A proposal for

The Manambaro Hospital Latrine Project

For

Trade Aid UK

SEED Madagascar

Suite 7, 1a Beethoven St, London, W10 4LG, United Kingdom

Villa Rabemanda, Ambinanikely, B.P. 318, Tolagnaro, Madagascar

Tel: +44 (0)208 960 6629

Email: projects@seedmadagascar.org

Web: madagascar.co.uk

UK Charity No. 1079121, Company No. 3796669

2

1. Project Summary

Project Title: The Manambaro Hospital Latrine Project

Project Aim: To improve the sanitation facilities at the Manambaro Hospital by providing hygienic and

sustainable latrines for the patients, visitors and staff members

Location: Manambaro Rural Commune, Anosy Region, southeast Madagascar

Project Duration: 4 months Project Budget: £14,374

Executive Summary:

Madagascar is considered one of the most biodiverse countries in the world, but it is also one of the

most impoverished and least developed. Despite repeated attempts by the Malagasy government to

make improvements towards global indicators the country continues to lag behind other nations

(World Bank, 2017). Ranked 158/188 on the UNDP 2016 Human Development Index and with 92% of

the population living below the international poverty line of $2 a day, the population is struggling with

high rates of child and maternal mortality, chronic malnutrition and insufficient infrastructure (UNICEF,

2016; UNDP, 2016). Spending on healthcare in Madagascar reaches only PPP $22 per capita, leaving its

people without basic infrastructure or services (Institute of Health Metrics and Evaluation, 2016).

Madagascar falls far below global sanitation standards; just 12-14% of the population have access to

improved sanitation facilities (WHO, 2014; World Bank, 2017). As such, open defecation is commonly

practiced, which alongside traditionally poor hand hygiene, accelerates the risk of waterborne illnesses

and faecal contamination. It is therefore unsurprising that for the last decade, diarrhoeal diseases have

been the primary cause of early and preventable mortality

The Manambaro Hospital, in the rural commune of Manambaro in southeast Madagascar, is

attempting to alter the chain of events that starts at preventable illness and leads to premature

mortality. Once a renowned and distinguished regional medical facility, decades of underfunding and

inattention have led to its decay, near bankruptcy and the cessation of major services. While the new

Medical Director has managed to restore many of the hospitals previous activities, the 50-year-old

latrine block does not meet even the basic needs of the patients, staff or visitors due to disrepair and

waste overflow. Inevitably, open defecation within the hospital grounds is prevalent, leading to flies

and vectors, and urine seeping into the surrounding soil. The Manambaro Hospital Latrines Project will

construct a new ventilated improved pit (VIP) latrine block for patients and visitors, flushing toilets with

a septic tank for staff, and repair an existing septic tank within the hospital compound. Alongside

water, sanitation and hygiene (WASH) training for staff, these provisions will decrease the incidence

and impacts of diarrhoeal diseases and provide the community of Manambaro with a dignified and

hygienic facility.

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2. Organisational background

SEED Madagascar (previously Azafady UK) is a British registered charity (1079121) established in 1994

and registered in England & Wales in 1999. The acronym SEED (sustainable environment, education and

development) reflects the organisation’s holistic approach, to projects; all of which are built around the

most pressing and directly expressed needs of disadvantaged communities. Cross departmental

collaboration between SEED’s four programmes – Community Health, Sustainable Livelihoods,

Environmental Conservation and Education – maximises progress towards SEED’s central mission: to

enhance the capacity of individuals, communities, organisations and government in fulfilling sustainable

environment, education and development goals in southeast Madagascar.

SEED works on the ground to design, plan, implement, monitor and evaluate projects, either

independently with its local staff or alongside partner organisations, such as Blue Ventures.

Collaboration between international and Malagasy teams provides SEED Madagascar’s projects and

programmes with the vital expertise and regional knowledge necessary to achieve conservation and

development goals. SEED’s specialist international staff and volunteers build professional and

organisational capacity amongst local staff members and partners, optimising the sustainability of

interventions.

SEED retains responsibility and accountability for financial management for all SEED funded operations.

With 92% of income spent in direct pursuit of SEED’s charitable aims, administration costs are minimal.

SEED has benefited an estimated 125,000 over the last fifteen years; building a healthier and more

educated and skilled region whose socioeconomic progress complements rather than harms the

uniquely rich natural environment.

