Empty rituals? A qualitative study of users’ experience of monitoring & evaluation systems in HIV interventions in western India

In global health initiatives, particularly in the context of private philanthropy and its ‘business minded’ approach, detailed programme data plays an increasing role in informing assessments, improvements, evaluations, and ultimately continuation or discontinuation of funds for individual programmes. The HIV/AIDS literature predominantly treats monitoring as unproblematic. However, the social science of audit and indicators emphasises the constitutive power of indicators, noting that their effects at a grassroots level are often at odds with the goals specified in policy. This paper investigates users' experiences of Monitoring and Evaluation (M&E) systems in the context of HIV interventions in western India. Six focus groups (totalling 51 participants) were held with employees of 6 different NGOs working for government or philanthropy-funded HIV interventions for sex workers in western India. Ten donor employees were interviewed. Thematic analysis was conducted. NGO employees described a major gap between what they considered their “real work” and the indicators used to monitor it. They could explain the official purposes of M&E systems in terms of programme improvement and financial accountability. More cynically, they valued M&E experience on their CVs and the rhetorical role of data in demonstrating their achievements. They believed that inappropriate and unethical means were being used to meet targets, including incentives and coercion, and criticised indicators for being misleading and inflexible. Donor employees valued the role of M&E in programme improvement, financial accountability, and professionalising NGO-donor relationships. However, they were suspicious that NGOs might be falsifying data, criticised the insensitivity of indicators, and complained that data were under-used. For its users, M& E appears an ‘empty ritual’, enacted because donors require it, but not put to local use. In this context, monitoring is constituted as an instrument of performance management rather than as a means of rational programme improvement

Tanzania Joint Health Technical Review 2002:final report HIV/AIDS

\ud Tanzania has a HIV epidemic at an estimated range of approximately 12% of the adult population (15-49 years) being infected. The epidemic is still increasing and there are few signs that the epidemic will level off in the near future. Until 2000 the response to the epidemic was the responsibility of NACP, the National AIDS Control Programme, within the MoH. As the epidemic and the insight of the impact of the epidemic on society progressed the health approach changed to a multi-sectoral response – still led by the MoH. However, as in other countries with a significant HIV epidemic it was decided to move the response of the epidemic to the highest level of government. The multi-sectoral approach thus underwent a transformation from a strategy of the MoH to a strategy of GOT by placing the responsibility under the Prime Ministers’ Office. In this transition the TACAIDS was formed to provide the leadership of GOT’s fight on HIV/AIDS in 2001. TACAIDS is placed within the PM’s Office and has slowly started to become operational. In January 2002 the commissioners were appointed and the first meeting will take place in February. The NACP is undergoing a transformation from being the body for the national response of all sectors in society to be part of the response from the MoH. The new role of NACP is still being developed, but it has been decided that the NACP in the future will operate under the authority of the CMO in the MoH. The task within the health sector is huge since the health sector is the first to be impacted by the epidemic and many of the cost-effective preventive measures to combat the epidemic, such as STI treatment, and the care of an increasing number of people being sick and dying from HIV/AIDS, fall on this sector to be appropriately dealt with in partnership with civil society and other stakeholders. The timing of the mission is appropriate as far as HIV/AIDS is concerned. Great expectations are attached to TACAIDS to ensure leadership and the MoH can now concentrate on improving the provision of services in the health sector where it has a comparative advantage. At the same time new money are being made available from the donors in the basket fund for district health services and new resources are soon going to be available for HIV/AIDS activities: the Global Fund for AIDS, the HIPC money, and the TMAP – perhaps effective from 2003. The opportunity to consolidate the achievements in the health sector has never been greater. It is the objectives of the review to assess the performance of the health sector’s response to HIV/AIDS; main challenges regarding the consequences and combat of HIV/AIDS; and based on this recommend actions in the short and medium term. The scope of work includes a review the performance of the National Aids Control Programme \ud and the opportunities lying ahead for TACAIDS. Further the review on HIV/AIDS will assess constraints and opportunities within the health sector with regard to both preventive and care interventions including MTCT and HAART treatment. The response is assessed with regard to the capacity of the health care sector. In all these areas the following should be considered: Experience within Tanzania with a view to possible best practices and lessons learned. Cost implications should be considered, with a particular view to opportunity cost in areas where there would be a choice. Private sector possible contribution and specific problems The team, Adeline Kimambo, medical doctor and Anita Alban, health economist, hold international and national experience in the field of HIV/AIDS. The team carried out a review of \ud existing documentation, including policies and guidelines, and interviews were carried out with key people within MOH, PORALG, TACAIDS and civil society (NGOs for PLWHA). Further a field trip was undertaken to a district that is part of the health sector reform process. For the Health District Reform to succeed it needs an effective facilitated response from the MoH and cooperation from all stakeholders in the process – not least PRORALG. The report reflects this approach by reviewing and assessing both the new opportunities and obstacles of the MoH in the transition from a multi-sectoral response to a consolidated health sector response and the progress of the decentralisation process at district level. Further the team has made a strategic choice in focusing on the HIV/AIDS interventions that can make a significant difference if scaled up. In the time available for the team a choice also had to be made between assessing MTCT interventions and the introduction of anti-retroviral drugs into the care agenda. We chose the latter since it is the greatest investment challenge to the MoH.\u

