Publications

Title Author Year Language Regions Keywords Abstract
East African Community Digital Health and Interoperability Assessments: The United Republic of Tanzania MEASURE Evaluation 2020 English Tanzania, EHealth, Zanzibar, HIS, Digital Health, Health Information Systems, Interoperability, Assessment This report is a summary of the East African Community (EAC) Digital Health and Interoperability Assessment that was conducted in The United Republic of Tanzania. The assessment was implemented separately in the Mainland of Tanzania and the semi-autonomous state of Zanzibar. After a background section about the EAC and the Digital Regional East African Community Health (Digital REACH) Initiative, the report is divided into two chapters that further describe the background, methods, results, and recommendations for Tanzania and Zanzibar.
East African Community Digital Health and Interoperability Assessments Results at a Glance: Zanzibar MEASURE Evaluation 2020 English Health Information Systems, EHealth, HIS, Digital Health, Assessment, Intervention, Zanzibar The East African Community (EAC), a regional intergovernmental organization of six partner states, has worked for the past decade to improve the efficacy and efficiency of health services in member countries, with a focus on strengthening digital health (also known as eHealth). The EAC has committed to supporting regional actions to strengthen the enabling environment for effective digital health information systems (HIS). In 2018, the EAC commissioned an assessment of the status of eHealth and the interoperability of its components across member states under the oversight of the EAC’s East African Science and Technology Commission. In 2019, the Ministry of Health, Community Development, Gender, Elderly, and Children (MOHCDGEC) of Tanzania, the President’s Office of Regional Administration and Local Government (PORALG), and the Ministry of Health of Zanzibar partnered with MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID)—to assess the interoperability and readiness of the United Republic of Tanzania’s HIS as part of this regional assessment. This brief highlights the results of this assessment for the semi-autonomous state of Zanzibar.
East African Community Digital Health and Interoperability Assessments Results at a Glance: Tanzania MEASURE Evaluation 2020 English Digital Health, EHealth, Health Information Systems, HIS, Tanzania, Interoperability, Assessment The East African Community (EAC), a regional intergovernmental organization of six partner states, has worked for the past decade to improve the efficacy and efficiency of health services in member countries, with a focus on strengthening digital health (also known as eHealth). The EAC has committed to supporting regional actions to strengthen the enabling environment for effective digital health information systems (HIS). In 2018, the EAC commissioned an assessment of the status of eHealth and the interoperability of its components across member states under the oversight of the EAC’s East African Science and Technology Commission. In 2019, the Ministry of Health, Community Development, Gender, Elderly, and Children (MOHCDGEC) of Tanzania, the President’s Office of Regional Administration and Local Government (PORALG), and the Ministry of Health of Zanzibar partnered with MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID)—to assess the interoperability and readiness of the United Republic of Tanzania’s HIS as part of this regional assessment. This brief highlights the results of this assessment for Mainland Tanzania.
Linking Data from Demographic and Agricultural Surveys to Examine the Drivers of Stunting and Wasting in Nigeria: Lessons Learned Emily H. Weaver, Siân Curtis, John Spencer, Gustavo Angeles 2020 English Nigeria, Data Science, Children, Child health, Population, Data, LMICs, Nutrition Stunting and wasting are still global issues, with an estimated 149 million children under five with stunted growth and 49 million children under five suffering from wasting worldwide. Wasting and stunting can have severe health effects on children and are therefore a major health concern for most low-middle income countries where stunting and wasting rates are highest (UNICEF/WHO/World Bank Group, 2019). Both stunting and wasting share underlying risk factors that derive from several different levels of influence. Existing studies focus on demographic and health indicators, such as those that are available in the Demographic and Health Surveys (DHS). However, additional influences on these outcomes are also agricultural and community-level indicators that are not included in conventional demographic and health surveys. Studies are needed to trial the linking of these data and to provide lessons learned for others seeking to do the same. The increased availability of data from multiple sources in low- and middle-income countries in recent years, combined with advances in data science, have stimulated an increased interest in using existing data in innovative ways to bring new insights to population, health, and nutrition problems. MEASURE Evaluation was contracted to do just that—to conduct an analysis of publicly available secondary data using innovative linking methods to better understand a broader range of drivers of wasting and stunting, particularly in contexts with stagnant or increasing wasting levels and decreasing stunting trends. The study links data from the Nigeria DHS (NDHS) with a Living Standards Measurement Survey Integrated Survey on Agriculture (LSMS-ISA) that contains agricultural and community information. This study also sought to use machine learning to identify additional or unique patterns of indicators that influence stunting and wasting. Neither of these two methods are prevalent in current research; therefore, these analyses also serve as proof of concept for these two approaches and provide lessons learned for future research.
Cross-Border Health Integrated Partnership Project Performance and Costing Evaluation Markiewicz, M., Weaver, E., Morris, L., & Xiong, K. 2020 English HIV, Scale-up, HIV prevention, Evaluation, Costing, AIDS East Africa and Southern Africa are the two regions most affected by the HIV/AIDS epidemic worldwide. East Africa alone is home to more than six million people living with HIV/AIDS. People whose occupations require travel, such as truckers and fisherfolk, are a priority population with heightened risk for HIV. Many of the people who inhabit areas regularly visited by mobile populations are also part of this priority population. The Cross-Border Health Integrated Partnership Project (CB-HIPP) worked from 2014–2019 to extend high-quality integrated health services to cross-border and mobile populations in strategic border areas and waterways in East Africa. As stakeholders consider a transition plan for CB-HIPP project activities, the United States Agency for International Development (USAID) East Africa Mission contracted with MEASURE Evaluation, which is funded by USAID and the United States President’s Emergency Plan for AIDS Relief, to conduct a performance evaluation of CB-HIPP and to assess the cost of CB-HIPP programmatic scale-up. The performance evaluation gathered information about each component of the program’s Standard Package of activities, and the cost assessment developed a model to project the price of various scale-up scenarios. Results indicate that the CB-HIPP model worked well to extend services to cross-border and mobile populations. Stakeholders were satisfied with the program and expressed interest in extending the reach and scope of the activity. The estimated cost of scaling up the program to six to ten additional sites ranges from $1.3–2.6 million per year. Costs vary based on the number of sites and type of implementing partner selected. At a dissemination meeting in February 2020, stakeholders discussed recommendations regarding the following topics: several operational modifications to the program, programmatic expansion, support for the continued development of the interoperable digital HMIS and portable insurance scheme, and work with stakeholders to build consensus on who will lead policy advocacy moving forward.
East African Community Digital Health and Interoperability Assessments: Rwanda MEASURE Evaluation 2020 English RWANDA Interoperability, eHealth, EAC, HIS, Health Information Systems, Rwanda The regional health program of USAID/Kenya and the USAID East Africa Mission, in coordination with the USAID Global Health Bureau, United States Global Development Lab, and USAID Bureau for Africa, engaged MEASURE Evaluation to provide technical support to EASTECO to conduct an EAC regional digital health readiness assessment, incorporating aspects of systems interoperability and the cost of investing in eHealth in the EAC region. The assessment will be conducted in four EAC Member States (Kenya, Rwanda, the United Republic of Tanzania, and Uganda). This report presents the results of the Rwanda assessment, which had two objectives: · Review the status of digital health and HIS interoperability in Rwanda by assessing the processes, structures, and capacities needed to support the enabling environment for digital health and interoperability in the country. · Using the Rwandan assessment results, contribute to the assessment of the regional landscape for digital health and interoperability in the EAC to inform a regional analysis of and recommendations for moving digital health forward in the EAC. Access the related Health Information Systems Interoperability Toolkit.
East African Community Digital Health and Interoperability Assessments Results at a Glance: Rwanda MEASURE Evaluation 2020 English RWANDA EAC, Interoperability, Rwanda, Health information systems, eHealth, HIS Over the past decade, the East African Community (EAC) has prioritized digital health by committing to regional actions to strengthen the enabling environment for health services. In 2019, the Ministry of Health (MOH) of Rwanda partnered with MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID)—to conduct an interoperability readiness assessment of the Rwandan health information system (HIS). This was part of a broader EAC-commissioned regional assessment carried out with oversight by the EAC’s East African Science and Technology Commission to understand the status of eHealth and interoperability in each of its member states. This brief provides an overview of the results.
How to Include Laboratories in a Master Facility List: Preliminary Guidance MEASURE Evaluation 2020 English Health data, Health Facilities, Master facility list, MFL A Master Facility List (MFL) is an authoritative, up-to-date list of all health facilities in a country. The original version of the MFL Resource Package was published by the World Health Organization (WHO) in January 2018 to guide country governments and other stakeholders through the key decisions in planning, establishing, maintaining, and sharing an MFL. This document is intended to be a supplement to the MFL Resource Package to provide additional guidance on incorporating laboratories into an MFL.
East African Community Digital Health and Interoperability Assessments Results at a Glance: Kenya MEASURE Evaluation 2020 English Over the past decade, the East African Community (EAC) has prioritized digital health by committing to regional actions to strengthen the enabling environment for health services. In 2019, the Ministry of Health (MOH) of Kenya partnered with MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID)—to conduct an interoperability readiness assessment of the Kenyan health information system (HIS). This was part of a broader EAC-commissioned regional assessment carried out with oversight by the EAC’s East African Science and Technology Commission to understand the status of eHealth and interoperability in each of its member states. This brief provides an overview of the results.
Report on the Review of Sierra Leone’s National Malaria Monitoring and Evaluation Plan 2016–2020: Addendum to the Malaria Programme Review MEASURE Evaluation 2020 English Malaria Control, Monitoring, Sierra Leone, Malaria, Evaluation The Sierra Leone Ministry of Health and Sanitation’s National Malaria Control Programme (NMCP) developed and launched the Sierra Leone Malaria Strategic Plan (SLMSP) 2016–2020, which was based on recommendations from the malaria program review (MPR) 2013, the recognition of the impact of malaria interventions, and the Sierra Leone Health Sector Recovery Plan 2015–2020. The SLMSP has guided the implementation of key malaria interventions as Sierra Leone continues to strengthen the country’s effort in the fight against malaria.The SLMSP follows the guiding principles of the broader National Health Sector Strategic Plan 2010–2015, the Sierra Leone Health Recovery Plan 2015–2020, the National Ebola Strategy for Sierra Leone 2015–2017, and the Basic Package of Essential Health Services 2010 (revised 2015). Among these principles are universal coverage with proven malaria interventions; equity, equality, and nondiscrimination; participation and accountability; and the right to the health elements of availability, accessibility, acceptability, adequacy, quality, and contiguous expansion of interventions.The national malaria monitoring and evaluation (M&E) plan 2016–2020 was developed alongside the SLMSP. The malaria M&E plan 2016–2020 is aligned to the SLMSP 2016–2020 and contains priority indicators that the NMCP uses to monitor and evaluate the implementation of the intervention strategies and track the performance of the malaria program.The objectives of the M&E plan review were as follows: To review the existing malaria M&E plan 2016–2020 To provide recommendations for developing a well-aligned comprehensive national M&E plan in preparation for the national malaria strategy 2021–2025 To build consensus on the understanding of a specific, measurable, relevant, attainable, and time-based (“SMART”) and actionable malaria M&E plan To contribute to the MPR
Cadre d’évaluation des programmes nationaux de lutte contre le paludisme dans les zones de transmission modérée et faible Groupe de travail sur l’évaluation du Groupe de référence pour le suivi et l’évaluation de Roll Back Malaria 2020 French Global Malaria control, Evaluation, Malaria Le cadre d'évaluation présenté dans ce document a l'intention de s'appuyer sur les travaux existants du Groupe de référence pour le suivi et l'évaluation de la gestion axée sur les résultats, en l'étendant pour aborder les paramètres le long du continuum de la transmission du paludisme, en mettant l'accent sur les paramètres de transmission modérée et faible. Ce cadre souligne également l'importance de l'évaluation des processus pour l'évaluation de l'impact, en reliant les processus de mise en œuvre à la force de la mise en œuvre pour ensuite démontrer l'impact du programme sur la transmission, la morbidité ou la mortalité du paludisme. Accédez au Framework for Evaluating National Malaria Programs in Moderate and Low Transmission Settings: Aide Memoire.
Assessment Tool for Electronic Health Record Security: Guidance for Low-Resource Settings MEASURE Evaluation 2020 English EHR, Health data, Electronic Health Records, Information System The Assessment Tool for Electronic Health Record Security: Guidance for Low-Resource Settings was developed to help ministries of health, implementing partners, software developers, donors, and other stakeholders examine the security of electronic health record (EHR) systems. Designed using internationally accepted best practices, the assessment approach is tailored to the needs of low-resource settings. The guidance takes into consideration typical EHR implementation scenarios, such as a single instance of an EHR being used for retrospective data entry, while also allowing users to continue to assess security as their EHR systems mature to interconnected point-of-care systems. This document provides instructions on the use of several tools to assess EHR system privacy and security and for instituting continuous monitoring of EHR privacy and security.
Standard Operating Procedures for a Secure Electronic Health Record in Low-Resource Settings MEASURE Evaluation 2020 English Electronic Health Records, EHR, Information system These standard operating procedures have the following objectives: Provide guidance for implementing security safeguards for an electronic health record (EHR) in a low-resource country using current best practices tailored for low-resource settings. Incorporate best practices based on National Institute of Standards and Technology Special Publication 800, International Organization for Standardization 27001, the Office of the National Coordinator Security Risk Assessment Tool, and other international privacy and security standards. Understand common threats to security that must be regularly assessed. Safeguarding an EHR to maximize privacy, confidentiality, and security while ensuring that the system data are accessible to users is critical to EHR adoption and acceptance as well as respecting the rights of patients to private and confidential treatment. EHR implementers should take advantage of safeguards built into software and operating systems that enhance privacy and security. In addition, policies and procedures should be in place that promote a culture of information and system security awareness and respect for privacy. Best practices around privacy and security for information systems are widely available, but often they do not account for the availability of resources, such as human resource capacity and Internet connectivity. This job aid has been curated to highlight critical privacy and security safeguards based on international best practices while taking into account EHR implementation scenarios commonly practiced in low-resource settings. 
Evaluation de la performance de la gestion du système d’information sanitaire de routine du Burkina Faso Kebe, M.R., Ouangaré, A., Tohouri, R.R., Kouassi, C., Barry, M.A., Chauffour, J., Sawadogo, I., & Ilboudo, F. 2020 French Burkina Faso, Routine Health Information Systems, Information systems, PRISM, Performance of Routine Information System Management, Health Information Systems Au Burkina Faso, de nombreux efforts de modernisation du système national d’information sanitaire ont été mis en œuvre pour répondre à la nécessité de disposer d’une information sanitaire de qualité. Ces initiatives font du Burkina Faso l’un des premiers pays d'Afrique de l'Ouest à disposer à l’échelle nationale depuis 2013, d’un système de gestion électronique des données sanitaires de routine basé sur le logiciel DHIS2 intégrant la plupart des programmes de santé. Des documents d’orientation sur des normes et procédures de gestion de l’information sanitaire ont également été élaborés et vulgarisés permettant ainsi de répondre aux exigences de qualité requises en vue de rendre plus performant le système de santé. Malgré ces efforts, le manque de données de base pour surveiller les performances du système d’information sanitaire de routine (SISR) reste encore non résolu. En outre, de nombreux programmes et projets de santé verticaux existent avec leurs propres systèmes d’information, au détriment d’un système de gestion intégré national. Dans le cadre de l'initiative mondiale de la santé unique, le Ministère de la Santé à travers la Direction des Statistiques Sectorielles avec le soutien technique et financier de l’USAID à travers le projet MEASURE Evaluation, a conduit une évaluation du SISR en utilisant la méthode et les outils PRISM (Performance of Routine Information System Management) développés par MEASURE Evaluation, afin d'évaluer les progrès et l'efficacité des interventions de renforcement du SISR. Cette évaluation contribuera à établir une base de référence permettant de mesurer dans le futur l’évolution de la performance du SISR. Un poster résumant cette évaluation est disponible au lien suivant : https://www.measureevaluation.org/resources/publications/gr-19-101-fr/ Les outils PRISM développés par MEASURE Evaluation sont disponibles au lien suivant : https://www.measureevaluation.org/prism English Many efforts aimed at modernizing Burkina Faso’s national health information system have been implemented to respond to the need for high-quality health data. These initiatives have made Burkina Faso one of the first West African countries to have an electronic health management information system (HMIS) set-up nationwide since 2013. This DHIS2-based system integrates most of the health programs’ data. National guidelines, norms, and procedures to manage health data have been developed and disseminated to respond to data quality improvement needs in hopes of strengthening the overall health system. Despite these efforts, the lack of baseline data to monitor routine health information system (RHIS) data remains unsolved. Furthermore, many vertical health programs and projects operate their own health information system, to the detriment of an integrated national HMIS. In the context of the Global Health Security Agenda, the Ministry of Health and its Directorate for Sectoral Statistics, with financial and technical support from USAID through the MEASURE Evaluation project, conducted a Performance of Routine Information System Management (PRISM) assessment using the PRISM Tools developed by MEASURE Evaluation. This assessment aimed to evaluate the progress and the effectiveness of RHIS-strengthening interventions, and will contribute to establishing a baseline reference allowing future evaluations to measure the progress of the RHIS’ performance. An English-language poster summarizing this assessment is available at https://www.measureevaluation.org/resources/publications/gr-19-101 The PRISM tools developed by MEASURE Evaluation are available at https://www.measureevaluation.org/prism
Evaluation de la performance de la gestion du système d’information sanitaire de routine (PRISM) au Burkina Faso (2018) Mohamed Rahim Kebe, MD, MPH, MBA; Cyrille Kouassi; Issaka Sawadogo; Romain-Rolland Tohouri, MD, MSc; Jeanne Chauffour, MSc 2020 French Performance of Routine Information System Management, Information System, Evaluation, Burkina Faso, PRISM Une évaluation de la performance de la gestion du système d'information sanitaire de routine (SISR) a été menée en 2018 avec les outils PRISM récemment révisés par le projet MEASURE Evaluation, financé par l'Agence des Etats-Unis pour le développement international (USAID). L'évaluation a inclus 64 formations sanitaire, cinq hôpitaux, quatre districts, une direction régionale de la santé et le niveau central représenté par la Direction des Statistiques Sectorielles (DSS). Le Burkina Faso a un SISR qui porte le nom d’ENDOS basé sur le District Health Information Software, version 2 (DHIS2). Il intègre les données provenant de tous les niveaux de la pyramide sanitaire et appuie la saisie, l'analyse et l'interprétation des données. ENDOS intègre aussi des indicateurs de qualité des données. D'après les résultats du PRISM de 2018, les efforts de renforcement du SISR devraient se focaliser sur les visites de supervision à la fois régulières et systématiques à tous les niveaux du système sanitaire, accompagné d'un développement consensuel de rapports et de plans pour le suivi et la mise en œuvre des recommandations. Mettre en place une culture de l'utilisation des données est d'une importance primordiale. Chaque niveau du système sanitaire devrait être encouragé de produire des rapports périodiques ou des bulletins de rétro-informations, et les procédures opérationnelles standards et les tâches de saisie des données devraient être étendues aux points de prestation de services.  Le rapport complet de l'évaluation PRISM menée au Burkina Faso est disponible au lien suivant: https://www.measureevaluation.org/resources/publications/tr-20-420-fr La version anglaise de ce poster est diponible au lien suivant: https://www.measureevaluation.org/resources/publications/gr-19-101
La plateforme électronique « One Health » du Burkina Faso Mohamed Rahim Kebe, MD, MPH, MBA; Cyrille Kouassi; Issaka Sawadogo; Romain-Rolland Tohouri, MD, MSc; Jeanne Chauffour, MSc 2020 French Information System, One Health, Global health security, DHIS 2, Burkina Faso, Zoonotic MEASURE Evaluation—financé par l’Agence des Etats-Unis pour le développement international (USAID)—a débuté sous le Global Health Security Agenda au Burkina Faso en mars 2018. La priorité de l’USAID étant le renforcement de l'approche “une seule santé”, le projet a entrepris de renforcer les systèmes de surveillance épidémiologique du Ministère de la Santé (MS) pour la santé humaine, du Ministère des Ressources Animales et Halieutiques (MRAH) pour les animaux d'élevage et du Ministère de l'Environnement (MEEVCC) pour la vie sauvage à travers le développement et la mise en œuvre de plateformes de surveillance électroniques des maladies zoonotiques basées sur le logiciel DHIS2 (District Health Information Software, version 2). Il en a découlé une coalition multisectorielle et la plateforme électronique One Health, qui fournit des données en temps réel sur les évènements inhabituels et cas suspects aux directions centrales, aux laboratoires et au Centre des Opérations de Réponses aux Urgences Sanitaires (CORUS). Le comité national One Health assure le pilotage de la plateforme électronique. De plus, le système électronique de gestion de l'information sanitaire au Burkina Faso—ENDOS— est intégré avec la plateforme One Health. Les zones d'intervention du projet MEASURE Evaluation sont les régions du Centre-Sud et du Plateau Central, où les agents des trois ministères ont été formés sur l'utilisation de la plateforme électronique One Health et sont capables d'effectuer la remontée des information en temps réel. Depuis mars 2020, cette plateforme joue un rôle essentiel dans la lutte contre et la réponse à l'épidémie de COVID-19. Le rapport sur l'architecture d'entreprise "une seule santé" du Burkina Faso est accessible au lien suivant: https://www.measureevaluation.org/resources/publications/tr-20-406-fr/ Le manuel des procédures de gestion de l'information sanitaire "One Health" au Burkina Faso est accessible au lien suivant: https://www.measureevaluation.org/resources/publications/tr-20-416-fr  La version anglaise de ce poster est diponible au lien suivant: https://www.measureevaluation.org/resources/publications/gr-19-100
Standard Operating Procedures for the Health Management Information System: Data Management Procedures Manual I MEASURE Evaluation 2020 English Africa, SIERRA LEONE Information System, Data, Health data, Sierra Leone, HMIS A health management information system (HMIS) is a routine, integrated system for the collection, collation, analysis, presentation, dissemination, and use of relevant health‐related information. It covers other health information system (HIS) sub‐systems, such as the human resources information system, administrative records, integrated disease surveillance and response, the logistics management information system, registration of births and deaths, population‐based information systems, and research‑generated health information. It is designed for use at the community and health facility levels, and by district health management teams, local councils, civil society organizations, partners, and the Ministry of Health and Sanitation (MOHS) for planning, allocating resources, and managing and evaluating the healthcare delivery system. The Data Management Procedures Manual, within the context of the HIS, is a written description of the management practices required for effective coordination, monitoring, and supervision of the HIS, as well as the procedures required to address issues relating to data collection, quality, and accessibility. The Data Management Procedures Manual should therefore accurately reflect good information management practices, be sufficiently practical, and be usable in the HIS sub‐system. Good HIS management practices relate to general aspects of HIS management functions, including the following: data collection, compilation, analysis, storage, and processing; records storage; handling of urgent data requests and needs; and management of the devices, tools, and appliances used to manage the data. The goal of the Standard Operating Procedures for HMIS: Data Management Procedures Manual is to provide a standardized system of data management practices for the MOHS and its partners, with the view of reaching maximum data accuracy, correctness, completeness, integrity, and reproducibility in the HMIS in Sierra Leone. The application of the Data Management Procedures Manual requires effective coordination and oversight at all levels. Access the related Standard Operating Procedures for the Health Facility Registers and Summary Forms: Data Management Procedures Manual II.
Standard Operating Procedures for the Health Facility Registers and Summary Forms: Data Management Procedures Manual II MEASURE Evaluation 2020 English Africa, SIERRA LEONE Information System, Data, Health data, Sierra Leone, HMIS The purpose of these standard operating procedures (SOPs) is to provide guidance in filling health facility registers and summary forms at the health facility level. These SOPs are an additional document to the Standard Operating Procedures for the Health Management Information System: Data Management Procedures Manual I. 
A Compendium of the Kenya Malaria Programme Review 2018 Kenya Ministry of Health 2020 English Kenya, Malaria Kenya conducted a malaria programme review (MPR) at the end of the Kenya Malaria Strategy (KMS) 2009–2018 (revised 2014). The MPR was conducted to assess the progress made during the implementation of the KMS 2009–2018. Recommendations and findings of the MPR informed the development of the KMS 2019–2023. The MPR consisted of nine thematic area reviews formed along the key strategic and intervention areas of the KMS 2009–2018. The thematic area reviews were evidence-based assessments of progress made against the KMS objectives and strategies. This compendium contains 10 separate reports developed as part of the MPR. Chapter 1 contains the report detailing the process for conducting the MPR and the nine thematic reviews. Chapters 2–10 provide the nine thematic reports, covering these areas: programme management; finance; procurement and supply management (PSM); vector control; malaria in pregnancy; case management; advocacy, communication, and social mobilisation (ACMS); epidemic preparedness and response (EPR); and surveillance, monitoring, evaluation, and operational research (SMEOR). These thematic reviews provided the information used to develop the main findings and recommendations of the MPR.
Open Client Registry: Final Deliverables MEASURE Evaluation 2020 English Electronic Health Records, Data, Information System, Client Registry, Digital Health With support from the United States Agency for International Development (USAID), through MEASURE Evaluation, IntraHealth International developed a prototypical client registry (CR) informed by stakeholders in Uganda, including the Ministry of Health (MOH) and the Central Public Health Laboratory (CPHL), as well as technical teams at the United States Centers for Disease Control and Prevention (CDC) and USAID. OpenCR is an open source and standards-based client registry. A client registry facilitates the exchange of patient information between disparate systems and holds patient identifiers and a subset of patient demographic information. It is a necessary tool for public health to help manage patients, monitor outcomes, and conduct case-based surveillance. This document provides an overview of the project and the deliverables.
