MONITORING MONITORING AND EVALUATION

[M&E]

 Systematic collection, analysis, and use of information from programs

for 3 basic purposes:  A robust M&E system is required to assess the effect of integrated
service delivery
 Learning from the experiences acquired

Appropriate Support Decision-making

 Accounting internally and externally for the resources used Indicators
 Thelearning
results function
obtained and taking decisions Successful
Data Collection Help Guide implementation of
monitoring function steering function System integrated services

Data Analysis Effect on both

Measures service delivery
and use of services
EVALUATION

 Assessing an ongoing or completed program or policy as systematically M&E FRAMEWORK

and as objectively as possible
 The object is to be able to make statements about their:  M&E is a core component of current efforts to scale up for better
health.
 Relevance  Global partners and countries have developed a general framework for
 Effectiveness – accomplished purpose M&E of health system strengthening (HSS)
 Efficiency – small amount of intervention
 Impact M&E PLAN
 Sustainability
 An M&E plan:
 Has both:
 Addresses the components of the framework
 Learning Function – the lessons learned need to be incorporated  Establishes the foundation for regular reviews
into future proposals or policy
 Monitoring Function – partners and members review the during the implementation of
implementation of policy based on objectives and resources the plan for the national level.
mobilized

Lesson 6: HMIS Monitoring and Evaluation

 WHO FRAMEWORK FOR MONITORING AND EVALUATION OF HEALATH SYSTEMS REFORM/ STRENGTHENING
INPUT & PROCESSES OUTPUTS OUTCOMES IMPACT
Infrastructure; Infromation & Improved Health Outcomes &
Communication Technologies Intervention Access & Service Equity

Governance

Financing
Coverage of Interventions
INDICATOR Readiness Social and Financial Risk
Health Workforce
DOMAINS Protectioin
Supply Chain Prevalance Risk Behaviors & Responsiveness
Intervention Quality, Safety
Information Factors Efficiency
Population-Based Surveys
Administrative Resources Facility Assessments
Coverage, Health Status, Equity, Risk Protection, Responsiveness
DATA COLLECTION Financial Tracking Systems; NHA Database Clinical Reporting Systems
and Records; HR, Infrastructure, Medicines, Service Readiness, Quality, Coverage, Health Status
etc. Policy Data Civil Registration
ANALYSIS & Data Quality Asssessment; Estimates and Projections; In-depth Studies; Use of Research Results; Assessment of Progress and Perforance
SYNTHESIS and Efficiency of Health Systems
COMMUNICATION
Targeted and Comprehensive Reporting; Regular Countrry Review Processes; Global Reporting
& USE

 For Monitoring Medical Services: indicators should be tracked to assess processes and results associated with the various indicator domains.
 Monitoring these indicators provides information on the strengths and weaknesses of implementation; and can help to identify “Red Flags” where
further investigations and adjustments may be needed.

Problem:
 Stop
 Analyze
 Take Action

Lesson 6: HMIS Monitoring and Evaluation

 THE WHO’S M&E OF HEALTH SYSTEMS STRENGTHENING FRAMEWORK
Presents Indicator Domains and Considerations for Data Collection, Synthesis and Use Along The Pathway for Achieving Health Impact at Scale

INPUTS PROCESSES OUTPUTS OUTCOMES IMPACT

Funding National Plan Implementation Improved Survival

Governance, HR, Medial Protocols,

Health System Strengthened
Increased Service Utlization Child mortality, Maternal

Access, Safety, Quality, Efficiency

Domestic Sources, International Systems Strengthening, Priority
and Intervention Coverage Mortality, Adult Mortality due
Sources Interventions Scale-up
to Infectious Diseases

