Binder all posters bandgladesh zambia - copy

This poster was made possible by the generous support of theAmerican people through the United States Agency for InternationalDevelopment (USAID), under the terms of the Leader with AssociatesCooperative Agreement GHS‐A‐00‐08‐00002‐00. The contents are theresponsibility of the Maternal and Child Health Integrated Program(MCHIP) and do not necessarily reflect the views of USAID or theUnited StatesGovernment.

Overview of Technical Areas and DonorsTechnical Area(s) Primary Donor/Mechanism Program InterventionsMALE CIRCUMCISION PEPFAR/CDC Expansion of Male Circumcision Services to Prevent HIV

in Botswana (MC Training and Service Delivery)

PRE‐SERVICE EDUCATION PEPFAR/CDC Strengthening PSE programs in Health Training Institutions

Monitoring, Evaluation and Research ActivitiesTitle of Program or Research/

Evaluation ActivityPrimary Monitoring or Study

Data Source(s)For Research and Evaluation Activities

Name of IRB(s) That Approved Activity Project Status

Male Circumcision Facility registers, training register, mentoring tool

n/a n/a

Pre Service Education Training registers, site visit assessment tool

n/a n/a

A Study of Adverse Events Related to Male Circumcision In Botswana

Client interviews, facility registers JHU SPH, CDC, MOH HRDC Awaiting approval from JHU, CDC and MOH HRDC Review Boards

Assessment of In‐service HIV and AIDS Training Methods and

Models in Botswana

Health care provider interviews, management interviews, Event Costing worksheet, focus group

discussions

JHU SPH, MOH HRDC CDC Non research determination obtained from MOH HRDC (Botswana) and JHU SPH Review Boards. Awaiting

approval from CDC

Male circumcision Facility registers, Facility quality assessment

JHU SPH for routine monitoring beingdeveloped

Multi‐country ethical clearance under way

Key Monitoring, Evaluation and Research Challenges

BotswanaMonitoring, Evaluation and

Research

Challenges How did you or how are you currently addressing these challenges?

1. Final National SMC M&E framework not yet in place so it is difficult to develop a final Jhpiego SMC M&E plan. MOH and CDC yet to give final guidance on Jhpiego focus area (Training /Service delivery).

Periodic review and reorientation of M&E plans, budgets and continuous consultation with MOH and CDC.

2. Changing targets and unclear reporting guidelines due to changes in Jhpiego SOW and MOH SMC scale up plans.

Maintaining close collaboration with MOH in planning processes.

3. Lack of current textbooks and journals for student use in Health Institutions E‐granary installed and increased wireless internet access

Office OverviewNumber of staff: 15

Number of dedicated M&E staff: 1

Workshop AttendeesNumber of staff: 1

Name: Rudo M. Mhonde

Title: M&E Advisor

M&E‐related success story or achievement of our program• Jhpiego has trained 72 Health

care providers on MC (includingSMC M&E & QA) sinceNovember 2010. SMC dataquality has improvedconsiderably in facilities wherethe health care providers weretrained.

A trainee recording data during SMC Training

Rudo Msipa MhondeM&E Advisor

• Jhpiego has set up proxy networks in IHSs after monitoring challenges with internet access and connectivity. All students now have individualinternet accounts.

• Two protocols for a study on Adverse Events Related to Male Circumcision In Botswana and an Assessment of In‐service HIV and AIDS TrainingMethods and Models in Botswana have been submitted and the latter has been approved.

Introduction to Computing Lesson Gaborone IHS, Computer Lab

Overview of Technical Areas and Donors

Technical Area(s) Primary Donor/Mechanism Program Interventions

HIV CDC/JHU TSEHAI Male Circumcision, HIV Counseling and Testing

HIV DoD Male Circumcision

MNH USAID/MCHIP Multiple MNH Activities

MNH Pathfinder/IFHP BEmONC training and SBM-R

MNH UNICEF BEmONC training and SBM-R

Monitoring, Evaluation and Research Activities

Title of Program or

Research/

Evaluation Activity

Primary Monitoring or

Study Data Source(s)

For Research and Evaluation Activities

Name of IRB(s) That Approved

Activity

Project Status

Ethiopia

Monitoring, Evaluation & Research

Office Overview

Number of staff: 49


Workshop Attendees

Number of staff:2

Ephrem Daniel, M&E Advisor

Tsigereda Bekele, M&E Officer

Maternal Neonatal and

Child Health (MNCH)

Team

Country Director

Male

Circumcisio

n

(MC) Team

HCT Team

Finance & Admin

Director

Technical Director

Deputy Country

Director

Infection Prevention (IP)

Performance Improvement (PI)

Unit

Pre-service Education (PSE)

Monitoring and Evaluation

(M&E) Unit

Senior Program Officer

This poster was made possible by the generous support of the American people

through the United States Agency for International Development (USAID), under the

terms of the Leader with Associates Cooperative Agreement GHS-A-00-08-00002-00.

The contents are the responsibility of the Maternal and Child Health Integrated

Program (MCHIP) and do not necessarily reflect the views of USAID or the United

States Government.

Male circumcision Facility registers JHU IRB for routine monitoring

being developed

Multi-country ethical clearance under way

Community Kangaroo Mother

Care

Client interviews, facility

registers

JHU SPH, EPHA (local) Protocol development is on the final stage

Cultural barriers affecting

women’s utilization of

optimal MNH practices

Literature review, focus group

discussion and key informant

interview

JHU SPH, EPHA (local) Literature review started to prepare the protocol

Preservice program

evaluation

Faculty interviews, student

interviews, document review,

JHU SPH, EPHA (local) Protocol development is underway



1. Delayed roll out of the new Ethiopian HMIS Use program funds to print and distribute the new HMIS tools to MCHIP

supported sites

2. Absence of baseline data in the SBM-R implementing facilities to

show improvement of service delivery

Key output/outcome indicators were selected to be included as part of SBM-R

standards to new programs

3. Absence of unique identifiers for individuals is a huge challenge for

data quality in TIMS

In addition to names, we use phone numbers to identify individuals

M&E-related success story or achievement• Use of TIMS to monitor all PEPFAR Ethiopia-supported training courses and to follow-up/track providers post

training

• Importance of M&E was given due attention and it is organized as a unit with three full-time staff

• M&E unit had been instrumental to improve program outcomes by providing evidence-based and timely feedback

- E.g. Data from the M&E unit was instrumental in showing the decline in MC clients and the need of demand

generation to increase MC uptake

- To shift to opt-out testing approach to improve the proportion of MC clients who are tested for HIV

This poster was made possible by the generous support of the American people through the United States Agency for International Development (USAID), under the terms of the Leader with Associates Cooperative Agreement GHS-A-00-08-00002-00. The contents are the responsibility of the Maternal and Child Health Integrated Program (MCHIP) and do not necessarily reflect the views of USAID or the United States Government.


Technical Areas Primary Donor/Mechanism Program Interventions

HIV USAID/MCHIP SBM-R, pre-service

MALARIA USAID/MCHIP SBM-R, pre-service

FAMILY PLANNING USAID/MCHIP SBM-R, pre-service

TUBERCULOSIS USAID/MCHIP SBM-R, pre-service

POST-PARTUM FAMILY PLANNING USAID/MCHIP SBM-R, pre-service

NEWBORN RESUSCITATION (HBB) USAID/MCHIP SBM-R, pre-service


Title of Program or Research/

Evaluation Activity

Primary Monitoring or Study Data Source(s)


Name of IRB(s) That Approved Activity

Project Status

Assessing Quality of Education, Student Competency and

Postpartum Family Planning Uptake - A Comparison Study

1. SBMR Assessments (tutors, clinical preceptors, students) 2. Survey of women one year

post delivery in well baby clinic

JHU IRB application to be submitted

IRB application



1. Limited indicators for pre-service activities (e.g. PEPFAR indicators focus on in-service training)

Some indicators that we are using include: 1. % of schools participating; 2. % tutors trained; 3. # students who have received training from tutors trained; 4. competence of students trained; 5. Utilization of services

Monitoring, Evaluation and Research in Ghana: a shared commitment and responsibility

