districts of the northern state of Uttar Pradesh, India. Factors contributing to men's knowledge in the areas of fertility, maternal health and STDs were investigated. Results showed that very few men had basic knowledge in any of these areas. The likelihood of reporting knowledge was associated with a set of determinants that differed in their magnitude and effect across the areas of reproductive health explored. In particular, men's belief about the ability of an individual to prevent pregnancy demonstrated an independent association with men's knowledge. After controlling for factors such as age, parity and educational and economic status, men who believed it not possible to prevent a pregnancy were less likely to know when during the menstrual cycle women would become pregnant and certain facts about STDs, but they were more likely to be able to name two or more symptoms of serious maternal health conditions. Possible explanations for this trend are discussed. |
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Adjusting antenatal clinic data for improved estimates of HIV prevalence among women in sub-Saharan Africa
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Zaba BW, Carpenter LM, Boerma JT, Gregson S, Nakiyingi J, Urassa M |
2000 |
English |
Southern Africa, TANZANIA, Africa, UGANDA |
HIV/AIDS, Maternal Health |
OBJECTIVES: To find a simple and robust method for adjusting antenatal clinic data on antenatal prevalence to represent prevalence in the general female population in the same age range, allowing for HIV differences by HIV status. BACKGROUND: HIV prevalence comparisons for pregnant women and women in the general community show that prevalence in the latter is significantly higher than in the former. An adjustment procedure is needed that is specific for the demographic and epidemiological circumstances of a particular population, making maximum use of data that can easily be collected in ante-natal clinics or are widely available from secondary sources. METHODS: Birth interval length data are used to allow for subfertility among HIV-positive women. To allow for infertility, relative HIV prevalence ratios for fertile and infertile women obtained in community surveys in populations with similar levels of contraception use are applied to demographic survey data that describe the structure of the population not at risk of child-bearing. RESULTS: For populations with low contraception use, the procedure yields estimates of general female HIV prevalence of 35-65% higher than the observed ante-natal prevalence, depending on population structure. Results were verified using general population prevalence data collected in Kisesa (Tanzania) and Masaka (Uganda). For high contraception use populations, adjusted values range from 15% higher to 5% lower, but only limited verification has been possible so far. CONCLUSIONS: The procedure is suitable for estimating general female HIV prevalence in low contraception use populations, but the high contraception variant needs further testing before it can be applied widely. |
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Monitoring the AIDS epidemic using HIV prevalence data among young women attending antenatal clinics: prospects and problems
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Zaba B, Boerma T, White R |
2000 |
English |
|
HIV/AIDS, Pregnancy |
OBJECTIVE: To assess the potential of antenatal surveillance data on HIV prevalence in young women as an indicator of trends in HIV incidence. DESIGN: Review of empirical data and discussion of problems encountered with surveillance systems, illustrated using cohort-component projection models. METHODS: Simple descriptive analyses are presented of prevalence and incidence data, with projection models used to explore aspects of the dynamic relationships between changes in HIV incidence and prevalence in young pregnant women for which empirical data are not yet available. Incidence changes due to change in risk among sexually active, and change in pattern of projection models are explored separately, and the resulting prevalence trends in pregnant women under age 25 years, and those expecting their first two births are described. RESULTS: HIV prevalence levels in young pregnant women categorized by age and by parity have different relationships to recent incidence levels. Age categorized prevalence data provide a reasonable indication of incidence under stable conditions, but may be very misleading if the age pattern of sexual debut changes. Prevalence levels categorized by parity are a reliable guide to incidence in the sexually active, but not necessarily to incidence in the population as a whole. CONCLUSIONS: Antenatal surveillance systems should categorize prevalence data by both age and parity to aid in the interpretation of underlying incidence levels. |
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Looking for change in response to the AIDS epidemic: trends in AIDS knowledge and sexual behavior in Zambia, 1990 through 1998
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Bloom SS, Banda C, Songolo G, Mulendema S, Cunningham AE, Boerma JT |
2000 |
English |
ZAMBIA, Africa, Southern Africa |
HIV/AIDS, Sexual Behavior |
This study investigates trends in AIDS knowledge and sexual behavior among men and women in urban Lusaka 1990 to 1998, and in all of Zambia, 1992 to 1998. Using data from representative surveys of urban Lusaka and of the country as a whole, population proportions were estimated to examine trends in knowledge and sexual risk behaviors. Differences in the estimated proportions between 1990 and 1998 were tested in Lusaka. In all Zambia, tests of difference were conducted between the earliest and latest years for which data were available for each indicator. A decline in premarital sexual activity was observed in urban Lusaka. In 1990, 50% of never married women reported no sexual experience, compared with 60% in 1998 (p = .003); among men, the figures were 38% and 53%, respectively (p < .001). Fewer women (1990, 8%; 1998, 2%;p < .001) and men (1990, 31%; 1998, 19%;p = .07) had extramarital partners. The bulk of change observed in urban Lusaka took place from 1990 to 1996; the changes in men's behavior observed between 1996 and 1998 were also observed in the national estimates for those years. National figures for other indicators from 1992 to 1998 were less encouraging. Apart from an increase in having ever used condoms, no change in women's sexual behavior was observed. Fewer men had premarital sex from 1996 to 1998 (1996, 64%; 1998, 46%;p < .001), but condom use with nonregular partners decreased among men (1996, 38%; 1998, 29%;p = .02). Prevention campaigns focused on education about AIDS and promoting safer sexual behavior appear to have made a difference in the early 1990s in Zambia. Findings from more recent years indicate that further change has stagnated. Renewed efforts are needed, particularly targeting condom use with nonregular partners. |
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Empirically based conversion factors for calculating couple-years of protection
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Stover J, Bertrand JT, Shelton JD |
2000 |
English |
|
|
Couple-years of protection (CYP) is one of several commonly used indicators to assess international family planning efforts. It has been the subject of much debate, relating in part to the specific conversion factors used to translate the quantity of the respective contraceptive methods distributed to a single measure of protection. This article outlines a comprehensive effort to revisit those conversion factors based on the best available empirical evidence. In most instances, the analysis supports previously established standard conversion factors. However, there are two notable departures. Fewer condoms and spermicides are recommended for each CYP (120 vs. 150), primarily because coital frequency among condom users is lower than previously assumed. Furthermore, for sterilization, the authors recommend the use of country or region-specific conversion factors. Every program evaluation indicator has strengths and weaknesses, and the best program evaluation efforts use a variety of indicators. If CYP is used to evaluate programs, however, the authors believe that the conversion factors presented reflect the best available evidence. |
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Collecte de données biologiques et cliniques dans le cadre d’enquêtes auprès de la population de pays en développement
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2000 |
French |
|
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This HTML document provides a link to complete English-, Spanish-, and French-language versions of a summary of a meeting MEASURE Evaluation held at the National Academy of Sciences in Washington, D.C., January 24-25, 2000. The meeting attempted to outline some of the new challenges and complexities of biological specimen collection in the developing world, as well as to discuss the new possibilities that biological specimen collection has to offer global public-health efforts. |
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Recolección de Datos Clínicos y Biológicos en Encuestas de Población en Países en Vías de Desarrollo
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2000 |
Spanish |
|
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This HTML document provides a link to complete English-, Spanish-, and French-language versions of a summary of a meeting MEASURE Evaluation held at the National Academy of Sciences in Washington, D.C., January 24-25, 2000. The meeting attempted to outline some of the new challenges and complexities of biological specimen collection in the developing world, as well as to discuss the new possibilities that biological specimen collection has to offer global public-health efforts. |
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Biological and Clinical Data Collection in Population Surveys in Less Developed Countries
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2000 |
English |
|
HIV/AIDS |
This HTML document provides a link to complete English-, Spanish-, and French-language versions of a summary of a meeting MEASURE Evaluation held at the National Academy of Sciences in Washington, D.C., January 24-25, 2000. The meeting attempted to outline some of the new challenges and complexities of biological specimen collection in the developing world, as well as to discuss the new possibilities that biological specimen collection has to offer global public-health efforts. |
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Measuring Capacity Building in Health and Population Programs
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2000 |
English |
|
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In November 1999, MEASURE Evaluation hosted a two-day meeting to present, analyze, and build consensus on a conceptual framework and indicators for measuring capacity building in the population, health, and nutrition sector. This 37-page document summarizes those proceedings. The proposed MEASURE framework of capacity at four levels of society: health system, organizational, health professional, and client. During the meeting, participants reviewed the basic structure of the framework and made substantive recommendations about specific relationships between components, the definition of capacity levels, and the description of elements of capacity for each level. |
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Tanzania Reproductive and Child Health Facility Survey, 1999.
