The USAID Office of Health and Nutrition requested that MEASURE Evaluation archive all monitoring and evaluation (M&E) tools developed by the BASICS I (1993-99) and OMNI (1993-98) projects. These projects focused on child health and micronutrients respectively. The purpose of this activity was to preserve USAID investment in M&E tool development and make these resources available to USAID and its partners.
MEASURE Evaluation reviewed each tool in collaboration with BASICS and OMNI. Reviewers summarized a defined set of information for each tool. The summaries provide a description of the tool, including its purpose and technical focus, the indicators measured, guidance on methods used, and lessons from experience applying the tool in a developing country setting.
The compendium includes a variety of population- and facility-based assessment tools which can be used at different levels of the health system.
Many of the tools were unavailable in electronic format and had to be scanned from existing paper copies. We have made every effort to present clean and complete files, but this was not always possible. We apologize for the lack of clarity of some files. However, we felt it would be more useful to include them, than to exclude them altogether.
Tool 1: Health Centre Supervision Checklist
The Health Centre Supervision Checklist is job aid for district level
supervisors. It is a comprehensive checklist which is split into two main parts: Core Health
Facility Activities and Specialized Health Centre Activities. The checklist is comprised of 91
questions, some with multiple elements.
Tool 2: BASICS Child Mortality Survey
A mortality survey or surveillance system which identifies deaths in children
under five years (or in perinates and neonates), and then interviews relatives of the dead child
(completing a verbal and social autopsy questionnaire) to identify the cause of death and the
associated risk factors.
Tool 3: Draft Methods for Assessing the Cost-Effectiveness of Micronutrient Programs
Guidelines include step-by-step explanations, forms, worksheets and
examples on how to set study objectives, design/identify program options, calculate costs,
calculate effectiveness, develop final estimates of cost-effectiveness, and interpret the results. It
is an aid to program planning and evaluation. It is currently in draft form and needs to be revised
to capture the experience of cost-effectiveness studies carried out in Indonesia, the Philippines,
Peru, and S. Africa during 1996-1998.
Tool 4: Trials of Improved Practices (TIPS) for Evaluating Feeding Recommendations
A guide for conducting qualitative research primarily on recommended child
feeding practices. It provides the objectives, planning steps, worksheets, detailed field guidelines
for implementation, analysis plans, forms and examples to assist a team of health/nutrition
professionals and para-professionals to carry out the trials and develop feeding
recommendations.
Tool 5: Checklist for Assessing Priority Nutrition Interventions in District Health Services
A checklist of items used by district health managers to determine the extent
to which priority nutrition interventions are integrated with routine maternal/reproductive health
and child health services in facilities and at the community level. The tool is used to assist
program planning. Although the checklist was designed primarily for district health teams, it has
been used at the national level to identify areas for donor support.
Tool 6: The Urban Private Health Sector Inventory (UPSI)
The UPSI was utilized in Nigeria as a tool for determining the composition,
size and basic service capabilities of the urban private sector. Three methods were used prior to
or concurrently with the application of the inventory to identify participants for the inventory:
review of existing records and professional organization registries; interviews with key
informants in the communities; and visual surveys and rapid street assessments. The inventory
itself is composed of three questionnaires: one designed to collect information from community-based organizations, the second to collect information from private health providers and
facilities, and the third to collect information from owners of pharmacies and chemist shops.
These questionnaires collect descriptive data on the organizational and technical capabilities, as
well as the stability and potential impact, of private sector organizations and facilities. This data
can be used in project development for selecting private sector partners and target communities,
and in the development of operational frameworks for program implementation. In addition, the
data can be used as a baseline assessment of organizational and technical capabilities among
private sector providers.
Tool 7: The Polio Eradication Initiative
Guide for national and district immunization program managers to assist them
in their polio eradication efforts and improvement of routine health services, with particular
emphasis on service delivery and disease surveillance.
Tool 8: Monitoring and Supervising Immunization Services from Health Facility to
National Levels
This tool uses information collected by routine reporting for monitoring the
following: immunization coverage, contraindication rates, drop out rates, vaccine supply and
usage, the cold chain (equipment and storage temperatures), vaccine usage, and the reliability of
information reported, including population figures (denominators), and immunizations given.
Tool 9: Lot Quality Assurance Sampling Survey
The surveyed population is to be divided either geographically or
administratively into smaller "lots". In each lot the target survey "unit" should be identified; for
example, "a fully vaccinated child". Those lots with less than a pre-determined allowable
number of defective units, for example a child who is "not fully vaccinated", are considered of
acceptable quality, and those lots with more than the allowable number of defective units are
"rejected". A sample size in each "lot" is determined by the level of precision desired. The
sample size and the maximum allowable "defective units" per lot are provided in probability
standard tables. For example, a precision of 80% requires a sample of 13 units per lot and an
acceptable lot can not have more than four defective units.
Tool 10: Verbal Case Review for IMCI Clinical Practices
The Verbal Case Review (VCR) is a household survey instrument and
methodology used for assessing the quality of clinical care being provided to sick under-five
children (under five years) by the full range of practitioners and vendors who are consulted in a
target population. Households with children under five years are screened to identify those with
children who have been sick with either diarrhea, fever, or cough/respiratory symptoms during
the previous two weeks. The mothers of these children are then interviewed using the VCR
instrument which asks them to recall from whom they purchased medicines, from whom they
obtained clinical care, and the actions or behaviors of those drug sellers and practitioners
consulted for the child's illness. The WHO protocol for the Integrated Management of
Childhood Illness (IMCI) is the clinical standard from which the questions regarding clinical
quality in the interview instrument are derived. Practitioners' behaviors are compared to these
standards to determine the gap between current practices and the quality standard.