Quality of Tuberculosis Services Assessment: Global Tools MEASURE Evaluation 2020 English TB, Tuberculosis, QTSA, Tools The Quality of Tuberculosis Services Assessment (QTSA) is conducted with the support of four tools: the Facility Audit, the Provider Interview, the Patient Interview, and the Register Review. MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID)—developed these four tools with the assistance of colleagues at USAID. These tools exist in a generic format that demonstrates the content and topics covered in the QTSA. They are not meant to be used without proper adaptation by a country. For instance, some countries may have different names for their health administrative units (e.g., district, province, ward, or woreda) or the name of their tuberculosis (TB) registers (e.g., TB patient logbook, TB confirmed cases register). The tools must be customized to fit the country priorities and context in which they will be used. Note that these tools were designed to be administered electronically and may need to be restructured if used in hard copy format. This document presents detailed information about the structure and content of the tools. It also includes a generic version of all the associated consent and assent forms needed.     More information on the QTSA purpose, methods, and steps for implementation can be found in the QTSA Global Implementation Guide: https://www.measureevaluation.org/resources/publications/ms-19-170/ MEASURE Evaluation also adapted the QTSA tools for use in several country assessments. These examples are available here: https://www.measureevaluation.org/our-work/tuberculosis/quality-of-tb-services-assessments
Manuel des procédures de gestion de l’information sanitaire « One-Health » au Burkina Faso MEASURE Evaluation 2020 French HIS, Burkina Faso, Health Information Systems, One Health, Health data Ce manuel de procédures représente le document de référence principal pour le système d'information sanitaire One-Health (SIS-OH) et formalise les principales procédures de gestion des données. Ce manuel est destiné aux directions centrales des trois Ministères du Burkina Faso impliqués dans l’approche One-Health (« une seule santé »), aux coordinateurs des programmes de surveillance des maladies humaines et zoonotiques et aux partenaires. Ce manuel décrit le SIS-OH, indique l'objectif de la collecte de données, la structure du SIS-OH, le circuit de l'information et également le concept de cycle de données et aussi explique la fréquence à laquelle les rapports doivent être établis, pour chaque niveau de la pyramide. Pour chaque niveau de la pyramide sanitaire, du niveau central au niveau communautaire, le manuel identifie les ressources nécessaires à la collecte des données, désigne les personnes responsables de ces données et fournit des consignes permettant de savoir quelles données de santé doivent être recueillies et faire l'objet de rapports, quand et comment. Ce manuel de procédures est accompagné d'un rapport sur l'architecture d'entreprise "une seule santé" du Burkina Faso, accessible au lien suivant: https://www.measureevaluation.org/resources/publications/tr-20-406-fr/ English Abstract: This French-language standard operating procedures (SOP) manual is the main reference document for the One-Health health information system (OH-HIS) of Burkina Faso. It formalizes the main procedures for managing One-Health data. This SOP is aimed at central directorates within the three Burkina Faso ministries involved in the One-Health work (namely the Ministry of Health, the Ministry of Livestock and Fisheries, and the Ministry of the Environment), at coordinators of human and zoonotic diseases surveillance programs, as well as to implementing partners. This manual describes the OH-SIS, its data collection purpose, its structure, its information flow, and its data cycle. It also provides information on the frequency at which reports should be developed at each level of the health system. For each of these levels, from the central to the community level, this manual also identifies the resources necessary to collect data and designate staff as responsible for these data, and provides instructions so as to recognize which health data need to be collected and reported, when, and how. A companion to this SOP is a French-language report on the enterprise architecture for the One-Health system in Burkina Faso, available at the following link: https://www.measureevaluation.org/resources/publications/tr-20-406-fr/
L’architecture d'entreprise « une seule santé » du Burkina Faso Tohouri, R.R., Kebe, M.R., Kouassi, C., & Chauffour, J. 2020 French Global health security, One Health, Burkina Faso, Infectious disease, Zoonotic Suite à l'avènement de menaces sanitaires graves impliquant des maladies transmises des animaux aux hommes, le gouvernement burkinabè a décidé de prendre au sérieux la menace que représente les maladies zoonotiques, en adoptant l’approche « One-Health » encore appelée « une seule santé » en français. Cette approche promeut une gestion unique et intégrée de la santé animale et humaine afin de fournir une réponse adéquate et compréhensible aux menaces d'épidémies en général et de maladies zoonotiques en particulier. Cependant, pour devenir une réalité, une telle approche nécessite la mise en place d'une plateforme électronique capable de remonter les informations en temps réel et de notifier les acteurs clés de potentielles menaces sanitaires dans le pays, d'où la nécessité d'une infrastructure informatique en adéquation avec les objectifs poursuivis. Le présent document est une tentative de décrire les actions requises pour un alignement parfait entre les objectifs et l'infrastructure technique pour atteindre les résultats escomptés, à travers la mise en lumière des prérequis organisationnels, politiques, informationnels, techniques et infrastructurels nécessaires au succès d'une telle entreprise. L'objectif principal de ce document est de fournir un outil de politique et de planification aux différents ministères participant à l’approche « une seule santé » au Burkina Faso, leur permettant d'établir et de mettre en œuvre un système d'information commun de surveillance en temps réel des maladies zoonotiques, interopérable entre ministères afin d'offrir au pays une vue globale sur les données collectées afin d'optimiser la riposte. Plus particulièrement, ce document établit une analyse comparée des architectures d'entreprise des systèmes d'information sanitaire des Ministères de la Santé, de l'Environnement et des Ressources Animales et Halieutiques du Burkina Faso, afin de leur garantir un alignement parfait entre la vision de l'approche « une seule santé », leur politique de gouvernance, leur flux d'information, les applications informatiques mises en place et l'infrastructure informatique qui les supporte.  Ce rapport est accompagné d'une manuel des procédures de gestion de l'information sanitaire "One Health" au Burkina Faso, accessible au lien suivant: https://www.measureevaluation.org/resources/publications/tr-20-416-fr/ English Abstract: Following recent severe health threats and epidemics involving diseases transmitted from animals to humans, the Burkina Faso government has decided to take action against the threat posed by zoonotic diseases, by adopting the One-Health approach. This approach promotes a unique and integrated management of animal and human health so as to provide an adequate and comprehensive response to epidemic threats and zoonoses specifically. However, to become reality, such an approach necessitates the set-up of an electronic platform capable of transmitting data to higher-levels in real time and to notify key actors of potential health threats in the country, further stressing the need for a robust  IT infrastructure able to meet these demands. This report describes the actions required for a perfect alignment between these objectives and the technical infrastructure in order to reach the wished-for results, and highlights the organizational, political, informational, technical, and infrastructural prerequisites necessary to the success of such an enterprise. The main objective of this document is to provide a political and planning tool to the different ministries participating in the One-Health work in Burkina Faso. This, in the hope of allowing them to establish and implement a common real-time zoonotic diseases surveillance information system, interoperable across ministries in order to provide the country with a global perspective on data collected so as to optimize responses. Specifically, this document establishes a comparative analysis of the enterprise architectures of the health information systems of the Ministries of Health, of the Environment, and of Livestock and Fisheries of Burkina Faso, in order to guarantee a perfect alignment between the One-Health vision, these ministries' governance politics, the information flow within their system, the IT software in place, and the IT infrastructure that support them.  A companion to this French-language report is a French-language standard operating procedures manual (SOP) on managing the One-Health information in Burkina Faso, available at the following link: https://www.measureevaluation.org/resources/publications/tr-20-416-fr/  
Mobility and Treatment Outcomes among People Living with HIV and/or Tuberculosis in East African Cross-Border Regions Edwards, Jessie K.; Mulholland, Grace E.; Markiewicz, Milissa; Bahemuka, Ubaldo; Seeley, Janet; Kidega, William; De Bont, Jan; Kwena, Zachary; Oketch, Bertha; Okech, Brenda; Nanyonjo, Gertrude; Kidola, Jeremiah; Okello, Elialilia 2020 English UGANDA, Africa, East Africa HIV, HIV care, TB, Global health, Tuberculosis, HIV/AIDS Regional economic integration and trade are high on the political and development agendas of East African leaders. Greater regional integration and increased trade are expected to enhance opportunities for income generation and employment, resulting in increased movement of people as they look for new and expanded opportunities in the region. However, the increased movement of humans, animals, and goods across nations leads to intensified transmission of infectious diseases, including HIV/AIDS and tuberculosis (TB), which do not respect political boundaries. Health affects peoples’ ability to work, the type of work they can perform, and how long they can work. Unless specifically addressed in health programming, infectious diseases have the potential to dampen trade and even reverse economic growth. This report presents the results of a study—funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief—to understand mobility patterns, treatment outcomes, and the feasibility of regional tracing strategies among patients in care for HIV and/or TB in the Lake Victoria region. This study was undertaken by MEASURE Evaluation and local partners from the Lake Victoria Consortium for Health Research: Uganda Virus Research Institute and the International AIDS Vaccine Initiative; Kenya Medical Research Institute; Medical Research Council/Uganda Virus Research Institute and the London School of Hygiene and Tropical Medicine; and the Mwanza Intervention Trials Unit. Results of this study will improve treatment strategies for mobile populations, identify facilities serving mobile populations, and inform planning for cross-border coordination of health services, including medical record linkages, patient referrals, and defaulter tracing.
Quality of Tuberculosis Services Assessment in Uganda: Report Kola Oyediran, Bruce Kirenga, Stavia Turyahabwe, Nikki Davis, Jeanne Chauffour, Winters Muttamba, Abel Muzoora, Herbert Muyinda 2020 English Tuberculosis, Uganda, TB, QTSA According to the 2018 Global Tuberculosis Report released by the World Health Organization (WHO), tuberculosis (TB) is the tenth leading cause of death and is the leading cause of death from a single infectious agent. Heads of state committed to ambitious targets aimed at eliminating TB during the first-ever United Nations High-Level Meeting on Tuberculosis conducted in September 2018 at the United Nations General Assembly. Uganda is one of the 30 countries with the highest burden of TB/HIV, with an estimated TB incidence of 200 cases per 100,000. The proportion of multidrug-resistant tuberculosis and rifampin-resistant TB among new and previously treated TB cases was estimated at 1 percent and 12 percent, respectively, in 2018. For the estimated 86,000 people who fell ill with TB in 2019, TB treatment coverage was 65 percent, and the treatment success rate was 72 percent—both far below the 85 percent national target for 2019. In response, the Government of Uganda gave the Ministry of Health, through the National Tuberculosis and Leprosy Programme (NTLP), a mandate to bring the disease under control by means of providing high-quality prevention, diagnosis, and treatment services to affected Ugandans. Specifically, TB incidence is to be reduced by 5 percent by 2019/2020, and the treatment success rate among notified incident cases is targeted to increase from 75 percent in 2015/16 to 85 percent by 2019/20. Studies show that good quality of care in TB services helps patients and their families address their health needs safely and effectively. Therefore, to enhance TB service use, there is a need to assess and improve the quality of TB services. A Quality of TB Services Assessment (QTSA) was conducted by MEASURE Evaluation in Uganda to assess the quality of TB services in randomly selected health facilities. Its purpose was to identify where services were of high quality and where there were gaps and to ensure that TB patients were receiving the care that they deserve. The QTSA assessed three domains of quality of care: the structure of the health facility, the service delivery process, and the outcomes of service delivery. The results were used to develop programs or interventions to improve TB service delivery.   The qualitative findings from the QTSA in Uganda are described in a separate report, available here: https://www.measureevaluation.org/resources/publications/tr-20-417/   The QTSA tools adapted for use in Uganda are available here: https://www.measureevaluation.org/resources/publications/tl-20-79/   QTSA documents for other countries are available here: https://www.measureevaluation.org/our-work/tuberculosis/quality-of-tb-services-assessments
Quality of Tuberculosis Services Assessment in Uganda: Report on Qualitative Findings Herbert Muyinda, Stavia Turyahabwe, Kola Oyediran, Bruce Kirenga, Nikki Davis, Jeanne Chauffour, Esther Buregyeya, Winters Muttamba, Linda Ruvwa 2020 English Tuberculosis, TB, Uganda, QTSA This report describes findings of a qualitative study on tuberculosis (TB)-related stigma among community members from two regions in Uganda. This research is part of a broader Quality of Tuberculosis Services Assessment (QTSA) conducted in Uganda in 2019 by MEASURE Evaluation, which is funded by the United States Agency for International Development (USAID), in collaboration with the Uganda National TB and Leprosy Programme (NTLP), and implemented by Makerere Lung Institute—a local research organization at Makerere University’s College of Health Sciences that was contracted by MEASURE Evaluation.  Stigma is a recognized challenge affecting prevention, diagnosis, treatment, and care of infectious diseases, including TB. Stigma is a complex social construct shaped by inadequate knowledge and information about modes of transmission, care, and prevention and is exacerbated by the inadequate availability of TB services and low-quality services, especially in rural areas. This qualitative study explored community-level knowledge, attitudes, and perceptions of TB-related stigma to inform the NTLP to design interventions to improve TB prevention, diagnosis, and treatment in Uganda. The study had the following objectives: (1) assess the causes of TB-related stigma; (2) document the manifestations of stigma; (3) determine the perceived effects of stigma on treatment-seeking behavior; and (4) provide evidence-based recommendations to address stigma and discrimination toward people with TB at the community level. The quantitative findings from the QTSA in Uganda are described in a separate report, available here: https://www.measureevaluation.org/resources/publications/tr-20-398 The QTSA tools adapted for use in Uganda are available here: https://www.measureevaluation.org/resources/publications/tl-20-79/   QTSA documents for other countries are available here: https://www.measureevaluation.org/our-work/tuberculosis/quality-of-tb-services-assessments
Quality of Tuberculosis Services Assessment in Ethiopia: Report Upama Khatri, Nikki Davis 2020 English Tuberculosis, QTSA, TB, Ethiopia, Service delivery According to the 2018 Global Tuberculosis Report released by the World Health Organization (WHO), tuberculosis (TB) is the tenth leading cause of death and is the leading cause of death from a single infectious agent. Heads of state committed to ambitious targets aimed at eliminating TB during the first-ever United Nations High-Level Meeting on Tuberculosis conducted in September 2018 at the United Nations General Assembly. WHO has identified 30 countries where the TB burden is high, including Ethiopia. The incidence of TB in Ethiopia was estimated to be 151 per 100,000 population, and the mortality was 22 per 100,000 population in 2018. TB treatment coverage was 69 percent in 2018, indicating that 31 percent of TB cases were missed. In response, the Government of Ethiopia has committed to accelerating the fight to end the TB epidemic by 2035 by endorsing the post-2015 Global End TB Strategy and the targets set by the United Nations High-Level Meeting. The Federal Ministry of Health’s National Tuberculosis and Leprosy Program strategy aims to end the TB epidemic by reducing TB-related deaths by 95 percent and cutting incident TB cases by 90 percent between 2015 and 2035. Studies show that good quality of care in TB services helps patients and their families address their health needs safely and effectively. Therefore, to enhance TB service use, there is a need to assess and improve the quality of TB services. A Quality of TB Services Assessment (QTSA) was conducted by MEASURE Evaluation in Ethiopia to assess the quality of TB services in randomly selected health facilities. Its purpose was to identify where services were of high quality and where there were gaps and to ensure that TB patients were receiving the care that they deserve. The QTSA assessed three domains of quality of care: the structure of the health facility, the service delivery process, and the outcomes of service delivery. The results were used to develop programs or interventions to improve TB service delivery. The QTSA tools adapted for use in Ethiopia are available here: https://www.measureevaluation.org/resources/publications/tl-20-87/   QTSA documents for other countries are available here: https://www.measureevaluation.org/our-work/tuberculosis/quality-of-tb-services-assessments
Quality of Tuberculosis Services Assessment in Uganda: Tools MEASURE Evaluation 2020 English Uganda, QTSA, Tuberculosis, Tools, TB The Quality of Tuberculosis Services Assessment (QTSA) in Uganda was conducted with the support of five tools: the Facility Audit, the Provider Interview, the Patient Interview, the Register Review, and the Focus Group Discussion Guide. MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID)—developed these five tools with the assistance of colleagues at USAID.  The tools exist in a generic format that is adaptable to any country wishing to conduct a QTSA. For instance, some countries may have different names for their health administrative units (e.g., district, province, ward, or woreda) or the name of their TB registers (e.g., TB patient logbook or TB confirmed cases register). They are customized to fit the country priorities and context in which they will be used.  The generic QTSA tools are available at the following link: https://www.measureevaluation.org/resources/publications/tl-19-41/ This document presents only the QTSA tools adapted for use in Uganda. It provides detailed information about the structure and content of the tools. More information on the QTSA purpose, methods, or results can be found in the individual QTSA reports.  Uganda’s QTSA report is available here:  https://www.measureevaluation.org/resources/publications/tr-20-398   The report on qualitative findings is available at the following link: https://www.measureevaluation.org/resources/publications/tr-20-417/     QTSA documents for other countries are available here: https://www.measureevaluation.org/our-work/tuberculosis/quality-of-tb-services-assessments
Quality of Tuberculosis Services Assessment in Ethiopia: Tools MEASURE Evaluation 2020 English Tuberculosis, QTSA, Tools, TB, Ethiopia The Quality of Tuberculosis Services Assessment (QTSA) is conducted with the support of four tools: the Facility Audit, the Provider Interview, the Patient Interview, and the Register Review. MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID)—developed these four tools with the assistance of colleagues at USAID.  The tools exist in a generic format that is adaptable to any country wishing to conduct a QTSA. For instance, some countries may have different names for their health administrative units (e.g., district, province, ward, or woreda) or the name of their TB registers (e.g., TB patient logbook or TB confirmed cases register). They are customized to fit the country priorities and context in which they will be used.  The generic QTSA tools are available at the following link: https://www.measureevaluation.org/resources/publications/tl-19-41/ This document presents only the QTSA tools adapted for use in Ethiopia. It provides detailed information about the structure and content of the tools. More information on the QTSA purpose, methods, or results can be found in the individual QTSA reports.  Ethiopia’s QTSA report is available here: https://www.measureevaluation.org/resources/publications/tr-20-415/ QTSA documents for other countries are available here: https://www.measureevaluation.org/our-work/tuberculosis/quality-of-tb-services-assessments
Malaria Routine Data Quality Assessment Tool: A Checklist to Assess the Quality of Malaria Program Data MEASURE Evaluation 2020 English Routine data, Malaria, Data Quality, Data quality assessment, Tool A comprehensive approach to data quality assurance should include three complementary approaches using standardized methods and tools. These approaches are as follows:  Routine and regular (i.e., monthly) reviews of data quality built into a system of checks of the malaria or other program reporting systems as part of a feedback cycle that identifies errors in near real-time so that they can be corrected as they occur. An annual independent assessment of a core set of tracer indicators to identify gaps and errors in reporting and the plausibility of trends in health facility data reported during the previous year. Periodic in-depth program-specific reviews of data quality that focus on a single disease or program area and are timed to meet the planning needs of the specific programs (e.g., before program reviews). This tool aims to standardize and facilitate the routine review of malaria data quality at health facilities, by the district monitoring and evaluation teams that support them via routine supervision to health facilities. While the Malaria Routine Data Quality Assessment (MRDQA) tool provides some details on use of the tool, a User Manual expanded details exists and is meant to accompany this tool. Access the manual at https://www.measureevaluation.org/resources/publications/ms-20-190/
Malaria Routine Data Quality Assessment Tool: User Manual MEASURE Evaluation 2020 English Routine data, Malaria, Tool, Data Quality, Data quality assessment In 2020, the United States Agency for International Development- and U.S. President’s Malaria Initiative-funded MEASURE Evaluation project developed the Malaria Routine Data Quality Assessment (MRDQA) Tool: A Checklist to Assess the Quality of Malaria Program Data, for use by malaria programs (MEASURE Evaluation, 2020; https://www.measureevaluation.org/resources/publications/tl-20-85/). The MRDQA tool is a checklist that supports a targeted, rapid data-quality assessment focused on malaria data for use in routine data quality monitoring as part of regular supervision efforts. The tool aims to standardize and facilitate the routine assessment of malaria data quality by a district team during supportive supervision visits at health facilities. The tool can also be used by central and regional staff jointly with district teams to assist in data quality efforts. This manual describes the purpose and structure of the MRDQA tool and offers considerations for personnel and logistics, sampling considerations, details on preparing for fieldwork, and step-by-step instructions for using the tool. The MRDQA tool provides even more detail on use of the tool in the Instructions tab.
Creating a New Digital Health System in Bangladesh by Building Interoperability between the Country’s Family Planning Service Statistics System and the DHIS2 Mohammad Golam Kibria, Nibras- Ar-Rakib, Md. Humayun Kabir, Gabriela Escudero 2020 English The government of Bangladesh is prioritizing the management of comprehensive digital health information and is increasingly generating high-quality data for planning and decision-making purposes, which ultimately leads to better health outcomes. The Directorate General of Family Planning (DGFP), under the Ministry of Health and Family Welfare, has collected subdistrict-level family planning (FP) service statistics (SS) in electronic form for more than 10 years. However, this SS system lacked an interactive visual interface, which hindered data analysis and the use of data for decision making. To resolve this issue and maximize the effective use of the copious data collected through the SS system, with technical assistance from implementing partners (IPs), the DGFP created an innovative interoperability mechanism between the SS and the country’s District Health Information Software, version 2 (DHIS2) platform. This brief shares more.
MEASURE Evaluation Phase IV Project Les réussites du projet Mali 2016–2019 MEASURE Evaluation 2020 French Mali, Health, Monitoring, Evaluation, Health Information Systems MEASURE Evaluation a travaillé au Mali afin d’apporter une assistance technique dans le suivi-évaluation (S&E) des programmes sanitaires depuis 2014. Le projet a fourni des outils, de la recherche, des formations, de l’encadrement et des stratégies pour aider à améliorer les systèmes d’information sanitaire du Mali. Le projet a procuré un appui important dans le renforcement des systèmes d’information sanitaire de routine, des systèmes de surveillance épidémiologique et du système national d’information sanitaire (SNIS) en intégrant ces systèmes dans la plateforme du District Health Information Software, version 2 (DHIS2) aux niveaux districts, régions et central. Le portfolio des activités a inclus: Le renforcement du S&E du paludisme Le renforcement du SNIS malien Les évaluations des campagnes nationales de promotion de la planification familiale de 2016 et 2017 au Mali L’appui au plan de S&E de l’USAID/Mali en s’adressant à des besoins en information spécifiques liés à la prévention de la mortalité maternelle et infantile Le développement et le déploiement d’un système de surveillance de la maladie à virus Ebola et l’amélioration des indicateurs, des outils de collecte des données et de la qualité des données du système de surveillance Ce livret décrit, de manière plus détaillée, certains aspects du travail impressionnant que le gouvernement et le Ministère de la Santé du Mali ont réalisé ces dernières années.
Counseling on injectable contraception and HIV risk: Evaluation of a pilot intervention in Tanzania Janine Barden-O’Fallon, Jennifer Mason, Emmanuel Tluway, Gideon Kwesigabo, Egidius Kamanyi 2020 English Contraception, Tanzania, Evaluation, Family Planning, HIV In a context of high rates of HIV prevalence, concerns over hormonal contraceptive use and the potential for increased risk of HIV acquisition have led to increased attention to counseling messages, particularly for users of the injectable. However, the consequence of adding additional HIV risk messages to family planning counseling sessions was not well understood. This evaluation assessed the effect of providing revised injectable and HIV risk counseling messages on contraceptive knowledge and behavior during a three month pilot intervention. The pilot intervention was conducted September-November 2018 with all eligible family planning clients in ten healthcare facilities located in the Iringa and Njombe regions of Tanzania. Data collection for the evaluation occurred November-December 2018 and included 471 client exit interviews, 26 healthcare provider interviews, and the extraction of service statistics for 12 months prior to the intervention and three months of the intervention. Univariate and bivariate analyses were used to assess quantitative interview data. Thematic qualitative assessment was used to assess qualitative interview data from healthcare providers. Interrupted time series analysis was used to assess changes in the trend of contraceptive uptake. Results indicate that the counseling messages did not cause a decrease in the uptake of injectables (Depo-Provera): 97 percent of interviewed clients received Depo-Provera at their visit; sixty percent reported an intention to use condoms for dual protection. The analysis of service statistics showed no statistical difference in the trend of Depo-Provera uptake between the pre-intervention and intervention periods (p = 0.116). Overall knowledge of counseling messages by clients was good; however only 64.8% of women correctly responded that women at risk of getting HIV can use any method of family planning. Providers’ knowledge of the messages was high, though it appears that not all messages were consistently provided during the counseling sessions. The findings from this evaluation provide evidence that complex HIV counseling messages can be implemented in family planning programs in Tanzania, and potentially in other countries that are considering how to better integrate HIV risk messages into family planning counseling.
Comparison of Cause-of-Death Classification Methods for Verbal Autopsies in Mozambique: 2017 Inquérito Sobre Causas de Mortalidade (INCAM)-2 Pilot MEASURE Evaluation 2020 English Mortality, Verbal Autopsy, Mozambique In advance of the August 2017 Population and Housing Census, the Mozambique National Institute of Statistics (INE) and Ministry of Health (MISAU) began discussing the implementation of a post-census mortality survey. This would be the country’s second such survey. Following the 2007 Population and Housing Census, INE and MISAU conducted a post-census mortality survey (Inquérito Sobre Causas de Mortalidade [INCAM]) in 2007/2008 using verbal autopsies (Mozambique National Institute of Statistics, et al., 2012). Like the first INCAM, the 2017 Population and Housing Census included questions on household deaths in the previous 12 months, collecting the name, sex, age, and date of death for the deceased. A sample of census enumeration areas representative of the national and provincial levels would then be selected, and all deaths reported in the census in those areas would be visited to administer a verbal autopsy (VA) for each death. In 2008, INCAM used physician-based certification of cause of death based on the VAs. Given the cost of using physicians to determine the cause of death from verbal autopsies and the development in the past 10 years of alternative methods for interpreting VAs, it was decided that the pilot for INCAM-2 would focus on a comparison of multiple methods for determining the cause of death. The goal of the comparison is to help the government select the most appropriate interpretation method for full implementation of INCAM-2. Based on other studies, it was determined that a minimum of 300 completed VAs with at least 30 neonatal deaths would be needed (King, Lu, & Sibuya, 2010).
Tool to Assess the Quality of Data on the Number of People on Antiretroviral Therapy: User Guide MEASURE Evaluation 2020 English Data Quality, Data quality assessment, ART, DQA, Toolkit Data from health facilities must be of high quality for U.S. government funders and for the country’s policymakers to make sound decisions on health policy, health programs, and the allocation of scarce resources. At the request of the United States Agency for International Development (USAID)/Zambia and with the benefit of expert guidance from the mission, the USAID- and United States President’s Emergency Plan for AIDS Relief (PEPFAR)-funded MEASURE Evaluation project and USAID/Zambia developed and implemented an intervention-based, expedited data quality assessment (EDQA) that was intensive and used a rapid set of activities and assessments focused on data quality. This tool (which is available here: https://www.measureevaluation.org/resources/publications/tl-20-84/) is based on Zambian experience where a novel method for classifying cases by treatment status was used that included organization of client records and cleaning of data. An assessment team can use the tool to clean up client files; it helps to clarify, identify, and follow up with clients classified as lost to follow-up (LTFU). Stakeholders needing to clean up files and improve the quality of data for the HIV clients currently on treatment are encouraged to use this tool. The tool focuses exclusively on the TX_CURR indicator (number of individuals currently on antiretroviral therapy [ART]) because the assessment of this indicator, in particular, requires effort and procedures well beyond what is needed for most HIV indicators. Verification of this indicator requires a thorough review of the individual (paper-based) client file folders. In many health facilities, these will number in the hundreds, and in the larger hospitals, there can be thousands of files to review. Sorting, organizing, reviewing, and documenting these files for an accurate indicator recount is an especially complicated and time-consuming process. The materials presented here incorporate experience gained from a collaborative effort between the MEASURE Evaluation project and USAID/Zambia. The manual and Excel-based tool are designed to facilitate efforts by USAID missions and their implementing partners in PEPFAR priority countries to undertake expedited data quality assessments for the TX_CURR indicator, during regularly scheduled site visits. Although the tool was built from instruments developed and used for a particular assessment in Zambia, it can be readily adapted to a specific country context. The tool is intended for use by health program staff, including project directors and program and monitoring and evaluation officers who work in HIV-sector initiatives, such as PEPFAR. These concepts and procedures can be adapted to fit an indicator quality assessment for any type of program providing ART in any country. The EDQA can be used as an intervention when source documents are found to be incomplete or inconsistent after assessment with the lotq uality assurance sampling triage system or following a more comprehensive data quality assessment.
Performance of Routine Information System Management (PRISM): Analysis Tool for Data from a PRISM Assessment MEASURE Evaluation 2020 English Data analysis, PRISM, Performance of Routine Information System Management, Tool The United States Agency for International Development-funded MEASURE Evaluation project developed this Excel-based Performance of Routine Information System Management (PRISM) Analysis Tool (PAT) to support the analysis of PRISM survey data. Users must configure the tool’s key elements (periods, indicators, and tolerance range), as appropriate. The tool also provides basic instructions on using its modules, guiding the user through the steps of PRISM data importation from the SurveyCTO (https://www.measureevaluation.org/resources/publications/ms-18-143/) and Open Data Kit servers into the PAT, in order to conduct the basic analysis as outlined in the PRISM Analysis Guide (https://www.measureevaluation.org/resources/publications/ms-18-141).