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2000 |
English |
TANZANIA, Africa, Southern Africa |
HIV/AIDS, Sexually Transmitted Infections (STIs), Reproductive Health, Child Health |
The 1999 Tanzania Reproductive and Child Health Facility Survey (TRCHS) collected information on the availability and use of selected reproductive and child health services in Tanzania. This report presents the results from the facility survey, which was conducted by the National Bureau of Statistics from June 1999 to February 2000. Data on various indicators of the availabilty and quality of services from 260 government and 185 NGO and private facilities in mainland Tanzania are listed and discussed. The report also presents the following main findings: 1) NGOs and the private sector play a major role in health service provision in Tanzania. 2) Health facilities scored fairly well on supplies of contraceptives, vaccines and antibiotics, though there was still room for improvement. 3)Health workers have received continuing education on a variety of topics during the 1990s, and many facilities now have providers trained in family planning, HIV counselling and testing, post-abortion care, STD management, and/or reproductive and child health skills. 4) There were significant increases in the numbers of family planning clients since 1996, with the government providing 82 percent of family planning services. 5) Voluntary counselling and HIV testing were only provided in hospitals and some NGO/private health centers. Stockouts of HIV tests were fairly common. |
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Uganda Delivery of Improved Services for Health (DISH) Evaluation Surveys 1999.
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2000 |
English |
UGANDA, Africa, Southern Africa |
Maternal Health, Health Facilities, HIV/AIDS, Child Health |
This report presents findings from the Ugandan 1999 Delivery of Improved Services for Health (DISH) Evaluation Survey, and, where possible, compares reproductive, maternal, and child health knowledge and behavior, and the use of health services, among a representative sample of men and women of reproductive age with similar samples measured in 1997 and 1995. Additionally, this report presents data on the availability of reproductive, maternal, and child health services. Information in this 93-page report is broken up into the following topics: Information, Education, and Communication; Family Planning; Maternal Health; Child Health; STDs and HIV/AIDS; Health Facilities; and a discussion of findings. |
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Monitoring Quality of Care in Family Planning by the Quick Investigation of Quality (QIQ): Country Reports
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2000 |
English |
ECUADOR, Asia, Africa, Southern Africa, Latin America and the Caribbean, Middle East, TURKEY, UGANDA, ZIMBABWE |
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The Quick Investigation of Quality (QIQ) was initiated in response to the need for a low-cost, practical means to routinely measure quality of care (QC) in family planning services. Many USAID cooperation agencies contribted to the process of identifying a "short list" of QC indicators, developing the set of instruments to measure them, and field testing the intruments in Ecuador, Turkey, Uganda, and Zimbabwe. This compilation includes an overview of the field test, country reports from each of the four countries, methodological lessons learned, an examination of the cost and practicality of the methodology, and recommendations for future applications. |
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Descentralización del Sector Salud en el Paraguay: Estudio de Evaluación del Impacto en el Costo, Eficiencia, Calidad Básica, Uso, y Equidad de los Servicios Básicos de Salud - Resultados de Línea de Base.
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Angeles G, Stewart JF, Gaete R, Mancini D, Trujillo A, Fowler CI |
2000 |
Spanish |
PARAGUAY, Latin America and the Caribbean |
|
Health policymakers have considered decentralization as a potential way to improve the delivery of health services. A decentralization initiative being conducted in Paraguay allowed researchers an opportunity to analyze the impact of the decentralization process. This Spanish-language report presents the results of the first phase of a study of decentralization's impact on the cost, efficiency, basic quality and equity of Paraguay's health service delivery. This first phase consists of baseline measures for key performance indicators; these results present the status of the health care system in the study municipalities prior to the implementation of decentralization. This study was designed with the ultimate intent of will examining the impact of decentralization in the following four areas: cost of providing basic health care services; efficiency in the use of resources to provide health services; service quality at health facilities and from the client's perspective; and patterns of health service use and equity of health service use by the population. An English-language version of this publication, "Health Care Decentralization in Paraguay: Evaluation of Impact on Cost, Efficiency, Basic Quality, and Equity - Baseline Report," is also available. |
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Health Care Decentralization in Paraguay: Evaluation of Impact on Cost, Efficiency, Basic Quality, and Equity - Baseline Report.
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Angeles G, Stewart JF, Gaete R, Mancini D, Trujillo A, Fowler CI |
2000 |
English |
PARAGUAY, Latin America and the Caribbean |
|
Health policymakers have considered decentralization as a potential way to improve the delivery of health services. A decentralization initiative being conducted in Paraguay allowed researchers an opportunity to analyze the impact of the decentralization process. This report presents the results of the first phase of a study of decentralization's impact on the cost, efficiency, basic quality and equity of Paraguay's health service delivery. This first phase consists of baseline measures for key performance indicators; these results present the status of the health care system in the study municipalities prior to the implementation of decentralization. This study was designed with the ultimate intent of will examining the impact of decentralization in the following four areas: cost of providing basic health care services; efficiency in the use of resources to provide health services; service quality at health facilities and from the client's perspective; and patterns of health service use and equity of health service use by the population. A Spanish-language version of this publication, "Descentralización del Sector Salud en el Paraguay: Estudio de Evaluación del Impacto en el Costo, Eficiencia, Calidad Básica, Uso, y Equidad de los Servicios Básicos de Salud - Resultados de Línea de Base," is also available. |
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A Framework for the Evaluation of National Aids Programmes
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Boerma T, Pisani E, Schwartlander B, Mertens T |
1999 |
English |
UGANDA, Africa, THAILAND, Asia |
Monitoring, Evaluation, HIV/AIDS |
At present, UNAIDS, WHO, and USAID are co-ordinating a global initiative to improve monitoring and evaluation of national programmes (UNAIDS/WHO/MEASURE Evaluation, 1999). This initiative builds upon the experience in monitoring and evaluation of a wide range of developing countries and aims to develop guidelines for a sound monitoring and evaluation system. Experience in countries such as Thailand and Uganda has shown that there is a great need to demonstrate the overall impact of national AIDS programmes. Showing that programmes change behaviour and consequently reduce new infections is an essential component of building public support to sustain or expand the current budget and activity level of the national AIDS programme. One of the shortcomings of existing monitoring and evaluation efforts by national AIDS programmes is that they exist independently of a clear framework which links programme efforts and behavioural trends to HIV-related outcomes in a logical way. This paper proposes a simple conceptual framework for monitoring and evaluation of AIDS programs, using the intermediate or proximate determinants conceptual framework used in the study of fertility and child survival. By specifying the programme outcomes as proximate determinants based on epidemiological theory the conventional input-output-outcome-impact monitoring and evaluation framework becomes conceptually clearer. The framework underscores the need for selection of indicators at different levels of the framework, ranging from context and programme inputs to health impact and mortality and emphasises the central role of the proximate determinants. The combination of monitoring data at different levels of the framework with disease surveillance data provides the most practical basis for the evaluation of national programmes. |
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National trends in AIDS knowledge and sexual behavior in Zambia 1996-98
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Banda C, Bloom S S, Songolo G, Mulendema S, Cunningham A E, Boerma J T |
1999 |
English |
ZAMBIA, Africa, Southern Africa |
HIV/AIDS, Sexually Transmitted Infections (STIs) |
Objective: To describe the trends in AIDS knowledge and sexual behaviour in Zambia between 1996 and 1998. Design: Analysis of data collected in two nationally representative surveys. Methods: Analyses were stratified by sex. In order to assess whether there had been changes in the levels of knowledge and high risk sexual behaviour over the two-year period, differences between estimated population proportions between both surveys were tested across several indicators, based on robust estimates of variance. Results: Levels of knowledge about AIDS transmission were already high in 1996, and very little change was observed over the two-year period. The proportion of men with multiple sexual partners decreased, and there was a lower level of premarital sexual activity among men. In 1996, 20.8% of men reported having two or more partners during the last year, compared to 15.2% in 1998 (p=0.002). Among men with four or more partners, the figures were 6.7% and 4.9%, respectively (p=0.05). Likewise, there was an increase of never married men who reported no sexual activity between the two years, with 35.8% in 1996 and 52.6% in 1998 (p Conclusions: After a decade of HIV-prevention activities in Zambia, one of the most severely affected countries in the world, some favorable changes in indicators of male sexual behaviour have been observed during 1996-1998. Other areas showed little change, indicating the need for renewed efforts in HIV/STD prevention programmes. |
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The Determinants of Contraceptive Discontinuation in Northern India: A Multilevel Analysis of Calendar Data
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Zhang F, Tsui A O, Suchindran C M |
1999 |
English |
INDIA, Asia |
|
Using contraceptive calendar data collected in a sample survey in a northern Indian state, we study the determinants of contraceptive discontinuation by reason and method. Reason-specific continuation rates differ significantly by method and source. With a multilevel, multinomial discrete-time hazard model, we find effects from socioeconomic wellbeing, age, parity, travel time, method access, method type and source on reason-specific risks for contraceptive discontinuation. Unobserved factors at the individual and community levels significantly affect contraceptive discontinuation by reason. Some shared unobserved risk factors across the competing alternatives are also present in the models. |
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Does Contraceptive Discontinuation Matter?: Quality of Care and Fertility Consequences
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Blanc A, Curtis S, Croft T |
1999 |
English |
Global, Asia, Africa |
Fertility |