Improved Services
Information
Plan Capacity Building Reduced Inequality (e.g. Improved Nutrition
Coherent, Prioritized and Programmes, Insituttions, gender, socio-economic, Children, Pregnant Women
Funded People position ) Reduced Morbidity
Harmonication Accountability Responsiveness HIV, TB, Malaria, RH
Performance Monitoring Improved Equity
Aligned International Efforts
No Drop-Off Non-Health Sector Social and Financial Risk
with National Plan. Well Results Focus and Evaluation
Interventions (e.g. water & Protection
Coordinated and Harmonized
sanitation) Reduced impoverishment due
Support Use for Better Practices  to health expenditures
KEY PERFORMANCE AREA KEY INDICATOR
1. Family Planning Acceptance Rate
Health-system
Aid Process Monitoring; 2. Antenatal Care Coverage Coverage Monitoring Impact Monitoring
Implementation
Reproductive Health Monitoring Monitoring
Resource Tracking 3. Proportion of Deliveries Attended by Skilled Health Personnel M&E ACTIONS
Strengthen Country Health Information System
4. Proportion of Deliveries Attended by HEWs
Evaluation: Process, Health-system strengthening, Impact
5. DPT-3 (Pentavalent-3) Coverage (> 1 Child)
Immunization
6. Measle Immunication Coverage (> 1 Child)
M&E AND HMIS INDICATORS
Table 7.1 7. Malaria Case Fertility Rate Among Patients under 5 Years of Age Categories of
HMIS Key 8. New Malaria Cases per 1,000 Population Indicators
Source: HMIS 9. New Pneumonia Cases Among Children Under 5 per 1,000 Population of <5 yrs Information use
Training Manual Disease Prevention and 10. TB Case Detection Rate (USAID, 2013)
Control 11. TB Cure Rate
12.Client Receiving VCT Services
13. PMTCT Treatment Completion Rate
14. PLWHA Currently on ART
15. Trace Drug Availabilty (in-stock)
16. OPD Attendance per Capita
Resource Utilizaiton
17. In-Patient Admission Rate
18. Average Length of Stay (in-patient)
Lesson 6: HMIS Monitoring and Evaluation 19. Bed Occupancy Rate
Data Quality 20. Reporting Competence Rate
21. Reporting Timeliness Rate
*Table 7.2 Quantitative Indicators for Monitoring Family Planning/ Immunization Integration [see presentation]

HMIS INDICATORS AND HEALTH PROGRAMS

 HMIS indicators  should be carefully selected to meet the essential THE MATERNAL SURVIVAL STRATEGY AND HMIS INDICATORS
information necessary for monitoring and performance of various (Campbell and Graham, 2006)
health programs and services and to present an overview of available
health resources.
 Lays down a framework for achieving the fifth Millennium
 Maternal Survival Intervention Development Goal of reducing maternal mortality
 Child Mortality and Child Survival Interventions
 STOP TB Program
 1st Antenatal Care Attendances
 4th Antenatal Care Attendances
Lesson 6: HMIS Monitoring and Evaluation
  Cases of Abnormal Pregnancies Attended at Out-Patient
departments (OPD) of Health Facilities
 Institutional Cases of Maternal Morbidity and Mortality due to
Antepartum Hemorrhage (APH), Hypertension, and Edema reported
by In-Patient Departments (IPD) of health facilities
 Cases of Abortion Attended at Health Facilities
 Cases of Medical (safe) Abortions Conducted at Health Facilities.
 HMIS INDICATORS RELATED TO INTRAPARTUM CARE:
 Deliveries by Skilled Attendance (at health facilities)
 Deliveries by Health Extension Workers (HEW) (at home of Health
Posts)
 Institutional cases of maternal morbidity and mortality due to
obstructed labor
 However, under-5 mortalities still remain high at 106 per 1000 live
births (LB) in 2010
 The country faces the challenge of reducing it to 61/1000 LB by 2015
 The EDHS 2011 estimated under5 mortalities to be 88 per 1000 LB that
is a 47% decline from 166/1000 LB in 2000
 Diarrhea, pneumonia, measles, malaria, HIV/AIDs, birth asphyxia,
preterm delivery, neonatal tetanus, and neonatal sepsis are the major
causes of under-5 deaths in Ethiopia, with under-nutrition attributing to
over one third of these deaths.
*Causes of under-five deaths [see presentation]
*Under-five Causes of Deaths and Mortality Rate [see
presentation]

 HMIS INDICATORS RELATED TO POST-PARTUM CARE:

 1st Postnatal Care Attendance

 Institutional cases of maternal morbidity and mortality due to
Postpartum Hemorrhage (PPH) and Puerperal Sepsis.

 HMIS INDICATORS RELATED TO INTER-PARTUM CARE:

 Between Pregnancies
 Family Planning Methods Acceptors (new & repeat)
 Family Planning Methods Issued by Type of Method

*Maternal Survival Strategies [see presentation]

THE CHILD MORTALITY AND CHILD SURVIVAL INTERBENTIONS

 Ethiopia is one of those countries who have made great strides towards
reducing the under-5 mortalities
Lesson 6: HMIS Monitoring
Ethiopia andChild
Maternal and Evaluation
Health Data (2012)