Data Quality Assessment for Number Currently on Antiretroviral Therapy: Toolkit MEASURE Evaluation 2020 English Data quality assessment, Toolkit, Data Quality, ART, DQA This is a semiautomated data quality assessment tool to determine a health facility's accuracy in reporting the number currently on antiretroviral therapy (ART) (TX_CURR) indicator to the country ministry of health and the United States President's Emergency Plan for AIDS Relief (PEPFAR). This toolkit is divided into four sections separated by coloured tabs: Introductions (blue), Data Capture (red), Data Outputs (green), and Dashboard (yellow). Access the user guide.
e-Learning Curriculum on Routine Health Information Systems: Guide for Facilitators Dufour, W., Kunaka, D., & Frankel, N. 2020 English Global Curriculum, Routine Health Information Systems, RHIS This guide was developed to help facilitators navigate the online routine health information systems (RHIS) course, select classes that meet learners’ capacity-building needs, support learning using adult learning principles, and provide updates and modifications to class content, as needed. This document provides an outline of the content of the online modules including learning objectives, quiz questions and answers, sample discussion questions that facilitators can use with learners, and definitions of key terms/concepts covered in the course, as well as an index of where those terms/concepts are covered in the modules. Also included in the document are tips on facilitation to improve adult learner engagement and the transfer of learning to the workplace. The online curriculum may also be used for teaching university students. This guide does not cover the specifics of using online materials with traditional students.
Implementation of the UgandaEMR: Results of a Security Assessment MEASURE Evaluation 2020 English EHR, Health data, Health information, Uganda The United States Agency for International Development (USAID), the United States President’s Emergency Plan for AIDS Relief (PEPFAR), and the United States Centers for Disease Control and Prevention (CDC) have all contributed significant funding to the development and implementation of electronic medical records (EMRs) to support the capture of patient medical data. Using USAID’s Software Global Goods Valuation Framework, it has been estimated that the total development cost for development of OpenMRS—a widely used open-source EMR system—is roughly $8 million (Center for Innovation and Impact, 2019). The increased demand for patient-level data needed to achieve epidemic control of HIV and for other health monitoring has caused a shift from using EMR software for retrospective data entry to real-time point-of-care systems. As these systems move from a single computer to interconnected computers at multiple sites, the need for improved security has become more critical. Security guidelines, such as International Standards Organization (ISO) 2700 and National Institute of Standards and Technology (NIST) 800, are burdensome to use as assessment tools in these settings. Instead, implementing partners (IPs) in low-resource settings require tools that can be tailored to their circumstances so they can continuously assess the privacy and security of the health information systems they manage. PEPFAR asked the USAID- and PEPFAR-funded MEASURE Evaluation project to develop an assessment tool to address this issue. We took high- and moderate-impact priority controls from NIST 800, ISO 2700, and the Health Insurance Portability and Accountability Act and adjusted them to be practical in a low-resource setting. We then used the tool to conduct a security assessment. This was a step-by-step process involving questionnaires, in-person assessment and verification, and automated security testing tools. USAID chose the UgandaEMR system for us to assess because it uses the most recent reference implementation of OpenMRS—version 2.9—and because it is being widely used at more than 1,000 facilities in Uganda. The Monitoring and Evaluation Technical Support (METS) Program, at the Makerere University School of Public Health, acts as the above-site mechanism to support the development and implementation of UgandaEMR, and numerous IPs; their subgrantees oversee the day-to-day use and maintenance. The assessment team visited six sites representing a range of IPs and donors as part of this assessment. UgandaEMR was determined to be a moderate-impact system based on three criteria: confidentiality, integrity, and availability. The assessment found gaps in all the control areas, although there was some variation between facilities. The recommendations to address and mitigate the gaps were identified though prioritization, and their implementation will vary by IP based on available resources and relevant risk.
Child Protection Case Management Information Systems: Promoting Appropriate Care for Children: A Framework for Engagement Molly Cannon, Stuardo Herrera, Patricia Mechael 2020 English Child Health, Children, CMIS, Care for children, Information systems In March 2017 USAID, through its Displaced Children and Orphans Fund (DCOF), engaged the USAID-funded MEASURE Evaluation (MEval) project to reinforce and build on U.S. government programming on childcare and protection in Armenia, Ghana, Moldova, and Uganda. MEval works globally to strengthen country capacity to gather, analyze, and use data for decision making to improve sector outcomes. Successful implementation of child protection and social welfare services depends on the availability and effective use of relevant child protection and social welfare data. With countries’ and programs’ increased interest in advancing digital solutions for case management of children at risk, USAID DCOF asked MEval to convene experts from December 4–6, 2019, at Palladium’s office in Washington, D.C. to inform the development of a framework for case management information systems (CMIS) centered on child protection and care. The main purpose of the Information Systems Framework for the Case Management of Child Protection and Care (hereafter, the framework) is to consolidate lessons learned from those who have developed, implemented, and used such systems and agree upon best practices when approaching the design and strengthening of such systems. This document is written from the perspective of supporting government-led and owned systems, but it recognizes that nongovernmental organizations (NGOs) may have other systems that feed into those government systems or operate independently for their programming purposes. S recommendations so ply to The framework is a product of a participatory design workshop involving 25 women and 17 men from USAID DCOF and the Office of HIV/AIDS, UNICEF headquarters and field offices, case management experts, monitoring and evaluation (M&E) experts, and digital solution experts. Armenia, Cambodia, Ghana, Guatemala, Kenya, Moldova, Romania, Uganda, and the United States were represented (https://www.measureevaluation.org/resources/publications/ws-20-57).
Health Information System Stages of Continuous Improvement Toolkit: Digital Assessment Tool Add-On Module 2020 English Global Data, Tool, SOCI, Toolkit, Health Information Systems, HIS, Stages of Continuous Improvement This add-on module is designed to accompany the full User Guide for the Health Information System (HIS) Stages of Continuous Improvement (SOCI) Toolkit, available at https://www.measureevaluation.org/resources/publications/ms-19-158. The guide was developed by the United States Agency for International Development-funded MEASURE Evaluation project, the United States Centers for Disease Control and Prevention, and members of the Health Data Collaborative’s Digital Health and Interoperability Working Group. Users of the digital assessment should review the full User Guide before using the digital version of the assessment. A description of the toolkit and its background and the assessment timeline and process can be found there. This document provides only technical guidance to use the digital version of the SOCI assessment. The HIS SOCI app can be downloaded from GitHub through this link: https://github.com/talexie/his_soci/blob/master/ dist/his_soci.zip/. Detailed instructions can be found in the Digital Assessment Tool Add-On Module.
Reproductive Health Cost Reporting System: Results of a Pilot Test in Nigeria Scott Moreland and Obialunamma Onoh 2020 English NIGERIA Reporting, Cost management, Reproductive Health, Pilot, Cost analysis MEASURE Evaluation, which is funded by the United States Agency for International Development, developed the Reproductive Health Cost Reporting System (RHCRS). The RHCRS is a management tool that can help health service delivery organizations capture and analyze financial and other data on a regular basis. It is designed to treat financial, commodity, labor, and other cost data as inputs to a system that allows service delivery organizations to estimate what it costs to deliver specific health services, what the cost drivers are, and how these costs may differ across service delivery points, across regions, and over time. This report summarizes MEASURE Evaluation's experience, and lessons learned, from conducting two pilot tests in Nigeria in the process of developing the RHCRS.
Discontinuation of Contraceptive Intrauterine Devices and Implants in Bangladesh MEASURE Evaluation, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) 2020 English Bangladesh, Contraception, Family Planning Intrauterine devices (IUDs) provide effective contraception for 10 years and implants for three. These two family planning (FP) methods are known as long-acting reversible contraceptives (LARCs), and both are highly effective. Unfortunately, low rates of use and high rates of discontinuation of these methods have negative implications for programs seeking to achieve effective contraception in Bangladesh. The Bangladesh FP program has long sought to increase the rates of acceptance and continuation of LARCs. Bangladesh’s Directorate General of Family Planning (DGFP) is responsible for mobilizing the resources necessary to promote the use of IUDs and implants, including procurement and supply of devices, training of service providers, and provision of insertion fees and client compensation. These investments are most costeffective when method acceptors continue to use LARCs throughout the effective life of the method. This brief presents an analysis of longitudinal data n IUD and implant discontinuation conducted by Research for Decision Makers—an activity under the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)—and MEASURE Evaluation. Both are funded by the United States Agency for International Development (USAID). We obtained longitudinal data from the Matlab Health and Demographic Surveillance System (HDSS)1 and compared the results of our analysis with those from the Bangladesh Demographic and Health Surveys (BDHS). The method discontinuation data collected by the BDHS (1994–2017) are nationally representative but suffer from small sample sizes. Exploring other reliable data sources, such as Matlab HDSS, can help generate evidence that will improve the rates of IUD and implant use.
Gaps in Global Monitoring and Evaluation of Adolescent and Youth Reproductive Health: Research Brief MEASURE Evaluation 2020 English Global Monitoring, Evaluation, Indicators, Adolescent health, Adolescents, Reproductive Health, M&E Adolescents and youth are a key population for reproductive health (RH) interventions, because young people suffer disproportionately from negative RH outcomes, including acquisition of HIV and other sexually transmitted infections; unintended, unwanted, or mistimed pregnancy; unsafe abortion; and gender-based violence. Effective monitoring and evaluation (M&E) of RH interventions designed for adolescents and youth is essential to determine their success and impact and show where improvement is needed. MEASURE Evaluation, which is funded by the United States Agency for International Development, conducted the research presented in this brief to identify gaps in the M&E of adolescent and youth reproductive health (AYRH) programs. This process consisted of reviewing the landscape of M&E of AYRH interventions, outcomes, and impacts; identifying measurement gaps; and making recommendations to improve the M&E of AYRH activities and programs across a spectrum of RH categories.
The Sustainability of the Electronic Management Information System of Bangladesh’s Directorate General of Family Planning Kabir, M.H. 2020 English Information System, Sustainability, EMIS, Family Planning, Bangladesh This report addresses the sustainability issues of the electronic management information system (eMIS) that has been implemented in the Directorate General of Family Planning (DGFP) under the Ministry of Health and Family Welfare (MOHFW) of Bangladesh. The pilot implementation of the eMIS began in January 2015 in two districts (Tangail and Habiganj), with support from the United States Agency for International Development (USAID)-funded MEASURE Evaluation project, in partnership with icddr,b and the Mamoni Maternal and Newborn Care Strengthening (MNCSP) project. The eMIS was scaled up in 2018 and reached 32 districts, either partially or in full, by December 2019. At the field level, the tools are being used by more than 10,000 users. The eMIS aimed to automate the business processes of community health and family planning workers, their supervisors, and providers working in first-line facilities (called Union Health and Family Welfare Center), based on mobile technologies. Web-based tools were also developed for managers at the subdistrict and district levels and for decision makers at the central level. The eMIS tools help users and managers of the DGFP gain the benefits of digitization, as well as enable the DGFP to become a data-driven organization. The eMIS reached a milestone with the declaration of a paperless Tangail on March 1, 2020 by the minister for health and family welfare. The implementation of the eMIS was supported within a project framework, and carrying it forward requires internalizing it within the DGFP and making it sustainable. Key issues related to sustainability, such as the acquisition of hardware, software maintenance and development, capacity building (human resource development, skills, training), implementation mechanisms, and the use of data for decision making are discussed in this report, and relevant recommendations are provided, along with an action plan.
Surveillance, Suivi, et Evaluation des Programmes de Lutte contre le Paludisme : Cours en Ligne MEASURE Evaluation 2020 French Monitoring, Malaria, Surveillance, Training, Evaluation La surveillance, suivi et'évaluation (SSE) jouent un rôle vital dans tous les programmes de contrôle et de prévention du paludisme. Ce cours en ligne, offert par MEASURE Evaluation, fournit une introduction complète aux SSE des programmes de lutte contre le paludisme. Téléchargez un PDF du cours complet ou téléchargez les modules individuels ci-dessous. Pour accéder au cours en ligne de certification, rendez-vous sur ce site: www.memalaria.org. Module 1: Présentation du Paludisme Module 2: Utilisation des Données pour la Prise de Décisions dans les Programmes de Lutte contre le Paludisme Module 3: Introduction à la Surveillance, Suivi et Évaluation des Programmes de Lutte contre le Paludisme Module 4: Comment Développer un Plan de Surveillance, Suivi et Évaluation pour les Programmes de Lutte contre le Paludisme Module 5: Les Cadres de Surveillance, Suivi et d’Évaluation pour les Programmes de Lutte contre le Paludisme Module 6: Les Indicateurs pour la Surveillance, le Suivi et l’Évaluation des Programmes de Lutte contre le Paludisme Module 7: Les Sources des Données pour la Surveillance, le Suivi et l’Évaluation des Programmes sur le Paludisme Module 8: Analyse, Interprétation et Présentation des Données sur le Paludisme Module 9: Les Éthiques dans la Surveillance, Suivi et Évaluation des Programmes de Paludisme Module 10: Le Leadership dans la Surveillance, Suivi, et Évaluation des Programmes de Paludisme Module 11 : La Surveillance des Programmes de Paludisme Module 12: Le Genre dans la Surveillance, Suivi et Évaluation des Programmes de Paludisme
Étude prospective sur le renforcement des systèmes d’information sanitaire (SIS) à Madagascar: Intégration des systèmes d’information sanitaire de routine et de surveillance épidémiologique axés sur la lutte contre le paludisme MEASURE Evaluation 2020 French HIS strengthening, Madagascar, Health Information Systems, HIS, Malaria, Routine Health Information Systems Le Ministère de la Santé Publique de Madagascar (MSANP), avec l’appui de l’Agence des États-Unis pour le développement international (USAID) et les autres bailleurs de fonds internationaux, oeuvre à l’amélioration le système d’information sanitaire (SIS) du pays. Le MSANP et plusieurs partenaires ont mis en place un système de gestion électronique des données sanitaires à travers une base de données Access appelé Gestion du système d’information sanitaire (GESIS), pour consolider et faciliter la transmission de l’information sanitaire au niveau national et à l’échelle des districts. Le Système de la surveillance intégrée de la maladie et la riposte (SIMR) et le Système de surveillance de la fièvre de l’Institut Pasteur sont les deux systèmes de surveillance de maladie existants. D’autres programmes verticaux ont développé des systèmes d’information parallèlles pour répondre à leurs besoins spécifiques. Le Plan national stratégique de renforcement du SIS de Madagascar (2013–2017) avait pour but de réduire la redondance des rapports au niveau des districts et à l’échelle régionale et nationale, en éliminant les systèmes de notification verticaux et en les intégrant au système d’information sanitaire national. L’USAID/Madagascar a financé le projet MEASURE Evaluation pour appuyer le processus de renforcement des systèmes d’information sanitaire de routine (SISR) et de la surveillance intégrée. En novembre 2016, le projet a commencé à fournir une assistance technique au MSANP visant à renforcer les SISR et les systèmes de surveillance du paludisme à Madagascar sur la base de résultats d’évaluation et à renforcer la capacitor du MSANP pour mieux gérer les SIS à travers l’installation de deux Conseillers Résidents au MSANP.Les principales activités du projet consistaient à mettre en place un système d’assurance qualité des données, le renforcement des SISR à travers la mise à jour du Plan Strategique de Renforcement du SIS, elaboration de document de normes et procedure du SIS, un meilleur accès en temps réel aux données sanitaires et une amélioration des compétences, et l’apport d’un soutien dans le cadre du suivi- évaluation et de la surveillance du paludisme. Peu de temps après avoir enclenché ce processus le MSANP, en collaboration avec le projet MEASURE Evaluation, a organisé un atelier en février 2017 à Antsirabe dans le but de rassembler les diverses parties prenantes et de rédiger la version préliminaire d’un plan de mise en oeuvre des activites de renforcement du SIS comprenant neuf stratégies et désigné comme la Feuille de route de renforcement du système d’information sanitaire. L’équipe d’étude de MEASURE Evaluation a utilisé la Feuille de route comme document clé pour les aider à comprendre les activités qui étaient planifiées afin de réaliser le but qui est de disposer d’un : « système d’information sanitaire performant, unique et intégré. » Outre les activités financées par l’USAID décrites ci- dessus et dans le cadre du Programme d’apprentissage de MEASURE Evaluation [une approche collaborative et adaptative pour répertorier et appliquer les résultats au renforcement du système d’information sanitaire (SIS)], nous avons réalisé une étude à Madagascar sur les effets de la performance du SIS de tous les efforts récemment entrepris par MEASURE Evaluation et d’autres parties prenantes pour renforcer le système d’information sanitaire. Cette étude avait pour but de fournir des données probantes au Ministère de la Santé Publique de Madagascar , à l’USAID et à la communauté élargie oeuvrant dans le SIS quant à la manière d’intégrer efficacement des éléments clés du système. Ce résumé rapporte les observations relevées dans le cadre de l’étude.
Prospective Study of Health Information Systems (HIS) Strengthening in Madagascar: Integration of Routine Health Information Systems and Epidemiologic Surveillance with a Focus on Malaria MEASURE Evaluation 2020 English Madagascar, Malaria, Health Information Systems, HIS strengthening, HIS, Routine Health Information Systems Madagascar’s Ministry of Public Health (MPH), supported by the United States Agency for International Development (USAID) and other international donors, is working to improve the country’s health information systems (HIS). The MPH and partners have developed an electronic health management information system—a Microsoft Access database called Gestion du Système d’Information Sanitaire (GESIS)—to strengthen and facilitate reporting of health information at national and district levels. Existing disease surveillance systems are the integrated disease surveillance and response (IDSR) system (Surveillance Intégrée de la Maladie et la Riposte [SIMR]) and the Pasteur Institute’s fever surveillance system. Other vertical programs have developed parallel information systems to meet their specific information needs. The Madagascar National HIS Strengthening Strategic Plan (2013—2017) aimed to reduce reporting redundancies at district, regional, and national levels by eliminating vertical reporting systems and integrating them in health management information systems (HMIS). USAID/Madagascar supported the USAID-funded MEASURE Evaluation project to strengthen the country’s routine health information systems (RHIS) and integrated surveillance. In November 2016, we began technical assistance to strengthen Madagascar’s RHIS and malaria surveillance systems based on assessment results and to build capacity in the MPH to manage HIS through the placement of resident advisors. These activities included establishing a data quality assurance system; strengthening the RHIS through updated policies, improved real-time access to health data, and improved capacity; and providing support to strengthen malaria monitoring and evaluation and surveillance. Soon after we began, the MPH, in collaboration with MEASURE Evaluation, convened a workshop in February 2017 in Antsirabe, bringing together stakeholders and drafting a nine-strategy implementation plan called the Road Map for the Sub-Committee on Health Information Systems. The MEASURE Evaluation study team used the Road Map as a key document to help us understand the activities that were planned to achieve the Road Map’s stated goal: “an efficient, unique and integrated health information system.”In addition to the USAID-funded activities described above and as part of MEASURE Evaluation’s Learning Agenda (a collaborative and adaptive approach to documenting and applying results for health information system [HIS] strengthening), we conducted a study in Madagascar of the effects on HIS performance of all recent efforts by MEASURE Evaluation and also other stakeholders to strengthen the HIS. This study aimed to provide evidence to the MPH, USAID, and the broader community working on HIS on how to integrate key elements of the HIS effectively. This brief reports our study’s findings.
Assessment of the MaMoni Health Systems Strengthening Project, in Bangladesh Barkataki, S., Billah, M., Chakraborty, N., Haider, M. M., Imam, M. A., Khan, S., Priyanka, S. S., Rahman, M, Rahman, M, & Al-Sabir, A. 2020 English Asia, BANGLADESH Child survival, Family Planning, Maternal and child health, Antenatal Care, Bangladesh, Maternal health, Maternal Health, Child health, Antenatal care The United States Agency for International Development (USAID)-supported MaMoni Health Systems Strengthening (MaMoni HSS) project sought to improve the use of integrated family planning (FP), maternal, newborn, and child health (MNCH), and nutrition services in six low-performing districts of Bangladesh from September 2013 to September 2017. Save the Children in Bangladesh implemented the project. The MaMoni HSS project pursued a multipronged strategy to ensure service delivery at the different types of health facilities in the six districts. At the union-level facilities, it focused on ensuring primary-level outpatient care and increasing skilled birth attendance and round-the-clock delivery care. At the district and upazila levels, MaMoni HSS focused on referrals for maternal and newborn care, including caesarean section services, management of preeclampsia/eclampsia, care for newborns at specialized units, and management of severe acute malnutrition. Although the MaMoni HSS project followed this multipronged strategy, its primary purpose was to strengthen the delivery of services at the union-level facilities. Moreover, although the project worked with community clinics (CCs) for growth monitoring and promotion, counseling, and antenatal care (ANC), the CCs were not a focus area of the intervention.
An Assessment of the Advancing Adolescent Health Program in Bangladesh Quamrun Nahar, Anadil Alam, Sadia Afrin, Sharad Barkataki, Shusmita Khan, Ali Ahmed, Iffat Sharmin, Musarrat Rubina Mannan, and Mizanur Rahman 2020 English BANGLADESH Adolescents, Reproductive Health, family planning, Adolescent health, Reproductive Empowerment The Advancing Adolescent Health (A2H) program was funded by the United States Agency for International Development (USAID) and implemented by Plan International in Rangpur District, Bangladesh, from January 2016 to January 2019. Plan International collaborated with two local nongovernmental organizations to implement A2H: The Eco-Social Development Organization and World Mission Prayer League’s LAMB Hospital—popularly known as LAMB Hospital. The goal of A2H was to improve adolescent sexual and reproductive health and family planning knowledge and access and use of related services for married and unmarried adolescents. To assess the program, the USAID-funded projects Research for Decision Makers, based at the International Centre for Diarrhoeal Diseases Research, Bangladesh, and MEASURE Evaluation, based at the University of North Carolina at Chapel Hill (USA), conducted a household survey from July–September 2018 among 8,501 girls ages 15–19 years from the two selected program areas and 3,005 similar girls from a comparison area. This report presents findings from an analysis of this survey.
The PEPFAR Local Capacity Initiative Strengthens Organizational Capacity in Uganda Mary Freyder, Eve Namisango, Tory M. Taylor, Annie Glover, and Katherine Andrinopoulos 2020 English UGANDA Sex Workers, Capacity Assessment, People Living with HIV, Key Populations, Capacity Building, HIV, M&E The Local Capacity Initiative (LCI) strengthened the capacity of civil society organizations (CSOs) to support policy advocacy, with the ultimate goal of improving health services for key populations affected by the HIV epidemic. The United States President’s Emergency Plan for AIDS Relief (PEPFAR) funded the initiative from 2013–2018 to help local CSOs create an enabling environment for PEPFAR’s objectives. Under the LCI, the United States Centers for Disease Control and Prevention worked in Uganda between 2015 and 2018 to strengthen the policy advocacy capacity of CSOs that worked with men who have sex with men, transgender women, and sex workers and develop the capacity of public health officials to consider gender and sexual diversity issues. MEASURE Evaluation, which is funded by the United States Agency for International Development and PEPFAR, conducted an evaluation of LCI Uganda between 2017 and 2018. This brief presents the results of LCI's efforts to build capacity through training and structural interventions. Additional briefs summarize the main interventions that LCI employed to create an enabling environment for policy advocacy, the community scorecard strategy to improve HIV clinical services in Uganda, efforts to support KPs in coalition building, the methods used by the evaluation team to study the efficacy of LCI’s work and measure change resulting from it, and the process used to measure changes in organizational capacity.
The PEPFAR Local Capacity Initiative Evaluation Measures Organizational Capacity in Uganda Tory M. Taylor, Annie Glover, Katherine Andrinopoulos, and Mary Freyder 2020 English UGANDA Key Populations, Capacity Assessment, M&E, HIV, Sex Workers, Capacity Building, PLHIV, Assessment The Local Capacity Initiative (LCI) strengthened the capacity of civil society organizations (CSOs) to support policy advocacy, with the ultimate goal of improving health services for key populations affected by the HIV epidemic. The United States President’s Emergency Plan for AIDS Relief (PEPFAR) funded the initiative from 2013–2018 to help local CSOs create an enabling environment for PEPFAR’s objectives. Under the LCI, the United States Centers for Disease Control and Prevention worked in Uganda between 2015 and 2018 to strengthen the policy advocacy capacity of CSOs that worked with men who have sex with men, transgender women, and sex workers and develop the capacity of public health officials to consider gender and sexual diversity issues. MEASURE Evaluation, which is funded by the United States Agency for International Development and PEPFAR, conducted an evaluation of LCI Uganda between 2017 and 2018. This brief provides an overview of efforts to measure changes in organizational capacity. Additional briefs summarize the main interventions that LCI employed to create an enabling environment for policy advocacy, the community scorecard strategy to improve HIV clinical services in Uganda, efforts to support KPs in coalition building, the methods used by the evaluation team to study the efficacy of LCI’s work and measure change resulting from it, and the results of organizational capacity building.
Cadre d'évaluation des programmes nationaux de lutte contre le paludisme dans les zones de transmission modérée et faible: Aide-Mémoire MEASURE Evaluation 2020 French Global L’épidémiologie du paludisme est devenue de plus en plus hétérogène dans de nombreux pays. Ces pays ont besoin de données détaillées sur le risque et l’incidence de la transmission pour orienter la mise en œuvre efficace de leurs interventions et suivre les progrès réalisés. Pour répondre à ces besoins de renforcement des programmes nationaux de lutte contre le paludisme (PNLP), un groupe de travail sur l’évaluation composé d’un sous-groupe du Groupe de référence sur le suivi et l’évaluation de Roll Back Malaria - « Faire reculer le paludisme » a élaboré le Cadre d’évaluation des programmes nationaux de lutte contre le paludisme dans les zones de transmission modérée et faible. Ce document fournit un cadre général d’évaluation des PNLP tout au long du continuum de transmission du paludisme. Chaque zone de transmission est définie par les classifications de l'Organisation Mondiale de la Santé [1]. L’examen et la synthèse des documents d’orientation et des outils existants pour la surveillance, le suivi et l’évaluation du paludisme ont permis de définir la portée et les objectifs de ce document. Cet aide-mémoire est un résumé du document complet sur le cadre. Les principaux objectifs du cadre d'évaluation sont les suivants : Fournir un cadre général d’évaluation des PNLP tout au long du continuum de transmission du paludisme Fournir une description des liens entre l’évaluation d’impact et l’évaluation de processus Donner des recommandations et orientations spécifiques pour la mise en œuvre des évaluations d’impact dans les pays où la transmission est modérée, faible ou hétérogène. Donner des conseils pratiques sur la manière d’analyser les résultats d'évaluation au niveau sous-national pour avoir une vue d’ensemble au niveau national dans des contextes de transmission hétérogène
Enquadramento para Avaliação de NMPs em Cenários de Transmissão Moderada e Baixa: Aide Memoire MEASURE Evaluation 2020 Portuguese Global A epidemiologia da malária tornou-se cada vez mais heterogénea em muitos países. Estes países requerem dados granulares sobre o risco e incidência para informar efectivamente e direccionar as suas intervenções e acompanhar o seu progresso. Para responder a estas necessidades de fortalecimento dos programas nacionais para controlo da malária (NMPs) um grupo de trabalho compreendendo um subgrupo do Grupo de Referência para Monitoria e avaliação do Programa Roll Back Malaria desenvolveu o Quadro para Avaliação dos Programas Nacionais Contra a Malária em Cenários de Transmissão Moderada e Baixa. Este documento oferece um quadro abrangente para avaliação dos NMPs ao longo do contínuo da transmissão da malária. Cada cenário de transmissão é definido pelas classificações da Organização Mundial da Saúde [1]. O âmbito e objectivos foram informados através de uma revisão e síntese dos documentos de guia e ferramentas existentes para vigilância, monitoria e avaliação da malária. Este aide memoire resume o documento do quadro completo. Os objectivos chave do quadro de avaliação são fornecer o seguinte: Um quadro abrangente para avaliação dos NMPs ao longo do contínuo da transmissão da malária Descrição de ligações entre o impacto e processo de avaliação Recomendações específicas e orientação para conduzir avaliações do impacto em países com cenários de transmissão moderada, baixa e heterogénea. Orientação sobre como juntar os resultados da avaliação a nível sub-nacional para contar uma narrativa nacional em cenários de transmissão heterogénea
The PEPFAR Local Capacity Initiative Evaluation Methods in Ghana Mary Freyder, Samuel Essah 2020 English The Local Capacity Initiative (LCI) strengthened the capacity of civil society organizations (CSOs) to support policy advocacy, with the ultimate goal of improving health services for key populations (KPs) affected by the HIV epidemic. The United States President’s Emergency Plan for AIDS Relief (PEPFAR) funded the initiative from 2013–2018 to help local CSOs create an enabling environment for PEPFAR’s objectives. The United States Agency for International Development (USAID) funded a local partner to implement the People for Health project in Ghana between 2015 and 2020. People for Health implemented interventions that strengthened CSO capacity and mobilized citizen groups to advocate better health services. LCI funding supported the integration of KP-specific interventions in the general health policy advocacy strategy of People for Health. Key population citizen groups included men who have sex with men (MSM), sex workers, and people living with HIV (PLHIV). MEASURE Evaluation, which is funded by USAID and PEPFAR, conducted an evaluation of People for Health in Ghana in 2019.  This brief provides an overview of the most significant change (MSC) methods used to evaluate the People for Health project in the Greater Accra and Eastern Regions. Access additional resources on the LCI evaluation in Ghana and Uganda.