3. Project Rationale

Ranked second-last in its receipt of development assistance per capita (UNICEF, 2016), Madagascar is a

“donor orphan”. The government of Madagascar is ill-supported to invest in the framework essential to

change its inadequate development outcomes. Indeed, Madagascar’s education, health, nutrition and

water access outcomes are among the poorest in the world, with many of the costs associated with

poor health attributed to limited access to water and sanitation (World Bank, 2017). Consequently,

sanitation is considered a national emergency and the prevalence of open defecation is a major

contributing factor to the incidence of diarrhoea (UNICEF, 2016). While less than one-fifth of urban

populations access improved sanitation facilities, rural communities suffer worse; less than 9% have

access to hygienic and suitable amenities (WashWatch, 2015). Clinical spaces such as hospitals and

healthcare centres present even more challenges: vulnerable and infective patients have special

sanitation requirements. In these environments the safe disposal of human waste and advanced

handwashing practices can reduce the incidence of diarrhoeal diseases by one-third (WHO, 2015).

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Currently the hospital in Manambaro fails to meet the acceptable level of improved sanitation required

to ensure patient safety and staff hygiene.

Located in the remote southeast Anosy Region, the Manambaro Hospital is in the centre of

Manambaro town, providing services to some 5,000 villagers and wider community members. Once

famous across Madagascar as a training hospital, devastating underfunding over the past few decades

led to near bankruptcy and facilities falling into a state of disrepair. In recent years the new Medical

Director, Dr Heuric, has worked tirelessly to reform the healthcare provisions whilst increasing

community trust and participation. Unfortunately, the latrines fail to meet even the minimal

requirements of a hygienic and dignified resource for the intended beneficiaries – staff, patients and

visitors.

Meanwhile, healthcare activities are increasing rapidly, with Dr Heuric and his team of 32 doctors,

nurses and trainees assessing and treating over 100 inpatients, 200 outpatients and multiple surgical

cases per month. Dependent on the good nature and expertise of European and American medical and

nursing volunteers, the hospital is quickly expanding to meet the burgeoning needs of the community,

but the insufficient latrine block has been left behind. Comprised of seven cubicles with minimal

drainage, only five are functioning on a sporadic basis, resulting in patients and visitors openly

defecating in the surrounding area and hospital grounds. Serving patients in private and isolation

rooms, a broken septic tank is contaminating the surrounding soil in the centre of the hospital

compound. The only handwashing facility – even for staff – is an outside tap approximately 30 metres

away. Hand-washers must walk through the open defecation site with no lighting and a damaged

walkway, adding not only to the spread of faecal contamination of ideally sterile medical provisions,

but preventable diseases.

Left: At the Manambaro Hospital, latrines are often broken or overflowing. Middle: the current handwashing facilities are situated in an open defecation site. Right: two cubicles have been nailed shut due to disrepair.

5

SEED’s reputation and strong community relationships led Dr Heuric to directly request help with his

ongoing renovation of the hospital services. On the premise that for every $1 spent on sanitation the

cost of healthcare can be reduced by $5.50 (WHO, 2017), and with water, sanitation and hygiene

(WASH) related illness costing Madagascar as much as $9 million (WSP, 2012), SEED is prioritising this

initiative for the sustained safety, well-being and productivity of the Manambaro community.

Case Study – Lucien, Maintenance Manager at Manambaro Hospital

Lucien has worked at Manambaro Hospital for the past few years and is very

pleased with the progress that has been made to the services and increase in

patient attendance. However, he finds the latrines an incredibly negative

aspect of the hospital, which is unhygienic and offensive. As such, along with

other members of the staffing team, he leaves the hospital throughout the day

to use the facilities in his own home. This causes a reduction in productivity

and extra strain on his work commitments.