Country Office staff: 4; Dedicated M&E staff: 0

Workshop Attendee: Joyce Ablordeppey, Sr Technical Advisor

Country Director*

Sr Technical Advisor*

Sr Technical Advisor*

Finance & Admin Assistant

* M&E responsibilities

Ghana Team

Success Story: Using SBMR Data for Advocacy • This year MCHIP in Ghana is focusing on strengthening

HIV, TB, Malaria and FP in pre-service education for Midwives, Public and Community Health Nurses

• SBMR baseline assessment data was used to communicate with the National Programmes for HIV, TB and Malaria to secure their commitment and resources to strengthening pre-service education

• After a presentation and discussion on the results, each program committed trainers for a 2 week period to train tutors, provided resource materials and committed ongoing support to schools

Baseline Assessment: % Standards achieved in HIV, TB, Malaria and FP

Average performance of of 23 schools Teaching Materials; Knowledge & Skills

Elements Necessary for a Functional M&E System: Developing M&E Standards

To support organizational and country program growth we are developing M&E standards based on UNAIDS Organizing Framework for a Functional M&E System. Country programs need 1) a dedicated M&E unit with well-defined relationships between HQ and field staff, 2) sufficient numbers of trained, dedicated M&E staff representing a wide range of skills (including GIS, health informatics, data analysis, etc), 3) strong ties to program staff, facility staff, and government representatives, 4) an annually updated M&E plan, 5) a budget sufficient to strengthen and maintain a high-quality M&E system, 6) ongoing activities to enhance data use across the organization, including global MER meetings, 7) strong monitoring systems from facility to HQ, 8) ability to implement targeted surveys to support program development, 9) databases such as RISE and TIMS to communicate results across the organization, 10) routine (annual) data quality audits in all country programs, 11) expertise to carry out program evaluations to demonstrate technical program successes and research to fill gaps in knowledge, and 12) publishing and presenting Jhpiego’s program successes and technical innovations.

Intermediate Result 4: Improved Health Knowledge, Attitudes and

Capacity for Community Action

Intermediate Result 3: Availability of Quality Health Services Increased

Intermediate Result 2: Quality of Health Services Improved



Jhpiego Global M&E Vision Jhpiego measures program results in terms of improved health

and lives saved drawing on an organization-wide results framework that articulates pathways and milestones leading to impact.

Key Activities:

1. Support country programs to: develop M&E plans and frameworks, develop data collection tools, analyze qualitative and quantitative data, identify areas and methods for data quality improvement, displaying data including mapping, providing results information systems

2. Design and implement operations research in priority areas for the organization 3. Support the dissemination of Jhpiego’s program and technical results

Success Story: Tremendous Organizational and MER Growth

Jhpiego, Baltimore Monitoring, Evaluation and Research

Office Overview

Number of dedicated M&E staff: 12 Workshop Attendees

Number of staff: 10

Sr. M&E Advisors: Eva Bazant, Young Mi Kim

Health Informatics Advisor: Ed Bunker

RISE Project Director: Catherine Schenck-Yglesias

M&E Advisors: Mary Drake, Megan Harris, Mainza Lukobo-Durrell, Reena Sethi, Maya Tholandi

Director, MER: Linda Fogarty

Challenges How did you or how are you currently addressing these challenges? 1. Integrating more successfully into Global Program Operations

Attending regional, country and GPO general meetings; assisting with quarterly country review reporting; providing M&E-specific LOE guidance for program planning, budgeting

2. Helping to ensure data quality at the program level Involvement in quarterly country review reporting; providing routine data quality audit tools and support; requesting annual country visits

3. Supporting RISE in a way that meets users’ needs across the organization

Involving countries in RISE development process; providing in-person training at global meeting; developing training guides; planning RISE support into technical assistance visits

4. Balancing new program development with program technical assistance Developing a system that tags and searches past proposals, (e.g., by country, donor, technical area) to make future responses more efficient, richer, and more contextualized

GOAL: Health Status Improved and Lives Saved

Strategic Objective: Use of MCH/FP/HIV/AIDS Services Increased and Positive Health Behavior Adopted in

the Population

Intermediate Result 1: Health Systems Strengthened

Jhpiego Results Framework

Whe

re w

e w

ork Current MER Capacity and Organizational Commitment: • Fully staffed HQ MER unit with wide range of expertise across M&E

competencies • Quantitative and qualitative research capacity and commitment to

impact evaluation • Investment in information systems to assist country programs and

organization to track and publish results (RISE, TIMS, SBMR database) • Advocating for M&E components in new programs; commitment to

5-10% of all program funds for M&E


PPFANI Program/ ACCESS -FP


Technical Areas Primary Donor/Mechanism

Program Interventions

- Institutional strengthening (friends of youth service improvement, strengthening technical capacity, staff training, increase range of services, availability of services, space for the provision of FP services) - Community activities (creation of adult and young Committee, clubs, development of awareness and education, radio equipment)

USAID FP for girls and young mothers aged 15-24

Monitoring, Evaluation and Research Activities Title of Program or Research/

Evaluation Activity Primary Monitoring or Study Data Source(s) For Research and Evaluation

Activities Name of IRB(s) That Approved Activity

Project Status

Operational research on low FP use determinants by girls and young mothers

(15 - 24 years)

Primary investigation: interviews, focus group, institutional records

consultation,

Minister of Health in Haiti

Completed

Key Monitoring, Evaluation and Research Challenges Challenges How did you or how are you currently addressing these challenges?

1. Inability for youth to negotiate their sexual relationship linked to their socio-economic situation (low income, unemployment)

Partnership established with professional / social institutions for preparing girls and young mothers to have a useful trade. Empowering women to

negotiate sexual relations (FP)

2. Young mothers lack of decision power.

Men's participation in the activities, training of parents, clubs, and Committee of surveillance of maternal mortality (the project champion)

Achievements •Fewer early pregnancies in the rural community, •Fewer dropout in the second year of implementation of the project (statement by the Director of the school of Azile : less than 4 pregnancies compare to 20 in previous years.) •FP is no longer a taboo, FP is part of the daily life of the inhabitants of the area the integration of young people with participatory research project

Haiti Monitoring, Evaluation and Research

Office Overview

Number of staff: 7


Number of staff: 1 Honore Marie Patrice, Technical Coordinator

Family Planning Project Accessibility- Nippes

Results dissemination workshop

262

80

1193

160 70

200

400

600

800

1000

1200

Nom

bre

de o

lient

s P

F

Condom Lo-femenal DMPA Norplant IUD Othernaturalmethod

Types de methodesPF

Asile- Centre de Sante

15-24 yrs.

58

1558

0

500

1000

1500

2000

utilisatrices de depart utilisatrices à la fin

Evolution de l'utilisation du debut à la fin du projet

18 mois (Janv 08 – May 09)

Situ

atio

n de

bas

e Contraintes Manque des connaissance profondes en matière SSR et PF Initiation des rapports sexuels a l’âge de 12 à 14 ans Rumeurs sur la PF Manque de communication entre les parents/adultes et les jeunes Manque d’opportunités économiques Manques de satisfaction avec les service SSR/PF

Facilitateurs Politiques nationales

Dial

ogue

com

mun

auta

ire

Création des comites des adultes et jeunes Recherche de base participative Développement des stratégies/ interventions L’élaboration des matériaux Suivi du projet Evaluation

Résu

ltats

Structures sanitaires •Amélioration des services amis-des- jeunes

Individuel •Amélioration des connaissances: PF, source d’information et services •Utilisation des méthodes Social •Amélioration de la communication parents et jeunes •Amélioration des connaissances SSR dans la communauté •Augmentation de la discussion de SSR

L’Im

pact

Communautaire •Support communautaire pour SSR et PF pour les jeunes •Institionalisation des services amis-des-jeunes

Amélioration des SSR pour les jeunes mères jeunes filles

This poster was made possible by the generous support of the American peoplethrough the United States Agency for International Development (USAID), under theterms of the Leader with Associates Cooperative Agreement GHS‐A‐00‐08‐00002‐00.The contents are the responsibility of the Maternal and Child Health IntegratedProgram (MCHIP) and do not necessarily reflect the views of USAID or the UnitedStates Government.