The PEPFAR Local Capacity Initiative Evaluation Findings in Ghana Mary Freyder, Samuel Essah 2020 English Key Populations, PEPFAR, Ghana, Evaluation, HIV prevention, HIV The Local Capacity Initiative (LCI) strengthened the capacity of civil society organizations (CSOs) to support policy advocacy, with the ultimate goal of improving health services for key populations (KPs) affected by the HIV epidemic. The United States President’s Emergency Plan for AIDS Relief (PEPFAR) funded the initiative from 2013–2018 to help local CSOs create an enabling environment for PEPFAR’s objectives. The United States Agency for International Development (USAID) funded a local partner to implement the People for Health project in Ghana between 2015 and 2020. People for Health implemented interventions that strengthened CSO capacity and mobilized citizen groups to advocate better health services. LCI funding supported the integration of KP-specific interventions in the general health policy advocacy strategy of People for Health. Key population citizen groups included men who have sex with men (MSM), sex workers, and people living with HIV (PLHIV). MEASURE Evaluation, which is funded by USAID and PEPFAR, conducted an evaluation of People for Health in Ghana in 2019.  This issue brief provides an overview of the most significant change findings from the evaluation of the People for Health project in The Greater Accra and Eastern Regions. Access additional resources on the LCI evaluation in Ghana and Uganda.
Considerations for the Use of Routine Data for Evaluation of Public Health Programs MEASURE Evaluation 2020 English Data quality, Evaluation, RHIS, Routine Health Information Systems, Data use A routine health information system (RHIS) collects and provides data about standard health and vital events at regular intervals to support the decision-making process at each level of the health system. Use of data from RHIS for evaluation has grown as more resources are dedicated to improving these systems. Secondary data, including routine data, are not collected by the data user but have appealing advantages over primary data collected for specific research. They are typically collected more frequently or over a longer period; boast greater cost efficiency, in some cases; and may be available more quickly. However, routine data are not appropriate for all evaluation questions or all contexts. Evaluators must carefully consider aspects such as data quality, usability, and accessibility before deciding to use these data. MEASURE Evaluation, which is funded by the United States Agency for International Development (USAID), has used RHIS data in numerous evaluations over the past 20 years. This brief shares field experiences from this work and key considerations for the use of RHIS data in evaluation.
An Assessment of the Prerequisites for a Social Welfare Information Management System in Ghana Otieno, P., Mutwiri, J., & Antwi-Boasiako, E. W. 2020 English GHANA, Africa Ghana, Social services, Information System, Alternative Care, Children, Child Health, Care for children Since 2017, through financial support from the USAID Displaced Children and Orphans Fund, the MEASURE Evaluation project has collaborated with the Republic of Ghana’s Department of Social Welfare (DSW), USAID/Ghana, and UNICEF to assess, address, and monitor alternative care of children in Ghana in line with the United Nations Guidelines for the Alternative Care of Children, which serves to enhance the implementation of the United Nations Convention on the Rights of the Child. In 2018, Ghana’s MOGCSP, with support from UNICEF, developed a concept note for an information system that would capture data for child protection and social welfare services. This system aims to strengthen the coordinated delivery of social services across the areas of social protection, community development, gender-based violence, justice for children, child protection, education, and health. Alternative care will be included in the system, with the plan to eventually provide access to RHCs. The SWIMS will adopt an open-source case management software, developed by UNICEF headquarters, called Protection Related Information Management System, or “Primero.” This online platform is designed to be adapted to the country-specific context and can be configured to the specific system of child welfare services in Ghana. To support preparations for the SWIMS deployment, MEASURE Evaluation gathered information for some of the requirements for the rollout of a national Ghana SWIMS. This report presents our findings.
Learner’s Guide to Monitoring and Evaluation of Care Reform in Armenia Charyeva, Z., Ghukasyan, H., & Gheorghe, C. 2020 English Monitoring, Evaluation, Alternative Care, Child health, Armenia, Children, Care for children The United States Agency for International Development (USAID) Displaced Children and Orphans Fund (DCOF) works in countries around the world to improve the safety, well-being, and development of vulnerable children, with particular attention to preserving and facilitating their access to appropriate, protective, and permanent family care. The overall goal of the USAID/DCOF-funded activity in Armenia is to strengthen the country’s leadership to advance the reform of national policies and systems for the care of children who lack adequate family care. Enhanced government capacity to assess, address, and monitor care reform is the long-term vision of USAID/DCOF, the USAID-funded MEASURE Evaluation project, and government partners in the country. To support this agenda, MEASURE Evaluation conducted a series of training sessions in monitoring and evaluation (M&E) during 2018 to 2019 for stakeholders in Armenia. The training included basic training in M&E, training on data use and demand, data quality, and data analysis. This guide serves as a reference document for participants who attended the MEASURE Evaluation training sessions. It also serves as a self-learning guide for people who do M&E work but who were unable to attend the training. It is expected that the guide’s users will apply key M&E concepts in their daily work. Because this is a self-learning material, there is no opportunity to discuss new concepts in a group setting or to ask questions. It is therefore suggested that users visit the MEASURE Evaluation website (https://www.measureevaluation.org/resources) for additional M&E materials.
Evaluation of mainstreaming youth-friendly health in private clinics in Malawi Janine Barden-O’Fallon, Shara Evans, Chrissie Thakwalakwa, Witness Alfonso, Ashley Jackson 2020 English Youth, Adolescents, Evaluation, Family Planning, Malawi BackgroundHigh fertility rates and low modern contraceptive use put African youth and adolescents at high risk for health complications, including maternal mortality. Mainstreaming youth-friendly health services (YFHS) into existing services is one approach to improve access to reproductive health services for youth and adolescents. The objective of the evaluation was to assess the effects of a Population Services International (PSI)-sponsored YFHS training package on voluntary uptake of family planning among youth and perceptions of service quality by youth and trained healthcare providers in Malawi. MethodsIn 2018, a mixed-methods convergent parallel design was used to assess relevant monitoring and evaluation documents and service statistics from PSI Malawi and qualitative data on perceptions of service quality from Malawian youth and healthcare providers. The data were assessed through separate descriptive and thematic analysis and integrated to generate conclusions. ResultsResults show that the number of family planning clients ages 15–24 increased from 72 to 2278 per quarter during the implementation of the YFHS training packages, however, positive trends in client numbers were not sustained after youth outreach activities ended. Focus group discussions with 70 youth and adolescents indicated that clinics were perceived as providing high-quality services to youth. The main barriers to accessing the services were cost and embarrassment. Interviews with ten healthcare providers indicated that many made efforts to improve clinic accessibility and understood the barrier of cost and importance of outreach to youth and the broader community. ConclusionsThe findings support research showing positive effects of mainstreaming YFHS when training for healthcare staff is combined with additional YFHS programming components. Furthermore, the findings provide evidence that provider training alone, though beneficial to perceived service quality, is not sufficient to sustain increases in the number of adolescent and youth family planning clients.
Reproductive Empowerment Scale MEASURE Evaluation 2020 English Reproductive Health, Reproductive Empowerment, Fertility, Women To strengthen and standardize a measurement of reproductive empowerment among women in sub-Saharan Africa, MEASURE Evaluation—a project funded by the United States Agency for International Development—recently developed and validated a multidimensional scale that can be incorporated in survey instruments. The Reproductive Empowerment Scale consists of five short subscales that measure women’s communication with healthcare providers; communication with partners; decision-making; social support; and social norms on issues related to women’s reproductive health and fertility. Access related reports from work done in Nigeria, Kenya, and Zambia.
Evaluating malaria programmes in moderate- and low-transmission settings: practical ways to generate robust evidence Ruth A. Ashton, Debra Prosnitz, Andrew Andrada, Samantha Herrera & Yazoumé Yé 2020 English Evaluation, Malaria, Transmission BackgroundMany countries have made substantial progress in scaling-up and sustaining malaria intervention coverage, leading to more focalized and heterogeneous transmission in many settings. Evaluation provides valuable information for programmes to understand if interventions have been implemented as planned and with quality, if the programme had the intended impact on malaria burden, and to guide programmatic decision-making. Low-, moderate-, and heterogeneous-transmission settings present unique evaluation challenges because of dynamic and targeted intervention strategies. This paper provides illustration of evaluation approaches and methodologies for these transmission settings, and suggests how to answer evaluation questions specific to the local context. MethodsThe Roll Back Malaria Monitoring and Evaluation Reference Group formed a task force in October 2017 to lead development of this framework. The task force includes representatives from National Malaria Programmes, funding agencies, and malaria research and implementing partners. The framework builds on existing guidance for process and outcome evaluations and impact evaluations specifically in high transmission settings. ResultsThe theory of change describes how evaluation questions asked by national malaria programmes in different contexts influence evaluation design. The transmission setting, existing stratification, and data quality and availability are also key considerations. The framework is intended for adaption by countries to their local context, and use for evaluation at sub-national level. Confirmed malaria incidence is recommended as the primary impact indicator due to its sensitivity to detect changes in low-transmission settings. It is expected that process evaluations provide sufficient evidence for programme monitoring and improvement, while impact evaluations are needed following adoption of new mixes of interventions, operational strategies, tools or policies, particularly in contexts of changing malaria epidemiology. Impact evaluations in low-, moderate-, or heterogeneous-transmission settings will likely use plausibility designs, and methods highlighted by the framework include interrupted time series, district-level dose–response analyses, and constructed control methods. Triangulating multiple data sources and analyses is important to strengthen the plausibility argument. ConclusionsThis framework provides a structure to assist national malaria programmes and partners to design evaluations in low-, moderate- or heterogeneous-transmission settings. Emphasizing a continuous cycle along the causal pathway linking process evaluation to impact evaluation and then programmatic decision-making, the framework provides practical guidance in evaluation design, analysis, and interpretation to ensure that the evaluation meets national malaria programme priority questions and guides decision-making at national and sub-national levels.
Experiences and Lessons Learned: Implementing the Ripple Effects Mapping Method MEASURE Evaluation 2020 English Africa, BOTSWANA, TANZANIA, Global REM, ripple effects mapping, Qualitative Evaluation, Monitoring, Evaluation, Mapping Ripple effects mapping (REM) is a qualitative, participatory group method for evaluating complex programs. MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID)—adapted and used REM to supplement traditional evaluation methods and increase stakeholder participation. This brief shares how the application of REM was carried out in two studies in sub-Saharan Africa and lessons learned from the experience. 
A Practical Way to Prevent Mother-to-Child Transmission of HIV: Learning from the Partnership for HIV-Free Survival Hales, D. K., Bobrow, E. A., Davis, H. B., & Munson, A. J. 2020 English HIV prevention, PEPFAR, PHFS, Transmission, HIV, PMTCT The Partnership for HIV-Free Survival (PHFS) was an innovative project designed to prevent mother-to-child transmission of HIV. PHFS brought together proven practices from prevention of mother-to-child transmission (PMTCT), quality improvement (QI), nutrition, and community outreach initiatives to improve the health outcomes for mothers living with HIV and their HIV-exposed infants. Supported by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR), PHFS was active from 2012 to 2016 in six sub-Saharan African countries: Kenya, Lesotho, Mozambique, South Africa, Tanzania, and Uganda. A team from the USAID- and PEPFAR-funded MEASURE Evaluation project conducted a legacy evaluation of the PHFS in 2018. We identified several compelling lessons for successful PMTCT programs from the ways the project was implemented in the participating countries. These lessons are broadly applicable to countries and facilities that are working to reduce mother-to-child transmission of HIV, increase retention in antiretroviral therapy (ART), support better nutrition practices, and improve clients’ health-seeking behaviors. Although many of the lessons are cited in the PHFS legacy evaluation report (Hales, Davis, Munson, & Bobrow, 2019; https://www.measureevaluation.org/resources/publications/tr-18-314), this document was prepared to provide practical guidance for identifying and implementing appropriate activities in the local context. It includes descriptions of the key lessons, tips, and an extensive checklist to help decision makers and implementers understand how and why to launch, implement, and sustain the critical activities in the PHFS approach. Access a separate, editable Word file of the checklists at https://www.measureevaluation.org/resources/publications/tl-20-80/
A Practical Way to Prevent Mother-to-Child Transmission of HIV: Learning from the Partnership for HIV-Free Survival—Checklists Hales, D. K., Bobrow, E. A., Davis, H. B., & Munson, A. J. 2020 English PHFS, PMTCT, HIV prevention, PEPFAR, HIV, Transmission The Partnership for HIV-Free Survival (PHFS) was an innovative project designed to prevent mother-to-child transmission of HIV. PHFS brought together proven practices from prevention of mother-to-child transmission (PMTCT), quality improvement (QI), nutrition, and community outreach initiatives to improve the health outcomes for mothers living with HIV and their HIV-exposed infants. Supported by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR), PHFS was active from 2012 to 2016 in six sub-Saharan African countries: Kenya, Lesotho, Mozambique, South Africa, Tanzania, and Uganda. A team from the USAID- and PEPFAR-funded MEASURE Evaluation project conducted a legacy evaluation of the PHFS in 2018. We identified several compelling lessons for successful PMTCT programs from the ways the project was implemented in the participating countries. These lessons are broadly applicable to countries and facilities that are working to reduce mother-to-child transmission of HIV, increase retention in antiretroviral therapy (ART), support better nutrition practices, and improve clients’ health-seeking behaviors. We used what we learned from the legacy evaluation to develop a manual offering guidance for identifying and implementing appropriate activities in the local context. A Practical Way to Prevent Mother-to-Child Transmission of HIV: Learning from the Partnership for HIV-Free Survival (available here: https://www.measureevaluation.org/resources/publications/ms-19-182/) includes descriptions of the key lessons, tips, and an extensive checklist to help decision makers and implementers understand how and why to launch, implement, and sustain the critical activities in the PHFS approach. We offer this separate Microsoft Word version of the checklists to make it easy for users to adapt them to their context and needs.
Using a quality improvement approach in the prevention of mother-to-child HIV transmission program in Uganda improves key outcomes and is sustainable in demonstration facilities: Partnership for HIV-Free Survival Flax VL, Kasasa S, Ssendagire S, Lane C, Atuyambe L, Lance PM, Ssengooba F, Draru J, Bobrow EA 2020 English Uganda, HIV prevention, AIDS, HIV, PMTCT Background: The Partnership for HIV-Free Survival (PHFS) in Uganda used a quality improvement (QI) approach to integrate the prevention of mother-to-child transmission (MTCT) of HIV, maternal and child health, and nutrition services, with the goal of increasing the retention of mother-baby pairs in care and decreasing vertical transmission of HIV. Methods: This evaluation of PHFS used a retrospective longitudinal design to assess the program’s association with four outcomes. Data were extracted from patient records from 2011 (before the program) to 2018 (after the program) at 18 demonstration, 18 scale-up, and 24 comparison facilities. Difference-in-differences analyses were conducted with significance set at p<0.15 during and p>0.15 or a continued improvement after PHFS. Results: PHFS was associated with an increase in exclusive breastfeeding (EBF) (p=0.08), 12- month retention in care (p<0.001), and completeness of child 18-month HIV test results (p=0.13) at demonstration facilities during program implementation. MTCT at 18 months decreased but did not differ between groups. Increases in EBF (p=0.67) and retention in care (p=0.16) were sustained, and data completeness (p=0.10) continued to increase at demonstration facilities after the program. PHFS was associated with an increase in EBF (p<0.001) at scale-up facilities, but there was no difference between groups for retention in care, MTCT, or data completeness. Gains in EBF were lost (p=0.08) and retention in care declined (p<0.001) at scale-up facilities after the program. Conclusion: PHFS′ quality improvement approach increased EBF, retention in care, and data completeness in demonstration facilities during the program and these benefits were sustained.
Identifying the Right Gender M&E Resource for Your Needs MEASURE Evaluation 2020 English Global Monitoring, Evaluation, Gender, M&E This resource can help users identify the best gender monitoring and evaluation (M&E) resource for their needs. A version for printing is available here.
Surveillance, Monitoring, and Evaluation of Malaria Programs: Online Course MEASURE Evaluation 2020 English Malaria, Training, SME, Malaria Surveillance Surveillance, monitoring, and evaluation (SME) plays a vital role in all malaria control and prevention programs. This course provides a comprehensive introduction to SME of malaria programs. Download a PDF of the full course or download the individual modules below. The course is also available in French. To access the online course for certification, go to www.memalaria.org. Module 1: Overview of Malaria Module 2: Using Data for Decision Making Module 3: Introduction to SME for Malaria Programs Course Module 4: Designing and Implementing a SME Plan Module 5: Frameworks Module 6: Indicators for Malaria Programs Module 7: Data Sources for Malaria SME Module 8: Analysis, Interpretation, and Presentation of Malaria Data Module 9: Ethics of Malaria SME Module 10: Leadership for Malaria SME Module 11: Malaria Surveillance Module 12: Gender in Malaria SME
Promoting Appropriate Care for Children: Report on a Workshop on Case Management Information Systems MEASURE Evaluation 2020 English Child health, Children, Case management, Information System, Worskhop, CMIS, Care for children The United States Agency for International Development (USAID) works in countries around the world to improve the lives of the world’s most vulnerable children in keeping with the three objectives established in the U.S. government strategy for Advancing Protection and Care for Children in Adversity (APCCA). Those objectives are to build strong beginnings, put family first, and protect children from violence (https://www.childreninadversity.gov). In support of key country priorities and in line with APCCA objectives, USAID/DCOF-funded activities focus on assisting families to better care for their children, reforming national systems for children’s care, strengthening child welfare and protection policies, and developing and operationalizing the local systems needed to sustain program efforts. In March 2017, USAID/DCOF engaged the USAID-funded MEASURE Evaluation (MEval) project to build on and reinforce current USG programming on child care and protection in four focus countries: Armenia, Ghana, Moldova, and Uganda. MEval works globally to strengthen country capacity to gather, analyze, and use data for decision making to improve sector outcomes. The overall goal of this USAID/DCOF-funded activity is to intensify country leadership in advancing national efforts on behalf of children who lack adequate family care, that is, national care reform. MEval is working to strengthen the capacity of government partners to accomplish the following: Provide leadership in implementing a structured assessment of national care reform systems and strategies using a standardized framework/tool. Identify gaps and continuing needs in care reform. Develop plans to address priority needs. Establish indicators and systems for the regular assessment of progress and monitoring of results against country plans for care reform. Efforts to build digital information systems have been made in the four focus countries, with lessons learned about what is working well and what can be strengthened. In light of the increased interest in advancing digital solutions for the case management1 of children in various settings, USAID/DCOF asked MEval to convene a group of experts from December 4–6, 2019, at Palladium’s office in Washington, DC, on case management information systems (CMIS). This report outlines the workshop sessions and provides highlights, key discussion points, and action items.  Access Ignite presentations from the workshop.
Gaps in Global Monitoring and Evaluation of Adolescent and Youth Reproductive Health Bridgit Adamou 2020 English Global Indicators, Youth, Reproductive Health, Monitoring, M&E, adolescent, Monitoring, Evaluation Adolescents and youth are a key population for reproductive health (RH) interventions, because young people suffer disproportionately from negative RH outcomes, including acquisition of HIV and other sexually transmitted infections; unintended, unwanted, or mistimed pregnancy; unsafe abortion; and gender-based violence. Effective monitoring and evaluation (M&E) of RH interventions designed for adolescents and youth is essential to determine their success and impact and show where improvement is needed. MEASURE Evaluation, which is funded by the United States Agency for International Development, conducted the research presented in this report to identify gaps in the M&E of adolescent and youth reproductive health (AYRH) programs. This process consisted of reviewing the landscape of M&E of AYRH interventions, outcomes, and impacts; identifying measurement gaps; and making recommendations to improve the M&E of AYRH activities and programs across a spectrum of RH categories.
The Story of DHIS2 in Mali: Toward a Fully Integrated Health Information System MEASURE Evaluation 2020 English HIS, Mali, Health Services, Health Information Systems, Data Quality, DHIS 2, HIS strengthening, Health outcomes, Data A strong health information system provides high-quality data to measure health outcomes, track disease outbreaks, measure service coverage, and guide strategy. Mali transformed its health information and can track disease trends and health services, manage resources, and plan strategically for the future. Thousands of users and multiple stakeholders work in concert.
Building a Cadre of Experts in Routine Health Information MEASURE Evaluation 2020 English Routine Health Information Systems, Data, Data Demand and Use, Data use, RHIS, Mali, Training Good data management provides Mali evidence for meeting health needs. Read about work in Mali to improve data quality and use for sound decision making by implementing routine health information systems (RHIS) training.
Mali takes deliberate steps to improve health information MEASURE Evaluation 2020 English Health Information Systems, HIS strengthening, RHIS, Routine Health Information Systems, HIS, Mali Assessing and improving health data systems enables better outcomes. In 2013, MEASURE Evaluation supported Mali to conduct a study to develop evidence of gaps and challenges in its HIS and recommendations for improvement. The findings guided Mali’s steps to strengthen its HIS. In 2018, a second assessment showed major accomplishments in data accuracy at the service level, data completeness and timeliness in reporting, a functioning system integrated from the local to the national level, and suggestions for improvements.
Global Health Security: Surveillance that keeps abreast of potential outbreaks MEASURE Evaluation 2020 English Digital Health, Global health security, Data, Surveillance, GHSA, Mali, Data use This poster reviews Mali's path to stronger disease surveillance. Digital data systems—when well-maintained—yield real-time disease surveillance for quick response. Strengthening digital systems requires skilled people and continuous monitoring for data quality and facilitated data use.
A Successful Trial of Digitized Health Records in Mali MEASURE Evaluation 2020 English Mali, Pregnancy, Digital Health, Child Health, Health outcomes, EHealth, Health, Antenatal Care eRegisters in Mali improved monitoring of pregnant women and children and reduced the health provider workload.
Statistical Yearbooks--Current data helps Mali track health services and performance MEASURE Evaluation 2020 English Health data, Health Information Systems, Data, DDU, Mali Mali produced draft yearbooks with compiled data from local and national disease surveillance and other health data—plus indicator analysis of performance. These population health statistics constitute a reliable basis for Mali’s health planning.
Mali's Mighty Malaria Bulletins MEASURE Evaluation 2020 English HIS, Mali, Health Information Systems, Malaria, DHIS 2, Malaria Surveillance Malaria bulletins in Mali provide consistent and high-quality malaria data to guide program implementation and measure achievements.
The PEPFAR Local Capacity Initiative Supports the Community Scorecard to Improve HIV Services for Key Populations in Uganda Mary Freyder, Eve Namisango, Tory M. Taylor, Annie Glover, and Katherine Andrinopoulos 2020 English UGANDA Health care, Health Services, Key Populations, Capacity Building, KP, policy The Local Capacity Initiative (LCI) strengthened the capacity of civil society organizations (CSOs) to support policy advocacy, with the ultimate goal of improving health services for key populations affected by the HIV epidemic. The United States President’s Emergency Plan for AIDS Relief (PEPFAR) funded the initiative from 2013–2018 to help local CSOs create an enabling environment for PEPFAR’s objectives. Under the LCI, the United States Centers for Disease Control and Prevention worked in Uganda between 2015 and 2018 to strengthen the policy advocacy capacity of CSOs that worked with men who have sex with men, transgender women, and sex workers and develop the capacity of public health officials to consider gender and sexual diversity issues. MEASURE Evaluation, which is funded by the United States Agency for International Development and PEPFAR, conducted an evaluation of LCI Uganda between 2017 and 2018. This brief provides an overview of the community scorecard strategy to improve HIV clinical services in Uganda. Additional briefs summarize the main interventions that LCI employed to create an enabling environment for policy advocacy, efforts to support KPs in coalition building, and the methods used by the evaluation team to study the efficacy of LCI’s work and measure change resulting from it.
The PEPFAR Local Capacity Initiative Supports a Coalition of Civil Society Organizations Serving Key Populations in Uganda Katherine Andrinopoulos, Eve Namisango, Tory M. Taylor, Annie Glover, and Mary Freyder 2020 English UGANDA Health Services, Key Populations, Health care, policy, KP, Capacity Building The Local Capacity Initiative (LCI) strengthened the capacity of civil society organizations (CSOs) to support policy advocacy, with the ultimate goal of improving health services for key populations affected by the HIV epidemic. The United States President’s Emergency Plan for AIDS Relief (PEPFAR) funded the initiative from 2013–2018 to help local CSOs create an enabling environment for PEPFAR’s objectives. Under the LCI, the United States Centers for Disease Control and Prevention worked in Uganda between 2015 and 2018 to strengthen the policy advocacy capacity of CSOs that worked with men who have sex with men, transgender women, and sex workers and develop the capacity of public health officials to consider gender and sexual diversity issues. MEASURE Evaluation, which is funded by the United States Agency for International Development and PEPFAR, conducted an evaluation of LCI Uganda between 2017 and 2018. This brief summarizes LCI’s efforts to develop organizational capacity through coalition building in Uganda. Additional briefs summarize the main interventions that LCI employed to create an enabling environment for HIV policy advocacy, implement the community scorecard strategy to improve HIV clinical services, and the methods that the evaluation team used to study the efficacy of LCI’s work and measure change resulting from it.
The PEPFAR Local Capacity Initiative Evaluation Methods in Uganda Mary Freyder, Eve Namisango, Tory M. Taylor, Annie Glover, and Katherine Andrinopoulos 2020 English UGANDA Health care, Health Services, Key Populations, Capacity Building, KP, policy The Local Capacity Initiative (LCI) strengthened the capacity of civil society organizations (CSOs) to support policy advocacy, with the ultimate goal of improving health services for key populations affected by the HIV epidemic. The United States President’s Emergency Plan for AIDS Relief (PEPFAR) funded the initiative from 2013–2018 to help local CSOs create an enabling environment for PEPFAR’s objectives. Under the LCI, the United States Centers for Disease Control and Prevention worked in Uganda between 2015 and 2018 to strengthen the policy advocacy capacity of CSOs that worked with men who have sex with men, transgender women, and sex workers and develop the capacity of public health officials to consider gender and sexual diversity issues. MEASURE Evaluation, which is funded by the United States Agency for International Development and PEPFAR, conducted an evaluation of LCI Uganda between 2017 and 2018. This brief provides an overview of the methods that  the evaluation team used to measure change resulting from LCI’s work in Uganda. Additional briefs summarize the main interventions that LCI employed to create an enabling environment for HIV policy, provide overviews of work to develop organizational capacity through coalition building, and an overview of the community scorecard strategy to improve HIV clinical services.