Contraceptive discontinuation is often cited as an outcome that is associated with the quality of care provided by family planning programs. The primary objective of this study is to document levels of discontinuation across countries and to assess the utility of using this indicator as a reflection of the quality of the service environment. The study also examines contraceptive behavior following a discontinuation and the fertility consequences of contraceptive discontinuation and failure. The contraceptive histories collected in 15 DHS surveys are used to calculate a range of life table measures of discontinuation, including method and reason-specific rates. The 15 countries included in the study represent a diversity of situations with overall contraceptive prevalence among married women ranging from 31 to 77 percent. The most used method is the pill in six countries, the IUD in two countries, female sterilization in six countries, withdrawal in one country, and periodic abstinence in two countries. Hormonal methods (pill and injectables) are more likely to be discontinued as a result of side effects or health concerns than are other methods. Except for Zimbabwe, which has very low rates, the percentage discontinuing the pill for these reasons within a year ranges from 11 to 35 percent while for injectables, the percentage varies from 15 to 37 percent. For most countries, the 12-month cumulative rate of discontinuation of the IUD for side effects or health concerns is much lower, varying between 6 and 14 percent. Other method-related reasons (and contraceptive failure) are more important reasons for discontinuation of periodic abstinence, withdrawal, and condoms. Service-related reasons for discontinuation include cost of the method and lack of access to the method; these are rarely mentioned by women as the primary reason for discontinuing use of any method. In all but three of the countries, the most common action women take after discontinuing use of a modern reversible method for method or service related reasons is to switch to a different modern method. In these countries, between 29 and 58 percent of women begin using a different modern method within three months of discontinuation. Few women return to the method they had discontinued. In contrast, women who experience a contraceptive failure and resume using after the birth are most likely to return to the same method. All-method discontinuation rates, which measure the rate at which women stop using any method of contraception, are calculated separately for two groups of reasons: reduced need and quality related reasons. Overall, between 9 percent (Zimbabwe) and 34 percent (Dominican Republic) of women stop using contraception within 12 months for quality related reasons. The all-method discontinuation rate for quality related reasons accounts for between approximately a half and three quarters of the total rate at 12 months. This all-method rate for quality related reasons is inversely associated with overall Family Planning Program Effort (FPPE) scores; that is, strong programs tend to have relatively low quality related discontinuation rates. The relationship between the two indicators is statistically significant, but not particularly strong. The relationship between the all-method discontinuation rate for quality related reasons and the service related component of the FPPE score is also negative and statistically significant but stronger. However, contrary to expectation, two different indicators of method choice are not associated statistically with rates of method discontinuation for quality related reasons. Nevertheless, the study suggests that the measure of contraceptive discontinuation that most closely approximates an overall indicator of quality of care is the all-method rate for quality related reasons. The advantages of this measure over other types of discontinuation rates are, first, that it focuses on discontinuation of any method of contraception rather than on a specific method. It thus incorporates the notion that high rates of method switching are not necessarily negatively related to quality. Discontinuation of any method is of greater programmatic interest than discontinuation of a specific method because it leaves women unprotected from the risk of unwanted pregnancy. Second, this rate includes only those who discontinued for reasons other than a desire to get pregnant or reduced exposure to pregnancy risk; many of these reasons are ones that can effectively be addressed by improvements in the family planning program. One disadvantage revealed by a trend analysis is that change in this indicator over relatively short periods of time may not be possible to detect with sample sizes in the range utilized by DHS surveys. In addition, we hesitate to recommend this measure unequivocally as a summary indicator of quality of care because it does not have a consistent relationship with one of the core components of a high quality service environment - method choice. The study demonstrates clearly that contraceptive failure and discontinuation make a substantial contribution to overall fertility rates and to rates of unwanted fertility. In the 15 countries included in this analysis, the total fertility rate (TFR) would be between 4 and 29 percent lower in the absence of contraceptive failure. The average across all countries is 14 percent. Without other types of contraceptive discontinuation, the TFR would be reduced by between 20 (Indonesia) and 48 percent (Jordan). More than half of recent unwanted fertility was due to either a contraceptive failure or a contraceptive discontinuation in all countries except Guatemala. The total unwanted fertility rate would be between about 0.2 and 1.1 births lower in the absence of failure and discontinuation. This result implies that as fertility declines, family planning programs would profit from a shift in emphasis from providing methods to new clients towards providing services to existing clients, such as counseling, th at may help reduce failure and discontinuation rates. |
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Socioeconomic Status and Class in Studies of Fertility and Health in Developing Countries
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Bollen K A, Glanville J L, Stecklov G |
1999 |
English |
Africa, Global, Asia |
|
The concepts of socioeconomic status (SES) and class are pervasive in sociological studies, yet an examination of the sociological and social science literature suggests that there is a lack of consensus on their conceptual meaning and measurement. Our review focuses on the use of SES and class in a specific substantive field, studies of child health and fertility in developing countries. We provide a brief review of the theoretical literature on SES and class, contrasting unitary and component views. We then examine the use of SES and class in empirical studies of child health and fertility in developing countries and investigate the relationship between the conceptual and empirical literature, highlighting the inconsistencies we find. In addition, we discuss the variety of meanings and measures of SES that researchers use in these studies. Next, we address a series of methodological issues that arise from the review. Finally, we make recommendations for the treatment of SES and class in these and related areas. |
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"Monitoring and Evaluation Indicators Reported by Cooperating Agencies in the Family Planning Services and Communication, Management and Training Divisions of the USAID Office of Population"
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Elkins C |
1999 |
English |
|
Indicators |
In 1998, the Office of Population at USAID (G/PHN/POP) identified a need for a central compilation of Monitoring & Evaluation (M&E;) indicators being used by USAID's Cooperating Agencies (CAs). This report presents MEASURE Evaluation's review of indicators used by selected CAs in two divisions. The immediate goal of the compilation is to improve the Office of Population's understanding of current indicators' breadth and depth. Further objectives may include improving G/PHN/POP's ability to support and advise its Missions and CAs on a useful range of relevant indicators across a number of different categories and data types, in order to 1) report on and reflect the division portfolios more comprehensively, and 2) investigate the possibilities for coordinating CA (central project) indicators and USAID Mission (country-specific) indicators, if that might improve CA performance reporting. Toward these objectives, G/PHN/POP developed a framework of categories and classes, herein called the CA Indicator Framework, based on its review of project objectives, specifically those of central projects that have been operating within the Family Planning Services Division (FPSD) and the Communication, Management, and Training (CMT) Division. |
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The results framework - an innovative tool for program planning and evaluation
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Toffolon-Weiss MM, Bertrand JT, Terrell SS |
1999 |
English |
Latin America and the Caribbean, Central American Project |
HIV/AIDS |
This article constitutes a case study of the development and implementation of the "results framework," an innovative planning and evaluation tool that is rapidly becoming a standard requirement for United States Agency for International Development (USAID) projects. The framework is used in a USAID-funded regional initiative for HIV/AIDS prevention in Central America. This new program evaluation and monitoring tool provides many advantages over traditional evaluation approaches that use outside consultants to provide midterm and end-of-project evaluations. The results-framework process, which spans the life of the project, provides an opportunity for program staff, donors, partners, and evaluators to work as a team to collect and use rich, longitudinal data for project planning, implementation, and evaluation purposes. |
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The impact of family planning service provision on contraceptive use dynamics in Morocco
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Steele F, Curtis S, Choe M |
1999 |
English |
Africa, West Africa, MOROCCO |
Contraception |
This article uses linked data from the 1995 Morocco DHS calendar and the 1992 Morocco DHS service-availability module to study the effect of service environment on contraceptive discontinuation, switching, and adoption of a modern method following a birth. The 1995 Morocco DHS also collected information on the source of supply for each episode of use of a modern method recorded in the calendar, allowing study of the association between the source of supply and discontinuation and switching rates. Multilevel event-history models are used to evaluate the impact of individual-level sociodemographic characteristics and community-level indicators of family planning service provision. The findings show that the presence of a nearby public health center is associated with higher modern-method adoption after a birth and lower method-failure rates; the presence of a pharmacy is associated with lower discontinuation due to side effects or health concerns. The degree of method-choice potential has a positive impact on both the rate of switching from the pill to another modern method and on modern-method adoption after a birth. |
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The impact of the family planning supply environment on contraceptive intentions and use in Morocco
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Magnani RJ, Hotchkiss DR, Florence CS, Shafer LA |
1999 |
English |
Africa, West Africa, MOROCCO |
Contraception |
The extent of organized family planning programs' influence on reproductive preferences remains open to debate. However, most observers grant that such programs play a key role in helping individuals to realize their contraceptive and reproductive intentions. Yet few prior studies have quantified the magnitude of this effect, given existing demand for contraception. This study takes advantage of panel survey data and linked information on the supply environment for family planning services in Morocco in order to bridge this research gap. In the analysis, contraceptive use during the 1992-95 period is related to contraceptive intentions in 1992. Estimation procedures control for unobserved joint determinants of contraceptive intentions and use. Study authors found evidence of a significant enabling or facilitating role of family planning services, and the results also suggest that family planning program factors influence contraceptive intentions in important ways. |
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The effects of maternal-child health service utilization on subsequent contraceptive use in Morocco
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Hotchkiss DR, Magnani RJ, Rous JJ, Azelmat M, Mroz TA, Heikel J |
1999 |
English |
Africa, MOROCCO |
Child Health, Maternal Health, Contraception |
There are a number of reasons for anticipating that contact by women in developing country settings with modern maternalchild health (MCH) services will lead to increased use of family planning services. Indeed, the expectation of such a relationship underlies the integrated service delivery strategy that has been adopted on a more or less global basis. However, the available empirical evidence in support of this proposition is inconclusive. This study re-examines this issue in Morocco. Household survey data and data on the supply environment for health and family planning services gathered in 1992 are analysed in the study. A full-information maximum likelihood estimator is used to control for the possible endogeneity of health care and contraceptive choices. The findings indicate a substantial and apparently causal relationship between the intensity of MCH service use and subsequent contraceptive use. Policy simulations indicate that sizeable increases in contraceptive prevalence might be realized by increasing the coverage and intensity of use of MCH services. |
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Domestic violence in northern India.