United Nations Development Assistance Framework for Kenya

The United Nations Development Assistance Framework (2014-2018) for Kenya is an expression of the UN's commitment to support the Kenyan people in their self-articulated development aspirations. This UNDAF has been developed according to the principles of UN Delivering as One (DaO), aimed at ensuring Government ownership, demonstrated through UNDAF's full alignment to Government priorities and planning cycles, as well as internal coherence among UN agencies and programmes operating in Kenya. The UNDAF narrative includes five recommended sections: Introduction and Country Context, UNDAF Results, Resource Estimates, Implementation Arrangements, and Monitoring and Evaluation as well as a Results and Resources Annex. Developed under the leadership of the Government, the UNDAF reflects the efforts of all UN agencies working in Kenya and is shaped by the five UNDG programming principles: Human Rights-based approach, gender equality, environmental sustainability, capacity development, and results based management. The UNDAF working groups have developed a truly broad-based Results Framework, in collaboration with Civil Society, donors and other partners. The UNDAF has four Strategic Results Areas: 1) Transformational Governance encompassing Policy and Institutional Frameworks; Democratic Participation and Human Rights; Devolution and Accountability; and Evidence-based Decision-making, 2) Human Capital Development comprised of Education and Learning; Health, including Water, Sanitation and Hygiene (WASH), Environmental Preservation, Food Availability and Nutrition; Multi-sectoral HIV and AIDS Response; and Social Protection, 3) Inclusive and Sustainable Economic Growth, with Improving the Business Environment; Strengthening Productive Sectors and Trade; and Promoting Job Creation, Skills Development and Improved Working Conditions, and 4) Environmental Sustainability, Land Management and Human Security including Policy and Legal Framework Development; and Peace, Community Security and Resilience. The UNDAF Results Areas are aligned with the three Pillars (Political, Social and Economic) of the Government's Vision 2030 transformational agenda

Making Aid Effectiveness Work for Family Planning and Reproductive Health

This Population Action International Working Paper analyzes the five principles of aid effectiveness -- country ownership, alignment, harmonization, managing for results, and mutual accountability -- from a family planning and reproductive health perspective. It also describes how the Paris Declaration has changed the ways of managing and delivering aid; highlights entry points and obstacles for champions working to improve funding and policies; and makes recommendations for civil society organizations, governments and donors

Toward establishing a universal basic health norm.

Vast improvements in human health have been made during the past century. Indeed, gains in increased life expectancy and reduced physical impediments for much of the population were greater than in any previous century. Yet the gains were not uniform across the world or even within individual countries. The variations in health status among people cannot for the most part be explained through genetic differences. Instead, in most instances the variations in the last century and at the turn of the current century correspond to the variations in the distribution of control over material resources.</jats:p

Proliferation and fragmentation: Transactions costs and the value of aid

The problem of the proliferation of the number of aid donors and aid channels continues to worsen. It is widely and plausibly believed that this significantly; reduces the value of aid by increasing direct and indirect transactions costs. We contribute to the existing literature by: (a) categorising the apparent adverse effects of proliferation; (b) producing a reliable and fair indicator of the relative degree to which the main bilateral donors proliferate or concentrate their aid; (c) giving some explanation of why some donors proliferate more than others; (d) constructing a reliable measure of the extent to to which recipients suffer from the problem of fragmentation in the sources of their aid; and (e) demonstrating that the worst proliferators among the aid donors are especially likely); to be suppliers of aid to recipients suffering most from fragmentation. There are significant implications for aid policy

Curbing the HIV Epidemic by Supporting Effective Engagement in HIV Care: Recommendations for Health Plans and Health Care Purchasers

The United States is poised to dramatically reduce the scope of its HIV epidemic, but this demands increased leadership and attention from health plans and health care purchasers (including Medicaid, Medicare, marketplaces, and other private purchasers). This new amfAR report identifies changes in policy and practice in clinics, communities, and health care programs to reduce unnecessary health spending, increase the effectiveness of services, and increase the integration of services. Done right, the same steps that lead to appropriate management of care by health plans and purchasers also will help to achieve national public health goals

Performance Assessment of Six Public Health Programs in Katsina State, Nigeria

This research aimed to evaluate the performance of six ongoing public health programs through core performance indicators in Katsina State, Nigeria. The healthcare delivery in Africa is mostly program-based. This requires that such programs need to be evaluated which may in turn help to identify any existing gaps towards the improvement of patients' access and coverage to their given service. We identified all active health facilities where our programs on malaria, Routine Immunization (RI), Family Planning (FP), Tuberculosis and Leprosy (TBL), HIV/AIDS, and Free Medicare (FMC) were being carried out. After that, a representative sample was derived to obtain data regarding five key performance indicators by using a Logistics Indicators Assessment Tool. Of 1,718 facilities, a total of 983 (57.22%) were visited, In other words, by assuming a normal distribution; each facility expectedly covers only 3,371 individuals. All programs provided different and diverse results on each indicator; however, the most obvious challenge was in the stock-out and demand vs. receipt of required medications. These are particularly for malaria, FMC, FP, and HIV. For instance, the stock-out lasted 222 days for malaria and 135 days for FP. Despite this, none of the programs had a lower than gold-standard near-term availability of required products. Program-based healthcare delivery is inadequate and ineffective unless the local system gets simultaneously developed. If required medications are not becoming available, optimal access, coverage, and benefits cannot be expected to be obtained. Clearly, Nigeria experiences a push system of meeting term supplies. Nigeria needs to strengthen its pharmaceutical system