Évaluation de la qualité des données sur le paludisme à l'aide de l'outil d'examen systématique de la qualité des données de l’OMS au Mali Diadier Diallo, Ignace Traoré, Seydou Fomba, Assitan Dembélé, Madina Konaté, Issiaka Dembélé, Adama Ouattara, Madina Kouyaté, Aminata Traoré, Ramine Bahrambegi, Jules Mihigo, Erin Eckert, Alimou Barry, et Yazoume Yé 2020 French Data Quality, Health Information Systems, HISS, DHIS 2, RDQA, Malaria, Mali, HIS, Information System Le Mali s'appuie sur les données des formations sanitaires (FS) pour la planification et le suivi des progrès et des performances des programmes de santé. Cependant, le manque de données de qualité pour une prise de décision saine reste un défi majeur dans les pays à ressources limitées. Depuis 2010, le projet MEASURE Evaluation travaille avec le Ministère de la Santé (MS) et d'autres partenaires locaux pour améliorer la disponibilité de données de qualité pour la prise de décision. En 2016, le logiciel DHIS2 a été introduit et déployé au niveau des FS en tant que plateforme nationale pour la collecte et la gestion des données de routine avec le soutien de MEASURE Evaluation. En 2018, MEASURE Evaluation a appuyé le MS dans l’intégration de l’application DQR (Data Quality Review) de l'Organisation mondiale de la santé dans DHIS2 afin de continuer à améliorer la qualité des données.
Intégration des données de routine et de surveillance du paludisme dans le système national d’information sanitaire du Mali: Acquis et meilleures pratiques Diadier Diallo, Edem Kossi, Ignace Traoré, Issiaka Dembélé, Madina Konaté, Diakalia Koné, Jules Mihigo, Aminata Traoré, Ramine Bahrambegi, Jean-Marie N’Gbichi, Erin Eckert, Alimou Barry, and Yazoume Yé 2020 French HIS, Routine Health Information Systems, HMIS, Information System, DHIS 2, Mali, Malaria, Data Quality, Routine Data, RHIS, HISS, Health Information Systems Jusqu’en 2010, le logiciel de la plateforme du système national d’information sanitaire (SNIS) du Mali était sous Microsoft Access. Cette plateforme avait été conçue pour le rapportage trimestriel des données sanitaires de routine et incluait seulement quatre indicateurs clés du paludisme. A cause des limitations présentées par cette plateforme, MEASURE Evaluation a appuyé le Programme National de Lutte contre le Paludisme (PNLP) en 2011 à développer et mettre en oeuvre une application pour le rapportage des données paludiques de routine en utilisant des téléphones portables dans certaines régions. A la fin de 2015, 465 centres de santé communautaire (CSCom) utilisaient cette application pour la collecte et la transmission des données de routine du paludisme. En 2013, cette application a été adaptée pour la surveillance hebdomadaire du paludisme afin de détecter des flambées et prévenir des épidémies dans plusieurs CSCom. Ceci dit, l’intérêt qu’a eut le Mali dans un SNIS intégré capable de collecter et d’analyser toutes les données sanitaires pour une planification d’actions stratégiques et le développement de politiques a mené à l’évaluation du système d’information sanitaire de routine (SISR) en 2013. Les recommandations qui en sont sorties a conduit à l’introduction du District Health Information Software (DHIS2), développé afin d’appuyer la gestion des données sanitaires des districts.
Évaluation de la performance du système d'information hospitalier au Mali (2018) Aminata Traoré, Madina Ba Kouyaté, Abdoulaye Maiga, Adama Ouatara, Issaka Dembélé, Alamako Doumbia, Ismael Dembélé, Ouassa Berthe, Mamoutou Diabaté, Mamadou Alimou Barry, Jeanne Chauffour 2020 French HMIS, Data Quality, Health Information Systems, RHIS, HISS, Routine Health Information Systems, PRISM, Performance of Routine Information System Management, Information System, Mali L'évaluation 2018 de la performance de la gestion du système d'information hospitalier (SIH) est la première évaluation de ce système. Elle a permis d’établir une base de référence àpartir de laquelle des interventions plus pertinentes seront conduites pour suivre et renforcer le SIH. Si des progrès importants ont été notés dans le domaine de la collecte et de l’automatisation des procédures de contrôle et d’analyse des données, il est important de relever le besoin de renforcer le système à la base. En d’autres termes, sur l’ensemble des domaines explorés, il a été observé des faiblesses non seulement au niveau des hôpitaux mais également au niveau de la Cellule de Planification et de Statistique (CPS) ---en dehors de l’analyse---qui méritent d’être revues et renforcées. Fait notable, nous n’avons pas été enmesure de confirmer l’utilisation des données au niveau de la CPS. Bien qu'un rapport analytique soit produit à ce niveau, le plan annuel ne couvre pas la gestion des ressources humaines et les disparités liées au genre. Ceci représente une grosse inquiétude quand on sait que la ressource la plus importante est celle des ressources humaines qui mérite une attention particulière de manière à déployer le personnel là où se situent les besoins. Les résultats ont également montré que la seule promotion de la culture de l’information ne suffit pas pour changerles habitudes et qu’un suivi plus rapproché est nécessaire pour une pratique régulière des capacités du personnel en s’appuyant sur les outils rendus disponibles à cet effet. Les résultats ont également montré que les fonctions critiques de gestion et de support bien qu’existantes restent hautement vulnérables et méritent d’être renforcées pour mieux soutenir le SIH, et cela à tous les niveaux (hôpitaux et CPS). Il a aussi été observé un besoin important de développement d’outils normatifs pour le soutien du SIH (manuel de procédures de gestion des données, procédures de validation des données, outils de supervision adaptés aux hôpitaux, etc.).
Évaluation de la performance du système local d'information sanitaire au Mali (2018) Aminata Traoré, Madina Ba Kouyaté, Abdoulaye Maiga, Adama Ouatara, Issaka Dembélé , Alamako Doumbia, Ismael Dembélé, Ouassa Berthe, Mamoutou Diabaté, Mamadou Alimou Barry, Jeanne Chauffour 2020 French HMIS, Data Quality, Health Information Systems, RHIS, HISS, Routine Health Information Systems, PRISM, Performance of Routine Information System Management, Information System, Mali L'évaluation 2018 de la performance de la gestion du système local d'information sanitaire (SLIS) du Mali, à l’aide des outils PRISM, a mesuré les changements de l'état du système d'information sanitaire de routine (SISR) depuis la dernière évaluation datant de 2013. L'évaluation de 2018 a révélé des progrès significatifs dans l'utilisation des données, l'assurance de la qualité des données et les preuves de l'analyse des données aux niveaux district, régional et central du SISR. Cependant, l'évaluation a également révélé des faiblesses au niveau des formation sanitaires (FS). Surtout, l'exactitude des données était une préoccupation à (et seulement à) ce niveau car c'est là que l’entrée de toutes les données se fait à présent. Les autres faiblesses qui se sont dégagées de l'évaluation de 2018 sont liées aux difficultés d'archivage des outils et des rapports du SISR, au mauvais partage des documents de gestion normatifs du SISR, à l'instabilité et au renouvellement fréquent du personnel de santé et aux problèmes de sécurité dans le nord et le centre du pays. Ces problèmes ont sérieusement affecté la performance des sites enquêtés, en particulier au niveau le plus périphérique (c'est-à-dire les centres de santé communautaire, ou CSCom), non seulement en terme de qualité des données mais aussi en terme d'utilisation des données. Les résultats de l’évaluation ont montré que la promotion de la culture de l’information ne suffit pas à elle seule à changer les habitudes. Un suivi plus étroit est nécessaire pour renforcer la capacité du personnel à travailler avec les outils à leur disposition et leur volonté de les utiliser régulièrement. Les résultats ont montré que des fonctions de gestion essentielles existent mais doivent être renforcées, afin qu'elles soutiennent mieux le SISR à tous les niveaux de la pyramide sanitaire: FS, district, région et central. L'évaluation de 2018 a également souligné la nécessité de maintenir les progrès accomplis par le SISR du Mali.
Registre électronique dans les centres de santé communautaire au Mali Ouassa Berthé, Mamoutou Diabaté, Madina Kouyaté, Issiaka Dembélé, Adama Ouattara, Edem Kossi, Aminata Traoré, Alimou Barry, Souleymane Ya Samaké 2020 French HIS, HISS, Immunization, Health Information Systems, Information System, Antenatal Care, Mali Face à la multiplicité et à la complexité des supports dans les structures de santé, en 2017, la Direction Nationale de la Santé avec l’appui technique et financier de MEASURE Evaluation a mis en place une expérience pilote sur l’utilisation du registre électronique à travers DHIS2. Compte tenu du volume des activités et de l’aspect longitudinal des services de consultations prénatales (CPN) et de la vaccination dans le paquet minimum d’activités, le choix des registres de CPN et de vaccination a été fait pour expérimenter l’approche. En effet, dans le DHIS2, un modèle standard a été développé par l’Université d’Oslo et chaque pays l’adapte à sa situation. C’est dans ce contexte que le Mali a commencé en 2017 l’expérimentation des registres électroniques pour la CPN et la vaccination dans le centre de santé communautaire (CSCom) de Sanancoroba.
Collaboration des parties prenantes dans le développement d’un logiciel d’information sanitaire intégré avec une couverture nationale: l’historique de la mise en oeuvre du DHIS2 au Mali Aminata Traoré, Alimou Barry, Edem Kossi, Karim Traoré, Mamoutou Diabaté, Moussa Samaké,, Ouassa Berthe, Madina Kouyaté, Issiaka Dembélé, Adama Ouattara, Alamako Doumbia, Ismael Dembélé, Abdoulaye Maiga, Jessica Posner 2020 French Health Information Systems, Mali, DHIS 2, Stakeholder engagement, HIS, HISS, HMIS, Information System Le système d’information sanitaire (SIS) du Mali était jusqu’à présent géré par différentes entités qui ne communiquaient pas assez entre elles. Le système local d’information sanitaire était géré par la Direction Nationale de la Santé (DNS), le système d’information sanitaire des hôpitaux par la Cellule de Planification et de Statistique, le système d’alerte épidémiologique par la DNS. En plus, chaque programme de santé gérait son propre système d’information avec une multitude de logiciels différents. L’intégration des données sanitaires se faisait seulement lors de l’élaboration de l’annuaire statistique. Développer et mettre en oeuvre un système d’information intégré et le soutenir est une tâche difficile dans tout contexte. Ces défis sont encore plus importants quand les ressources (financières, infrastructurelles et humaines) sont limitées. Cette pénurie de ressources rend le financement du SIS malien très dépendant des bailleurs. Malheureusement, dû à la complexité du SIS et des coûts élevés de mise en oeuvre, un seul partenaire ne peut le soutenir. Par conséquent, multiples partenaires doivent être invités à travailler avec le Ministère de la Santé (MS) pour l’appuyer dans la mise en oeuvre du système national d’information sanitaire (SNIS).
A Guide for Conducting Malaria Data Review Meetings Hai, T., Andrada, A., & Yé, Y. 2020 English RHIS, Data, Health Information Systems, Malaria control, Malaria, Routine Health Information Systems, Surveillance, Data Quality Routine health information systems, including surveillance systems, have become critical tools to streamline malaria control efforts in endemic countries. Governments and health programs rely on health information systems to allocate resources to subpopulations to optimize interventions (Ashton, Bennett, Yukich, Bhattarai, Keating, & Eisele, 2017; World Health Organization, 2017). These systems often face data quality issues that limit their use by service providers and decision makers to better inform health services (Chilundo, Sundby, & Aanestad, 2004). To improve the quality of the data generated from these systems, national malaria control programs (NMCPs) from several malaria-endemic countries began to conduct regular data review meetings at the subnational levels (e.g., counties; health facilities) to review and address data quality issues. These periodic data review meetings provide feedback on the quality of routine malaria data and the use of data to improve service delivery. The need for good-quality data at subnational levels, particularly at service delivery points (health facilities), increases as transmission reduces and the risk of epidemics increases; health facilities need to be analyzed more frequently to ensure early detection of a potential outbreak or abnormal increases in cases (World Health Organization, 2018). Data review meetings bring together national and subnational stakeholders to identify data quality issues more immediately and provide an opportunity to use the data to identify gaps in the performance of health services compared to national policy. The results should be converted into informational presentations to allow participants to assess trends and define action plans quickly to address data quality and performance disparities. MEASURE Evaluation conducted a review in five malaria-endemic countries (the Democratic Republic of the Congo, Kenya, Liberia, Madagascar, and Mali) to understand how NMCPs conduct data review meetings. The review found that countries have different processes for conducting these meetings. Some countries have better structures in place to improve data quality and use data for service delivery compared to other countries. Although NMCPs conduct data review meetings periodically, we did not come across consolidated standard guidelines or protocols for conducting these meetings. In addition, few documents exist on the follow-up action plan recommended from these meetings. In light of these findings, MEASURE Evaluation proposes a brief standard protocol for these periodic data review meetings. The protocol aims to highlight the best practices for conducting data review meetings and is derived from the findings of the review (see MEASURE Evaluation, 2019). Having a standard protocol that countries can use and adapt to their specific context can streamline the validation process, optimize data use, and improve the documentation of follow-up actions to improve data quality and service delivery. Access a related report on data review meetings in five countries. 
Assessing Efforts to Mainstream Youth-Friendly Health Services in Madagascar, Malawi, and Mali Janine Barden-O'Fallon and Shara Evans 2020 English MADAGASCAR, MALAWI, MALI Reproductive Health, Youth, adolescent, Evaluation High fertility rates and low modern contraceptive use put African youth and adolescents at high risk for health complications, including maternal mortality. Mainstreaming youth-friendly health services (YFHS) into existing services is one approach to improve access to reproductive health services for youth and adolescents. This report details an evaluation MEASURE Evaluation conducted to assess the effects of three YFHS training packages sponsored by Population Services International (PSI) on voluntary uptake of family planning (FP) among youth and perceptions of service quality by youth and trained healthcare providers. In 2018, a retrospective review and analysis of relevant monitoring and evaluation documents and service statistics from PSI Madagascar, PSI Malawi, and PSI Mali was conducted. Qualitative data on perceptions of service quality from Malawian youth and healthcare providers were also collected and assessed through thematic analysis. Results show that the number of FP clients ages 15–24 increased after implementation of the YFHS training packages. Data from PSI Madagascar and PSI Malawi show that positive trends were not sustained after other YFHS components ended. Focus group discussions with youth in Malawi indicated that clinics were perceived as providing high-quality services to youth. The main barriers to accessing the services were cost and embarrassment. Malawi’s healthcare providers made many efforts to improve clinic accessibility and understood the barrier of cost and importance of outreach to youth and the broader community. The results provide evidence that provider training alone will not sustain initial increases in youth FP clients. Across the three countries, the greatest benefits of the YFHS training packages were seen when combined with demand-generation activities and increased access to peer education.
L’effet boule de neige de la compétition sur la qualité des données sanitaires au Mali MEASURE Evaluation 2020 French Health Information Systems, DHIS 2, HIS, Data, Mali En 2018, le Mali a organisé une compétition amicale entre les structures sanitaires afin de motiver tous les niveaux du système sanitaire à améliorer la qualité des données sanitaires et d’utiliser ces données stratégiquement. La première compétition a eu lieu une fois que le Mali eut adopté et déployé le District Health Information Software, version 2 (DHIS2) avec succès comme plateforme nationale de gestion des données sanitaires. Ce qui commença en 2018 comme une incitation à la bonne qualité des données conçue par le Ministère de la Santé et des Affaires Sociales (MS) a depuis été accueillie avec enthousiasme par les prestataires de soin à travers tout le système sanitaire. Non seulement a-t-elle attiré plus de participants en 2019 (comparé à 2018), elle a aussi manifestement amélioré la qualité des données sanitaires. Le MS compte institutionnaliser cette compétition, et l’a incluse parmi ses activités prioritaires pour le système national d’information sanitaire (SNIS) et organisera une troisième édition de cette compétition pour 2020. En 2018, la compétition a récompensé huit structures sanitaires (cinq centres de santé communautaire [CSCom], deux centres de santé de référence [CSRef] et un hôpital) pour l’amélioration de la qualité de leurs données de 2017 à 2018. En 2019, le MS a récompensé 16 structures sanitaires (10 CSCom, quatre CSRef et deux hôpitaux). L’atteinte, par les structures sanitaires, des critères pour juger la qualité des données (100% de complétude et 80% de promptitude des données) a considérablement augmenté entre la compétition de 2018 et celle de 2019 et le nombre de structures participant à la compétition a également augmenté de 65 structures en 2018 à 308 en 2019 (un chiffre cinq fois supérieur à celui de l’année précédente).
Le bulletin mensuel du paludisme contribue à l’amélioration de l’utilisation des données pour le contrôle du paludisme au Mali MEASURE Evaluation 2020 French Malaria, Mali En tant que partenaire proche du Programme National de Lutte contre le Paludisme (PNLP) au Mali depuis 10 ans, MEASURE Evaluation a appuyé des activités de contrôle et de prévention du paludisme qui ont eu un impact dans la lutte collaborative contre cette maladie. Ensemble, MEASURE Evaluation et le PNLP ont amélioré la qualité des données paludisme disponibles, en partie à travers des efforts de renforcement des capacités du personnel du PNLP en suivi-évaluation.
Une approche durable et abordable du renforcement des capacités du personnel du système d’information sanitaire de routine au Mali MEASURE Evaluation 2020 French Health Information Systems, RHIS, Routine Health Information Systems, HIS strengthening, HIS, Mali Jusqu’à récemment, le Ministère de la Santé et des Affaires Sociales (MS) du Mali n’avait aucun programme de formation spécifique pour fournir à son personnel un renforcement des capacités abordable afin de gérer et renforcer le système d’information sanitaire de routine (SISR) du pays. Aucun mécanisme formel n’existait pour reconnaitre et engager le personnel du SISR ou pour lui fournir la formation nécessaire à son parcours professionnel. De plus, la plupart des formations sur le SISR étaient organisées au niveau régional dans des institutions de pays voisins et y participer était souvent coûteux par rapport aux ressources du gouvernement malien. Le manque de personnel qualifié dans le maintien et la gestion du SISR pose un important défi à la performance de l’ensemble du système d’information sanitaire. Le SISR comprend des ressources et outils pour appuyer la collecte, la revue, l’analyse et l’interprétation des données—toutes essentielles pour la production de données de qualité pour la prise de décisions basée sur les évidences. En connaissance de cause, MEASURE Evaluation a approché l’Ecole de Santé Publique de la Faculté de Médecine de l’Université de Bamako pour discuter des options possibles pour fournir une telle formation au Mali. Ces conversations ont commencé en début 2017 et ont conduit à la création d’un diplôme universitaire sur le SISR au sein du Département d’Enseignement et de Recherche en Santé Publique (DERSP), utilisant le curriculum du SISR développé conjointement par MEASURE Evaluation et des partenaires mondiaux — tels que l’Organisation mondiale de la santé— et plusieurs universités.
Surveillance épidémiologique en temps réel au Mali: L’importance de la qualité des données pour une bonne prise de décisions afin de prévenir et riposter aux épidémies MEASURE Evaluation 2020 French DHIS 2, Infectious disease, Surveillance, HIS, Health Information Systems, HIS strengthening, Mali, Information systems Depuis le tout début de la riposte à l’épidémie de la maladie à virus Ebola au Mali en 2014, le Ministère de la Santé (MS) a rendu prioritaire le renforcement du système de rapportage des maladies à potentiel épidémique. En 2016, MEASURE Evaluation, projet financé par l’Agence des Etats-Unis pour le développement international (USAID), en collaboration avec la Direction Nationale de la Santé (DNS) et la Division de Prévention et Lutte contre la Maladie du MS, a mis en place une surveillance et un rapportage épidémiologique en temps réel dans le DHIS2 pour améliorer la prise de décision fondée sur des preuves. MEASURE Evaluation a fourni son assistance dans l’adaptation de DHIS2 à couvrir les maladies principales et les maladies prioritaires identifiées par le pays: la fièvre hémorragique, la rougeole, la méningite, la fièvre jaune, le choléra et l’anthrax, parmi d’autres. Le Mali utilise le DHIS2 à tous les niveaux du système sanitaire (central, intermédiaire et opérationnel), avec l’exception des structures sanitaires situées en zone de conflit (qui représentent environ quatre pourcent de toutes les formations sanitaires). Les données de surveillance épidémiologique basées sur DHIS2 sont maintenant disponibles à tous les utilisateurs quel que soit leur niveau de prise de décision (communautaire, district, régional et central). MEASURE Evaluation et la DNS ont développé un plan de suivi des utilisateurs, mis en oeuvre une année après le déploiement du DHIS2, qui inclut des visites de supervision post-formation. Deux ans après la mise en oeuvre de DHIS2, cependant, des difficultés de qualité des données sont devenues un défi majeur pour la DNS. Une pauvre qualité des données a limité la capacité du Mali à utiliser les données pour la prise de décision car les données ne répondaient pas aux standards de qualité—tels que la complétude, promptitude, exactitude et fiabilité.
L’amélioration de la qualité des données du paludisme au Mali permet une meilleure prise de décisions dans le secteur santé MEASURE Evaluation 2020 French Mali, DHIS 2, Malaria, Data Quality, HIS strengthening, HIS, Health Information Systems Depuis l’introduction du système d’information de routine du paludisme (SIRP) en 2011, le Programme National de Lutte contre le Paludisme (PNLP) du Mali n’a pas été capable de soutenir adéquatement la plateforme. Un nombre de facteurs qui incluent le financement limité—ainsi qu’une insuffisance dans les formations du personnel, l’équipement et les connexions Internet—ont abouti à un manque de données promptes dans plusieurs régions, limitant ainsi la capacité du PNLP de cibler les services de manière plus efficace. Pourquoi les données fiables sont-elles si importantes? Les gouvernements dépendent d’informations promptes sur les besoins en services sanitaires et sociaux de leur population afin de permettre des politiques publiques et des allocations de ressources efficaces. Les systèmes d’information sanitaire permettent le suivi d’indicateurs sanitaires critiques, et dans plusieurs pays ces données sont capturées dans le DHIS2. Au Mali, la Cellule de Planification et de Statistique du Ministère de la Santé a dirigé le déploiement national du DHIS2. Cet effort ambitieux, mené avec l’appui de MEASURE Evaluation, inclut la personnalisation des indicateurs du paludisme et l’intégration de la base de données SIRP dans la plateforme du DHIS2.
Développement participatif pour une gestion pérenne du système d’information sanitaire MEASURE Evaluation 2020 French Health Information Systems, HIS strengthening, HIS, DHIS 2, Mali Durant la dernière décennie, le Mali a utilisé un logiciel personnalisé pour gérer son système d’information sanitaire (SIS). Malgré son utilité des années durant, le système, qui n’était pas adaptable aux technologies modernes et électroniques, dépendait d’un groupe de développeurs tiers pour sa gestion et restait limité dans son utilité pour gérer et analyser une grande quantité de données. Récemment, le Mali a pris la décision—dans le cadre de son processus de renforcement du SIS de manière générale—de passer de son système de l’époque (DESAM) au DHIS2, qui est perçu comme étant le système le plus prometteur pour l’intégration, la gestion, l’analyse et la présentation des données sanitaires pour la prise de décision au sein du secteur santé. MEASURE Evaluation a apporté une assistance technique au Ministère de la Santé (MS) du Mali au cours de cette transition.
L’alignement de parties prenantes pour renforcer le système d’information sanitaire: Une démarche en plusieurs étapes MEASURE Evaluation 2020 French Health Information Systems, HIS, Mali, HIS strengthening Mettre en oeuvre des systèmes d’information sanitaire (SIS), qu’ils soient privés ou publics, est un défi de taille en raison de nombreux facteurs, dont la pénurie de ressources humaines et financières et d’un leadership nécessaire à la durabilité d’un SIS fonctionnel. Ces défis sont particulièrement préoccupants dans les pays en développement où les SIS et les technologies de l’information qui les accompagnent peuvent avoir un impact important sur les services sanitaires disponibles. Des SIS forts sont l’épine dorsale de systèmes de santé robustes. Un SIS qui fonctionne correctement envoie les données pertinentes aux bons acteurs au bon moment, permettant aux décideurs, politiques, gestionnaires et prestataires de soin de prendre des décisions fondées sur des preuves pour des sujets importants allant des soins du patient aux budgets nationaux. Des SIS robustes soutiennent davantage la transparence et la reddition de comptes en augmentant l’accès à l’information. Deux principaux défis de la mise en oeuvre complète du SIS au Mali sont la difficulté de passer d’un projet pilote à une mise à l’échelle, et une focalisation singulière sur les technologies de l’information ou les solutions techniques au détriment d’une approche plus large pour améliorer la performance technique, comportementale et organisationnelle du SIS. Par exemple au Mali, comme dans de nombreux autres pays, la gouvernance et la gestion du SIS, qui inclut les ressources financières et humaines et les rôles et responsabilités des contributeurs clés à chaque niveau du système sanitaire, sont de la même importance –si pas plus importantes– que les facteurs techniques. En réponse à ces défis, le projet MEASURE Evaluation au Mali, financé par l’Agence des Etats-Unis pour le développement international (USAID), a proposé une approche en étapes pour aligner les parties prenantes qui mettent en oeuvre des initiatives disparates sur le SIS dans un « réseau » en appui au SIS national du Mali.
Les données actuelles permettent au Mali de suivre les services sanitaires et la performance MEASURE Evaluation 2020 French HIS, Mali, Health Information Systems, HIS strengthening, Population Les statistiques de la santé de la population sont une référence fiable pour la planification sanitaire du Mali.
La réussite du pilotage de registres sanitaires électroniques au Mali MEASURE Evaluation 2020 French Health Information Systems, HIS strengthening, Digital Health, EHealth, HIS, Mali Les registres électroniques ont amélioré le suivi des femmes enceintes et des enfants et ont réduit la charge de travail des prestataires de soins. L’essai au Mali fut un succès et démontre que la couverture sanitaire peut bénéficier de l’utilisation de registres électroniques pour améliorer le suivi et réduire la charge de travail.
Les puissants bulletins du paludisme MEASURE Evaluation 2020 French Health Information Systems, Malaria, Mali Les bulletins fournissent des données du paludisme cohérentes et de bonne qualité afin de guider la mise en oeuvre de programmes et de mesurer les réalisations. Les décideurs à tous les niveaux peuvent maintenant prendre de bonnes décisions fondées sur des données fiables au bénéfice de toute la population malienne.
Sécurité sanitaire mondiale MEASURE Evaluation 2020 French Health Information Systems, HIS strengthening, Global health security, HIS, Mali, Surveillance Les systèmes de données électroniques bien entretenus génèrent des données de surveillance en temps réel afin d’assurer une riposte rapide.
Des institutions fortes et des experts pour l’information sanitaire MEASURE Evaluation 2020 French HIS, Mali, Health Information Systems, HIS strengthening, Capacity Building Une bonne gestion des données fournit au Mali des évidences pour répondre aux besoins sanitaires.
L’histoire du DHIS2 au Mali MEASURE Evaluation 2020 French Mali, DHIS 2, HIS strengthening, HIS, Health Information Systems Un système d’information sanitaire robuste fournit des données de bonne qualité pour évaluer les résultats de santé, détecter les flambées épidémiques, mesurer la couverture des services et guider la stratégie. Le Mali a transformé son système d’information sanitaire. 
Le Mali prend des démarches délibérées pour améliorer les données sanitaires MEASURE Evaluation 2020 French HIS strengthening, Health Information Systems, HIS, Mali Evaluer et améliorer les systèmes de données sanitaires mène à de meilleurs résultats. Comment une évaluation de la performance de la gestion du système d’information sanitaire a guidé la stratégie du Mali.