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Martin SL, Tsui AO, Maitra K, Marinshaw R |
1999 |
English |
INDIA, Asia |
Maternal Health |
This study examined the prevalence and characteristics of wife abuse as reported by nearly 6,700 married men living in five districts of northern India during 19951996. In addition, associations between wife abuse and sociodemographic factors were investigated to enable two theoretical/conceptual perspectives regarding abuse to be evaluated: that abuse is more common among families under stress and among more "private" families. The district-specific percentages of men who reported physically abusing their wives ranged from 18% to 45%, with 1840% of the men in each district having had nonconsensual sex with their wives and 49% having physically forced their wives to have sex. The authors used logistic regression analyses to control for a variety of sociodemographic variables and found positive associations between wife abuse and stress-related factors, including the husband having a low educational level, the couple living in poverty, the husband being young when he first lived with his wife, and the couple having multiple children. Contrariwise, there was no strong empirical support for the idea that wife abuse may be more common in more "private families". Am J Epidemiol 1999;150:41726. |
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Fertility implications of reduced breast-feeding by HIV/AIDS-infected mothers in developing countries.
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Stecklov G |
1999 |
English |
Asia, Africa, Global |
Maternal Health, HIV/AIDS |
The article comments on the announcement by the United Nations that mothers infected with HIV/AIDS should not breast-feed their children. The announcement is a major reversal in health policy indicating that breast feeding increases the risk of vertical transmission of HIV/AIDS by about 14% above and beyond the roughly 15% risk associated with transmission before birth. It details the role of breastfeeding in reducing infant susceptibility to illnesses such as diarrhea and infectious diseases and its role in lowering fertility by delaying the return of menses and lengthening the time interval between births. |
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Family planning program structure and performance in West Africa.
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Stewart J, Stecklov G, Adewuyi A |
1999 |
English |
BENIN, Africa, West Africa, COTE D'IVOIRE, GHANA, GUINEA, NIGERIA |
Reproductive Health |
Context: The long-standing debate over the relative merits of vertical and integrated organizational structure for the delivery of family planning services has taken on added significance, particularly in poorer regions such as West Africa, given increasing emphasis on reproductive health services as a whole. Methods: Case studies from Cote d'Ivoire, Nigeria, Benin, Ghana and Guinea, as well as large-scale facility surveys using multiple measures of staff utilization in Cote d'Ivoire and Nigeria, are used to examine the efficiency of different organizational structures for delivering family planning services. Results: Vertical programs operated by nongovernmental organizations provided close to half (44%) of all couple-years of contraceptive protection in Cote d'Ivoire and about one quarter in Benin and Guinea. When social marketing efforts are considered as well, sectors other than governmental, integrated programs were responsible for a majority of the couple-years of protection. Only in Nigeria did integrated programs provide the bulk of couple-years of protection in 1994. Facility surveys conducted in Cote d'Ivoire and Nigeria suggest that vertical family planning service structures have staff capacity utilization rates at or above 100%, and thus appear to use their labor resources more efficiently than do the integrated sites. Staff utilization rates are somewhat higher in the privately operated vertical programs in Cote d'Ivoire than in the government integrated programs; in Nigeria, vertical programs also had somewhat higher staff utilization rates, even within government-operated programs. Conclusions: Where both vertical and integrated programs exist, integrated programs may not necessarily be superior. The relative merits of the two approaches almost surely depend on the socioeconomic and political environments in which they operate; thus, optimal program structures may depend on the local situation. |
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Quality, accessibility, and contraceptive use in rural Tanzania.
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Mroz TA, Bollen KA, Speizer IS, Mancini DJ |
1999 |
English |
TANZANIA, Africa, Southern Africa |
Rural Populations, Contraception |
Authors examine how informants' reports on community perceptions of the quality and accessibility of family planning facilities relate to the use of modern contraceptives by individuals in rural Tanzania. Using information on individual level contraceptive use in conjunction with community-level information on the accessibility and quality on contraceptive use. Both procedures treat the community-level variables as imperfect indicators of characteristics of the facilities, and they yield nearly identical implications. Authors find that a community-level, subjective perception of a family planning facility's quality has a significant impact on community members' contraceptive use whereas other community measures such as time, distance, and subjective perception of accessibility have trivial and insignificant direct impacts, net of the control variables. Future research that uncovers the determinants of perceptions of both community-level and individual-level quality could provide key insights for developing effective and efficient family planning programs. |
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Review of Results of the Multi-Country Field Test of Quality of Care Indicators in Clinic-Based Family Planning Programs
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|
1999 |
English |
Asia, Africa |
|
This HTML document presents the results from a four-day meeting held on April 23, 1999 to discuss a multi-country field test of quality of care indicators in clinic-based family planning programs. In addition to the meeting minutes, this document also contains 12 PowerPoint slide show presentations from the meeting. |
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Towards Improving Monitoring and Evaluation in Maternal and Perinatal Health: Proceedings from a Workshop on the Use of Birth Registers as a Data Source for Maternal and Perinatal Health Care
|
|
1999 |
English |
Global, Latin America and the Caribbean |
Maternal Health, Monitoring, Evaluation, Child Health |
This 56-page report summarizes the proceedings from a workshop on the use of birth registers as a data source for maternal and perinatal health care held from March 2-4, 1999, in Arlington Virginia. The workshop had the objectives of describing the range of data currently collected in registers and exploring current reporting practices based on these data. The meeting also examined issues affecting birth register data use. Based on discussions during the workshop, MEASURE Evaluation cited the following activities for possible follow-up: 1) strengthening the use of obstetric register data by conducting pilot studies looking at issues regarding core data items and their use, as well as approaches to feedback provisions; 2)collaborating with the Latin American Center for Perinatology staff to develop and pursue secondary analysis plans using their data; 3) pursuing collaboration with concerned parties to conduct a meeting on maternal and perinatal death audits; 4) compiling a series of case studies on national-level reporting and obstetric register data use; and 5) maintaining the meeting working group via a list serve, Web site communication, an electronic conference, or follow-up meeting. |
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HIV, STDs and Infertility: Past Trends and Current Monitoring Problems.