Overview of Technical Areas and DonorsTechnical Area(s) Primary Donor/Mechanism Program Interventions

Pre‐Service Education MCHIP Strengthening Pre‐service education, SBM‐RFamily Planning USAID/MCHIP Strengthening FP services, SBM‐R, Capacity buildingFamily Planning Bill & Melinda Gates Foundation Repositioning of PPFP/PPIUCD, SBM‐R, In‐Service Training, IEC/BCCFamily Planning Norway‐India Partnership Initiative (NIPI) Strengthening PPFP/PPIUCD services, In‐Service Training, IEC/BCCVaccine Preventable Disease USAID/MCHIP Capacity building, demonstration of best practices, Supportive

Supervision, New Born Tracking, synergies between PEI & RINew Born Care USAID/MCHIP Supportive Supervision, In‐Service Trainings, Facility strengthening for

ENCWater, Sanitation & Hygiene USAID/MCHIP Double –blinded RCT, IEC/BCC;

Monitoring, Evaluation and Research ActivitiesTitle of Program or Research/

Evaluation ActivityPrimary Monitoring or Study Data

Source(s)For Research and Evaluation Activities


Project Status

Assessment of Postpartum Intrauterine Contraceptive Device (PPIUCD) Services

Facility registers, Interviews, FGDs Protocol to be submitted for IRB

Postpartum Systematic Screening in Jharkhand, India PPSS tool, Observations Protocol to be submitted for IRB

MCHIP Immunization program in India WHO Thirty Cluster Survey, Supportive Supervision checklist

Protocol to be submitted for IRB

Assessment of Facility readiness for ENC/R in two selected districts of Jharkhand

Survey, Facility registers

Key Monitoring, Evaluation and Research ChallengesChallenges How did you or how are you currently

addressing these challenges? 1. Although, it is crucial to monitor the counseling of pregnant/post‐partum women, timing of counseling (during antenatal period/early labor or postpartum) and subsequent decision of acceptance/non‐acceptance of PPFP/PPIUCD and method opted; however, the counseling data is poorly recorded in the service records of the facility and is not captured in the current HMIS.

A column is being added in the clinic registers to record provision of family planning counseling services. The providers are also being sensitized about the need for this data and on how to capture this data.

2. Measuring the practice of ‘Active Management of Third stage of Labor’ which includes (i) administration of uterotonic (Inj. Oxytocin 10 I.U. intramuscular after delivery of baby, (ii) uterine massage, (iii) controlled cord traction. Although, use of uterotonic is recorded on the case sheets but other two steps are not mentioned in the case sheets.

The use of uterotonic in third stage of labor will only be measured.

3. Number of newborns receiving essential newborn care including essential preventive care and recognition of danger signs and referral through USG‐supported programs‐ prioritized facilities in focus districts only. At present the facilities do not record all the steps of essential newborn care in the case sheets or registers.

The health staff will be sensitized and supported for recording some of the steps of essential newborn care and resuscitation as proxy during the mentoring visits to the facilities.

INDIAMonitoring, Evaluation and Research

Office OverviewNumber of staff: 58 (MCHIP + Jhpiego)



Siddhartha Saha, M&E Advisor

PPIUCD Facility Registers‐Circulated in all PPIUCD service delivery sites in 19 states of India in around 40 facilities across different projects (MCHIP/BMGF/NIPI)

PPIUCD Facility Reporting format‐Standardized monthly reporting system for all PPIUCD service delivery sites (this being new service yet to be integrated in electronic HMIS).

Project Reporting Tools currently in MS Excel, being developed in MS Access for data entry and collation by project field staff

PPIUCD Multi‐site database providing information on PPIUCD insertion, follow‐up etc. for program monitoring

‐


Community formative research on health practices of the MCHIP key messages : FGD with Health Center Staffs



MNH USAID/MCHIP, ExxonMobil, Chevron Community, facility, health office management

Cervical Cancer Screening Ford Foundation VIA

Infection Prevention GITEC Pre-service infection prevention curriculum



Evaluation Activity




Project Status

Evaluation of Quality improvement interventions

Clinical observations, facility registers, provider interviews

JHU IRB Report writing

Assessment of referral processes

Interviews of postpartum women

JHU IRB Report writing

Handwashing practices amongst mothers with

newborns

Videotaping, in-depth interviews, focus group

discussions

London School of Hygiene and Tropical Medicine (collaboration

with Unilever

Report writing

Community formative research on health practices of the MCHIP key messages

Interview with community, health practices at health

center, midwives, and district health office

JHU IRB

Report writing

CECAP Appreciative Inquiry Client interviews JHU IRB Report writing

Ongoing SBM-R initiatives SBM-R tools On-going

Key Monitoring, Evaluation and Research Challenges Challenges How did you or how are you currently addressing these challenges?

1. Prioritizing the key indicators—balancing between the “nice to know” and “need to know”

Consultation with M&E team in Washington

2. Using the existing data collection at district level to answer the key indicators

Assessment on the existing data collection system at district level (starts from the village, subdistrict and district level)

3. Prioritizing SBM-R standards—how to balance wanting to measure compliance with key life-saving interventions and wanting to measure broader quality of care

At this time, we are measuring broader quality but also feeling a need to be able to measure the most important life-saving interventions amongst those

standards

SBMR Calculator • What? Develop a calculator to help midwives, health centers and

hospitals analyze their SBMR data • Why? Total number of standard performance in each SBMR tool is

a lot and limitation of midwives, health centers and hospitals staffs’ skills on Ms. Office (Excel) in order to generate the graphs. No special data operator at midwives, health centers and hospitals to entry and analyze SBMR data also become the reason of the calculator development.

INDONESIA Monitoring, Evaluation and Research

Office Overview

Number of staff: ~ 40

Number of dedicated M&E staff:

4 for MCHIP, including 2 Jhpiego staff

Workshop Attendees

Number of staff: 1

Mia Pesik, Senior Program Manager

Main Menu



Technical Area(s) Primary Donor/Mechanism Program Interventions EmONC, FP, Child Health, ASRH, HIV/AIDS,TB,

Malaria, Mental Health, Emergency USAID, sub on RBHS bilateral with JSI PSE, SBMR, training, policy/guidelines, clinical

site strengthening FP USAID/MCHIP Policy, in-service training, site renovation, BCC

Monitoring, Evaluation and Research Activities Title of Program or

Research/ Evaluation Activity


For Research and Evaluation Activities Name of IRB(s) That Approved

Activity Project Status

Task Analysis Provider interviews JHSPH Complete

BPHS monitoring Service statistics, TIMS forms, Reports from site TA visits

n/a Ongoing

EPI/FP Integration Facility registers JHSPH – Submission pending Planning

FP Facility registers, TIMS forms, Reports from site TA visits

n/a Ongoing

PPH prevention TBD TBD Design

Key Monitoring, Evaluation and Research Challenges Challenges How did you or how are you currently addressing these challenges? 1. Data quality

Initial visit conducted and site-level plans made. MCHIP to provide regular follow-up. Liaising with USAID bilateral where Jhpiego is sub to follow-up data quality concerns for facilities supported by RBHS, and negotiating with USAID to reorganize resources in order to provide regular sites visits that include data quality and clinical technical assistance for non-RBHS MCHIP sites. Considering development of job aid to standardize reporting.

2. Coordinated follow-up between MOH, MCHIP and RBHS

Conduct joint site visits with MOH, MCHIP and RBHS (where applicable).