Plan d’analyse des données de planification familiale Une évaluation des tendances de la PF pour le Mali Moussa Konaré, MD, MPH; Janine Barden-O’Fallon, PhD 2020 French Data, Family Planning, Mali, Data analysis, Evaluation Dans le cadre du repositionnement de la PF, le Mali participe de manière active, à l’instar des pays francophones de l’Afrique de l’Ouest à l’initiative mondiale Family Planning 2020 (FP2020) et le Partenariat de Ouagadougou afin de contribuer à la réduction des taux élevés de mortalité maternelle (325 pour 100 000 naissances vivantes), et de mortalité néonatale (33 pour 1000 naissances vivantes), selon l’EDSM-VI 2018. Ainsi, pour accompagner les différentes stratégies et initiatives des acteurs nationaux et internationaux les données sont essentielles pour prendre des décisions sur l’évolution du programme PF dont l’objectif du TPCm est de 30% dans le PANB-PF 2019–2023. Le gouvernement du Mali, à l’aide du financement et du soutien technique de donneurs et partenaires de mise en oeuvre, s’est engagé à renforcer et à améliorer la collecte d’informations sanitaires de routine. En 2017, la plateforme du système d’information de santé DHIS2 a été lancée pour obtenir des informations sur les indicateurs clés concernant la santé à des fins de surveillance et d’évaluation. Le DHIS2 comporte un certain nombre d’indicateurs concernant la planification familiale (PF), qui sont utilisés pour évaluer les activités du programme, notamment la campagne annuelle de PF au niveau national. Ce plan d’analyse des données présente les étapes nécessaires pour utiliser les données DHIS2 concernant la PF, afin d’évaluer l’efficacité des activités de PF. Le plan d’analyse des données ci-dessous présente des instructions étape par étape, à titre d’exemple, de l’utilisation des données DHIS2 de routine dans l’analyse des performances du programme de PF. Ces instructions sont fondées sur les données recueillies dans le DHIS2 au cours des années 2017, 2018 et 2019. En 2019, le système a été mis à niveau, et certains indicateurs de routine ont été modifiés ou ajoutés. La section portant sur les recommandations propose des analyses ultérieures pour les données provenant du système mis à niveau. Les étapes fondamentales d’analyse et les conseils d’interprétation des données présentés dans ce document peuvent être suivis pour les analyses ultérieures, y compris celles concernant les nouveaux indicateurs. Ce plan d’analyse des données met l’accent sur l’analyse des tendances, qui permet d’examiner l’évolution des indicateurs clés de PF au cours du temps, notamment le nombre de nouveaux utilisateurs de PF, le nombre d’anciens utilisateurs qui continuent d’utiliser la PF et le nombre d’utilisateurs de PF âgés de moins de 25 ans. L’analyse de tendance proposée inclut les données recueillies en dehors des mois de la campagne nationale de PF, afin d’obtenir des informations concernant l’impact de la campagne sur les résultats de PF au Mali avec le temps.
Reproductive Empowerment Scale: Psychometric Validation in Nigeria Mandal, M., & Albert, L. M. 2020 English Reproductive Empowerment, Reproductive Health, What's New, Empowerment, Family Planning MEASURE Evaluation, a project funded by the United States Agency for International Development (USAID), validated a previously developed measure of reproductive empowerment (RE) that can be used in evaluations or other types of surveys in sub-Saharan African countries, with the goal of providing family planning (FP) and reproductive health (RH) programs and national or regional governments with a tool to measure the status of and changes in RE in their populations. We examined the validity of the RE scale by embedding the scale items in a baseline survey, implemented from May to June 2019, for the evaluation of the John Templeton Foundation-funded Masculinities Faith, and Peace (MFP) intervention in Plateau State, Nigeria. First, we examined the psychometric properties of the scale by using confirmatory factor analysis (CFA). We assessed the construct validity of the scale by using logistic regression to test the association between RE and FP outcomes. The results from this study suggest that the final RE scale has considerable potential to be a valid and predictive measure of RE. When used in future studies, the scale should be psychometrically tested with various samples to provide additional data on its validity. The new 20-item RE scale presented in this report can be used to evaluate programs or interventions designed to improve women’s RE and to assess the state of RE in populations of sub-Saharan Africa. Access the reproductive empowerment scale and related reports sharing findings from a study in Zambia and findings from a study in Kenya.
Validating Measures of Reproductive Empowerment in Kenya Mandal, M., Treves-Kagan, S., & Mejia, C. 2020 English Empowerment, What's New, Kenya, Reproductive Health, Reproductive Empowerment, Family Planning Although a substantial body of research has examined the role of empowerment in influencing reproductive outcomes, the reproductive sphere has only recently emerged as a distinct dimension of empowerment. Inconsistency in the conceptualization and measurement of reproductive empowerment (RE) has led to the use of a wide range of research measures on the determinants of reproductive behavior in relation to empowerment. We adopted the following definition of RE from a recently developed framework: “Both a transformative process and an outcome, whereby individuals expand their capacity to make informed decisions about their reproductive lives, amplify their ability to participate meaningfully in public and private discussions related to sexuality, reproductive health and fertility, and act on their preferences to achieve desired reproductive outcomes, free from violence, retribution or fear” (Edmeades, Hinson, Sebany, & Murithi, 2018). MEASURE Evaluation—a project funded by the United States Agency for International Development—developed a draft RE scale using three steps. First, we conducted a systematic literature review to identify existing domains, subdomains, scales, and indexes related to RE. Second, through a consultative meeting, we shared our findings from the systematic review with experts in reproductive health (RH) and empowerment research and measurement, and sought their feedback on gaps and limitations in the field. Third, we conducted focus group discussions with men and women in Zambia to explore in depth the meaning of the identified domains and subdomains of RE, and to surface new domains and subdomains. At the end of this process, we prepared a draft RE scale with 44 items across five subscales. The next step in the development of the RE scale was to establish its face validity, the subject of this study. The objectives of this study were to (1) pretest the draft scale items using cognitive interviews (CIs) with women and men in Kenya to examine the items’ face validity; and (2) revise the draft RE scale based on the results of the CIs. This report shares more on the work in Kenya. Access the reproductive empowerment scale and related resources on work done in Nigeria and Zambia.
Midline Evaluation of the Tanzania Public Sector System Strengthening Program – Final Report Gustavo Angeles, Jessica A. Fehringer, Lisa Calhoun, Brittany Iskarpatyoti, Willis Odek, Gideon Kwesigabo, Joe L.P. Lugalla, Aimee M. Benson, Hannah Silverstein, Courtney McGuire 2020 English Africa, TANZANIA Health Systems Strengthening, Health Services, Health System, Monitoring, Evaluation, Evaluation, M&E, Tanzania, Public Health, Africa The Public Sector System Strengthening (PS3) project, funded by the United States Agency for International Development (USAID), supports the Government of Tanzania (GOT) in strengthening the public-sector system to promote the delivery, quality and use of public services. This report presents the findings of a midline performance evaluation of PS3 conducted by MEASURE Evaluation which examined time trends and pre- and post-program inception changes in the uptake of health services as well as in financial and human resources indicators in PS3 regions and in other regions of the country. The evaluation also used qualitative methods to examine the perceptions from program implementers, community members, and other stakeholders about the adoption and performance of the PS3 intervention, its strengths and remaining challenges, and the stakeholders’ recommendations on ways to address those challenges. PS3 works across national, regional, and local government levels. The implementation strategy seeks to strengthen each of the five component areas, while working across all sectors and levels of public governance. The expectation is that strengthening systems at all levels will result in improved service delivery at the lowest level—the service provider—which will lead to higher public service utilization by the population and better health outcomes. At the national level, emphasis is placed on providing support for key policies and strategies as well as strengthening the national system to foster improvements in service delivery at lower government levels. At the regional and LGA levels, the PS3 program facilitates the understanding and implementation of national policies and guidelines as well as providing targeted assistance to improve the management and strengthening of systems and resources. This midline evaluation undertook an outcome evaluation to understand how system-level indicators related to human resources, financial resources, and health service utilization changed over time in PS3 and in other (non-PS3) regions of the country. Data from national routine information systems formed the basis for quantitative measurements. Adapted difference-in-differences models were used to examine time trends before PS3 and during the time PS3 has been active, changes in those trends, and to examine differences between PS3 regions and other regions of the country. Potential differences between Phase 1 and Phase 2 PS3 LGAs were also examined. In addition, qualitative methods provided a more in-depth understanding of the performance of the PS3 intervention in human resources, finance, and system strengthening, captured unintended, indirect effects of the intervention, illuminated the process of change, and examined the quality and character of the intervention implementation. The qualitative component also captured the stakeholders’ perceptions of pending challenges in system functioning and community engagement and their recommendations on how to address them. The findings of this evaluation will contribute to USAID’s portfolio of projects focused on public-sector strengthening while informing PS3’s continued program implementation. This evaluation was performed at about the mid-point of PS3, three years after the project’s inception.
The PEPFAR Local Capacity Initiative Interventions in Uganda Mary Freyder, Eve Namisango, Tory M. Taylor, Annie Glover, and Katherine Andrinopoulos 2020 English UGANDA policy, Health Services, Key Populations, Health care, Capacity Building, KP The Local Capacity Initiative (LCI) strengthened the capacity of civil society organizations (CSOs) to support policy advocacy, with the ultimate goal of improving health services for key populations affected by the HIV epidemic. The United States President’s Emergency Plan for AIDS Relief (PEPFAR) funded the initiative from 2013–2018 to help local CSOs create an enabling environment for PEPFAR’s objectives. Under the LCI, the United States Centers for Disease Control and Prevention worked in Uganda between 2015 and 2018 to strengthen the policy advocacy capacity of CSOs that worked with men who have sex with men, transgender women, and sex workers and develop the capacity of public health officials to consider gender and sexual diversity issues. MEASURE Evaluation, which is funded by the United States Agency for International Development and PEPFAR, conducted an evaluation of LCI Uganda between 2017 and 2018. This brief summarizes LCI’s effort to create an enabling environment for policy advocacy in Uganda by identifying key interventions. Additional briefs provide overviews of work to develop organizational capacity through coalition building, the community scorecard strategy to improve HIV clinical services, and methods that the evaluation team used to study the efficacy of LCI’s work and measure resulting change.
Quality of Tuberculosis Services Assessment: Global Implementation Guide MEASURE Evaluation 2020 English Global Tuberculosis, Quality of care, TB, Assessment, Toolkit The guide is coming soon.
Framework for Evaluating National Malaria Programs in Moderate- and Low-Transmission Settings: Aide Memoire Evaluation Task Force of Roll Back Malaria’s Monitoring and Evaluation Reference Group 2020 English Transmission, Monitoring, Evaluation, Malaria, Evaluation The epidemiology of malaria has become increasingly heterogeneous in many countries. These countries require granular data on transmission risk and incidence to effectively inform and target their interventions and track their progress. To meet these needs for strengthening national malaria programs (NMPs), an evaluation task force comprising a subgroup of the Roll Back Malaria Monitoring and Evaluation Reference Group developed the Framework for Evaluating National Malaria Programs in Moderate- and Low-Transmission Settings. This document provides an overarching framework for evaluating NMPs along the continuum of malaria transmission. Each transmission setting is defined by the World Health Organization classifications. The scope and objectives were informed through a review and synthesis of existing guidance documents and tools for malaria surveillance, monitoring, and evaluation. This aide memoire summarizes the larger framework document.
Framework for Evaluating National Malaria Programs in Moderate- and Low- Transmission Settings Evaluation Task Force of the RBM Monitoring and Evaluation Reference Group 2020 English Global Malaria, Evaluation, Monitoring, Evaluation, Transmission The evaluation framework presented in this document intends to build on existing work by the RBM Monitoring and Evaluation Reference Group, expanding it to address settings along the continuum of malaria transmission, with a specific focus on moderate- and low-transmission settings. This framework also emphasizes the importance of process evaluation to impact evaluation, linking implementation processes to implementation strength to then demonstrate program impact on malaria transmission, morbidity, or mortality. Access the related Framework for Evaluating National Malaria Programs in Moderate and Low Transmission Settings: Aide Memoire. 
L’expérience du Mali dans le déploiement du DHIS2 MEASURE Evaluation 2019 French DHIS 2, HIS, Health Information Systems, Mali Dans le but de renforcer le système d’information sanitaire, le Ministère de la Santé et des Affaires Sociales avec l’appui des partenaires techniques et financiers, dont l’Agence des Etats-Unis pour le développement international (USAID) à travers MEASURE Evaluation, s’est engagé en août 2015 dans un processus d’adaptation du Logiciel de Gestion de l’Information Sanitaire de District version deux : District Health Information Software (DHIS2). La présente documentation, donne les principaux résultats du déploiement de DHIS2 au Mali après quatre (4) années de mise en œuvre des activités.
Postpartum Family Planning in Bangladesh: A Situation Analysis and Way Forward Barkataki, S., Huda, F., Nahar, Q., Rahman, M. 2019 English Contraception, Postpartum care, Pregnancy, Family Planning, Bangladesh Postpartum family planning (PPFP) focuses on providing family planning (FP) counseling and services to women and couples in the first 12 months after birth. This publication reviews the policies, programs, and status of PPFP in Bangladesh and seeks to identify the need, gaps, and future focus areas for PPFP in the country.
East African Community Regional Digital Health and Interoperability Assessments: Kenya MEASURE Evaluation 2019 English Interoperability, Digital Health, Health Information Systems, Assessment, HIS, Kenya The regional health program of the United States Agency for International Development (USAID)/Kenya and East Africa Mission, in coordination with the USAID Global Health Bureau, U.S. Global Development Lab, and USAID Bureau for Africa, engaged MEASURE Evaluation to provide technical assistance support to EASTECO in conducting an East African Community (EAC) regional digital health readiness assessment incorporating aspects of systems interoperability and the cost of investing in digital health in the EAC region. When completed, the assessment will have covered four of the six EAC partner states. This report details the results of the Kenya assessment, which had two objectives: Assess the status of digital health and HIS interoperability in Kenya by assessing the processes, structures, and capacities needed to support the enabling environment for digital health and interoperability. This objective included beginning to develop a registry of digital health solutions being implemented in Kenya. Using the Kenyan assessment results, contribute to the regional landscape assessment of digital health and interoperability in the EAC to inform regional analysis and recommendations for moving them forward. Access the related Health Information Systems Interoperability Toolkit.
Effective Access to Long-Acting Reversible Contraceptives and Permanent Methods in Bangladesh M. Moinuddin Haider, Sharad Barkataki, Ali Ahmed, Quamrun Nahar, Mizanur Rahman 2019 English BANGLADESH Health Facilities, Service delivery, Assessment, Contraception, Service access and availability This report presents the results of an analysis to determine the effective accessibility of health facilities designated to provide long-acting reversible contraceptives (LARCs) and permanent methods (PMs) of contraception to Bangladeshi couples.  We define LARC and PM services as effectively accessible to consumers if facilities that are designated to offer LARCs and PMs do indeed offer these types of contraception and if those facilities are ready to provide an appropriate quality of services. Bangladesh has an extensive health infrastructure that delivers preventive and curative services, including family planning. However, compared to global rates, Bangladesh has a relatively low prevalence of LARCs and PMs.  This analysis is based on data collected from 963 facilities during the Bangladesh Health Facility Survey 2014 (National Institute of Population Research and Training, Associates for Community and Population Research, and ICF International, 2016).
Bangladesh District Level Socio-demographic and Health Care Utilization Indicators 2019 English Asia, BANGLADESH Maternal and child health, Bangladesh Demographic and Health Survey, Bangladesh Maternal Mortality and Health Care Survey, Antenatal care, Maternal Health, Maternal health, Health care, Family Planning, Bangladesh, Antenatal Care, Maternal Mortality The purpose of this report is to present health care utilization and socio-demographic indicators at the district level. The data from this report comes from the 2016 Bangladesh Maternal Mortality and Health Care Survey (BMMS). The objectives of the 2016 BMMS were to a) estimate the national level  Maternal Mortality Ratio (MMR); b) identify the specific causes of maternal and nonmaternal deaths among adult women; c) assess the pattern of antenatal, delivery, and postnatal care practices; d) assess maternal complications experience and careseeking; e) estimate childhood mortality rates; f) measure the level of selected maternal morbidities (obstetric fistula and pelvic organ prolapse); and g) provide district-level socioeconomic, demographic, family planning, and health care utilization indicators.
La Surveillance à base communautaire des maladies et zoonoses prioritaires au Sénégal MEASURE Evaluation 2019 French Global health security, Zoonotic, One Health, Senegal, GHSA, Global Health Security Agenda, Surveillance, Infectious disease Le Sénégal est membre du Programme de Sécurité Sanitaire mondiale (PSSM), financé par l’USAID et visant à renforcer la capacité des pays à mieux prévenir, détecter et riposter aux menaces des maladies infectieuses, et à élever la sécurité sanitaire mondiale au rang de priorité nationale et mondiale. Dans le cadre de ce PSSM, MEASURE Evaluation, a apporté un appui technique pour la mise en oeuvre de la surveillance à base communautaire (SBC) des zoonoses prioritaires dans une approche « Une Seule Santé » dans six districts sanitaires dans les régions de Saint Louis et Tambacounda. Cette initiative met l’accent sur la collaboration multisectorielle et le partage de l’information à temps réel pour une réponse rapide. Elle est la continuité du projet de SBC des huit maladies prioritaires appuyé par MEASURE Evaluation entre Avril 2016 et Mars 2018. Les contributions phares de cette activité comprennent tout d’abord l’élaboration des définitions de cas communautaires pour chacune des maladies prioritaires pour la SBC, en concertation avec les experts techniques des Ministères de la Santé, de l'Environnement, de l'Elevage et des partenaires techniques intervenants dans la surveillance. MEASURE Evaluation a soutenu le développement de la plateforme électronique dénommée mInfoSanté, accessible via internet et permettant aux agents communautaires de la santé d’envoyer par SMS des signaux de maladies prioritaires sous surveillance et recevoir des instructions et retro informations des infirmiers et agents de l’élevage. Un curriculum, des guides et outils de formation ont été développés dans un processus participatif en collaboration avec le Haut Conseil de la Sécurité Sanitaire Mondiale (HCNSSM) et les secteurs parties prenantes. Des formations en cascade des professionnels des secteurs de la santé humaine, animale et environnementale et des comités de veille et d’alerte communautaire (CVAC) ont eu lieu dans les six district pilotes. En outre, MEASURE Evaluation a réalisé en collaboration avec le Ministère de l’éducation, l’orientation de 391 lycéens sur l’approche « Une Seule Santé » et les maladies prioritaires sous surveillance, dans un lycée de chacun des districts pilotes. Enfin, le guide technique national pour l’opérationnalisation de la SBC dans une approche « Une Seule Santé » a été élaboré dans une approche participative. Dans cette phase pilote, un total de 1650 signaux a été reçus à la date du 31 mai 2019, soit 135 par les infirmiers chefs de poste (ICP) et chefs de poste vétérinaire (CPV) pour les zoonoses et 1515 par les ICP pour les autres maladies prioritaires. Parmi les signaux, 999 ont été vérifiés, dont 744 dans les 48 heures, pour 617 cas suspects. La proportion de signaux vérifiés est de 60%, celle des cas suspects parmi les signaux vérifiés est de 62%. La diarrhée sanglante est la maladie la plus signalée avec 976 signaux, soit 59% de l’ensemble des signaux. Vient ensuite la rougeole avec 322 signaux, soit 20%. Parmi les zoonoses, la tuberculose bovine reste la maladie la plus fréquemment signalée avec 58 signaux, soit 37% de tous les signaux de maladies zoonotiques y compris la maladie à virus Ebola, qui est sous surveillance depuis le début de la phase pilote en 2017. Elle est suivie de la rage avec 38 signaux, soit 24%.
MEASURE Evaluation–Tanzania Final Project Report (2014–2019) MEASURE Evaluation–Tanzania 2019 English Tanzania, MEASURE Evaluation Tanzania The five-year MEASURE Evaluation–Tanzania (MEval-TZ) Associate Award (AA) began on February 28, 2014 and ends on September 30, 2019. The project was funded by the United States Agency for International Development (USAID), the United States President’s Emergency Plan for AIDS Relief (PEPFAR), and the President’s Malaria Initiative (PMI). The aim was to strengthen monitoring and evaluation (M&E) and research capacity of community health and social service programmes in the United Republic of Tanzania for malaria and HIV control programmes in Mainland Tanzania and Zanzibar.MEval-TZ addressed three intermediate results (IRs): IR 1: Policy makers use quality data to develop policies and guidelines, and advocate for community health and social service programs (activities to strengthen national-level M&E systems, data quality, and data use) IR 2: Quality data routinely used by local governments, community providers, and facilities to improve program planning, budgeting, and program implementation (subnational strengthening of M&E, data quality, and data use with health management teams, local government, and implementing partners) IR 3: Increased evidence base for community health and social service programs (crosscutting activities to strengthen the evidence base and enhance capacity for M&E and research) The project’s technical approach assumed that health and social service programmes are more successful when supported by relevant, robust, and timely information to guide resource allocations and programming. Two complementary pillars were described to achieve this: (1) the foundation of an enhanced evidence base derived from evaluation, monitoring, and focused research; and (2) widespread use of this evidence to develop policies and guidelines; advocacy for community health and social service programmes; and the details of programme planning, budgeting, and implementation. The project worked at the national and subnational levels. Underpinning the project’s work were the principles of collaboration, gender integration, and sustainability. Working in a collaborative and participatory manner while fostering relationships with government and non-governmental partners, the project sought to establish and strengthen systems that would be sustained through enhanced local capacity. By focusing on gender as a crosscutting issue, the project sought to highlight gender disparities in health access, programming, and health outcomes, and to promote investigation and action to address those issues to ensure the best services for all Tanzanians. Gender integration encompassed three strategies: (1) gender-focused M&E training with M&E staff at selected ministries; (2) increased availability of sex-disaggregated and gender-specific data; and (3) support for special studies related to gender.
Decreased consumption of common weaning foods is associated with poor linear growth among HIV-exposed infants participating in the Kigali antiretroviral and breastfeeding assessment for the elimination of HIV (Kabeho) study Charlotte Lane, Emily A Bobrow, Dieudonne Ndatimana, Gilles F Ndayisaba, Linda S Adair 2019 English Children, HIV prevention, Child health, HIV, Nutrition ObjectiveThe World Health Organization recommends that complementary foods that are adequate, safe, and appropriate be introduced to infants at age 6 months. Using an innovative modeling technique, we examine patterns of nutrient intake in HIV‐exposed and uninfected (HEU) infants and establish their relationship with growth. MethodsSingle‐day dietary recalls and anthropometrics were collected every two to 3 months from 543 infants living in Kigali, Rwanda, and attending clinics for the prevention of mother‐to‐child HIV transmission. A common weaning food index (CWFI) was calculated in grams and nutrient density for infants to reflect the extent to which the infants consumed the weaning foods typical of this population at ages 6 to 10, 11 to 15, and 16 to 20 months. Regressions among the CWFI, length‐for‐age z‐scores (LAZ), and weight‐for‐length z‐scores (WLZ) were conducted to estimate the relationship between the dietary patterns and growth. ResultsMean absolute intake of zinc and calcium from complementary foods was insufficient. Increasing CWFI was related to increasing cow milk consumption. The density CWFI showed a decrease in the density of iron and folate as infants consume more of the weaning foods typical of this population. Density CWFI, breastfeeding, and caloric intake act on early LAZ and WLZ and interact with one another. Among breastfed infants, those who consume little of the common weaning foods and have a high caloric intake develop deficits in LAZ and have an elevated WLZ. ConclusionsA diet that is more dominated by the typical weaning foods of this population may support a healthy growth pattern.
Caregiver exposure to malaria social and behaviour change messages can improve bed net use among children in an endemic country: secondary analysis of the 2015 Nigeria Malaria Indicator Survey Kirsten Zalisk, Samantha Herrera, Uwem Inyang, Audu Bala Mohammed, Perpetua Uhomoibhi, & Yazoumé Yé 2019 English Bed nets, Malaria, Malaria control, Nigeria, ITN Background: To reduce the malaria burden in Nigeria, the National Malaria Strategic Plan (NMSP) 2014‒2020 calls for the scale-up of prevention and treatment interventions, including social and behaviour change (SBC). SBC interventions can increase awareness and improve the demand for and uptake of malaria interventions. However, there is limited evidence supporting the implementation of SBC interventions to improve key malaria behaviours, such as insecticide-treated bed net (ITN) use, among children in Nigeria. Methods: Using data from 2015 Nigeria Malaria Indicator Survey, this study used multiple logistic regression to assess the relationship between caregiver exposure to malaria messages and ITN use among children under fve. Results: Caregiver exposure to ITN-related messages was signifcantly associated with ITN use among children under fve (odds ratio [OR]=1.63, p<0.001). Conclusions: The results suggest that caregiver exposure to topic-specifc SBC messages improves the use of ITNs among children. Given these results, Nigeria should strive to scale up SBC interventions to help increase ITN use among children in line with the objectives of the NMSP. Further evidence is needed to determine which SBC interventions are the most efective and scalable in Nigeria.
A subnational profling analysis reveals regional diferences as the main predictor of ITN ownership and use in Nigeria Andrew Andrada, Samantha Herrera, Uwem Inyang, Audu Bala Mohammed, Perpetua Uhomoibhi, & Yazoumé Yé 2019 English Nigeria, Malaria control, Malaria, ITN BackgroundTo reduce the malaria burden in Nigeria, the country is scaling up prevention and treatment interventions, especially household ownership and use of insecticide-treated nets (ITNs). Nevertheless, large gaps remain to achieve the goals of the National Malaria Strategic Plan 2014–2020 of universal access to ITNs and their increased use. To inform the targeting of intervention strategies and to maximize impact, the authors conducted a sub-national profiling of household ITN ownership and use in the general population to identify key predictors of ITN ownership and use, and the sub-groups that are at higher risk of low ITN coverage and use. MethodsThe authors conducted a secondary analysis of data from the 2015 Nigeria Malaria Indicator Survey. Using the Chi square automatic interaction detector (CHAID) and multiple logistic regression analysis, the authors examined the key predictors of ITN ownership and use in the general population throughout Nigeria. ResultsThe CHAID models identified region of the country as the best predictor of household ownership of at least one ITN and its use in the general population, with higher ownership and use observed in the northern regions. The odds of a household owning an ITN were five times greater in the North West region compared with the North Central region (odds ratio [OR] = 5.47, 95% confidence interval [CI] 4.46–6.72, p < 0.001). The odds of ITN use were two times greater for those living in the North West region compared with the North Central region (OR = 2.04, 95% CI 1.73–2.41, p < 0.001). Other significant predictors were household size, head of household education level, household wealth quintile, and place of residence. The CHAID gain index results identified households in the South West, North Central and South Central regions with low ITN ownership, and the general population in the South South, South East and North Central regions with low ITN use. ConclusionsThis study reveals regional differences in ITN ownership and use in Nigeria. Therefore, the findings from this analysis provide evidence that could inform the NMEP to better target future campaign and routine distribution of ITNs, to achieve universal access and increased use by 2020 in Nigeria.
Data Review Meetings in Five President’s Malaria Initiative-Funded Countries Hai, T., & Yé, Y. 2019 English RHIS, Health Information Systems, Data, Malaria control, Malaria, Routine Health Information Systems, HIS, Data Quality As malaria continues to pose a public health burden, malaria-endemic countries increasingly rely on routine health information systems, including surveillance systems, and other tools to optimize malaria prevention and treatment, particularly at the subnational level. These systems identify areas or population groups most affected by malaria and target resources to communities most in need (World Health Organization, 2017). Routine health information systems often face data quality issues that limit their use by service providers and decision makers to improve health services (Chilundo, et al., 2004). To address these issues, national malaria control programs (NMCPs) from several malaria-endemic countries began conducting data review meetings at subnational levels (e.g., counties; health facilities) to review and improve the data quality of these systems. NMCPs conduct data review meetings with subnational levels to give feedback on the quality of malaria data from routine health information systems and use the data to improve service delivery. These data review meetings are held regularly—often quarterly or monthly. Subnational levels that participate in these meetings range from the lowest level, or the health facility, to intermediate levels, such as districts, provinces, or states, depending on the country’s health infrastructure. Other stakeholders, including partners, may participate in and provide input for these meetings. Information on how countries conduct data review meetings is limited and not publicly available. MEASURE Evaluation—a project funded by the United States Agency for International Development and the U.S. President’s Malaria Initiative (PMI)—conducted an assessment to understand better the processes and tools used in data review meetings in five malaria-endemic countries. Access a related guide for conducting malaria data review meetings.