|
|
1999 |
English |
Africa |
HIV/AIDS, Sexually Transmitted Infections (STIs) |
This 15-page document summarizies the results of a meeting held by MEASURE Evaluation, UNAIDS, and the CDC to discuss past trends and current monitoring problems in HIV, sexually transmitted diseases, and infertility. This document describes key issues researchers raised while working to illuminate the relationship between these three interrelated elements of sexual health. |
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Does Contraceptive Discontinuation Matter?: Quality of Care and Fertility Consequences
|
|
1999 |
English |
Asia, Africa |
|
Contraceptive discontinuation is often cited as an outcome associated with the quality of care provided by family planning programs. This study documented levels of discontinuation across countries and assessed the utility of using these indicators as a reflection of the quality of the service environment. Additionally, this study examined contraceptive behavior following a discontinuation and the fertility consequences of contraceptive discontinuation and failure. Study authors collected contraceptive histories in 15 DHS surveys to calcuate a range of life table measures of discontinuation. The study found the following key findings: 1) Hormonal methods are more likely than other methods to be discontinued as a result of side effects or health concerns. 2) For most countries, women were most likely to switch to another contraceptive method after discontinuing the use of one method. Few women return to a method they have discontinued. 3) Overall, between 9% and 34% of women stop using contraception within one year for quality-related reasons. 4) Contraceptive failure and discontinuation make a substantial contribution to overall fertility rates and to rates of unwanted fertility. The total fertility rate for the 15 countries sampled would have been, on average, 14 percent lower in the absence of contraceptive failure. This report recommends that as fertility declines, family planning programs shift from providing methods to new clients towards providing more services to existing clients that help reduce failure and discontinuation rates. |
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Zambia Sexual Behavior Survey 1998
|
|
1999 |
English |
ZAMBIA, Africa, Southern Africa |
HIV/AIDS, Sexual Behavior, Condoms |
The 1998 Zambia Sexual Behavior Survey (ZSBS) collected information on key indicators of HIV/AIDS/STD-related indicators of knowledge, attitude, and sexual behavior. The population-based survey consisted of a national sample of 1943 households, 97% of which responded. Individual response rates among eligible men and women were 92% and 96%, respectively. This 95-page report summarizes the ZSBS findings. Some key findings: virtually all respondents had heard of AIDS, and 86% of men and 78% of women thought that HIV infection could be avoided. Two-thirds of men and 57% of women agreed that condom use was an effective prevention method. Only 7% of respondents thought it was acceptable for a married man to have extra-marital sexual relations, but 19% of men and 29% of women thought a man could not be sexually satisfied with just one partner. One in five adults were estimated to be HIV positive by 1995; however, few people knew their HIV status, and many held negative attitudes about HIV-positive people. Sexual behavior in Zambia had not changed drastically from 1996 to 1998, though unmarried men did report fewer partners. Close to one-thid of men reported using condoms in non-marital relationships, a slight decrease from 1996. |
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Uganda Delivery of Improved Services for Health (DISH) Evaluation Surveys 1997.
|
|
1999 |
English |
Africa, Southern Africa, UGANDA |
Reproductive Health, Sexually Transmitted Infections (STIs), Health Facilities, HIV/AIDS, Maternal Health, Child Health |
This report presents findings from the 1997 Delivery of Improved Services for Health (DISH) Evaluation Survey, and, where possible, compares the status of reproductive health services and individuals with those measured in the 1995 Uganda Demographic and Health Survey. The DISH Evaluation Survey gathered information from 1,967 women, 900 men, and 173 health facilities. This 94-page document presents key findings in the following areas: information-education communication; family planning; maternal and child health; health facilities; and STDs and HIV/AIDS. |
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Household Health Expenditures in Morocco: Implications for Health Care Reform
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Hotchkiss D R, El-Idrissi Z E, Hazim J, Gordillo A |
1998 |
English |
MOROCCO, Africa, West Africa |
Child Health, Public Health, Maternal Health |
The purpose of this study is to investigate the level and distribution of household health care expenditures in Morocco, and to compare the level of health care funds provided by households with the levels provided by the government and international donors. In addition, the reliance of poor and non-poor households on both public and private providers is investigated. The study is based on data collected in the 1995 Demographic and Health Survey, which included a special supplement on health care expenditures. Descriptive statistics are presented on utilization of and out-of-pocket expenditures for antenatal and obstetric care, chronic care, and non-chronic care associated with illness and injury, by urban/rural status and by socio-economic status. The results indicate that government health care providers are an important source of modern health care not only for poor households, but for better-off households as well. While individuals who use private health care providers incur substantially higher costs than those who use public providers, an unexpected finding of the study is the degree to which public clients pay for health care services, despite the fact that public care is nominally priced in Morocco. The results indicate that carefully designed financing strategies may be effective in achieving a higher level of cost recovery and efficiency within the public sector. |
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Report of a Technical Meeting on the Use of Lot Quality Assurance Sampling (LQAS) in Polio Eradication Programs
|
|
1998 |
English |
Global |
|
Discussion points and conclusions are presented from a 1998 technical meeting on the use of Lot Quality Assurance Sampling (LQAS) in polio eradication programs. The meeting was a response to donors organizations' interest in strengthening monitoring and evaluation of polio eradication activities and applying rapid assessment tools in the health sector. LQAS was chosen as the focus of the meeting due to its potential for use in rapid assessment and the relative lack of widespread experience with the method. Participants discussed strengths and limitations of using LQAS as a rapid assessment tool to monitor polio eradications activities and other immunization activities. |
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How Well Do Perceptions of Family Planning Service Quality Correspond to Objective Measures? Evidence from Tanzania
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Speizer IS, Bollen KA |
1998 |
English |
Africa, TANZANIA, Southern Africa |
Contraception |
This study examines the objective determinants of perceptions of facility quality. The underlying assumption is that perceptions of family planning facilities have the key effects on whether a potential client is a user or non-user of a facility . The data are from two surveys in rural Tanzania. Three models are tested separately for females and males. The important determinants of perceived quality among women and men are: perceived time to the facility, maternal and child health service availability, size of the facility, and type of facility. The data only explain a moderate amount of the variance in the quality measures, indicating that perceived quality is a difficult concept to quantify. Future surveys of facility quality need to inclu de information on perceptions directly linked to objective traits to better determine how to improve perceived quality with the goal of increasing contraceptive use. |
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Family Planning Program Effects on Contraceptive Use in Morocco, 1992-1995
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Hotchkiss DR |
1998 |
English |
Africa, West Africa, MOROCCO |
Health Facilities, Contraception |
This study assesses the impact of improvements in public sector family planning services on the prevalence of contraceptive use in Morocco during the 1992-95 period. Data from a panel of women interviewed in both the 1992 and 1995 Morocco Demographic and Health Surveys were used in the study, along with ""program"" data from Service Availability Modules undertaken in conjunction with each survey round. Fixed-effects estimation methods were used to control for the non-random allocation of program resources . The results indicate that changes in the family planning supply environment, in particular increased presence of nurses trained in family planning at public clinics, played a significant role in the increased use of modern contraceptives during the study period. However, program efforts to broaden the mix of contraceptive methods used by Moroccan women were less successful. |
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Do Family Planning Service Providers in Tanzania Unnecessarily Restrict Access to Contraceptive Methods?