3. Use of data by facility staff

Monthly mentoring monitoring visits with feedback to facility staff

• Task analysis provided evidence to strengthen MNH clinical practice requirements of PA and RN curricula

• Task analysis results presented at several conferences, including upcoming Global Health Council

• Increased availability of data on MNH services

Liberia Monitoring, Evaluation and Research

Office Overview

Number of staff:2 MCHIP, 2 RBHS


Number of staff: 1

Comfort Gebeh, MCHIP FP/RH Advisor

Data Quality Exercise, FP Data Jan-March2011, 2 Hospitals

Indicator HIS Report

Facility Registers

Difference % Match

New FP clients 1741 1452

289 120%

Revisit FP clients

3102 3236

-134 96%

RBHS



Technical Area(s) Primary Donor/Mechanism Program Interventions HIV USAID/MCHIP SBM-R in PMTCT, Male Circumcision,

MNH BEmONC, Community MNH/Mobilization, KMC, SBM-R in RH

Child Health Water and Sanitation, Malaria IEC, LLIN distribution

Performance Based Incentives linked to SBM-R Helping Babies Breathe

PPFP, FP Social Marketing

List the primary technical areas (e.g., MNH, HIV, etc.) covered by your program and your major donors, for example:



Evaluation Activity




SBM-R evaluation Client interviews, provider interviews, facility HMIS,

SBM-R assessments

WIRB and NHSRC/Malawi Manuscript submitted to Midwifery Journal

Male circumcision Facility registers, mobile clinic registers

JHU IRB for routine monitoring being developed


Malaria Tracking Results Continuously (TRaC) Study

Client interviews COMREC Malawi IRB protocol submitted, awaiting review

Family Planning TRaC Study Client interviews COMREC or NHSRC IRB being developed

Protocol under draft

Helping Babies Breathe Evaluation

Provider observations, client interviews, service statistics

Concept note developed and under finalization

Key Monitoring, Evaluation and Research Challenges Challenges How did you or how are you currently addressing these challenges? 1. The Malawi National Health Sciences Committee (NHSRC) charges a 10% fee based on the study budget for all approved studies. Because the fee is considered unethical, this will limit Jhpiego’s participation in any operational research to be conducted in the country.

USG and other donors in the country have taken up the issue with NHSRC to discuss an agreement. Operational research that may be considered as

“development assistance” are being submitted for IRB approval and a waiver of the fee is requested.

2. HMIS system does not collect the host of indicators required by the MCHIP program and there is tremendous resistance to introducing parallel systems for data collection, unless approved by the MOH

MCHIP is looking into partnering with the MOH to set up a sentinel site surveillance system for selected MNH, Malaria, and HIV related indicators. MCHIP will also explore the use of electronic systems to collect data at the

point of care. 3. Quality of data is generally poor, requiring active follow-up by program staff.

M&E personnel have been included in all supportive supervision visits to provide an opportunity for M&E mentoring and validation of data.

Description of up to three key M&E challenges for your unit

MALAWI Monitoring, Evaluation and Research

Office Overview

Number of staff: 28


Number of staff: 1

Aleisha Rozario, M&E Advisor

List the primary monitoring, research and evaluation activities currently under way in your office, for example:

23.3 24.5

80.9 88.4 92.6

82.1

19.8 8.74

51.4 51.5

75.7 87.3

0102030405060708090

100

% ofpregn.women

attending> 4 ANC

visits

% preg.women

attendingANC in 1sttrimester

% preg.women

receiving>2 doses

IPTp

% preg.womennewly

tested forHIV

% HIVpositive

preg.women

receivingCPT

% HIVpositive

preg.women

receivingARVs

Intervention

Control39

63

88 3.2

2.9 2.7

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

0

10

20

30

40

50

60

70

80

90

100

2008 2009 2010

Perc

enta

ge (%

)

Perc

enta

ge (%

) PQI RHscores

DirectObstetricDeath Rate

22

63 65

59.2 61.2

79.8

0

10

20

30

40

50

60

70

80

90

0

10

20

30

40

50

60

70

2008 2009 2010

Perc

enta

ge

Perc

enta

ge

PQI score

% SBA

Deliveries by SBA rise at Mpasa Health Center as PQI scores increase Direct Obstetric Deaths decline as PQI scores increase, Machinga Disrtict Hospital

Increased coverage in MNH-PMTCT in MCHIP supported sites, Phalombe district



Technical Area(s) Primary Donor/Mechanism Program Interventions Maternal Health USAID/MCHIP

Organization of Islamic Conference

Active Management of Third Stage of Labor Postpartum Family Planning

Postabortion Care Oxytocin in Uniject Device

Newborn Health

USAID/MCHIP

Essential Newborn Care Kangaroo Mother Care

Child Health USAID/MCHIP

Community Case Management



Evaluation Activity




Baseline Assessments Client interviews, provider interviews, facility need

assessment

Ministry of Health

Planning Phase

Use of matrons to provide LAM at community health

center

Client interviews, provider interviews, facility HMIS,

Ministry of Health Planning Phase

Key Monitoring, Evaluation and Research Challenges Challenges How did you or how are you currently addressing these challenges? 1. High expectations from the Mission in regards to measurable results within a short timeframe

We will work with the HMIS and existing data collection systems to build capacity and ensure effective and efficient data collection

MALI Monitoring, Evaluation and Research

MALI Office Overview

Number of staff: 9 technical


Number of staff: 1

Dr Camara Tiguida

Monitoring and Evaluation Manager

MCHIP Chief of party Dr Diarra

Maternal health /FP Advisor

Mme Haidara

Regianal cordinator of Kayes Dr Yorotté

District Cordinator of Kita

Dr Lazare

District cordinator of Diéma Dr Lala

Newborn Health Advisor

Dr Kanté

Program Assistante Child health/CCM

Advisor Dr Ouattara

Monitoring and Evaluation Manager

Dr Tiguida

This poster was made possible by the generous support of the American peoplethrough the United States Agency for International Development (USAID), under theterms of the Leader with Associates Cooperative Agreement GHS-A-00-08-00002-00.The contents are the responsibility of the Maternal and Child Health IntegratedProgram (MCHIP) and do not necessarily reflect the views of USAID or the UnitedStates Government.



HIV CDC TB/HIV Infection Control Community Counseling TestingProvider Initiated Counseling and Testing

Infection Prevention and Control Minor Surgery/Male circumcision services

Human Capacity Development CDC In-service training information systemPre-service training information system

Nursing curricular revision SBM-R in pre-service educationModel inpatient wards Workplace safety/ post-exposure prophylaxis

In-service training ancillary workers

MNH USAID/MCHIP Strengthening of EMNC and BEmONC services, including PPFPSBMR (model maternities) CECAP



Evaluation Activity




Project Status

Model maternities Facility registers n/a Protocol development

Male circumcision Facility registers JHU IRB for routine monitoring being developed


Impact of SBM-R in new graduates performance

Client interviews, provider interviews

n/a Protocol development



1. Creating awareness within the programs regarding the importance of timely and accurate M&E.

Require minimal mastery of tools by program staff [they should know what data exists and how to access it…].

2. Getting technical teams to identify indicators able to measure the outcome/impact of Jhpiego programs in Mozambique.

Clarify with technical teams how their programs contribute to Jhpiego local and global results.

3. Knowledge management not understood as part of institutional (program-level) mandate and individual duties at Jhpiego Mozambique.

Ensure, within each team, a continuous process of identification and communication of success stories, lessons learned, best practices, besides mere reporting of numbers.

Integrating CECAP forms in the national Health Information System: a success story

• The Ministry of Health of Mozambique launched CECAP in 2009, as part of family planning consultations (single visit approach). Interventions use low cost screening tools, with training being supported by Jhpiego, which also developed and tested temporary CECAP forms, in articulation with MOH.

• Jhpiego used excellent work relations with MOH to support the revision of all reproductive health data forms. In this process, Jhpiego advocated for the successful inclusion of CECAP data elements, which are now part of FP forms, as well as for the mainstreaming of CECAP client forms.

• Jhpiego also facilitated the country-wide training of health workers in the use of the new FP/CECAP forms.• Program managers at MOH are now able to access data required to appropriate planning and monitoring

of CECAP interventions.

Picture (right): Facility health workers discuss data in forms developed with Jhpiego support

Monitoring, Evaluation and Research

Office Overview

Number of staff: 10


Workshop Attendees

Number of staff: 3

Argentina Balate, M&E Advisor

Victor Muchanga, Senior M&E Advisor

Humberto Muquingue, M&E Manager

M&E/IST Manager

M&E of CDC-funded programs

M&E Advisors

DatabaseManagers

Database Assistant

M&E of USAID-funded programs(MCHIP)

M&E Advisor

InformationSystems and Technologies

IST Advisors

ICT Assistant

“For a M&E agile in supporting the management of Jhpiego’s programs, with recourse to compatible technologies”

Health worker developing a results framework, in a M&E training held in Southern Mozambique. Courtesy of FORTE Saúde.

Organizational chart of M&E and IST unit at Jhpiego Mozambique

This poster was made possible by the generous support of the American people

through the United States Agency for International Development (USAID), under the

terms of the Leader with Associates Cooperative Agreement GHS-A-00-08-00002-00.