Tool 11: Preceding Birth Technique
All child health programs aim to prevent the deaths of young children.
Despite this, accurate and reliable measures of childhood deaths in developing countries are
rarely available. The preceding birth technique (PBT) is a simple and inexpensive method for
obtaining regular information on childhood mortality and monitoring changes in mortality over
time.
Tool 12: Community Assessment and Planning Process
The design of the community assessment and planning process reflects
current interest in decentralized planning for local health care, and increased community
involvement (and cost sharing) in health service delivery. It responds to a need for increased
skills and tools for local level decision making and collaborative planning.
Tool 13: Process Documentation of Community Involvement
This tool enables health care managers to undertake systematic
documentation of community involvement in maternal and child health programs
Tool 14: Integrated Health Facility Assessment
Local planning tool used to collect information on the quality of integrated
child health care at facility level.
Tool 15: Assessment of Hand Washing Behavior and Diarrheal Prevalence
The tool is a quantitative household study to assess the handwashing behavior
of children below ten years of age and mothers of children under ten. In addition, it measures the
incidence of diarrhea in children below age five. It has been utilized in a pre-test/post-test design
on a nationally representative sample of households with children under five years of age. The
main objective of the research is to understand the motivation of mothers and children to practice
correct handwashing and to assess the obstacles (i.e., personal or environmental, such as access
to clean water) to proper handwashing. Proper handwashing includes duration of washing,
washing during critical moments of contamination and technique.
Tool 16: Assessment of ORS Commercialization Interventions: Public/Private Partnerships for Child Survival
A quantitative and qualitative multi-study methodology to assess and
evaluate ORS commercialization interventions. The five parts of the tool include: 1) a
knowledge, attitudes and practices (KAP) household survey with mothers of children under five
years; 2) focus group discussions with consumers; 3) a simulated purchase study (SPS) in
pharmacies; 4) in-depth interviews with doctors and pharmacists; and 5) a partnership process
evaluation with members of an inter-agency task force consisting of international donors,
Ministry of Health officials, pharmaceutical companies, advertising agencies and project
managers.
Tool 17: National Micronutrient Survey
The instrument gathers countrywide information on the nutritional status of the population, based on anthropometric (EPM), VAD, IDA and
IDD indicators. [It covers family and individual information on women/caretakers and pre-school aged children: household sanitation; parental schooling;
marital status; work status; occupation; mother/caretaker pregnancy status; number of previous pregnancies; breast-feeding practices; use and source of iron
supplements and anti-helminthics; food items consumed in previous 24 hours; weight, height and hemoglobin; child's health status, recent morbidity, use and
source of vitamin A and iron supplements and anti-helminthics, food items consumed in previous 24 hours, weight, height and hemoglobin. Other laboratory
tests (e.g. acute phase proteins, micronutrient content of food samples) are optional. The current instrument does not include IDD information other than iodine
content of table salt from households, as VAD and IDA surveys often focus on pre-school age children and women in reproductive age whereas the target group
for IDD assessments (e.g. goiter, urinary iodine excretion) is usually the school-aged population.]
Tool 18: Assessment of Micronutrient Supplement Supply and Demand Systems
The two sets of instruments were designed to be used for systematic identification of supply and demand constraints and problems.
Tool 19: Qualitative Assessment of Feeding Practices Related to Vitamin A Deficiency and Anemia in Pregnant and Lactating Women and Children
The instruments provide specific guidelines for collection of qualitative information through in-depth interviews with pregnant and lactating
women and mothers of children under 36 months of age, and with influential persons in the community (fathers, grand-mothers with grandsons under 36
months, community health workers, traditional birth attendants, nursing aides), as well as for trials of improved practices (TIPS) with mothers on feeding
children aimed at increasing consumption of vitamin A and iron rich foods.
Tool 20: Knowledge, Attitudes and Practices (KAP) on Anemia in Pregnant Women
The tool and manual guide data collection from pregnant women and their partners, mothers, local health care personnel and influential
community members. Data are gathered on knowledge, attitudes and practices related to anemia and iron/folate supplementation. Trained interviewers conduct
in-depth interviews, focus group discussions and implement iron/folate supplementation trials (TIPs).
Tool 21: Food Fortification Quality Control and Monitoring System
The four sets of instruments and their accompanying manuals are designed to
be used by fortified staple food producers and government units responsible for food control to
establish and maintain effective QA/QC and monitoring systems for fortified staple foods.
Tool 22: Baseline for Monitoring and Evaluation of a Micronutrient IEC Program
The instrument is used prior to initiating IEC programs to collect semi-quantitative information on knowledge, attitudes and practices on
vitamin A and iron. Data are used as a baseline for subsequent program monitoring and evaluation.
Tool 23: Iodized Salt Program Assessment Tool (ISPAT)
The process and tool are designed to be used by a team composed of members
from the national program and technical support agencies, together with external experts, to
assess an array of program elements to evaluate program effectiveness and sustainability. It
gathers and analyzes information on the product (salt), the process (policy, advocacy, program
implementation, monitoring), and the progress made (coverage, impact) in achieving program
goals.
Tool 24: Community Risk Assessment of Vitamin A Deficiency
The Food Frequency Manual forms the second of a two-part series on assessment. (Part One is: Conducting a Qualitative Assessment of
Vitamin A Deficiency: A Field Guide for Program Managers.) The Food Frequency Manual describes the steps for using the HKI Food Frequency Method for
three purposes: to identify communities where vitamin A deficiency is a problem of public health importance; to provide baseline and end-line data which can
be used to evaluate changes in frequency of intake of vitamin A-rich foods as a result of project interventions in communities; and to provide guidance on
discontinuing mass distribution of high dose vitamin A supplements when vitamin A consumption in the community may be sufficient.