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Speizer I S |
1998 |
English |
TANZANIA, Southern Africa, Africa |
Contraception |
Context: Medical barriers can limit the use of family planning services, even in situations where family planning services are physically accessible and economic barriers are few. This study investigates the presence of four types of medical barriers among providers at government family planning service delivery points in Tanzania: overspecialization, eligibility restrictions, process hurdles, and provider bias. Methods: Data from the 1996 Tanzania Service Availability Survey are used in the study. Barriers are analyzed by type of provider, type of facility, and urban/rural location. Estimates of the proportion of facilities that are ""barrier-f ree"" are also made. Results: A relatively high proportion of provider's restrict eligibility by age, particularly for oral contraceptives, the most widely used method by Tanzanian women. Restrictions were also observed according to a woman's marital status, parity, and spousal consent. Medical aides, trained midwives, MCH aides, and auxiliary staff, the most common type of family planning service provider in rural areas, were the most likely to impose age restrictions (79 to 81 percent) for the pill. Ten to 13 percent of providers reported that there was at least one modern method that they would never recommend, and 40 percent reported inappropriate process hurdles in the provision of hormonal methods. In the aggregate, these restrictions and hurdles se verely limit access to contraceptives for certain groups of women. Young, unmarried, non-menstruating women, for example, would encounter one or more barriers or process hurdles at more than 70 percent of urban and 80 percent of rural facilities. Conclusions: Although the Tanzanian National Family Planning Program has made considerable progress in improving access to family planning services in the 1990s, further efforts are needed to reduce and ultimately eliminate unnecessary p rovider restrictions to contraceptive use. Compliance with the National Family Planning Program's service guidelines and standards would seem to be in need of greater emphasis in pre- and in-service training and during supervisory visits. |
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Contraceptive Intentions and Subsequent Use: Family Planning Program Effects in Morocco
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Magnani R J |
1998 |
English |
West Africa, MOROCCO, Africa |
Contraception |
While the extent to which organized family planning programs influence reproductive preferences remains a subject of debate, most observers would grant that such programs play a key role in helping individuals to realize their contraceptive/reproductive intentions. However, few prior studies have quantified the magnitude of this ""facilitating"" or ""enabling"" effect of family planning services given demand for contraception. This study takes advantage of panel survey data and linked information on the supply environment for family planning services in Morocco to attempt to bridge this research gap. In the analysis, contraceptive use during the 1992-95 period is related to contraceptive intentions in 1992, individual-, household-, and community-level determinants of contraceptive behavior, and family planning supply factors. Estimation procedures are used that control for unobserved joint determinants of contraceptive intentions and use. While evidence of a significant enabling/facilitating role of family planning services is indeed found, the findings also suggest that family planning program factors influence contraceptive intentions in important ways. |
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Estimating the Health Impact of Industry Infant Food Marketing Practices in The Philippines
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Stewart J F |
1998 |
English |
South Asia, PHILIPPINES, Asia, East Asia |
Child Health |
Though a considerable literature exists on the relationship between infant feeding practices and infant health and some work analyzing the effect of infant food marketing activities on mothers' feeding choices has been done, very little has been done tracing the links from marketing to ultimate health outcomes. Using a panel data set covering some nearly 2900 infants born between May 1, 1983 and April 30, 1984 in the Cebu region of the Philippines, mothers' feeding decisions and infantile diarrheal morbidity rates are modeled and jointly estimated using semi-parametric estimation methods. The data clearly supports the hypothesis that infant feeding practices are important determinants of diarrheal morbidity and that breast-feeding, both exclusively and in combination with supplementation, reduces the incidence of diarrhea. Our results also show that marketing activities have affected infant feeding choices and simulations are used to trace the effects of marketing on child health. |
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Testing Indicators for Use in Monitoring Interventions to Improve Women's Nutritional Status
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Adair L |
1998 |
English |
South Asia, East Asia, PHILIPPINES, Asia |
Nutrition, Public Health, Maternal Health, Reproductive Health |
The Reproductive Health Indicators Working Group of the Evaluation Project developed a series of indicators for the evaluation of reproductive health programs. We examined a subset of indicators of women's nutritional status using data from the Cebu Longitudinal Health and Nutrition Survey (CLHNS). The CLHNS is an ongoing community-based study of more than 2,200 mothers in Metro Cebu, the second largest and most rapidly growing area of the Philippines. Our analysis had a focus on intermediate and long term outcomes of undernutrition, including meal patterns and consumption of vitamin A rich foods, low birth weight (LBW) and a range of anthropometric indicators of nutritional status. We present prevalence of each indicator in the Cebu cohort at selected points in time, assess the degree to which each indicator adequately characterizes nutritional risk, determine the degree to which different nutritional indicators lead us to the same conclusions about h ealth or nutritional status, and assess how the prevalence of indicators changes over time as women age. |
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Obstacles to Quality of Care in Family Planning and Reproductive Health Services in Tanzania
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Richey L |
1998 |
English |
Southern Africa, TANZANIA, Africa |
Maternal Health, Reproductive Health |
This paper presents case study data from family planning clinics in Tanzania which suggest that obstacles in three realms -- supply, interpersonal relations, and policy/program -- may interfere with the provision of good quality of care for clients. By examining these obstacles carefully, this paper builds on our current understanding of quality of care, suggesting that the way quality of care studies are operationalized and interpreted may be improved. In addition, this study identifies areas needing improvement in a given family planning program. |
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Family Planning, Maternal/Child Health, and Sexually-Transmitted Diseases in Tanzania: Multivariate Results Using Data from the 1996 Demographic and Health Survey and Service Availability Survey
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Dietrich J |
1998 |
English |
TANZANIA, Africa, Southern Africa |
Child Health, Maternal Health, Reproductive Health, HIV/AIDS, Sexually Transmitted Infections (STIs) |
This report presents background information on two linked surveys: The 1996 Tanzania Demographic and Health Survey (TDHS96) which provides us with information on important outcomes at the individual level, as well as individual level explanatory factors such as the respondent's age and education; and, the 1996 Tanzania Service Availability Survey (TSAS96) which provides us with program variables measured at the facility level that may also have impact on individual level outcomes, such as the choice to use a contraceptive method or the choice to obtain antenatal care. An overview of the multilevel, multivariate statistical methods that are used and descriptive statistics for all variables are presented. Results for the multivariate analysis of the choice of contraceptive method and the closely related variable, additional children desired are discussed. This report also attempts to measure the impact of the FPU training program, which has been highly targeted to urban areas. This targeting makes eval uation more difficult. And last, results for other important outcome variables are presented: MCH related outcome variables such as the use of antenatal care, the use of trained delivery services, and child immunizations; and, program effects on STD related outcomes. |
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Family Planning Program and Recent Fertility Trends in Iran
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Aghajanian A |
1998 |
English |
Middle East, Europe and Eurasia (was ENIS), IRAN, ISLAMIC REPUBLIC OF |
Fertility |
Iran is a Middle Eastern country that shares as a religion with other countries in the region. The majority of Iranians practice the Shiat sect of Islam, which differs in some details from the Sunit sect practiced in most of the Arab countries of the Middle East. From the pre-Islamic era, Iran has inherited the Persian culture and language. The pre-Islamic religion in Iran was Zoroastrianism, a polytheistic religion. Formerly known as Persia, the modern state of Iran has emerged as a strong and rich civilization. The Iranian socio-cultural system has evolved through an interaction of Islam and the pre-Islamic Iranian civilization. During the spread of the Islamic Empire, Iranian society made great contributions to eastern culture, literature, philosophy and science. However, after suffering several devastations, such as Mongul and Timurid invasions, Iran entered the 20th century with an underdeveloped economy, weak central government, and strong internal interference from the European colonial powers. Western culture first impacted Iran in the early years of the 19th century and this built up into a full scale westernization of Iranian society in the 1970s (Banani, 1961; Menashri, 1992). The first half of the 20th century saw a sustained effort at modernization and westernization by the government. Political centralization and exportation of oil facilitated some industrial development and modernization of the infrastructure (Abrahamian, 1982; Lapidus, 1988). Economic development and modernization were accompanied by the growth of a strong and modern army, a secular educational system, and a strong nationalistic ideology. During the postwar period, 1955-1979, Iran was characterized by rapid economic growth and modernization supported by government spending and fueled by oil exports (Bill, 1988) . Structural changes in the economy were accompanied by social reforms, such as an effort to redistribute farm land in order to provide a more favorable social milieu for economic development. Legal and symbolic changes were introduced to enhance the social status of women and increase their participation in social and economic domains outside the household. These changes included granting women the right to vote and political participation, and placing women in high positions within the government bureaucracy. A new set of family laws were passed to improve the legal status of women within marriage and the family. These legal and symbolic changes were aimed not only at promoting the status of women, but also at affecting patterns of family formation and levels of fertility and family growth. Despite a relative improvement in the well-being of the urban population (especially those in certain regions), the Monarchy's modernization process in Iran generated a growing regional and ethnic polarization (Aghajanian, 1983). The massive economic growth of the 1960s and 1970s benefitted the central and northern regions of Iran but left the population living in the marginal areas deprived (Amirahmadi, 1987). Notwithstanding a remarkable improvement in economic growth, the society faced growing ethnic, regional, and class inequalities in the 1970s. Along with modernization efforts, a strong infiltration of Western culture, and especially those components of Western culture that were at odds with Iranian Islamic traditions, created other divisions among the populations of various areas. Cultural, religious, economic, and social discontent accumulated over the years and culminated in the 1979 Islamic Revolution. The Islamic revolution was a turning point in the social and economic history of Iran. The revolution changed the social fabric of the society and the economy of Iran through policies aimed at revitalizing Islamic values in all aspects of life. Legal changes introduced to implement these policies, and a cultural shift toward Islamic values were reinforced by mass media, especially television, as well as formal and informal educational programs. Unfortunately, eight years of war with Iraq, 1981-1988 (Chubin, 1988), drained off a significant portion of the social and economic resources which otherwise would have been available for infrastructure development and social programs after the revolution. In recent years, there have been new efforts made to faster economic development and reconstruction in the wake of this destructive war. Serious efforts have been made by the Islamic government to improve living standards and to provide basic amenities to the rural communities and villages. A second economic development plan has been implemented, and a strong program of basic health care and family planning established. The existing institutions and social arrangements in Iran reflect influences from the pre-Islamic civilization, long-standing Islamic values and prescriptions, the earlier (1960s and 1970s) modernization efforts, the Islamic Revolution, eight years of destructive war, and the more recent efforts toward economic development. In addition to the historical influences, the physical and ethnic diversity of Iran has always influenced family formation and child bearing in local areas and among the major ethnic communities. Although the inhabitants of Iran are both ethnically and linguistically diverse, they have in common that over 99 percent are Moslems. There are a limited number of Jews and Armenians in Iran, but they have never constituted a significant proportion of the population. The most important ethnic groups are the Persians, Turks, Baluchis, Arabs, and Kurds. Apart from Tehran, the capital city, and a few other major industrial centers, such as Isfahan, that have drawn a large number of migrants from different ethnic groups, the other regions in the country are ethnically and linguistically homogeneous. Three provinces in the Northwest have Turkish communities. Two provinces in the west include Kurdish communities. In the southern part of Iran, three provinces on the Persian Gulf include a mixture of Arabs and Persians. In the East, Baluchis live in the province of Baluchistan. The Central Plateau of Iran is populated by Persians. The recent history of Iran can be divided into three periods. Each period approximates contrasting eras in terms of ideology, economic growth, modernization, and population policy. The 1966-76 period approximates an era of government policies that sought to accelerate economic growth, control the birth rate, and promote modernization. The 1976-88 period approximates an era of revolutionary changes and a return to the basic principles of an Iranian Moslem society, deterioration of the economy due to the war, and a lack of government policy on population growth. Since 1988, a new direction of reform and change has been established in Iran. Soci-economic planning has been taken seriously as a means for achieving economic growth and increasing living standards. Economic modernization is promoted while at the same time preservation of Iranian and Islamic values and orientations are encouraged. During this period, a high population growth rate has been viewed as an impediment to economic development. Therefore, a population policy has been established and a fertility control program vigorously implemented.