The contents are the responsibility of the Maternal and Child Health Integrated

Program (MCHIP) and do not necessarily reflect the views of USAID or the United

States Government.



Title of Program or

Research/

Evaluation Activity

Primary Monitoring or

Study Data Source(s)


Name of IRB(s) That Approved

Activity

Project Status

Field testing of AAC LRP Training sites N/A N/A

Acceptability and compliance of

calcium supplementation for

prevention of PE/E

•Program monitoring

•HMIS

•Surveys

local IRB Approved, waiting for getting calcium

Test the sensitivity and

specificity of the Point of Care

(POC) test compared to dipstick

urinalysis and the Esbach test in

a laboratory setting (Step 1

and 2)

Laboratory findings JHU IRB and local IRB Completed

Determine the acceptability

and ability to interpret the

results of POC among pregnant

women in clinic setting (Step 3)

• Program monitoring

• Interviews with pregnant

women, staff

•FGD with PW

JHU IRB and local IRB Planned

Determine the acceptability,

coverage and compliance of

community-based POC among

pregnant women (Step 4)


• Surveys (FCHVs, PW)

FGD (FCHVs, PW, MIL)

JHU IRB and local IRB Planned

Using Standards to Improve

MNH Services


• SBM-R assessments

N/A Planned



1. Lack of dedicated M&E staff or staff with M&E expertise to oversee

research

• Training, capacity-building

• Coordination and support from US

• Plan to increase staff (MNH Advisor, M&E Officer, Program Officer)

2. Working in collaboration with large projects that allows limited

control over development and implementation of M&E tools &

Indicators

• Program staff working consistently with the M&E staff from these large

projects

Nepal

Monitoring, Evaluation and Research

Office Overview

Number of staff: 9


Workshop Attendees

Number of staff: 1

Geeta Sharma, Program Officer


MNH (Anesthesia) Nick Simons Foundation (NSF) • Training Course Development (AAC LRP) for

Anesthesia Assistants (AAs)

MNH USAID/MCHIP

USAID/Development Innovation Venture (DIV)

• Pre-eclampsia prevention detection and

management

• MNCH integration

• Evaluation, research and capacity-building

Training Systems NSF, Jhpiego • Revision of Clinical Training Skills (CTS) course

• Training

FP, MNCH USAID bilateral, Nepal Family Health Program II

(NFHP II): Sub to JSI

• Performance improvement

• Training systems

• Innovations

FP, MNCH, nutrition USAID bilateral, Integrated Nutrition Program

(INP): Sub to Save the Children (pending award)

•Performance improvement

• Training


Program OfficerFuncionaria del Pais

Carmen Crow

**TECHNICAL LEAD /

LĺDER TECNICOMaternal Health AdvisorEncargado de Programas

de Salud Materna

Vicente Bataglia

Newborn Health Advisor

Encargada de Programas de Salud

Neonatal

Mercedes Portillo

Community Interventions

Advisor Encargada de IntervencionComunitaria

Maria Peña

**ADMINISTRATIVE LEAD / LĺDER

ADMINISTRATIVAProgram Coordinator

Coordinadora de Programas

Jhalily Hermosilla

Admin/Finance Assistant

Asistente de Adm inistración y

Finanzas

Mirtha Ayala

Consult together for coordination

Se ponen de acuerdo paracoordinación

Technical advisors from headquarters provide supportAsesores técnicos de la sede proporcionan apoyo

Jeffrey Smith, Bertha Pooley , Joseph de Graft-Johnson, Jennifer Luna, Goldy Mazia


Overview of Technical Areas and Donors Technical

Area(s) Primary

Donor/Mechanism Program Interventions

Maternal Newborn Health

USAID/Paraguay (MCHIP)

•Quality Improvement of facility based care (SBM-R ) •Updating MOHSW MNH protocols, policies, norms •Improving use of SIP (National, computerized MNH information system) •Facility based quality, high-impact essential and basic emergency maternal and neonatal care and resuscitation training in targeted facilities •Improving communities and families’ MNH knowledge/ practices

•IEC for pregnant women waiting for ANC in health facility and new mothers staying in hospital group home •Training health care providers on MNH messages & IEC techniques • Community Health promotion activities

•Establishing KMC demonstration centers

Newborn Sepsis

USAID/LAC Regional (MCHIP)

• Prevention of facility based newborn sepsis

AMTSL USAID/LAC Regional (MCHIP)

•Integrate AMTSL into Paraguay midwifery curriculum (South-to-South technical assistance from Peru)

Monitoring, Evaluation and Research Activities Title of Program or Research/

Evaluation Activity Primary Monitoring or Study Data Source(s) For Research and Evaluation

Activities Project Status

SBM-R

Client interviews, provider interviews, facility HMIS, SBM-R assessments

First workshop to be implemented at the end of April

Improved MOHSW and health facility systems for better completion of SIP

As shown in quality control flow chart System designed, discussed and permission obtained from National MOHSW

Information on AMTSL and Essential Newborn Care that complements facility HIS

Stamp with format for additional information to be collected on back of Partogram

Information has been defined

M&E for community interventions •Exit interviews of women after ANC antenatal care visits •Pre-post tests of new mothers staying in hospital group home and receive education on newborn health •Pre-post tests of providers trained on MNH messages and IEC

Being developed

M&E for KMC at demonstration centers KMC registers Information determined

Key Monitoring, Evaluation and Research Challenges Challenges How did you or how are you currently addressing these challenges? Various clinical providers fill information on SIP clinical history form, so nobody feels responsible for the information

•Developing an organized information flow system for which the head of each clinical rotation is accountable for complete information and where health facility director and MOHSW at national level enforce the system; •Involves obtaining buy-in from MOHSW and health facility directors

HIS is based on SIP, ( computer based information system) which is a LAC regional maternal newborn health record system , from CLAP ( Latin American perinatal and human development center) Obtaining permission to customize the system to country context and newer interventions is difficult.

At suggestion of facility staff, adding a format to partogram to collect information on AMTSL and essential newborn care

Paraguay Monitoring, Evaluation and Research

Organizational Chart

Quality control Flow Chart

Office Overview

Number of staff: 5

Number of dedicated M&E staff:

Technical team leader responsible

for M&E with support from

community and newborn advisors Workshop Attendees

Number of staff: 1 / Maria S Peña

Community Interventions adviser

Left to right: Mercedes Portillo, Mirtha Ayala, Vicente Bataglia, Maria Peña, Jhalily Hermosilla, Carmen Crow.



Technical Area(s) Primary Donor/Mechanism Program Interventions Child Health USAID/MCHIP IMCI (Facility and Community) and Pediatric HIV

MNH USAID/MCHIP FP, EmONC, FANC, ENC, Nutrition, and KMC Community Health USAID/MCHIP FP/CBP, CB-MNH

Pre-services Training USAID/MCHIP Practical training and nursing council support BCC USAID/MCHIP MNCH BCC Sub-strategy

Immunization USAID/MCHIP Rota Virus Introduction Male circumcision DOD/Jhpiego HIV Prevention in RDF



Evaluation Activity




Malaria surveillance Facility ANC registers JHU/ Rwanda national ethical committee

Protocol developed and ready for submission to USAID and MoH

Feasibility and effectiveness

of distributing Misoprostol at community level to prevent

PPH in Rwanda

Community based registers and self administered survey with

CHWs

JHU/ Rwanda national ethical committee

Protocol developed and still under review


Challenges How did you or how are you currently addressing these challenges? 1. Data quality

• Training of data managers at facility and CHWs supervisors in M&E • Orient data collectors on indicator definition and data collection tools

2. Many database in the health sector that are not linked

Advocacy to MoH

3.Data is not fully used for decision

Training of decision makers at national, district and community level on data driven decision making (DDDM)

Rwanda MCHIP-Ikiraro Project M&E success story: • District needs assessment and planning for the 13 MCHIP supported districts was done in the participatory way with districts

stakeholders to ensure their ownership and sustainability, where collecting baseline information and the process of disseminating the findings of the assessment to MoH, USAID and other implementing partners was seen as a mechanism to avoid duplication of efforts and to save resources. Also the involvement of the MoH in planning process for MCHIP interventions provides leadership and guidance based on country priorities