4. Project Details

4.1 Objective

To improve the sanitation and hygiene infrastructure and behaviours at the Manambaro Hospital

4.2 Outcomes at endline

1. Adequate sanitation facilities for patients, staff and visitors of the Manambaro Hospital

2. Cessation of open defecation and bed-pan emptying within the Manambaro Hospital grounds

3. All 32 hospital staff can correctly answer 90% of key WASH knowledge indicator questions, and

provide three or more examples of how to engage patients and visitors in positive WASH behaviours

4. A long-term plan outlines the key management and maintenance steps for the new latrines, with

responsibilities assigned, ensuring the sustainability and cleanliness of the new latrines

4.3 Outputs

1. An eight-cubicle ventilated improved pit (VIP) latrine completed by week 11

2. A staff toilet block consisting of two toilets and a septic tank completed by week 11

3. Existing septic tank in the hospital compound is repaired by week 11

4. 16 WASH workshops delivered to hospital staff by week 12

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5. Four workshops held with key hospital staff to develop long-term plans for the management and

maintenance of the new sanitation and hygiene facilities by week 10

4.4 Activities

4.4.1 Construction of sanitation facilities

The duration of the project spans four months; this includes planning and design, construction

activities and a buffer month in preparation for the rainy season. The construction team will start by

preparing, cleaning and fencing-off the site at Manambaro Hospital, and transporting materials from

Fort Dauphin. The needs of patients and their families – beneficiaries most likely to practice open

defecation – will be prioritised first, through the construction of an eight-cubicle ventilated improved

pit (VIP) latrine. SEED often uses the VIP latrine design due to its advanced ventilation system which

aerates the cubicle, encouraging regular use. A piece of netting at the end of the ventilation pipe also

prevents vectors and flies from leaving the latrine, reducing faecal contamination. As long-term

maintenance of VIP latrines includes the manual safe emptying of faecal waste, the hospital plans to

use the latrine block on a four-cubicle rotation over two-year periods to ensure sufficient waste

decomposition before removal, and long-term sustainability.

SEED will then turn to staff sanitation, with the construction team building a toilet block comprised of

two toilets with a septic tank. These improvements to staff facilities are essential for the health and

well-being of all beneficiaries, with the current unimproved facilities presenting high-risk exposure to

diarrhoeal diseases in what should be an immaculate clinical setting. Additionally, new handwashing

facilities will replace the current handwashing station, before repairs are made to the damaged septic

tank located within the hospital compound. The septic tank is connected to toilets currently utilised by

patients in private rooms and those with infectious diseases, and its repair will eliminate further soil

contamination.

Left: patients waiting for surgical procedures. Right; the cleaner currently cleans the latrines up to 11 times a day to prevent overfilling.

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4.4.2 Water, Hygiene and Sanitation workshops

SEED’s extensive experience in WASH has highlighted that simply providing infrastructure is rarely

sufficient for achieving positive long-term change in sanitation habits; fostering motivation, knowledge,

and a sense of ownership of new infrastructure are all required. To facilitate long-term commitment to

improved health and maintained latrines, a WASH Community Liaison Officer will deliver activities and

workshops to hospital staff, promoting important WASH principles, as well as training in management

and maintenance planning. Key WASH knowledge includes basic information on pit latrine use and

maintenance, such as the provision of buckets for toilet paper and ensuring the lid is replaced on the

pit over time, and the imperative of handwashing with soap. In a clinical setting, these are of crucial

importance. In addition, the staff will receive training on how to ensure patients and visitors, who

often have very little knowledge, adhere to sanitation and hygiene principles. A WASH mural will be

painted on the VIP pit latrine block, and will include a diagram on effective handwashing and a clear

sign that Manambaro Hospital is not an open defecation site.

4.4.3 Sustainability

With guidance from SEED, Dr Heuric and his team will develop a long-term management and

maintenance plan to ensure the latrines are hygienic and do not fall into disrepair. Plans typically

address the everyday cleaning of the latrines, including burning toilet paper; ensuring human waste has

sufficient time to compost prior to cubicle rotation; arranging waste disposal by trained latrine emptiers

when required; the general upkeep of the buildings and septic tanks as appropriate; and the provision

of soap at the handwashing station. SEED will conduct a six-month review of the latrines to guarantee

the maintenance plan is being adhered to and support the hospital to respond to any emerging issues.

4.4.4 Monitoring, Evaluation and Learning

The Manambaro Hospital Latrines Project will employ organisation-wide and project-specific

monitoring, evaluation and learning to ensure that all aims and objectives are met throughout latrine

construction. As with all SEED projects, management includes weekly overviews of project finance,

milestones and activities, and internal project learning documents used to contribute to organisational

learning. These are further supported by weekly meetings with the Project Manager, wider

construction team and Project Development team to identify any emerging needs and address any

challenges which may arise. Short surveys will be used to gauge hospital staff knowledge before and

after WASH workshops. Dr Heuric and his team have been and will continue to be involved throughout

the planning, construction and development phases of this project to ensure that SEED continues to

meet the expectations of the Manambaro Hospital.