Rwanda’s Improved Services for Vulnerable Populations Project: Impact Evaluation: Summary of End Line Findings Fehringer, J., Lance, P., Ndirangu, K., Benson, A., Angeles, G., Parker, L., Foley, S., Gobin, S., Varela, V. C., Morris, L., Cannon, A., Iskarpatyoti, B. 2019 English Orphans and Vulnerable Children, Rwanda, Impact Evaluation, Evaluation, OVC The Improved Services for Vulnerable Populations (ISVP) project, known locally as Twiyubake, aims to improve the health, nutrition, and well-being of the populations on which the project focuses—orphans and vulnerable children (OVC), people living with HIV/AIDS, and economically vulnerable families—by strengthening their capacity in those domains. The ISVP is led by Global Communities (GC), along with international nongovernmental organizations (NGOs) and local civil society organizations. GC and its partners work within the Rwandan Ministries of Health (MOH) and Gender and Family Promotion framework. ISVP is supported by the United States Agency for International Development (USAID) Rwanda Mission. The USAID- and United States President’s Emergency Plan for AIDS Relief-funded MEASURE Evaluation project—with support from USAID/Rwanda and in collaboration with Incisive Africa and the National University of Rwanda, College of Medicine and Health Sciences, School of Public Health—conducted an impact evaluation of the ISVP project. The evaluation sought to measure the impact of the interventions on the health, education, and economic well-being of vulnerable children and their families. This summary report shares end line impact, trend, and cost-effectiveness results using data from the 2017 and 2018 surveys, and costing data collected from ISVP. A full-length end line report on the evaluation is available, as well as a report from the initial data collection.
Designing Interventions for Data Demand and Use MEASURE Evaluation 2019 English Tools, DDU, Tool, Data Demand and Use, Data This "decision tree" helps users identify tools that will best meet their needs when designing interventions for data demand and use.
L’histoire de l’élaboration de l’annuaire statistique 2018 du Mali MEASURE Evaluation 2019 French Health Information Systems, DHIS 2, HIS, Mali, Information System, HIS strengthening Les statistiques sur la santé de la population provenant des données de bonne qualité d’un système d’information sanitaire (SIS) national peuvent, de manière fiable, suivre la couverture et les lacunes des services sanitaires, ainsi que la réussite ou les limitations des efforts du gouvernement pour améliorer la santé de sa population. L’utilisation de ces informations peut faciliter la prise de décisions pertinentes par rapport aux politiques sanitaires, suggérer aux programmes de réduire ou d’intensifier certaines actions et guider l’allocation des ressources souvent limitées. Au Mali, toutefois, le SIS n’avait pas atteint son utilité maximale. Des annuaires statistiques qui auraient pu fournir les données compilées de l’année précédente n’étaient habituellement validés que durant le dernier trimestre de l’année suivante—neuf mois après la fin de l’année que ces données reflétaient. Ceci signifiait que l’annuaire n’était ni utile pour prendre promptement des décisions ni pour le développement de plans opérationnels. En effet, l’annuaire statistique de 2017 n’a jamais été élaboré car les ressources financières étaient indisponibles. Tout ceci changea en 2019. Pour la première fois, le Mali réussit à produire des données sanitaires validées de l’année précédente avant le 30 avril grâce à l’effort collaboratif mené par le Ministère de la Santé et des Affaires Sociales (MS) avec l’appui de MEASURE Evaluation, un projet financé par l’Agence des Etats-Unis pour le développement international (USAID). MEASURE Evaluation aida à mobiliser des ressources financières, avec le concours de Population Services International (PSI) dans l’élaboration des annuaires statistiques à travers un atelier national de validation.
Routine Health Information Systems Curriculum MEASURE Evaluation 2019 English Health Information Systems, HIS strengthening, RHIS, Routine Health Information Systems, Curriculum To ensure the delivery of good-quality health services to the people who need them, the World Health Organization (WHO) promotes strengthening the six building blocks of a health system: (1) governance and policy; (2) service delivery; (3) human resources; (4) health commodities; (5) health financing; and (6) health information systems (HIS). A strong HIS makes it possible to track progress on improving the other five health-system building blocks and, ultimately, to monitor the achievement of the health-related Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs). Strong HIS that produce reliable, timely, and good-quality data help health program managers to monitor, evaluate, and improve health system performance and make evidence-informed decisions. Since the 1990s, knowledge and understanding of the role of HIS development in global health systems have improved. Despite this, use of information for evidence-informed decision making—particularly data produced by routine health information systems (RHIS)—is still very weak in most low- and middle-income countries. RHIS generate data collected at public and private health facilities and institutions, as well as at community-level healthcare posts and clinics. These data—generated at regular intervals of a year or less—cover health status, health services, and health resources. Some of the root causes of poor RHIS performance are ill-defined information needs; poor data quality; issues surrounding the use of information; limited human resource capacity; and the centralization and fragmentation of HIS. There is a need to build the capacity of developing countries to collect, manage, and interpret health data. And this, in turn, will require training on an unprecedented scale. One focus of this training needs to be RHIS—the most common source of information on health services management and programs. Relevant and well-structured courses on RHIS are few, and are not tailored to the needs of developing countries. To address this gap, leaders in the field of RHIS—the USAID-funded MEASURE Evaluation project, in the United States; WHO, in Switzerland; the Free University of Brussels/European Agency for Development and Health (AEDES), in Belgium; the University of Oslo, in Norway; the National Institute of Public Health (INSP), in Mexico; the University of Queensland, in Australia; and the Public Health Foundation of India (PHFI)—developed the curriculum presented here. Using practical case studies, participants in this core RHIS course will learn how to improve the performance of RHIS, by producing reliable data to inform decisions at all levels of the health system. They will also come to understand the important contribution of information and communication technology. The full collection is also available online at https://www.measureevaluation.org/our-work/routine-health-information-systems/rhis-curriculum
What Works to Strengthen the Systems that Inform Health Services? MEASURE Evaluation 2019 English Systems strengthening, HIS strengthening, HIS, Information systems, Health Systems Strengthening, SOCI, Toolkit, Health Information Systems The Health Information System (HIS) Stages of Continuous Improvement (SOCI) Toolkit helps countries holistically assess and prioritize investments to strengthen their HIS. An assessment using the toolkit measures current and desired HIS status, and it maps a path for a system to improve. Using the toolkit, countries can increase the availability of timely data so they can make decisions with more confidence that better health outcomes will follow. The SOCI toolkit complements efforts by the World Health Organization to strengthen the capacity of countries’ HIS and workforce to monitor progress toward universal health coverage and the United Nations’ Sustainable Development Goals for health. This brief shares more.
Facilitating Surveillance, Monitoring, and Evaluation in Malaria-Endemic Countries: A Compendium for National Malaria Programs MEASURE Evaluation 2019 English Malaria Surveillance, ITN, Malaria, What's New, Monitoring, Evaluation, SME, Surveillance Concerted efforts in malaria control have led to a significant decrease in the disease burden globally and specifically in sub-Saharan Africa (SSA). Countries there have scaled up proven malaria interventions, such as insecticide-treated nets (ITNs), indoor residual spraying (IRS), diagnostic testing, prompt and effective treatment of malaria cases, and intermittent preventive treatment in pregnancy (IPTp). A strong surveillance, monitoring, and evaluation (SME) system is needed to measure progress and achievement to inform future efforts and investments. This compendium is designed for national malaria program (NMP) personnel, who need to learn SME skills quickly and apply them immediately to their work. It is also intended to be a valuable resource for implementing partners working on malaria projects, students taking an SME course in an MPH program, and scientists interested in malaria SME. Relevant documents and guidance materials are referred to throughout the document. Readers are encouraged either to read through the compendium in its entirety or reference specific chapters, as needed. Chapter 1 introduces the concepts of malaria SME. Chapters 2 and 3 look at the global burden of malaria and global efforts to control malaria. Chapter 4 discusses the role of data for decision making. Chapters 5 through 8 describe the development of an SME plan and a plan’s components: frameworks, indicators, and data sources. Chapter 9 discusses malaria surveillance—a concept particularly important as malaria transmission decreases and NMPs need to track each case closely. Chapter 10 describes key methods used for evaluating NMPs and provides references to key indicators, data sources, and practical examples. Chapter 11 discusses the nuts and bolts of data quality, data management, and data analysis. Chapter 12 focuses on what is needed to present, interpret, and use data correctly. Finally, Chapter 13 presents ethical concerns to think about in malaria SME.
Experiences and Lessons Learned: Implementing the Most Significant Change Method MEASURE Evaluation 2019 English The most significant change (MSC) method is a participatory qualitative approach to monitoring and evaluation (M&E) of complex programs. MEASURE Evaluation, which is funded by the United States Agency for International Development (USAID), has implemented this  technique in evaluations of health programs. This brief summarizes our experience and shares lessons learned in the application of MSC.
Feasibility of home-based HIV counselling and testing and linking to HIV services among women delivering at home in Geita, Tanzania: a household longitudinal survey Juma Adinan, Bridgit Adamou, Caroline Amour, Aisa Shayo, Paulo Lino Kidayi, Levina Msuya 2019 English HIV, PMTCT, HIV care, HIV counseling and testing, Tanzania, Women BackgroundSubstantial number of women who deliver at home (WDH) are not captured in prevention of mother-to-child transmission (PMTCT) services. This delays HIV infection detection that negatively impacts endeavours to fight the HIV pandemic and the health of mothers and children. The study objective was to determine the feasibility of home-based HIV testing and linking to care for HIV services among WDH in Geita District Council, Tanzania. MethodsA longitudinal household survey was conducted. The study involved all mentally-able women who delivered within 2 years (WDTY) preceding the survey and their children under the age of two. The study was conducted in Geita District Council in Geita Region, Tanzania from June to July 2017. Geita is among the region with high HIV prevalence and proportion of women delivering at home. ResultsOf the 993 women who participated in the study, 981 (98.8%) accepted household-based HIV counselling and testing (HBHCT) from the research team. HIV prevalence was 5.3% (52 women). HBHCT identified 26 (2.7%) new HIV infections; 23 (23.4%) were those tested negative at ANC and the remaining three (0.3%) were those who had no HIV test during the ANC visit. Among the 51 HIV+ women, 21 (40.4%) were enrolled in PMTCT services. Of the 32 HIV+ participants who delivered at home, eight (25.8%) were enrolled in the PMTCT compared to 100% (13/13) of the women who delivered at a health facility. ConclusionHBHCT uptake was high. HBHCT detected new HIV infection among WDH as well as seroconversion among women with previously negative HIV tests. The study findings emphasize the importance of extending re-testing to women who breastfeed. HBHCT is feasible and can be used to improve PMTCT services among WDH.
Improving Nutrition through Community-Based Approaches in Bangladesh Gustavo Angeles, Shusmita Khan, Mizanur Rahman, Nitai Chakraborty, Sharad Bartaki, & Gabriela Escudero 2019 English BANGLADESH nutrition, Impact Evaluation, Evaluation This document is the baseline survey report for the evaluation of the United States Agency for International Development (USAID)/Bangladesh’s Improving Nutrition through Community-Based Approaches (INCA) activity. The evaluation is being conducted by the USAID-funded MEASURE Evaluation project at the request of USAID/Bangladesh, and is part of a larger set of monitoring and evaluation activities for the INCA project. INCA is a three-year effort to improve the nutritional status of women and children under age two in rural areas of 11 priority upazilas in the districts of Bhola, Laxmipur, and Noakhali. Caritas Bangladesh and United Purpose are implementing the project. It started in May 2017 and will be active through April 2020. Total funding is approximately USD$4.4 million. The 2017 baseline survey is the first of two surveys to assess the performance and impact of INCA. The overall objectives of this external evaluation are (1) to inform USAID and other stakeholders about project achievements in terms of changes in key outcomes and impact at the target population level; (2) to learn about the effectiveness of the specific INCA intervention for eventual replication in other areas of the country; and (3) to inform the follow-up of the project. The evaluation is based on a prospective, quasi-experimental, difference-in-differences (DID) design to assess project impact using data collected through representative household surveys in INCA intervention and comparison areas in this baseline survey, and a follow-up end line survey that will be implemented by the end of 2019. MEASURE Evaluation also conducted a short community survey during this baseline assessment and will repeat it in the end line survey to assess changes in health and nutrition service availability.
Bangladesh Maternal Mortality and Health Care Survey (BMMS) 2016: Final Report 2019 English BANGLADESH BMMS, Maternal Mortality, Family Planning, Bangladesh Maternal Mortality and Health Care Survey, Bangladesh, Maternal mortality, Maternal and child health, Maternal health The Government of Bangladesh is committed to achieving its targets for Millennium Development Goal (MDG) 5: reducing the maternal mortality ratio (MMR) to 143 deaths per 100,000 live births by 2015 and increasing skilled attendance at birth to 50 percent by 2015 (United Nations Development Program [UNDP], 2015). The decline in MMR between 2001 and 2010 indicates remarkable progress. This progress is linked to fertility reduction, access to qualified maternal health care, and overall care-seeking during the antenatal period and during delivery (UNDP, 2015). By the end of the third sector program, a revised maternal health strategy and standard operating procedures (SOPs) for maternal and newborn health were finalized. With the MDGs phasing out and the Sustainable Development Goals (SDG) phasing in (United Nations, 2015), the Fourth Health, Population and Nutrition Sector Programme (4th HPNSP) 2017–2022 has set the target of reaching an MMR of 121 per 100,000 live births in 2022 (Ministry of Health and Family Welfare [MOHFW], 2017). Within this context, the Bangladesh Maternal Mortality and Health Care Survey (BMMS) 2016 was carried out to assess how well the country is progressing toward these targets. The BMMS 2016 was an activity under the Operational Plan of Training, Research, and Development of the National Institute of Population Research and Training (NIPORT) under the Health, Population and Nutrition Sector Development Program (HPNSDP) 2011–2016 (MOHFW, 2014). The major objectives of the BMMS 2016 were 1) to provide a nationally representative estimate of the maternal mortality ratio (MMR) for three years preceding the survey (approximately 2014–2016); 2) to identify the causes of maternal deaths, and 3) to assess maternal healthseeking behavior indicators and compare them with the BMMS 2010 to assess how well the country is progressing toward national and global targets for maternal health since the 2010 survey.
Implementation of the Electronic Management Information System in Bangladesh: Experience and Lessons Learned 2019 English BANGLADESH Bangladesh, electronic management information system, eMIS, Electronic Health Records, Family Planning In 2015, the Ministry of Health and Family Welfare (MOHFW) of Bangladesh undertook an initiative to develop and implement an electronic management information system (eMIS) to benefit community health service delivery. The initiative was implemented through a collaborative partnership among the United States Agency for International Development (USAID)-funded MEASURE Evaluation project, the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), MaMoni Health Systems Strengthening (now MaMoni MNCSP), and SIAPS (now MTaPS) and was supported by USAID. The intent of the initiative was to replace cumbersome paper instruments, reduce data burden for health providers, improve data-driven service delivery and quality of care, and make management of health and family planning activities at the grassroots level more efficient and effective. The resultant eMIS provides comprehensive and interlinked electronic tools for use by community-level healthcare and family planning workers (health assistants [HAs] and family welfare assistants [FWAs]), union-level service providers (family welfare visitors [FWVs], sub-assistant community medical officers [SACMOs]), their supervisors (health inspectors [HIs], assistant health inspectors [AHIs], and family planning inspectors [FPIs]), and their managers at the upazila level. Data from eMIS get linked to the mainstream reporting system for use by managers, planners, and policymakers at the directorate and ministerial levels. All tools created for the eMIS were vetted and approved by the Directorate General of Family Planning (DGFP) and the Directorate General of Health Services (DGHS). The district and upazila managers had overall responsibility for implementing the eMIS, while technical assistance was provided by the eMIS initiative through software development, the provision of equipment, and capacity building. Systems for Improved Access to Pharmaceutical and Services (SIAPS), another USAID project (now MTaPS), contributed in the area of logistics management. This document describes in detail the information technology (IT) structure of the eMIS and the experience of implementing it across several upazilas and districts in Bangladesh.
Principled Health Information Systems: Ethics Beyond Data Security James C. Thomas, Andreas Reis, and Victoria Fleming 2019 English Global Data ethics, HIS strengthening, HIS, Data use, Data security Low- and middle-income countries are creating and expanding digital data systems to monitor their health trends and guide their health programs. The construction of these systems is often regarded as purely technical, with little consideration given to ethical dimensions. Data security is a notable exception. To identify a broader range of ethical concerns, we carried out a scoping review of the literature for sets of principles to guide the development and use of digital information systems relevant to population health. The 11 sets we identified named a total of 34 principles, of which data security was one. We organized the principles into four stages of health information system (HIS) development: HIS design, data collection, data storage, and data use. To accommodate these principles, countries must first be aware of them and identify the staff responsible for addressing them in the design of their digital data systems.
MEASURE Evaluation’s Small Grants for Family Planning: Strengthening Research Capacity around the World Bridgit Adamou 2019 English Global capacity strengthening, capacity building, RHIS, Small grants Increasing family planning (FP) uptake in low- and middle-income countries (LMICs) requires a strong routine health information system (RHIS) and sound data. In turn, good data management can increase stakeholder ownership and subsequently increase FP uptake. Unfortunately, several knowledge gaps disrupt this virtuous cycle: how to improve the quality of FP data, address barriers to integration of FP data in RHIS, and encourage analysis and use of the data to improve FP outcomes. Small grants to in-country research groups promote capacity and provide financial support for FP research conducted in LMICs. The small-grants model creates sustainability by working through host-country institutions to research relevant FP issues, disseminate findings to local researchers, and help develop strategies for improvements. MEASURE Evaluation, which is funded by the United States Agency for International Development (USAID), implemented a successful small grants program from 2014–2019. During that time, 19 subagreements were signed with research organizations from 11 USAID FP priority countries. This paper documents experience gained from the small grants program.
Capacity of Sierra Leone’s National Malaria Control Programme for Monitoring and Evaluation: Baseline Assessment MEASURE Evaluation 2019 English SIERRA LEONE Assessment, Monitoring, Evaluation, Malaria control, Malaria Surveillance, capacity strengthening, Monitoring, capacity building, Malaria MEASURE Evaluation, which is funded by the United States Agency for International Development and the U.S. President’s Malaria Initiative, assessed the monitoring and evaluation (M&E) capacity of Sierra Leone's National Malaria Control Program (NMCP). This assessment had the following specific objectives: To understand the current capacity of the malaria program to conduct M&E activities To assess the capabilities of individual staff members to carry out M&E functions To determine gaps in malaria M&E capacity To identify and prioritize interventions to strengthen M&E To develop a capacity-building plan The assessment consisted of a desk review of existing documentation and primary data collection through group assessment and individual assessment tools described in the Monitoring and Evaluation Capacity Assessment Toolkit.
Guide for Assessing the Impact of a Total Market Approach to Family Planning Programs Dominique Meekers, Sarah C. Haynes 2019 English Africa, Asia, Global Family Planning, Total market approach, Impact Evaluation, Asia, TMA, Reproductive Health, Africa, contraceptive prevalence rate, Contraception A Total Market Approach (TMA) is an approach to coordinating family planning (FP) services among health planners and facilities, commodity suppliers, and funders from governmental, commercial, and private or nongovernmental sectors. With a TMA, these sectors work together to increase the market for and the availability of FP services and methods. Despite the growing popularity of TMA, the development of TMA strategies and their implementation are still in their infancy. As yet, there are no studies or agreed-upon approaches to assess the medium- and long-term impact of TMA on FP outcomes. This guide will describe a step-by-step approach for evaluating the impact of FP programs that are TMA-based. As such, it is complementary to earlier guides for designing and monitoring TMA programs. The United States Agency for International Development (USAID)-funded MEASURE Evaluation project produced this guide to help TMA implementers to properly plan for evaluations of the medium- to long-term impact of their TMA programs, which will also enable them to contribute to the evidence base on the impact of TMA programs. The objectives of this guide are fourfold: (1) to compare definitions of TMA currently being used by implementing organizations; (2) to identify objectives and components of current or past TMA implementations for FP; (3) to outline methods for an impact evaluation of TMA programs; and (4) to demonstrate how a TMA might be evaluated for impact using an example from Cambodia. To achieve these objectives, we conducted a systematic review of current and past implementations of TMA programs. To supplement the findings of this review, we followed up with authors and conducted key informant interviews with implementers and supporters of TMA projects.
Performance of Routine Information System Management Assessment in Burkina Faso (2018) Mohamed Rahim Kebe, Cyrille Kouassi, Issaka Sawadogo, Romain-Rolland Tohouri, Jeanne Chauffour 2019 English Burkina Faso, Routine Health Information Systems, RHIS, Information systems, PRISM, HISS, Performance of Routine Information System Management, Health Information Systems A Performance of Routine Information System Management (PRISM) evaluation was carried out in 2018 with PRISM tools newly revised by the United States Agency for International Development (USAID)-funded MEASURE Evaluation project. The assessment covered 64 health facilities (HFs); five hospitals; four districts; one health region; and the central level, represented by the Directorate for Sectoral Statistics (DSS). Burkina Faso has a national health management information system (HMIS), known as ENDOS. The system is based on District Health Information Software, version 2 (DHIS2); integrates data from the entire health pyramid; and supports data entry, analysis, and interpretation. It also integrates all data quality indicators. Given the 2018 PRISM findings, RHIS strengthening efforts should focus on supervision visits that are both regular and systematic at all levels of the health system, alongside a consensual development of reports and plans for the tracking and implementation of recommendations. Instilling a data use culture is paramount. Each level of the health system should be encouraged to produce periodic reports or feedback bulletins, and standard operating procedures (SOPs) and data entry tasks should be extended to service delivery points (SDPs). This poster was presented and exhibited at the Global Digital Health Forum, December 9–11, 2019 in Bethesda, MD, USA.   A French version of this poster is available at https://www.measureevaluation.org/resources/publications/gr-19-101-fr/ The French-language report on the PRISM Evaluation in Burkina Faso is available at https://www.measureevaluation.org/resources/publications/tr-20-420-fr
The One Health Electronic Platform in Burkina Faso Mohamed Rahim Kebe, Cyrille Kouassi, Issaka Sawadogo, Romain-Rolland Tohouri, Jeanne Chauffour 2019 English GHSA, Global Health Security Agenda, Global health, One Health, Global health security, Burkina Faso, Disease MEASURE Evaluation—funded by the United States Agency for International Development (USAID)—began its work in Burkina Faso in March 2018 under the global health security agenda. In the aftermath of Ebola and other highly pathogenic infectious diseases and zoonoses that have plagued West Africa, USAID’s priority was to strengthen the Burkina Faso electronic health information system to include routine data on priority zoonoses that could affect humans, animals, and the environment. A result of this multisectoral coalition is the One Health electronic platform, which provides real-time data on unusual events and suspected cases to central-level directorates, laboratories, and the Center for Health Emergency Response Operations (CORUS). The national One Health steering committee insures the piloting of the electronic platform. Furthermore, Burkina Faso’s electronic health management information system—ENDOS—is integrated with the One Health platform. The areas of intervention of the MEASURE Evaluation project are the Center-South and Central Plateau regions, where end users have been trained on the use of the One Health electronic platform and are able to notify suspected cases in real time. This poster was presented and exhibited at the Global Digital Health Forum, December 9–11, 2019, in Bethesda, MD, USA. A French version of this poster is available at https://www.measureevaluation.org/resources/publications/gr-19-100-fr/ A French-language SOP on managing the One Health health information system is available at https://www.measureevaluation.org/resources/publications/tr-20-416-fr A French-language report on the One Health enterprise architecture is available at https://www.measureevaluation.org/resources/publications/tr-20-406-fr
Assessment of the Performance of Routine Health Information System Management in Mali (2018) Aminata Traoré, Madina Ba Kouyaté, Abdoulaye Maiga, Adama Ouatara, Issaka Dembélé, Alamako Doumbia, Ismael Dembélé, Ouassa Berthe, Mamoutou Diabaté, Mamadou Alimou Barry, Jeanne Chauffour 2019 English Mali, HIS, Health Information Systems, PRISM, Routine Health Information Systems, RHIS, Assessment The 2018 Performance of Routine Information System Management (PRISM) assessment in Mali measured changes in the status of the routine health information system (RHIS) in the years since the last evaluation, in 2013. The 2018 assessment revealed significant progress in data use, data quality assurance, and evidence of data analysis at the district, regional, and central levels of the RHIS. However, the assessment also revealed weaknesses at the health facility (HF) level. Above all, data accuracy is a concern at that level—and only there—because that’s where all data are entered now. Other weaknesses that emerged from the 2018 assessment relate to difficulties in archiving the health management information system (HMIS) tools and reports, poor sharing of normative RHIS management documents, instability and frequent turnover of health personnel, and security challenges in the north and center of the country. These problems have seriously affected the performance of the sites surveyed, especially at the most peripheral level (i.e., community health centers, or CSCom), not only in terms of data quality but also in terms of data use. The assessment’s results showed that the promotion of a culture of information alone is not enough to change habits. Closer monitoring is necessary to strengthen staff’s capacity to work with the tools available to them and willingness to use the tools on a regular basis. The results showed that critical management functions exist but need to be strengthened, so that they better support the RHIS at all levels of the health pyramid: HF, district, region, and central. The 2018 assessment also pointed to the need to sustain the progress that Mali’s RHIS has achieved. This poster was presented and exhibited at the Global Digital Health Forum, December 9–11, 2019 in Bethesda, MD, USA.
Assessment of the Performance of Routine Health Information System Management in Côte d’Ivoire (2018) Edwige Bosso, Franck Olivier Ba-Gomis, Léontine Gnassou, Félix Mominé Malé, Aoua Camara Aka, Alain Koukou; Adama Sanogo Pongathié, Mamadou Alimou Barry, Jeanne Chauffour 2019 English Health Information Systems, Cote d'Ivoire, PRISM, RHIS, Routine Health Information Systems After two consecutive routine health information system (RHIS) performance assessments were conducted in Côte d’Ivoire in 2008 and 2012, the Ministry of Health and Public Hygiene (MSHP) implemented massive strengthening interventions. To evaluate their impact, a Performance of Routine Information System Management (PRISM) assessment was conducted in September 2018, using PRISM tools newly revised by the United States Agency for International Development- and United States President’s Emergency Plan for AIDS Relief (PEPFAR)-funded MEASURE Evaluation project. It concerned 234 health facilities (HFs), 24 districts, 12 health regions, and the central level, represented by the Directorate for Information Technology and Health Data (DIIS). Results for HFs show that data quality at that peripheral level remains low but has improved—along with management procedures—at higher levels (districts, regions, and central government). Likewise, data use is low at the HF level, average for districts and regions, and high at central level. Given the 2018 PRISM findings, RHIS strengthening efforts should focus on the HF level—where data are initially produced and gathered—because the quality of those data heavily determines the overall quality of the MSHP’s health data.   This poster was presented and exhibited at the Global Digital Health Forum, December 9–11, 2019, in Bethesda, MD, USA.