(Rwanda) Monitoring, Evaluation and Research

Office Overview

Number of staff: 34


Number of staff: 2

Dr. Twahirwa William

Mr. Sinzahera Jovite



Technical Area(s) Primary Donor/Mechanism Program Interventions HIV/AIDS and TB CDC/bilateral • HIV/AIDS Counseling and Testing (HCT) ,Greater Involvement of

People Living with HIV/AIDS (GIPA) training, Counselor trainings Maternal Child , Nutrition and Child Health USAID/MCHIP-bilateral • PMTCT in-service training, Mentoring and supportive supervision,

M&E data collection. We currently support t 23 health facilities

• CECAP in-service training, mentoring and supportive supervision, logistical support-buying cryotherapy machines and related inputs. There are 30 health facilities across two Provinces that are supported by the M&E unit

• TIMS training and mentoring of PEPFAR partner organization M&E staff. This project runs in 18 sites spread over five Provinces



Evaluation Activity

Primary Monitoring or Study Data Source(s) For Research and Evaluation Activities Name of IRB (s) That

Approved Activity Project Status

CECAP close out programme review

CECAP facility registers, baseline assessment tools, exit interview tools, Demographic health survey (DHS), StatsSA data

n/a • Desktop Literature review underway • Routine data collection underway • Close-out reports being prepared

Male circumcision programme review

Draft situational analysis reports, Provincial reports, subject matter experts (Provincial)

n/a • Desktop Literature review underway

PMTCT programme review PMTCT facility registers, baseline assessment tools, exit interview tools ,Demographic health survey (DHS), StatsSA data, District Health Information System data (DHIS)

n/a • Desktop Literature review underway • Routine data collection underway • Close-out reports being prepared

Key Monitoring, Evaluation and Research Challenges Challenges How did we or how are we currently addressing these challenges?

1. Although a unit workplan exists, there is no dedicated budget for the M&E work plan to carry out routine activities as well as on-site M&E support

We are currently involved in the budgeting process through advocacy and ongoing engagement with programme managers

2. Staffing continues to be a challenge to support all organizational activities especially data quality, capacity building and research, which are key to improvement in programme service delivery

Jhpiego recently lost several key staff in the M&E unit which have not been replaced to date due to budgetary restraints within projects, however with new business development initiatives, key proposals are incorporating new personnel to support the programme areas in the long term

3.Long term sustainability of the unit activities through turnover of key human resources (all M&E staff to leave by end of May 2011)

Currently all projects and new business initiatives incorporates sustainability plans for future continuation. Development of best practices is underway as part of Knowledge Management

M&E Key developments • Jhpiego ME staff have engaged with the national district health information system (DHIS) and are critically positioned to provide and strengthen the national

DHIS at facility and district levels • The MCHIP project has recently undergone a facility audit commissioned by the USAID mission-awaiting the results • Successfully implemented the USG/USAID mission online reporting inventory dataware house system to merger financial and programme activity performance. • Participated in the key new business initiatives for new programmes • Finalized standard operating procedures for the key programmes to introduce a culture of data use in programme planning and reporting

(South Africa) Monitoring, Evaluation and Research

Office Overview

Number of staff: 15


Workshop Attendees Number of staff: 1

John Lubwama, M&E Officer

Jhpiego ME&R portfolio : A background profile (2007-2011) Prior to 2007 and throughout the year, there was a single M&E advisor working with M&E support from Baltimore who supported all the programmes in the organization. By then ACCESS and the Siyazi HIV/AIDS Counseling and testing (HCT) projects were the main programmes in-country. ACCESS had a focus on cervical cancer screening within the North West Province. In 2007, the Art2scale project, a key flagship project for the South Africa office was operationalized. With it came a requirement to form a local NGO through which USAID would finance the in-country activities. Under Art2scale were two main projects- NIMART (Nurse Initiated and Managed ART) and Accreditation projects responsible for the accreditation of health facilities for provision of ARVs in South Africa. NIMART’s main activities were to build capacity of the nurses, as part of the task shifting process, so that they initiate and manage ART within PHC facilities. In 2009, two key core staff portfolios were added to the M&E in country team and a temporary PEPFAR M&E fellow to support the functions within the unit. The core staff by end of the year, comprised of the Senior M&E Advisor, M&E Advisor (Art2scale) and the Health Information officer. At the beginning of 2010, funding mechanisms created by USAID saw close out of ACCESS programme and the new development of MCHIP as the in country programme. MCHIP funds included carry overs from the ACCESS programme. Within MCHIP, plans were underway to recruit two Provincial M&E officers for the two Provinces that the programme operated in. Currently (2011), there are now two projects, Siyazi and MCHIP which are operational, staffed by the M&E officer and Health Information officer as part of the core team with support from Baltimore M&E team. We support an estimated 54 facilities in two Provinces under MCHIP and 54 partner organizations with workplace HCT under the Siyazi HCT project.



Technical Area Primary Donor

Program Interventions Primary Monitoring Data Source

Research / Evaluation Activity Project Status

HIV Counseling and Testing

USAID PITC, outreach HCT Nationally approved health facility registers ; stored in

web-based database

PHE STATUS (a multi-country study comparing three models of PITC in Outpatient Departments) (OGAC

approved; NIMR approved)

Orientation done to regions, data collection scheduled for June/ July

2011

Maternal and Newborn

Health

USAID / MCHIP

In-service training, SBM-R, research

Service statistics using sentinel sites; performance

standards assessments; observational assessment of deliveries and newborn care

(twice LOP)

MNH Quality of care study (JHSPH IRB and National Institute of Medical

Research)

Fieldwork completed, report written; identifying journal for

manuscript preparation

Malaria in Pregnancy (MIP)

CDC Study on placental parasitemia in Zanzibar; sub on program to

improve interpersonal communication skills of health

care providers on MIP

Facility-based data collection using study forms

ANC and OPD client exit

interview study

Placental Parasitemia among women who have not received IPTp in

Zanzibar (JHSPH IRB and Zanzibar Research Council approved)

Training of health care providers to take place end of May, data collection to start in June 2011

Exit interview study done, report

writing underway Cervical Cancer

Prevention USAID In-service training, service

delivery support, policy TA to MOHSW

Nationally approved health facility registers ; client level

data stored in web-based database

Secondary analysis of CECAP database data (JHSPH non-research

determination)

Poster under preparation for IAS 2011: PITC integration into CECAP

services

Male Circumcision

USAID / MCHIP

In-service training, service delivery support, qualitative

evaluation / assessment, TA to MOHSW on M&E tools for MC

Nationally approved health facility registers ; client level and routine data stored in

web-based database

Qualitative Assessment of MC Attitudes in Iringa Region (JHSPH IRB

approved)

Secondary analysis of MC database data (JHSPH non-research

determination)

Fieldwork completed, report written; identifying journal for

manuscript preparation

Manuscript submitted to PLoS Medicine

Integrated PMTCT/

postnatal care

USAID Community-based comprehensive MNH program using community volunteers,

facility-based program to improve postnatal care

CHW forms, nationally approved health facility

registers

-- --

Pre-Service Education

CDC Faculty and institutional support for medical and nursing /

midwifery schools

Performance standards assessments

Pre-service needs assessment for medical schools (program evaluation)

Tracking of nursing and midwifery graduates in Tanzania

Report written and disseminated

Application to PHIRST being prepared

Infection Prevention

CDC Establishing standards and guidelines at national level; in-

service training and service delivery support at facility level

Performance standards assessments

Study on hospital acquired infections Not yet in design stage

Accomplishment: Web-based databases in the Tanzania office Background Solution Databases Developed

Tanzania has programs in multiple technical areas, regional offices and a strong focus on monitoring service statistics. We also support MOHSW in the area of HMIS and wanted to come up with data management solutions which were in line with national HMIS approaches. Some departments of MOHSW have embraced DHIS as a national HMIS tool.