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4.5 Activities Plan and Project Schedule

Activity Week

1 Week

2 Week

3 Week

4 Week

5 Week

6 Week

7 Week

8 Week

9 Week

10 Week

11 Week

12

Initial preparation and finalisation of plans

Hospital liaison for construction

Start management & maintenance planning

Buy materials in FD

Transport materials to Manambaro

Campsite construction

Cleaning, fencing & site building

Pit digging & making cement blocks

Foundations for latrine & septic tank

Pit masonary work of rocks for VIP latrine

Make cement blocks for top structure

Raising the walls for the latrine block & compartment for septic tank latrine

Cement coating for septic tank walls

Make scaffolding

Make wooden roof supports for galvanised corrugated iron

Make reinforced concrete for slab

Cut steel for concrete slab

Raising the walls for top structure & urinal

Make concrete for cement pillars

Installation of WC and sink

Paint the latrine block

Raising blocks for outside veranda

Make and raise doors

Construct floor covering for 4 cubicles & urinals

Veranda covering

Connect latrine block to water access point & backfill with septic tank with sand

Paint door panels

Paint internal & external walls

Fix locks for doors

Paint the roof & removal of scaffolding

Final revision of construction

Clean & open latrines

WASH activities for staff

Key

VIP latrine only

Septic tank latrine only

Both septic tank latrine and VIP latrine

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5. Budget

Head of Construction Month 1,400,000 4 5,600,000.00 1,600.00

Construction Manager Month 800,000 4 3,200,000 914.29

Construction Agent Month 400,000 4 1,600,000 457.14

Construction Technician Month 300,000 4 1,200,000 342.86

Casual masons (five) Day 7,000 310 2,170,000 620.00

Casual carpenter Day 7,000 60 420,000 120.00

Casual diggers for pit excavation Pit 80,000 1 80,000 22.86

Casual manoeuvers (four) Day 4,000 240 960,000 274.29

WASH CLO Week 140,000 4 560,000 160.00

Project Development Intern Month 400,000 4 1,600,000 457.14

Permits, visa extensions, local registrations Role 200,000 1 200,000 57.14

17,595,026 5025.71

WASH workshops for hospital staff Event 100,000 20 2,000,000 571.43

2,000,000 571.43

Galvanised corrugated iron 2.5m.4/10 Sheet 35,000 8 280,000 80.00

Nails for roof Kilogram 6,000 1 6,000 1.71

Square wood 8x8x4m for roof support Piece 12,000 8 96,000 27.43

Crossing planks for shore Piece 12,000 3 36,000 10.29

Red oil paint Kilogram 18,000 5 90,000 25.71

Paint brush Piece 7,000 2 14,000 4.00

Paint roller Piece 9,000 2 18,000 5.14

Nails for fixing square wood on veranda Kilogram 5,000 1 5,000 1.43

Nails for fixing crossing planks of shore Kilogram 5,000 0.5 2,500 0.71

Nails for fixing scaffolding Kilogram 5,000 2 10,000 2.86

Nails for fixing 4 doors Kilogram 5,000 2 10,000 2.86

White spirit Litre 6,000 6 36,000 10.29

Mural water paint Can 90,000 3 270,000 77.14

Green oil paint for 4 doors Litre 18,000 6 108,000 30.86

Locks vachette Piece 15,000 4 60,000 17.14

Inside locks Piece 5,000 4 20,000 5.71

Groove tongue planks for doors Piece 9,000 14 126,000 36.00

Rod planks for doors Piece 4,000 9 36,000 10.29

Leafy square wood 6x6 for door support Piece 12,000 6 72,000 20.57

Block cement for rooms/urinal place Bag 30,000 30 900,000 257.14

Wall coating cement Bag 30,000 7 210,000 60.00

Human Resources

Community

Latrines

Equipment,

Materials &

Resources

Quantit

y

Staff Capacity Building

Subtotal

Subtotal

Item Sub-item Description Unit Cost/unitTotal Project

(MGA)

Total Project

(GBP)