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Contraceptive determinants in three leading countries.
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Jayne SH, Guilkey DK |
1998 |
English |
Africa |
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The purpose of this paper is to examine the relative importance of access to family planning and the motivation to restrict fertility in determining contraceptive use in three countries that have led the fertility transitions in their regions: Colombia, Tunisia, and Zimbabwe. A structural equations model is estimated where endogenous fertility intentions are allowed to affect contraceptive method use. Simulation methods are then used to quantify the size of the impact of intentions and access on method choice for the three countries. The results demonstrate that even after controlling for fertility intentions, family planning program variables still have important effects in all three countries. |
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The effects of monetized food aid on reproductive behavior in rural Honduras.
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Magnani RJ, McCann HG, Hotchkiss DR, Florence CS |
1998 |
English |
Central American Project, Latin America and the Caribbean, HONDURAS |
Rural Populations, Health Facilities |
This article presents research findings on the question of whether the monetization of non-emergency food aid has adversely influenced national family planning program efforts in Honduras. Women receiving food aid in the form of cash coupons are compared in the study with women receiving food rations and a third group of women with similar characteristics who were not food aid recipients on three types of outcomes: recent fertility, fertility preferences, and contraceptive use. The health facilities where study subjects received health/family planning services and food aid benefits were also compared to assess possible adverse cross-program effects on family planning service delivery. A "sample selection" model was used in the analysis to control for unobserved differences between comparison groups. No compelling evidence for adverse demand- or supply-side effects of monetized food aid on family planning efforts was observed. The most striking study finding was the extremely high level of unmet need for family planning. |
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Husbands' reproductive health knowledge, attitudes, and behavior in Uttar Pradesh, India
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Singh KK, Bloom SS, Tsui AO |
1998 |
English |
INDIA, Asia, Europe and Eurasia (was ENIS) |
Reproductive Health, Sexual Behavior |
To enhance the reproductive health status of couples in developing countries, the knowledge, attitudes, and behavior of both women and men must be investigated, especially where women depend on men for the decision to seek care. This study analyzes data from a survey of 6,727 husbands from five districts in the northern state of Uttar Pradesh, India. Data are presented on men's knowledge of women's health and on their own sexual behavior outside the context of marriage, on their perceptions of sexual morbidity and their attempts at treatment for specific conditions, and on their opinions concerning the social role of wives. Findings indicate that men know little about maternal morbidity or sexual morbidity conditions. Few husbands reported that they had had sexual experience outside of marriage and the majority of these few said they had had such a relationship with more than one partner. Of men who said they had had reproductive morbidity symptoms, many said they had not sought treatment. Men's views concerning the role of wives indicate a low level of women's autonomy in this region of India. Results indicate a pressing need for reproductive health education that targets both women and men in Uttar Pradesh. |
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Evaluación de Programas de Planificación Familiar con Adaptaciones para Salud Reproductiva
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Bertrand, Magnani, Rutenberg |
1996 |
Spanish |
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This Spanish-language manual prepares readers to: 1) differentiate between the main types of program evaluation, program monitoring, and impact assessment; 2) critically evaluate the strengths and limitations of alternative methods for impact assessment; 3) assess and select the types of evaluation most appropriate to a given setting; 4) Identify appropriate indicators and data sources for evaluation; and 5) designe an evaluation plan outlining study designs, indicators, and data sources that serves as an action plan for subsequent implementation. An English-language version of this manual, Evaluating Family Planning Programs with Adaptations for Reproductive Health, is also available. |
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Evaluating Family Planning Programs with Adaptations for Reproductive Health
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Bertrand, Magnani, Rutenberg |
1996 |
English |
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Reproductive Health, Family Planning, Evaluation, Maternal Health |
This 104-page manual prepares readers to: 1) differentiate between the main types of program evaluation, program monitoring, and impact assessment; 2) critically evaluate the strengths and limitations of alternative methods for impact assessment; 3) assess and select the types of evaluation most appropriate to a given setting; 4) identify appropriate indicators and data sources for evaluation; and 5) design an evaluation plan outlining study designs, indicators, and data sources that serves as an action plan for subsequent implementation. A Spanish-language version of this manual, Evaluación de Programas de Planificación Familiar con Adaptaciones para Salud Reproductiva, is also available. |
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Indicators for Reproductive Health Program Evaluation: Final Report of the Subcommittee on Adolescent Reproductive Health Services
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Stewart L, Eckert E |
1995 |
English |
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Reproductive Health, Sexually Transmitted Infections (STIs), Indicators, Fertility, HIV/AIDS, Maternal Health, Public Health |
This document contains 50 adolescent reproductive health service monitoring and evaluation (M&E) indicators developed by a subcommittee of the Reproductive Health Indicators Working Groups (RHIWG). Indicators within this document are organized according to the following categories: policy; functional outputs; service outputs; service utilization/program participation; exposure to communications; knowledge; attitudes; practice/behavior; and fertility. |
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Indicators for Reproductive Health Program Evaluation: Final Report of the Subcommittee on Breastfeeding
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O'Gara C, Newsome MH, Viadro C |
1995 |
English |
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Indicators, Reproductive Health, Maternal Health |
This compendium contains 40 monitoring and evaluation indicators recommended by the Reproductive Health Indicators Working Group's (RHIWG) subcommittee on breastfeeding. Indicators within this document are organized according to the following categories: policy, quality of care, community-level, training, family planning, information-education-communication, breastfeeding rates, breastfeeding duration, timing, and frequency, and feeding strategies. Additionally, this compendium includes recommendations and indicators from the World Health Organization (WHO). |
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Indicators for Reproductive Health Program Evaluation: Final Report of the Subcommittee on Women
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Galloway R, Cohn A |
1995 |
English |
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Reproductive Health, Nutrition, Pregnancy, Indicators, Public Health |
This document contains the 33 indicators for the monitoring and evaluation (M&E) of women's nutrition programs that were developed by a subcommittee of the Reproductive Health Indicators Working Group (RHIWG). Indicators within this document are organized according to the following categories: policy, service outputs, service utilization, intermediate outcomes, and long-term outcomes. |
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Indicators for Reproductive Health Program Evaluation: Final Report of the Subcommittee on STD/HIV
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Dallabetta G, Hassig S |
1995 |
English |
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Reproductive Health, Sexually Transmitted Infections (STIs), HIV/AIDS, Indicators, Maternal Health |
This compendium contains 31 indicators for the monitoring and evaluation (M&E) of sexually transmitted diseases (STDs) and HIV that were developed by a subcommittee of the Reproductive Health Indicators Working Groups (RHIWG). Indicators in this document are organized according to the following topics: functional outputs, service outputs, service utilization outputs, intermediate outcomes, and long-term outcomes. |
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Indicators for Reproductive Health Program Evaluation: Final Report of the Subcommittee on Safe Pregnancy
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Koblinsky M, McLaurin K, Russell-Brown P, Gorbach P |
1995 |
English |
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Reproductive Health, Indicators, Maternal Health, Public Health |
This compendium contains 66 indicators for the monitoring and evaluation (M&E) of safe pregnancy programs that were developed by a subcommittee of the Reproductive Health Indicators Working Groups (RHIWG). Indicators within this document are organized according to the following categories: maternal health outcomes and outputs, maternal health policy, operations and community-level outputs, newborn health outcomes and outputs, post-abortion care problem outcomes, post-abortion care policy, post-abortion care training, post-abortion counseling and family-planning services, access to post-abortion care, technical quality of service delivery for post-abortion care, quality of client-provider interaction, and costs of post-abortion care. |