Adopt DHIS-compatible service delivery databases, installed on servers to be accessible to both Jhpiego Tanzania HQ and

regional offices

Work with Jhpiego HQ to develop performance standards database to monitor SBM-R program achievements (called QI in Tanzania); installed on servers to be accessible to both Jhpiego

Tanzania HQ and regional offices

DHIS-compatible: MC database (client level and aggregated)

CECAP database UHAI-CT database (measures aggregated PITC

data)

QI Database

Tanzania: Monitoring, Evaluation and Research Office Overview

Number of staff: 86


Workshop Attendees

Marya Plotkin, Senior M&E Officer

Michael Machaku, M&E Officer, MC

Lusekelo Njonge, M&E Officer, UHAI-CT

Victor Mponzi, M&E Officer, MAISHA

Flora Hezwa, Senior Data Manager



Maternal Health USAID/MCHIP Support MoHCW to formulate national health policies

Newborn Health USAID/MCHIP Improve the quality of maternal and newborn health services provided by District Hospitals (DH) and Rural Health Centers (RHC)

Child Health USAID/MCHIP Improve the coverage and quality of high‐impact MNCH interventions provided by Primary Care Nurses in RHCs and by Village Health Workers in

communities

Immunization USAID/MCHIP Increase routine immunization

PMTCT USAID/MCHIP Integrate PMTCT with MNCH services

Postpartum Family Planning (PPFP) USAID/MCHIP Integrate PPFP with MNCH services


Title of Program or Research/ Evaluation Activity


For Research and Evaluation ActivitiesName of IRB(s) That Approved

Activity

Project Status

Maternal and Newborn Health (MNH) Standards Based Management and Recognition (SBM‐R) evaluation

(baseline)

Client/provider interviews, case observation, SBM‐R assessments

N/A Data collection completed; report writing currently underway

Child Health Needs Assessment Client/provider interviews, case observation, SBM‐R assessments

N/A Data collection completed; report writing currently underway

Immunization Needs Assessment Provider interviews N/A Data collection completed; report writing currently underway

MNH National Quality of Care Study Case observation, provider interviews N/A Attached to National Health Facility Assessment; on hold pending discussions between MOHCW

and donors


Challenges How did you or how are you currently addressing these challenges? 1. Data availability issues – some MCHIP indicators will be very difficult to measure given the current state of data collection tools/forms/registers in HFs, and current challenges faced by the HMISsystem. In particular, it will be challenging to measure the indicator related to provision of essential newborn care services, as there is no routine data currently being collected on these services in HFs.

In order to measure this indicator (and others with similar datacollection/quality issues), MCHIP/Zimbabwe is currently working towards developing separate data collection tools for use at facilities, and orient/train Health Facility workers as to proper use of these tools.

2. “Poor functioning” of the HMIS due to a series of issues, such as need for improved HMIS coordination/management at all levels; lack of HMIS forms and registers in some facilities; poor provider capacity to collect consistent, quality data; poor computing/communications infrastructure availability; and an unidirectional data flow, i.e., data always moves upwards without any system of giving routine feedback back to reporting sites.

MCHIP/Zimbabwe is currently working towards getting involved in strengthening of the national HMIS through participating in the Health Information Task Force meetings, providing technical and financial assistance for training of existing staff, and exploring other ways of improving data collection tools and methods.

3. Community‐based MNCH data collected by community‐based health workers is not linked to the HMIS and its usage is localized to individual health facilities.

MCHIP/Zimbabwe will work with village health workers (VHWs) to add MNCH‐related indicators to their existing registers. In addition, MCHIP will explore ability to pilot linking VHW registers to the HMIS system.

ZimbabweMonitoring, Evaluation and Research

Office OverviewNumber of staff: 20



Frank Chikhata, M&E Officer

May 2011

This poster was made possible by the generous support of the American people through the United States Agency for International Development (USAID), under the terms of the Leader with Associates Cooperative Agreement GHS‐A‐00‐08‐00002‐00. The contents are the responsibility of the Maternal and Child Health Integrated Program (MCHIP) and do not necessarily reflect the views of USAID or the United States Government.

MCHIP MER Support to USAID’s Child Survival and Health grantees resulted in: 17 operations research study designs that test innovations in

community-oriented programs in 16 countries; first results due 2012 21 project population-based baseline surveys in 19 countries 41 final evaluation surveys in 30 countries, demonstrating increased

coverage of high impact MNCH interventions including insecticide treated net use, handwashing, maternal tetanus toxoid, postnatal visits, and exclusive breastfeeding (example results in graph, below)

This poster was made possible by the generous support of the American peoplethrough the United States Agency for International Development (USAID), under theterms of the Leader with Associates Cooperative Agreement GHS-A-00-08-00002-00.The contents are the responsibility of the Maternal and Child Health IntegratedProgram (MCHIP) and do not necessarily reflect the views of USAID or the UnitedStates Government.



1. Data collection, aggregation, and analysis at the global level. This challenge will be addressed through the launch of the new Results Information System for Excellence (RISE)

2. Rapid growth of the Program in Years 2/3 without concomitant increases in human and financial resources dedicated to M&E

HQ will be hiring an additional full-time M&E Officer in the near future. New guidance to country programs will require either an M&E staff member

or program support person in-country

3. Outdated health information system registers and client charts and poor quality data (also affects our ability to link SBM-R to health outcomes)

MCHIP works to strengthen elements of the national HMIS in countries where appropriate and advocate for revised registers

4. PVOs must develop operations research (OR) designs that are practically suited to integrated programs with limited budgets

MCHIP provides individualized technical assistance, hosted an OR workshop, and disseminated an OR guidance document

Global MCHIPMonitoring, Evaluation and Research

MCHIP Global M&E VisionIncreased use of appropriate data to guide program decision-making and

policy formulation for delivery of high-impact maternal, newborn, and child health interventions and services at scale.

Key Priorities1. Developing M&E Indicators, Tools, & Resources2. Contributing to the Evidence Base on High Impact MNCH Interventions3. Strengthening Elements of Health Information Systems4. Building Capacity of MCHIP Staff and Collaborators in Monitoring, Evaluation, and Research

91 (0.51%)

80 (0.52%)

59 (0.33%)

80 (0.45%)

71 (0.40%)

49

(0.31%)

0

10

20

30

40

50

60

70

80

90

100

0

10

20

30

40

50

60

70

80

90

100

Jul-Sep09 Oct-Dec09 Jan-Mar10 Apr-Jun10 Jul-Sep10 Oct-Dec10

Nu

mb

er

of

Ma

tern

al D

ea

ths

Pe

rce

nt

Correlation between QI standards, intervention use, and

maternal deaths in Mozambique

% of SBMR related to SPE/E % of SBMR related to PPH % of AMTSL use # maternal deaths

Throughout the first six

quarters of the Model

Maternities Initiative, in

the 17 health facilities

that did follow-up

quality evaluations,

there was an upward

trend in the adherence

to quality standards

related to PPH and

eclampsia; an upward

trend in the use of

AMTSL; and a generally

downward trend in

number of maternal

deaths from all causes

(% in parentheses).

Cause-specific mortality

currently not available

in HIS.

MCHIP Results Achieved: Country Examples

Progress toward MCHIP LOP Goals: 16,200* lives saved among children under five 14 countries with improved coverage of high impact

MNCH interventions

Select global achievements to date: 25,094 people trained in MNCH/FP: 33 national policies or guidelines developed with MCHIP

support 6 international policies/standards/strategies

developed/revised with MCHIP support 82 MCHIP supported studies

Select country achievements to date: Improved facility-based and/or community

recordkeeping forms, including registers and client charts (e.g., Mozambique, Malawi, Nigeria, Bangladesh, Guyana) Increased capacity of health workers and supervisors to

accurately record, aggregate and display data (e.g. Mozambique, Nigeria, Guyana) Increased use of data for decision making by health

workers and/or supervisors and District Health Management Teams

(e.g., Mozambique, Nigeria, Bangladesh, Malawi) Increased capacity of partners to conduct research studies

*Lives saved is calculated using LiST by CSHGP grantees with baseline and midterm or final population-based coverage figures. Approx. 10 countries in Years 1 and 2.

GOAL: Reductions in under-five and maternal mortality and morbidity and accelerated progress toward reaching MDGs 4 & 5

Strategic Objective:Increased use/coverage of high impact MNCH interventions

Sub-Objective 1:Increased availability and use of appropriate high impact MNCH interventions, including supportive

family planning interventions

Sub-Objective 2:Global leadership in MNCH, including further

development and promotion of improved approaches

Sub-Objective 3:Innovative, effective & scalable community oriented strategies that

deliver integrated high impact interventions to vulnerable populations designed, implemented and evaluated by PVOs/NGOs.