Manambaro Hospital Latrines Project BUDGET

3500 MGA /GBP

10

Flooring cement for 4 rooms Bag 30,000 6 180,000 51.43

Paving rocks of the 4 rooms of veranda Piece 200 160 32,000 9.14

Cement for paving veranda/ bedrock Bag 30,000 6 180,000 51.43

Chalk for mural paint Bag 30,000 2 60,000 17.14

Cement for 4 sand plates Bag 30,000 1 30,000 8.57

Gravel for pil lars Bucket 700 50 35,000 10.00

Sand transport Trip 200,000 3 600,000 171.43

Steel bars 6mm for pil lars Bar 10,000 9 90,000 25.71

Planks for concrete form Piece 7,000 14 98,000 28.00

Fine wire Kilogram 5,000 3 15,000 4.29

Hinges Piece 1,000 12 12,000 3.43

Ventilation hood of PVC 100 Piece 15,000 4 60,000 17.14

Rocks for tank Rock 200 2300 460,000 131.43

Cement rocks for tank Bag 30,000 30 900,000 257.14

Steel bars 8mm for tank slab Bar 17,000 25 425,000 121.43

Steel bars 6mm for tank slab Bar 10,000 20 200,000 57.14

Gravels for slab Bucket 700 280 196,000 56.00

Planks for concrete slab form Piece 7,500 60 450,000 128.57

Scaffolding for concrete slab Piece 2,000 70 140,000 40.00

Cement for concrete slab Bag 30,000 14 420,000 120.00

Nails for concrete slab/scaffolding Kilogram 5,000 15 75,000 21.43

Loading/unloading materialsFixed

price 250,000 1 250,000 71.43

Whitewash brush/badigeon Piece 6,000 4 24,000 6.86

Salt Bag 30,000 1 30,000 8.57

Plastic small board for funder's logo Piece 16,000 1 16,000 4.57

Galvanised corrugated iron 2,5m.4/10e Sheet 35,000 7 245,000 70.00

Nails for roof Kilogram 6,000 1 6,000 1.71

Square wood 8x8 for roof support x 4m Piece 12,000 6 72,000 20.57

Crossing planks of shore Piece 12,000 3 36,000 10.29

Red oil paint for roof Kilogram 18,000 5 90,000 25.71

White spirit Litre 6,000 4 24,000 6.86

Paint brush Piece 7,000 2 14,000 4.00

Paint roller Piece 9,000 2 18,000 5.14

Nails for fixing square wood on veranda Kilogram 5,000 0.5 2,500 0.71

Nails for fixing crossing planks/doors Kilogram 5,000 1 5,000 1.43

Nails for scaffolding Kilogram 5,000 2 10,000 2.86

Nails for making two doors Kilogram 5,000 1 5,000 1.43

Mural water paint Can 90,000 2 180,000 51.43

Green oil paint for doors and crossing planks Litre 18,000 4 72,000 20.57

Locks vachette for doors Piece 15,000 2 30,000 8.57

Interior locks for doors Piece 5,000 2 10,000 2.86

Groove tongue planks for doors Piece 9,000 7 63,000 18.00

Rod plank for doors Piece 4,000 4 16,000 4.57

Leafy square wood 6x6 for doors support 2/2 Piece 12,000 3 36,000 10.29

Community

Latrines

Septic Tank

Latrines

Equipment,

Materials &

Resources

11

Cement blocks /mixing mortar Bag 30,000 15 450,000 128.57

Wall coating cement Bag 30,000 5 150,000 42.86

Flooring cement Bag 30,000 4 120,000 34.29

Paving two rooms of rocks and veranda space Rocks 200 470 94,000 26.86

Cement for paving and bedrock Bag 30,000 10 300,000 85.71

PVC pipe for tank connection Pipe 40,000 1 40,000 11.43

PVC pipe for sink connection Pipe 26,000 1 26,000 7.43

Elbow pipe 100 Piece 15,000 2 30,000 8.57

Elbow pipe 21/27 Piece 7,000 2 14,000 4.00

Chalk of the mural paint Bag 30,000 1 30,000 8.57

Sand transport from FD to Manambaro Trip 200,000 2 400,000 114.29

Gravel Bucket 700 30 21,000 6.00

Steel bars for reinforced concrete pil lars Bar 10,000 6 60,000 17.14

Fine wire Kilogram 5,000 1 5,000 1.43

Wheelbarrows Unity 100,000 2 200,000 57.14

Planks for pil lars' concrete form Piece 7,000 10 70,000 20.00