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Indicators for Reproductive Health Program Evaluation
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Tsui B |
1995 |
English |
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Reproductive Health, Fertility, HIV/AIDS, Sexually Transmitted Infections (STIs), Nutrition, Maternal Health, Public Health |
This 42-page document serves as an introduction to and rationale for the Reproductive Health Indicators Working Group (RHIWG), which convened to develop indicators for monitoring and evaluating reproductive health. RHIWG members formed subcommittees, each of which developed a series of indicators for one of the following areas: safe pregnancy, HIV and other STDs, women's nutrition, breastfeeding, and adolescent reproductive health services. |
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Binary outcomes and endogenous explanatory variables: Tests and solutions with an application to the demand for contraceptive use in Tunisia
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Bollen KA, Guilkey DK, Mroz TA |
1995 |
English |
TUNISIA, Africa, West Africa |
Contraception |
Many demographic studies examine discrete outcomes, and researchers often suspect that some of the explanatory variable may be influenced by the same unobserved factors that determine the discrete outcome under examination. In linear models, the standard solution to this potential endogencity bias is an estimator such as two-stage least squares. These methods have been extended to models with limited dependent variables, but there is little information on the performance of the models in the types of data sets typically used in demographic research. This paper helps to fill this gap. It describes a simple analytic framework for estimating the effects of explanatory variables on discrete outcomes, which controls for the potential endogeneity of the outcomes and the explanatory variables. It summarizes the results of a Monte Carlo study of the performanc of these techniques and uses these results to suggest how researchers should approach these problems in practice. Authors apply these methods to the examination of the impact of fertility intentions on contraceptive use, based on data from the 1988 Tunisia Demographic and Health Survey. |
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Manuel d'indicateurs pour L'évaluation des programmes de planification familiale
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Bertrand JT, Magnani RJ, Knowles JC |
1994 |
French |
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Contraception |
This is the French translation of the Handbook of Indicators for Family Planning Program Evaluation [ms-94-01-en]. This Handbook provides a comprehensive listing of the most widely used indicators for evaluating family planning programs in developing countries. The indicators are organized according to the conceptual framework developed under the EVALUATION project. The specific objectives of this Handbook are: to differentiate the levels for which family planning indicators are needed (program versus population level); to compile those indicators judged most useful in family planning program evaluation into a single volume; to provide a definition of these indicators to enchance the consistent use of terms across programs, countries, and donor agencies; and to promote evaluation of programs by making indicators better known and easier to use. |
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Manual de Indicadores para Evaluacion de Programas de Planificacion Familiar
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Bertrand JT, Magnani RJ, Knowles JC |
1994 |
Spanish |
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This is the Spanish translation of the Handbook of Indicators for Family Planning Program Evaluation [ms-94-01-en]. This Handbook provides a comprehensive listing of the most widely used indicators for evaluating family planning programs in developing countries. The indicators are organized according to the conceptual framework developed under the EVALUATION project. The specific objectives of this Handbook are: to differentiate the levels for which family planning indicators are needed (program versus population level); to compile those indicators judged most useful in family planning program evaluation into a single volume; to provide a definition of these indicators to enchance the consistent use of terms across programs, countries, and donor agencies; and to promote evaluation of programs by making indicators better known and easier to use. |
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Handbook of Indicators for Family Planning Program Evaluation
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Bertrand JT, Magnani RJ, Rutenberg N |
1994 |
English |
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Fertility |
For more updated indicators on family planning and reproductive health, please refer to the online Family Planning and Reproductive Health Indicators Database.
This Handbook provides a comprehensive listing of the most widely used indicators for evaluating family planning programs in developing countries. The indicators are organized according to the conceptual framework developed under the EVALUATION project. The specific objectives of this Handbook are: to differentiate the levels for which family planning indicators are needed (program versus population level); to compile those indicators judged most useful in family planning program evaluation into a single volume; to provide a definition of these indicators to enchance the consistent use of terms across programs, countries, and donor agencies; and to promote evaluation of programs by making indicators better known and easier to use. Spanish- and French-language versions of this publication are available. |
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Encuesta de Monitoreo y Evaluación del Programa del Altiplano Occidental, Línea de Base 2013
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Angeles G, Hidalgo E, Molina-Cruz R, Taylor T, Urquieta-Salomón J, Calderón C, Fernández JC, Hidalgo M, Brugh K, Romero M |
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Spanish |
GUATEMALA |
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Desde 2012, la Misión de USAID/Guatemala está implementando una integración de 18 programas distintos en 30 municipios del Altiplano Occidental de Guatemala. Este conjunto de programas inter-relacionados se conoce como el WHIP - Western Highlands Integrated Program - por sus siglas en inglés. Los objetivos principales del WHIP son reducir la pobreza y la desnutrición crónica, mejorar las condiciones de salud y nutrición, e incrementar el uso de servicios por parte de la población. Dos de los 18 programas se evalúan de manera directa en esta línea de base. Estos dos son el programa Cadenas de Valor Rural (CVR), que busca mejorar la producción agrícola y el acceso a los mercados, y el programa de salud y nutrición, el cual incluye a varios socios que implementan actividades comunitarias para mejorar la salud de las mujeres y los niños menores de 5 años, además de fortalecer la oferta de servicios de salud. Para evaluar el desempeño del WHIP se examinarán los cambios ocurridos en los indicadores claves a nivel de la población y el impacto del programa. Se examinarán los cambios entre el 2013 y el 2015 (a mitad de período del programa), y entre el 2013 y el 2017 (al final del programa). Para evaluar el impacto del programa se implementará un diseño cuasi-experimental de diferencias-en-diferencias, con grupo de control pareado y efectos fijos. La EMEPAO (Encuesta de Monitoreo y Evaluación del Programa del Altiplano Occidental) 2013 es la primera de tres encuestas longitudinales de hogares que proporcionarán datos representativos para evaluar al WHIP. |
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Factors Influencing the Willingness of Pregnant Women in Rural Ghana to Adopt Postpartum Family Planning
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Eliason S, Baiden F, Graham-Hayfron Y, Bonsu, D, Phillips J, Awusabo-Asare K |
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English |
GHANA |
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Uptake of postpartum family planning (PPFP) remains very low in sub-Saharan Africa. Very little is known about how pregnant women arrive at their decisions to adopt PPFP. This information is needed to guide the development of interventions to promote PPFP.
Method
We conducted a survey among pregnant women attending antenatal clinics in a rural district in southern Ghana to identify determinants of their willingness to adopt PPFP. We used univariate and multivariate analysis to explore predictors of the willingness to adopt PPFP.
Results
We interviewed 1914 pregnant women attending antenatal clinics in four health facilities. About 84% considered PPFP acceptable, and 70% expressed a willingness to adopt a method after delivery. The most preferred methods of PPFP were the injectables (31.5%), exclusive breastfeeding (16.7%), and oral contraceptive pills (14.8%). The perception of partner acceptability (O.R.=5.29, 3.23-8.38), acceptability of PPFP by the pregnant woman (O.R.=3.54, 1.65-7.60), having had prior experience with the use of injectables (O.R.=3.06, 1.71-5.47) and carrying an either unwanted or unexpected pregnancy (O.R.=1.50, 1.11-2.02) were independent predictors of a pregnant woman’s willingness to adopt PPFP. Conversely, women who had heard of the diaphragm (O.R.=0.48, 0.30-0.76) were less likely to want to adopt PPFP.
Conclusion
Male partner approval, acceptability of PPFP by the pregnant woman, past experience with the use of injectables, and the circumstances under which the current pregnancy occurred are the major determinants of the willingness of a pregnant woman to adopt PPFP. Procedures adopted at antenatal and early postnatal clinics should take these determinants into consideration.
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