MCHIP Results Framework

Development and revision of data collection tools and guides Community case management (CCM) toolkit Facility survey toolkit for assessing quality of care for prevention and

management of common maternal and newborn complications Knowledge, Practices, and Coverage Survey, Lives Saved Tool, and

Rapid Health Facility Assessment Application of mHealth tools in M&E activities

Innovating with mHealth Smart data capture on mobile phones Data transmission from remote field

locations to in-country web-servers Posting of preliminary data tables

onto the web.

Demonstrated global leadership in MER Leadership in various M&E technical working groups, including efforts to

identify global “benchmark” MNH indicators and (CCM) indicators Contributions to global MNCH evidence-base through special research

studies and program evaluations, ex. Healthy Fertility study in Bangladesh, calcium supplementation crossover trial, CCM case studies, Malaria in Pregnancy case studies, and Quality of Care for Maternal and Newborn Complications studies in five countries.

39

63

88

3.2

2.92.7

0

0.5

1

1.5

2

2.5

3

3.5

0

10

20

30

40

50

60

70

80

90

100

2008 2009 2010

Dir

ect O

bste

tric

De

ath

Ra

te (%

)

PQ

I RH

Sco

re (%

)

Direct obstetric death rate and PQI/RH scores for

Machinga District Hospital, Malawi (2008-2010)

PQI RH scores

Direct obstetric

death rate

The proportion of

direct obstetric

deaths has

declined from

3.2% in 2008 to

2.7% in 2010. In

the same period,

quality of RH

services increased

through MCHIP

programs. Based

on program data,

PQI IP and PQI RH

may have

contributed to the

decrease in

obstetric deaths.7685

22092

4679949006

1211292 1984

3675

283 (3.68%) 344 (1.56%) 338 (0.72%)163 (0.33%)

6287

21150

30467

45138

95.3%98.8%

86.5%

96.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

10000

20000

30000

40000

50000

60000

FY07 FY08 FY09 FY10

PPH and use of AMSTL compared with maternal deaths

and deliveries for 10 hospitals* in Nigeria (2007-2010)

# Total delivery by SBAs # of cases of PPH # of maternal death recorded # cases with AMTSL Proportion of AMTSL

In 10 hospitals* in

Nigeria, annual

deliveries have

increased from 2007 to

2010, as has the

number of cases of

post-partum

hemmorhage (PPH). The

proportion of women

wtih active

management of the

third stage of labor

(AMSTL) has also

increase, as maternal

deaths have declined

markedly from 283

(3.68% of all births

attended by a skilled

attendant) in 2007 to

163 (0.33% of all births

attended by a skills

attendant) in 2010.

*Facilities include Kaura Namoda GH, Kin Fahad WCH, Zurmi GH, MMSH, Gezawa GH, Rano GH, Dawakin Tofa GH, Daura GH, Funtua GH, and

DutseMa GH. 2007 data not available for Zurmi, Daura, Funtua, and DutseMa. 2008 data not available for Daura.

Success Story: Delivering on Promise of Immunization

“This will give mothers peace of mind.” “This will reduce my fear of my child dying of pneumonia.”

“This will reduce the number of trips mothers make to the health center.”

“This will save me money if my child doesn’t get sick.”

“This” is pneumococcal vaccine. Mothers in Rwanda shared their relief that they now have a vaccine to help protect against pneumonia, the most common cause of under-five mortality globally. With the recommendation

of WHO and support from MCHIP, Rwanda became Africa’s first sub-Saharan country to introduce

pneumococcal vaccine in its national Expanded Program on Immunization (EPI) in 2009.

0

20

40

60

80

100

Pe

rce

nt

Co

vera

ge fo

r EB

F (

%)

Baseline Endline

Exclusive breast feeding (EBF) is one of the Rapid CATCH indicators reported by all CSHGP grantees. There was a statistically significant increase in EBF coverage in the catchment areas for 8 of 13 projects ending in FY2010 with endline data available.

CSHGP Grantees Improve Coverage in High-Impact Interventions

Results from Projects Ending in FY10

Office Overview: MCHIP HQNumber of dedicated M&E staff: 14(2 full-time and 12 part-time staff)

Workshop Attendees

Number of staff: 13

Barbara Rawlins Heather RosenBecca Levine Mainza Lukobo-DurrellDavid Cantor Mary Drake Moussa LyEva Bazant Maya Tholandi Reena SethiFlorence Nyangara Megan Harris Young Mi Kim

mtholandi

Cross-Out



Technical Area(s) Primary Donor/Mechanism Program Interventions HIV CDC/bilateral ART, PMTCT, CT, TB/HIV, MC, SI HIV DOD ART, TB/HIV, PMTCT, System Strengthening, SBMR HIV CDC/Eastern bilateral PMTCT, CT, TB/HIV MC PSI/USAID MC training and site refurbishments MC PSI/BM Gates Foundation MC training and QA



Evaluation Activity




Training activities TIMS n/a Ongoing program monitoring Monthly DOD site data Site registers n/a Ongoing program monitoring Monthly MC site data Site registers n/a Ongoing program monitoring ART CME evaluation Participant interviews JHU SON, UNZA, CDC Data collected, analysis in process MC counseling study Client interviews, facility

registers WIRB, UNZA , CDC

Data collection under way

SBM-R evaluation Client interviews, provider

interviews, facility HMIS, SBM-R assessments

JHU SPH, UNZA Data collection under way

Key Monitoring, Evaluation and Research Challenges Challenges How did you or how are you currently addressing these challenges? 1. Data Quality from sites from MC and DOD program

Site visits, group training/orientation, revised data collection tools, site level data collection guide

2.Site level data not easy to use, summarize due to using Excel Hired contractor to develop site level database

3.Budgets for evaluation not always correct nor enough Request more funds, be more involved in work planning process

4. Ensuring all staff more aware of M&E activities Adding M&E to monthly All Staff agenda

5. No dedicated M&E nor data staff at sites Train and orient ZDF and MOH staff, use Jhpiego technical staff to assist with M&E follow-up during site visits

Highlights and Achievements • ART CME evaluation – preliminary results presented at AIDS 2010 in Vienna and led to improvements in the program implementation • M&E Unit instrumental in new Quarterly Review process • Development of Access database for site level data, leading to improved use • Using online SBMR database to share MC QA results with Prime Partner (in process) • Using MC data to improve the program implementation • Adopted data Quality Assessment tools to conduct DQ visits which lead to training/orientation for site managers on data collection, reporting

and use

Zambia Monitoring, Evaluation and Research

Office Overview

Number of staff: 33


Number of staff:3

Cyndi Hiner, Deputy Country Director

Webby Kanjipite, M&E Advisor

Shambulo Kabangu, M&E Officer

Country Director (Kwame Asiedu)

Technical Director (Joseph Nikisi)

DOD Program Manager

(Joseph Banda)

STI and CT Officer (Nchimunya Malambo)

ART Advisor (TBD) PMTCT Advisor (Maureen Chilila)

PMTCT Officer (Hilda Shasulwe)

TB/HIV and CT Officer

(Dominic Phiri)

Pre-service Advisor (Lastina Lwatula)

Administration and Human Resource Manager (TBD)

Office Manager (Susan Zeko)

Office Assistant (Martha Brango)

Office Assistant (Fannie Chipeta)

Receptionist (Edgar Wamundila)

Office Assistant /Gardener

(Kennedy Chiabi)

Travel Coordinator (Priscilla Miti)

Driver (Davies Matanda)

Driver (Moses Mvula)

Driver (Lameck Banda)

Driver (Michael Mtonga)

IT Officer (Gizmo’s consultants)

Finance Manager (Suki Mwale)

Finance Officer (Jonathan Mulenga)

Finance Officer (Sibeso Sefulo)

Procurement Officer (Doreen

Malambo)

Regional MC Advisor

(Jabbin Mulwanda)

MC Advisor (TBD)

MC Officer (Nashiol Nyirongo)

MC Advisor (Martha Ndhlovu)

MC Advisor (TBD)

Deputy Country Director

(Cyndi Hiner)

Program Officer (Michelle Wallon)

M&E Advisor (Webby Kanjipite)

M&E Officer (Shambulo Kabangu)

SmartCare Advisor (George Muyunda)

SmartCare Officer (Anthony Sikana)

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