Spades Piece 7,000 4 28,000 8.00

Shovels Piece 15,000 4 60,000 17.14

Nylon string to l ine-up blocks Roll 10,000 1 10,000 2.86

Sink set Piece 120,000 2 240,000 68.57

Hinges Piece 1,000 6 6,000 1.71

Porcelain toilet Box 200,000 2 400,000 114.29

Ventilation hood for septic tank Piece 15,000 1 15,000 4.29

Loading/unloading materials on shop to siteFixed

price200,000 1 200,000 57.14

Whitewash brush/badigeon Piece 6,000 4 24,000 6.86

Cement for tank blocks Bag 30,000 8 240,000 68.57

Cement for tank coating/flooring Bag 30,000 6 180,000 51.43

Cement for reinforced concrete slab for tanks Bag 30,000 4 120,000 34.29

Steel bars 6mm for slab Piece 10,000 8 80,000 22.86

Sand and gravel transport FD to Manambaro Trip 200,000 1 200,000 57.14

Fine wire Kilogram 5,000 1 5,000 1.43

Sikalite for tank tightness Kilogram 22,000 2 44,000 12.57

Planks for slab concrete form Piece 7,000 10 70,000 20.00

Nails for slab concrete form Kilogram 5,000 10 50,000 14.29

Machefer/clinker Heap 5,000 10 50,000 14.29

Tarpaulin for site building protection Metre 4,000 40 160,000 45.71

Laptop computer Item 1,500,000 1 1,500,000 428.57

Tents Item 350,000 2 700,000 200.00

Plastic plaque for founder's logo Piece 160,000 2 320,000 91.43

Safety equipment for managing faecal sludge Kit 1,000,000 1 1,000,000 285.71

Cement bag Bag 30,000 5 150,000 42.86

Machefer/clinker Heap 5,000 5 25,000 7.14

Sikalite for old tank Piece 22,000 2 44,000 12.57

Sand Wheelbarrow 2,000 15 30,000 8.57

Tarpaulin for site building Metre 4,000 15 60,000 17.14

Subtotal 16,339,000 4,668.29

Septic Tank

Latrines

Equipment,

Materials &

Resources

Septic Tank

Repair

12

Mobile communications Month 160,000 4 640,000 182.86

Internet Month 60,000 4 240,000 68.57

Photocopying / printing Month 20,000 4 80,000 22.86

IT maintenance and support Month 250,000 4 1,000,000 285.71

Translation Month 40,000 4 160,000 45.71

Subtotal 2,120,000 605.71

Town taxis Town taxis Month 70,000 4 280,000 80.00

Equipment to store room Shipment 80,000 4 320,000 91.43

Camion to transport materials Journey 300,000 3 900,000 257.14

Taxi brousse Journey 2,500 20 50,000 14.29

Per diems for construction team (three) Month 450,000 3 1,350,000 385.71

Per diems / cook Month 150,000 4 600,000 171.43

Food Food / casual workers Day 4,000 610 2,440,000 697.14

Flight Contribution to fl ights for PD staff Flight 3,150,000 0.5 1,575,000 450.00

Subtotal 5,940,000 1697.14

Monitoring visits Visit 60,000 6 360,000 102.86

Reporting (biannual/annual) Report 100,000 1 100,000 28.57

Subtotal 460,000 131.43

Contribution to Head of Project Development Month 180,000 4 720,000.00 205.71

Contribution to Finance Department Month 200,000 4 800,000.00 228.57

Contribution to Administration, HR & security Month 200,000 4 800,000.00 228.57

Contribution to office rent & util ities Month 400,000 4 1,600,000.00 457.14

Contribution to Managing Director Month 180,000 4 720,000.00 205.71

Contribution to PD Coordinator Month 125,000 4 500,000.00 142.86

Contribution to office rent & util ities Month 180,000 4 720,000.00 205.71

Subtotal MGA 5,860,000 1,674.29

50,314,026MGA 14,374.00£

Transport

and camp

costs

Running

Costs

Madagascar

Running

Costs

Bush

Transport

and per

diems

UK Running

Costs

Communications

TOTAL BUDGET

Monitoring, Evaluation &

Learning