Transcript M&E : the Ethiopian experience

M&E-The Ethiopian
Experience
MERG Meeting
Geneva,Switzerland
Oct. 25-26,2004
Dr. Wuleta Lemma, CDC/Tulane/WB
M&E and Surveillance Advisor, HAPCO/MoH
Outline
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Background
M&E---Case Study
After Bangkok
New Development
Status of HIV/AIDS
Background-Ethiopia
• People living with HIV/AIDS ……..…………….….. 1.5 million
• Estimated percent of adults (15–49) infected with HIV ….. 4.4%
• Rural = 2.6%;
Urban = 12.6%
• Cumulative deaths due to AIDS ………………..…... > 1 million
• Children infected and living with HIV ………………... 96,000
• Cumulative number of children orphaned by AIDS …... 540, 000
• Number of pregnant women living with HIV …………. 130,000
• Number of PLWHA needing ART ……………………. 245,000
E s tim a te d a n d P r o je c te d Ad u lt HIV P r e v a le n c e , Ur b a n
20
E th io p ia a n d Re g io n s , 1 9 8 2 -2 0 0 8
Eth io p ia
18
T ig ra y
H IV P re v a le n c e (% )
16
S o m a li
Ad d is Ab a b a
14
S NNP R
O ro m ia
12
Ha ra ri
10
G a m b e lla
Dire Da w a
8
Be n ish a n g u l G .
6
Weighted urban HIV
prevalence: 12.5%
Am h a ra
Afa r
4
2
0
82
84
86
88
90
92
94
96
Ye a r
98
00
02
04
06
08
7
Estimated and Projected Adult HIV Prevalence, Rural
Ethiopia and Regions, 1982-2008
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Ethiopia : 2.8% (2004)
Tigray
Somali
SNNPR
2004 prevalence
Oromia
range: 1.0% - 5.2%
Harari
Gambella
Dire Dawa
Benishangul G.
Amhara
Afar
HIV Prevalence (%)
5
4
3
2
Assumed start of
rural HIV
epidemic: 1984
1
0
82
84
86
88
90
92
94
96
Year
98
00
02
04
06
08
HIV Incidence (%)
1.2
1.0
0.8
Estimated and Projected HIV Incidence by
Age Group, Ethiopia, 1982-2008
15-19 yrs
20-24 yrs
25-29 yrs
0.6
0.4
0.2
0.0
82 84 86 88 90 92 94 96 98 00 02 04 06 08
Year
180
Estimated HIV Population Size by Sex and Age,
Ethiopia, 2003
No. HIV-positive (thousands)
160
No. HIV-pos, 2003:
140
120
Male
Female: 810,000
Female
Male:
650,000
Total:
1.5 million
100
80
60
40
20
0
0-4
5-9
10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65 +
Age Group (years)
M&E-The Ethiopia
experience
Challenges to “One M&E System”
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No M&E unit at the national level
Indicators not harmonized- Everybody have their own –
Ministries, Donors, CSO etc
No unified data collection formats- Organizations have
their own different formats for similar indicators- “Same
person ” at lower fills it all !!!!
Different report-Information Flow
Limited not unified capacity building plan -- including
training and human capacity at all levels to role out a
national M&E system
Non existence of an integrated data base (including
HMIS)
Surveillance more developed than Program Monitoring
Limited Budget for M&E
Non-existent and disjointed Evaluation plan
Infrastructure (road, telecommunication, networking, etc)
varies from region to region
M&E-2003-present
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M&E Department at national ( 5 Staff ), Regional HAPCOs and district focal
persons. M&E team includes MoH
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Secured budget (MAP,GF, PEPFAR and Others)
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Comprehensive training plan for all regions developed – ToT manual to
follow
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Equipment (Computers & accessories) for all regional M&E Departments
and all new ART sites- Take advantage of Woreda net
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National M&E Framework (with indicators, methods of data collection,
Information flow, who collects what etc) after extensive consultation
published in December 2003 and distributed to all Regions, NGOs, FBOs &
Donors
M&E 2003-present
 National M&E Operational Plan with detail M&E Formats
for all program activities
 Assessment of National Financial Monitoring System of
NHAPCO
 Harmonization of GF requirement with national Indicators
 Consolidated Surveillance and M&E resource mapping for
MoH completed
 Expanded Surveillance : 66 sites for 2003, almost twice
the number sampled in 2001 (34 sentinel surveillance
sites in 2001)
 first BSS done/report distributed nationwide (>27,000
sample)
 BBS-2 starting
After Bangkok
University Students
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2003/4 (1996 ET) M&E data collected
2 University Students/ Region plus
~2 per District (606 district)
Most regions completed
Information includes at Federal level -Sector Ministries, Bilateral, Multilateral and
NGOs
Example-Forms
D onors and others support, currently active H IV /A ID S projects/program s (Inform ation source: bilateral
and m ultilateral organizations , N G O s etc)
H IV /A ID S P roject title
P roject
duration
In fra stru c tu re in fo rm a tio n
R o a d to Z o n e to w n
A ll w e a th er a sp h a lt
A ll w e a th er g ra v e l
W in te r ro a d
T e le p h o n e
D ig ita l
M a n u a l (m e n u b e la )
T e le g ra m
E le c tric P o w e r
F ro m m a in so u rc e /h y d ra u lic
G e n era to r
P roject area
A llocated
P roject budget
utilized
B alance
N am e of im plem enting agency/agencies
M&E Operational Manual-12
modules-meeting in Nov, 2004
(>150 people)
Module 01
Education
Module 02
Drug Administration and Control Authority (DACA)
Module 03
Ethiopian Red Cross Society (ERCS)
Module 04
FMoH, RHBS, WHOs and Facilities (Health)
Module 05
Other Government Offices
Module 06
Bilateral and Multilateral Organizations
Module 07
Civil Societies (NGOs, FBOs, CBOs, POs, etc.)
Module 08
Kebele HIV/AIDS Committee??
Module 09
Woreda HIV/AIDS Committee??
Module 10
Zonal HIV/AIDS Committee??
Module 11
Regional HAPCO
Module 12
National HAPCO
OtherOpportunity/Challenge
• Ethiopia approved for the largest GF (GF2+GF4 >
$600M, PEPFAR around 50M/year)
• ~10-12% for M&E(inc. HMIS) and
Surveillance/year
• FMoH- HMIS (HMIS and M&E Advisory
Committee formed-Work stared)
• LMIS
• Lab Information system
• Patient monitoring system
• M&E National/Regional ToT training
• Training on Medical Record
The Network Model
Formal Health System Levels
Components
Tertiary Referral Hospitals ( 5)
C
O
Uniformed Services M
M
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Y
Regional / Zonal Hospital
District
Hospital
District Hospital
Health Center
Health Center
Transporters
ART
Specialty care
Acute Illness Care
HIV Counseling and Testing
Pain Management
District
Hospital
Health Center
Health Center
CSW
Health Posts
Service
HIV counseling and testing, PMTCT,
OI treatment and prophylaxis, TB dx ,
ART follow up, nutrition counseling
and support, psychosocial support [
pain management]
HEP: basic general health care
CHWs
Home based Care
Basic care, including pain and symptom
relief
New Development/Strategies
• HAPCO to Report to MoH
• Implication on M&E not clear (assumed not much
as the National M&E Framework was accepted in
SPM)
• Implication on structure not clear
• Health Extension Workers (23,000 to be deployed
in 5 years). 2005 M&E training planned
• Performance based District Block grants
Thanks!!!