The Global Evaluation and Monitoring Network for Health (GEMNet-Health): An Institutional Partnership as a Vehicle for Capacity Building Kulatilaka, H., & Smith, J. 2019 English The purposes of this paper are to (1) describe how GEMNet-Health has served as a global resource for teaching and training, research, and technical assistance while also strengthening the capacity of individual network members; (2) document the technical activities and materials that have been produced to date; and (3) explore how GEMNet-Health has added to the global knowledge base on partnership networks as vehicles for capacity building in the field of public health.
Lessons in Health Information System Strengthening: What Worked in Mali MEASURE Evaluation 2019 English Since 2010, MEASURE Evaluation has worked with the United States Agency for International Development (USAID) mission in Mali to strengthen national- and community-level health information systems (HIS), with an emphasis on malaria monitoring and evaluation (M&E). In collaboration with units and programs of the Mali Ministry of Public Health and Hygiene (MOH), MEASURE Evaluation streamlined data collection systems and strengthened governance and leadership and HIS management, to improve quality and use of health data. MEASURE Evaluation supported HIS strengthening by partnering with the MOH and working closely with United States Government (USG) implementing partners (IPs) and non-USG partners. The project also built MOH capacity to use and manage the HIS and use HIS data for decision making, by customizing electronic platforms, providing necessary hardware and software, and training and mentoring MOH staff. These approaches yielded the following gains: Nine parallel systems (on non-web-based platforms that were previously only available in electronic version above the site level) were combined into one streamlined system that is available at all levels of the health system on the DHIS 2 platform. HIS management and governance tools, resources, and coordinating bodies were established that have standard operating procedures, guides, steering committees, and technical working groups. More than 2,200 staff members and providers at all levels of the health system were trained in DHIS 2 use, data use, and other relevant topics through training of trainers and cascade trainings. Select staff at the central level were also trained in the customization of DHIS 2. One hundred percent of regional hospitals, 100 percent of district health facilities, and 98 percent of community health facilities reported in DHIS 2. Mechanisms for data monitoring (e.g., data review meetings, data competitions, a quarterly health management information system bulletin, and supportive supervision visits) were established. These accomplishments can be quantified, but it is also important to understand HIS users’ experiences and the context in which the system was strengthened and improved. To do so, in 2019, we conducted stakeholder interviews to capture perceptions and experiences of MOH staff who interact with Mali’s HIS. An analysis of these interviews yielded common themes of what worked in HIS strengthening in Mali. The objective of this document is to summarize lessons learned and highlight effective HIS strengthening approaches and interventions and their outcomes.
Indicators on the Status of a Health Information System MEASURE Evaluation 2019 English HIS, Health Information Systems, Indicators, HIS strengthening In an effort to document what works to strengthen health information systems (HIS), MEASURE Evaluation developed a validated, standard set of metrics and description of methods for use in HIS evaluation and strengthening. Learn more here. 
Health Information Systems Infographics MEASURE Evaluation 2019 English HIS, Health Information Systems Health systems rely on health data so policy makers can understand what health issues people are facing in a given country, what health programs are working, what resources are available, and what changes should be made to optimize health. The systems that produce this data are as complex as the overall health systems they support; and they comprise data collected from the smallest health clinic to the national health ministry. Further, to be of any use in improving health, data collection is not enough. Someone must check their quality; someone must aggregate data from many sources; someone must analyze what the data are saying. Then, someone must put this learning to good use. The operation and interaction that occur daily within a health information system (HIS) is sometimes easier to grasp in visual terms. This collection of graphics tells part of the story of how an HIS performs and what it can contribute to health improvements.
A Synthesis Collection: How HIS Strengthening leads to improved health systems in five areas MEASURE Evaluation 2019 English HIS, HIS strengthening, Health Information Systems The purpose of a health information system (HIS) is to get data into the hands of decision makers at all levels of the health system to improve the availability and quality of care. According to the HIS Strengthening Model, HIS strengthening interventions improve HIS performance, which leads to health systems better suited to meet the needs of the population. For future planning, it’s important that the effects of specific interventions to improve HIS are well-documented along with impacts on health systems. These syntheses are discrete studies of packages of HIS interventions and their effect on improving health systems. For example, one synthesis documents how streamlining health systems indicators for M&E reduces redundancies in data collection, thereby easing the data collection burden on people whose main job is to provide high-quality healthcare. Another examines how functioning community-based referral systems can improve linkages to care in rural areas, improving continuity of care for orphans and vulnerable children. And another focuses on how strengthening feedback loops and data quality checks improves detection of infectious disease outbreaks, such as Ebola. These examples in this collection of syntheses makes a case for ongoing investments in evidence-based interventions.
Health Information Systems Interventions MEASURE Evaluation 2019 English HISSM, Intervention, Health Information Systems, HIS From 2014-202, MEASURE Evaluation supported more than 20 countries in implementing programs to improve health information systems. This included programs to allow different systems to exchange data (interoperability), training staff in data analysis, and improving methods to validate data. What we learned in this work provides a foundation for documenting successful models for strengthening health information systems. In the 11 countries in which USAID investments were highest, MEASURE Evaluation documented the project’s interventions and mapped them to the Health Information Systems Strengthening Model (HISSM).
Health Information Systems Assessment Tools MEASURE Evaluation 2019 English Tools, HIS, Assessment, Health Information Systems This spreadsheet was created to catalog and serve as a guide to several tools that serve to assess different aspects of health information systems (HIS). This spreadsheet describes each tool’s purpose, its prescribed uses, and the area of HIS that it is designed to assess. The spreadsheet contains a variety of publicly available tools. These tools were selected by performing a search of available HIS assessment tools and consulting with experts in the field. This spreadsheet was last updated in 2019.
Evaluation of Health Information System Interventions in Targeted Countries Elizabeth Millar, Eva Silvestre, Heather Davis, Francine Wood 2019 English HISSM, Health Information Systems, Intervention, HIS, Evaluation MEASURE Evaluation Phase IV implemented several studies during Phase IV of the project (2014-2020) to document the factors and conditions for improving health information system (HIS) performance (defined as data quality and data use). From improvements in staff capacity, to conducting monitoring and evaluation, to interventions to help reach global goals that combat HIV/AIDS, these studies examine interventions across the Health Information Systems Strengthening Model (HISSM).
Health Information Systems Learning Agenda MEASURE Evaluation 2019 English HIS, Learning Agenda, Health Information Systems The primary function of national health information systems (HIS) is to collect and analyze data to help providers and policymakers improve patient care, identify a population’s most important health needs, and decide how to address those needs. Another function of HIS is to make data available for accountability in health initiatives and to provide evidence of a country’s progress toward global Sustainable Development Goals. A dividend of work to improve the reliability of an HIS is that a country and its partners can then also use the data that the HIS generates to monitor and evaluate the performance of health programs. From this analysis, best practices for the conduct of those programs often come to light. The effort required for an HIS to satisfy all these demands is a challenge in countries where human, financial, and technological resources are scarce. From 2014-2020, MEASURE Evaluation Phase IV worked at the intersection of a country’s need for reliable health information and the capacity of the HIS there to generate it. During this Phase, MEASURE Evaluation had a mandate to strengthen HIS and, moreover, to share what we are learning as we go. MEASURE Evaluation's “learning agenda” sought to answer three fundamental questions: What are the factors and conditions of HIS performance progress? What are the stages of progression to a strong HIS and how are they measured? What are the characteristics of a strong HIS? Answers to these questions are described in this collection.
Health Information Systems Interoperability Maturity Toolkit MEASURE Evaluation 2019 English HIS, Interoperability, Health Information Systems This toolkit identifies major components of interoperability for health information systems (HIS) and lays out a path to meet goals in leadership and governance, human resources, and information technology to support digital health. The kit contains three main pieces: a maturity model, an assessment tool, and a users’ guide. It also offers a complete list of the references consulted in a literature review that was conducted as part of the toolkit’s development. The HIS interoperability maturity model identifies the major components of HIS interoperability and lays out an organization’s growth pathway through these components. Countries can use the assessment tool to determine their HIS interoperability maturity level systematically. Using the assessment results, countries can create a path toward strengthening their HIS interoperability and building resilient systems. This is Version 1.0 of the toolkit published in January 2019 with lessons learned from early adoption by Ghana and Uganda.
Lessons Learned in Health Information System Strengthening: What Worked in the Democratic Republic of the Congo Lavanya Gupta, Scott McKeown, Johanna Karemere, Olivier Kakesa, Ramine Bahrambegi 2019 English HISSM, DRC, HIS, HISS, Democratic Republic of Congo, Data quality, HIS strengthening, Health Information Systems MEASURE Evaluation, a project funded by the United States Agency for International Development (USAID), works in 50 low- and middle-income countries, implementing 300 health system strengthening activities to generate high-quality health information. Since 2014, MEASURE Evaluation has helped the National Malaria Control Program (NMCP) of the Democratic Republic of the Congo (DRC) streamline and improve routine malaria data collection, reporting, management, and use at all levels of its health system. The DRC previously reported malaria data in an Access-based system that limited the NMCP’s ability to collect and analyze them. We provided technical and financial support and collaborated with the NMCP to achieve the following: Supported the rollout of the electronic health information platform—District Health Information Software, version 2 (DHIS2)—at all levels of the health system: in all 178 health zones and 77 health facilities (designated as Centers of Excellence [COEs]) in 9 priority provinces of the U.S. President’s Malaria Initiative (PMI) Integrated malaria indicators in DHIS2 Trained more than 400 staff in monitoring and evaluation (M&E), data collection, analysis, and use Developed health information system (HIS) management resources and implemented data-review and data-quality-check mechanisms Created and convened technical working groups (TWGs) to manage M&E and malaria intervention activities at the national and provincial level We documented the outcomes of our work with the NMCP and identified effective HIS-strengthening interventions to improve the quality of health data, including routine malaria data. This poster, presented at the  2019 annual meeting of the American Society of Tropical Medicine and Hygiene (ASTMH), shares more. 
Improved Reporting of Performance Data Supports Health Decision Making in Bangladesh MEASURE Evaluation 2019 English M&E, Bangladesh, Data, Data Quality, Monitoring, Evaluation MEASURE Evaluation contributed to institutionalizing regular health-sector performance reviews by the Ministry of Health and Family Welfare of Bangladesh and helped promote data use for program and policy decisions. This brief shares more. 
Snowball Effect of Data Competition in Mali MEASURE Evaluation 2019 English Data, Mali, Health Facilities, Health data, Health System, Routine data, DHIS 2, Data Quality In 2018, Mali held a friendly competition among health facilities to motivate all levels of the health system to improve the quality of health data and to make strategic use of those data. The first competition came as Mali had successfully adopted and deployed the District Health Information Software, version 2 (DHIS2) platform for management of health data across the health system. What began in 2018 as a data quality incentive designed by the Mali Ministry of Health (MOH) has won enthusiastic adoption by health providers across the health system. Not only has it attracted more competitors (from 2018 to the second competition in 2019), it also has demonstrably improved the quality of health data across the board. The MOH intends to institutionalize the competition, has included it in its priority health management information system (HMIS) activities, and is planning a third competition in 2020. In 2018, the competition rewarded eight health facilities (five community health centers [CSCom], two health districts [CSRef], and one hospital) for improving their data quality from 2017 to 2018. In 2019, the MOH rewarded 16 health facilities (10 CSCom, four CSRef, and two hospitals). Achievement in meeting the criteria for judging data quality (100% data completeness and 80% timeliness) improved significantly from the 2018 competition to the 2019 competition and the number of facilities competing grew from 65 in 2018 to 308 in 2019 (an almost fivefold increase). This brief shares more.
Preventing HIV among Guyana’s Key Populations: Guidelines MEASURE Evaluation 2019 English HIV, Guyana, Key Populations, KP, HIV/AIDS, HIV prevention These guidelines are designed to outline the public health response to HIV among key populations (KPs) in Guyana. The specific objectives are to: Define the populations of interest Define the combination prevention package for KPs Update guidance on the operationalization of interventions Define programme monitoring and evaluation (M&E) for KP prevention activities The focus of these guidelines is on HIV prevention for KPs and priority populations. To meet the HIVision 2020 goal of eliminating HIV in Guyana, a multi-pronged approach that goes beyond prevention will be required. These guidelines highlight the approaches needed before care and treatment are given and linking with treatment for people who have HIV. 
Family Planning Indicators Assessment and Data Quality Audit in Selected Health Facilities across Nigeria Olukemi Olugbade, Oluwayemisi Ishola, Olusegun Ricketts, Shakir Balogun, and Moreen Kamateeka 2019 English Africa, NIGERIA Data Quality Audit, Indicators, Family Planning, Data quality assessment, DQA, Data Quality Promoting family planning (FP) is an important strategy for preventing high-risk births and infant deaths, reducing unplanned pregnancies and unsafe abortions, and decreasing the burden of infant and maternal mortality globally. To be successful, FP programs must use information systems to accurately track FP use and trends. Although use of District Health Information Software, version 2 (DHIS2) to manage and aggregate health information is becoming the norm across Nigeria, issues still confound the operationalization, availability, accuracy, consistency, timeliness, completeness, and integrity of FP data at health facilities and in DHIS2 by extension. The purpose of this study was to assess FP data quality in select health facilities in Nigeria. The study used a mixed-methods approach. A total of 114 (103 public and 11 private) health facilities in six states (Bauchi, Delta, Enugu, Kano, Osun, and Nasarawa) were selected across Nigeria.
Engendering Evidence-Based Policy for Young People's Reproductive Health in India Sunita Nigam, Avantika Singh, and Vishakha Singh 2019 English INDIA adolescent, behavior, Reproductive Health, attitude Young people, defined by the World Health Organization as people 10–24 years old, account for more than a quarter of India’s population (2014). The country has the opportunity to harvest economic and social gains from its young, working-age population if it invests in human capital development and overcomes such challenges as poor education and healthcare, gender discrimination, and lack of access to adolescent and youth reproductive health care. This paper presents evidence for policymakers on the strengths and weaknesses of the health policy framework; service delivery mechanisms; and knowledge, attitudes, and practices of 10- to 24-year-olds related to reproductive health in India. The research incorporated exploratory and descriptive approaches, using qualitative and quantitative data from primary and secondary sources.
Understanding “the Last 90” in Guyana’s HIV Treatment Cascade: A Facility-Based Assessment of the Viral Loads of Key Populations Reynolds, Z. 2019 English ART, HIV, Guyana, Key Populations, KP, HIV/AIDS, HIV care, HIV prevention According to the National Guidelines for Management of HIV-Infected and HIV-Exposed Adults and Children (Ministry of Public Health [MOPH], 2015), viral load testing began in Guyana in 2009. It is indicated for adults at six months after initiation of antiretroviral therapy (ART) and every six to 12 months thereafter for clients who are virally suppressed. This supports what the midterm evaluation of Guyana’s HIVision 2020 reports is the ultimate goal of the HIV treatment cascade (the steps a client takes from testing through viral suppression): “viral load suppression” (MOPH, 2017). One strategy outlined in the document is to “increase the proportion of people with HIV (on HAART [highly active antiretroviral therapy]) who have viral load suppression to 90% by 2020.” That strategy is in line with other global goals to ensure that 90 percent of people enrolled in care have a viral load that is below standard limits or even undetectable. Implementing the strategy in Guyana is particularly important in the era of treatment as prevention, to ensure that the virus is undetectable in clients and therefore untransmittable. The most recent HIV treatment cascade analysis for Guyana, from 2016, reports that 68 percent of people on ART are virally suppressed (MOPH, 2017). These cascade data come from routine reports from health facilities. Although the information is valuable, it is incomplete, because that same cascade reports that 83 percent of clients on ART have a current viral load test. MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—realized that filling this gap would be essential to a full understanding of the HIV cascade in Guyana. If the sample of clients who were missing VL measures could be assumed to represent all clients missing VL measures, then we could leverage estimates of viral suppression from a sample of clients who were missing VL data to obtain a more accurate, representative estimate of viral suppression among a larger population in the care and treatment program. Answering these questions would contribute to USAID’s goal of controlling the HIV/AIDS epidemic and the global 90-90-90 targets that PEPFAR has adopted. Prior studies in Guyana have shown that the country’s key populations (KPs)—female sex workers (FSWs), men who have sex with men (MSM), and transgender women—face greater barriers to accessing services than the general population does. HIVision 2020 called for the country to pay special attention to KPs (MOPH, 2013). Not only are they engaged in higher-risk activities (National AIDS Programme Secretariat [NAPS] & MEASURE Evaluation, 2014), but also they face greater stigma than other HIV-positive clients. To better understand KPs’ engagement in HIV services and how they compare to non-KP clients, we chose to focus on KPs for this study. NAPS wanted to understand how KPs are progressing along the HIV cascade to viral load suppression. Our purpose in assessing viral loads among KPs was to estimate the level of HIV viral suppression among KP members who were enrolled in care. We designed the study to (1) quantify the missing viral load data for KPs, and (2) sample people who were missing viral load data to estimate viral suppression for those populations. The Society Against Sexual Orientation Discrimination facilitated the two stages of the study with technical oversight by MEASURE Evaluation in close collaboration with NAPS. The study took place in early 2019 at five health facilities in Georgetown, Guyana. The results of the study will help inform MOPH programs both for HIV-positive clients who are KP members and those who are not. It will illuminate gaps in data and show how viral load estimation can be improved at the health facility and national levels.
Monthly Malaria Bulletins Contribute to Improving Data Use for Malaria Control in Mali MEASURE Evaluation 2019 English Data, Mali, Malaria control, Malaria, Data use As a close partner of the National Malaria Control Program (NMCP) in Mali for the past 10 years, MEASURE Evaluation has supported malaria control and prevention activities that have made a difference in collective efforts to combat the epidemic. Together, MEASURE Evaluation and the NMCP have improved the quality of malaria data available, in part by strengthening the capacity of NMCP staff in monitoring and evaluation. Although the disease is preventable and curable, consistent and high-quality malaria data to guide program implementation and to measure achievements are in short supply. In response to the acute need for reliable malaria data at national and subnational levels, the NMCP, with the support of MEASURE Evaluation, created a monthly malaria bulletin to provide nationwide updates. This brief describes how the bulletin is helping improve data use for malaria control. 
Mise en oeuvre d'une surveillance fondée sur les événements au Burkina Faso. Recours à l'approche « Une Seule Santé » Connolly, A.M., Sawadogo, I., Geers, E., & Eugene, M.Y.B. 2019 French Africa, BURKINA FASO Burkina Faso, Global health security, One Health, GHSA, Surveillance, Disease De récentes flambées du syndrome respiratoire du Moyen-Orient, de la grippe aviaire et de la maladie à virus Ebola ont attiré l'attention au niveau local, national, régional et international quant aux capacités des pays à détecter les problèmes de santé publique émergents et à y remédier efficacement. Bon nombre de ces foyers ont impliqué des maladies zoonotiques, soit celles qui se transmettent de l'animal à l'homme. Ces flambées ont amené les pays à développer de nouvelles stratégies d'intervention par le biais du Programme mondial de sécurité sanitaire (GHSA) lancé en 2014. Le GHSA a pour but de renforcer les compétences mondiales et nationales pour prévenir, détecter et surmonter les menaces de maladies infectieuses, à l'aide d'une approche multilatérale et multisectorielle. MEASURE Evaluation, un projet financé par l'Agence des États-Unis pour le développement international (USAID), travaille au Burkina Faso depuis mars 2018 en partenariat avec le Ministère des Ressources animales et halieutiques (MRAH), le Ministère de la Santé (MS) et le Ministère de l'Environnement, de l'Économie verte et du Changement climatique (MEEVCC) dans le but de renforcer la capacité du pays à détecter les maladies à potentiel épidémique et épizootique et à offrir une riposte en recourant à l'approche « Une Seule Santé ». Une Seule Santé est une approche collaborative, multisectorielle et transdisciplinaire qui fonctionne à l'échelle locale, régionale, nationale et internationale pour suivre et contrôler les menaces en matière de santé publique et comprendre comment certaines maladies se transmettent chez les personnes, les animaux et leur environnement commun (Une Seule Santé). Au Burkina Faso, chacun des ministères responsables de la santé humaine et animale et de l'environnement possède un système de surveillance épidémiologique. Au sein du Ministère de la Santé, le système de surveillance et de riposte épidémiologique intégré (SSREI) veille à la surveillance des maladies, notamment celles à potentiel épidémique. Au niveau du MRAH, la surveillance des épizooties et la riposte y étant donnée sont coordonnées par le Réseau de surveillance épidémiologique des maladies animales (RESUREP). Le MEEVCC ne dispose pas d'un système de surveillance. Néanmoins, pour suivre les animaux vivant dans les parcs et les zones protégées, des formulaires de suivi écologique ont été instaurés afin de recueillir des renseignements sur les animaux sauvages, notamment concernant leur santé. Depuis 2017, MEASURE Evaluation s'allie à d'autres partenaires pour aider le Burkina Faso à améliorer son système de surveillance dans le cadre de l'objectif global du projet visant à appuyer le gouvernement dans ses efforts de renforcement du système d'information sanitaire (SIS). Les objectifs spécifiques de MEASURE Evaluation concernant le renforcement du SIS sont les suivants : (1) aider le gouvernement à renforcer son système de détection précoce en développant un système SFE à base communautaire pour les maladies à potentiel épidémique et épizootique ; (2) renforcer la collecte, l'analyse et l'utilisation des données sanitaires de routine ; (3) accroître la capacité du pays à gérer le SIS ; et (4) développer une plateforme électronique facilitant l'identification, la notification et le suivi de toutes les maladies sous surveillance par le Ministère des Ressources animales et le Ministère de la Santé. MEASURE Evaluation a offert son assistance au niveau national dans le développement d'une approche Une Seule Santé pour la SFE adaptée au contexte du Burkina Faso. Pour tester cette approche, la région Centre-Sud a été choisie comme zone d'intervention. Cette région comprend trois provinces : Zoundwéogo, Nahouri et Bazèga. Nahouri, dont la capitale est Po, a été choisie pour le test pilote des activités SFE recourant à l'approche Une Seule Santé.
Strengthening Health Information Systems in Nigeria—Building an OVC Information System MEASURE Evaluation 2019 English NIGERIA Nigeria, HIS, HISS, HIS strengthening, Health Systems Strengthening, Health data MEASURE Evaluation, which is funded by the United States Agency for International Development, has been working in Nigeria since 2005 to improve the availability of high-quality data to support decision making at all levels of the health system. This work fulfilled two main objectives:  1) Support the Department of Health Planning, Research and Statistics of Nigeria’s Federal Ministry of Health to develop a master facility list to improve data quality and ultimately lead to better coordination of health services 2) Work with the Federal Ministry of Women’s Affairs and Social Development to develop a directory of orphans and vulnerable children (OVC) service providers and build capacity to use OVC data collection tools for the National OVC Management Information System (NOMIS) We have mapped the HIS strengthening interventions to support each objective in two separate fact sheets. Each fact sheet superimposes on the HISSM depictions of MEASURE Evaluation’s activities in the enabling environment and information generation areas to support HIS performance in meeting the specific objective. By displaying key interventions across the HISSM, we see their strategic interaction, and how this combination of interventions works together to strengthen data quality and data use at all levels of the health system. This fact sheet documents MEASURE Evaluation's work to support development of a directory of orphans and vulnerable children (OVC) service providers and capacity building to use OVC data collection tools for the National OVC Management Information System (NOMIS). Follow the link to view the related document Strengthening Health Information Systems in Nigeria—Developing a Master Facility List
La surveillance à base communautaire des maladies et zoonoses prioritaires au Sénégal: Proposition d’un modèle dans une approche “Une Seule Santé” 2019 French Africa, SENEGAL Global health security, Surveillance, GHSA, Senegal, One Health, Community, Africa, Community-Based Surveillance, Global Health Security Agenda Une activité de l’Agenda de Sécurité Sanitaire Mondiale (ASSM) visant à la surveillance à base communautaire (SBC) des zoonoses, dans le cadre de l’approche « Une Seule Santé », a été lancée au Sénégal et mise en oeuvre de septembre 2017 à juin 2019 avec l’appui de l’Agence des États-Unis pour le Développement International (USAID). Cette activité faisait partie de la phase IV du projet MEASURE Evaluation, soutenu par l’USAID, dans le cadre du paquet d’action 2 de l’ASSM. Cette activité concernait particulièrement la SBC des maladies prioritaires au Sénégal, dont huit maladies infectieuses humaines et six zoonoses. Il s’agit de la mise en oeuvre de la SBC dans quatre districts pilotes (Tambacounda, Koumpentoum, Podor et Pété), situés dans deux régions du Sénégal. La mise en oeuvre de la phase pilote de la SBC s’est accomplie à travers la formation des agents communautaires à la détection de ces maladies dès qu’elles surviennent dans leur communauté respective et envoyer des messages texte (SMS) au poste de santé ou vétérinaire le plus proche. L’objectif de cette activité était d’obtenir une détection et une intervention précoce afin de limiter la transmission à large échelle des maladies concernées. L’expérience acquise au cours de cette phase pilote nous permet de faire des recommandations en vue d’élaborer un modèle de surveillance à base communautaire suivant l’approche « Une Seule Santé » pour le Sénégal et éventuellement pour d’autres pays.
Monitoring the Outcomes of Orphans and Vulnerable Children Programs in Kenya: Findings from 2016–2018 Panel Data: Walter Reed Program/Henry M. Jackson Foundation Medical Research International Irit Sinai, Clement O. Odour, Dennis Akeyo, Cheikh M. Faye, Damazo T. Kadengye, Nelson Langat 2019 English KENYA OVC programs, Indicators, OVC, Orphans and vulnerable children, Monitoring, PEPFAR This report presents findings from a panel study of beneficiary households receiving services from the Walter Reed Program/Henry M. Jackson Foundation Medical Research International (WRP/HJFMRI) project. WRP/HJFMRI is a United States President’s Emergency Plan for AIDS Relief (PEPFAR) project funded through the United States Department of Defense. The WRP/HJFMRI orphans and vulnerable children (OVC) program began in 2004 and operates in Bomet, Kericho, and Narok Counties in the Rift Valley region of Kenya. Key OVC program areas and intervention components of the project are education support, household economic strengthening, healthcare and nutrition, shelter, psychosocial care and support, and child protection services. This study was undertaken by MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID) and PEPFAR—at the request of PEPFAR and the USAID Kenya mission. This 2016–2018 panel study was designed to meet PEPFAR’s monitoring, evaluation, and reporting requirements, which include standard indicators. PEPFAR encourages the collection of data on these indicators every two years. The panel study compared results from Round 1 (2016) and Round 2 (2018, with the same households). It measured changes in the well-being of OVC beneficiaries over the two years using nine essential survey indicators required by PEPFAR and two supplemental indicators. Find other materials from Round 2 are here. Materials related to Round 1 can be found here.
Monitoring the Outcomes of Orphans and Vulnerable Children Programs in Kenya: Findings from a 2018 Survey of Recently Enrolled Beneficiaries: MWENDO Project Irit Sinai, Clement O. Odour, Dennis Akeyo, Cheikh M. Faye, Damazo T. Kadengye, Nelson Langat 2019 English KENYA PEPFAR, Monitoring, OVC programs, Indicators, OVC, Orphans and vulnerable children This report presents findings from a cross-sectional study of beneficiary households receiving services from Making Well-Informed Efforts to Nurture Disadvantaged Orphans & Vulnerable Children (MWENDO) in western Kenya, in areas not served by the AIDS, Population and Health Integrated Assistance Plus Program, Western Kenya, known as APHIAplus, in 2016. MWENDO is a five-year project funded by the United States Agency for International Development (USAID) and implemented by Catholic Relief Services that provides an umbrella of services to orphans and vulnerable children (OVC). Beneficiaries included in this study started receiving services from MWENDO in the past two years, and were not among the households that participated in a similar survey Round 1 conducted in 2016. This study was undertaken by MEASURE Evaluation—a project funded by USAID and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—at the request of PEPFAR and the USAID Kenya mission. This 2018 cross-sectional study was designed to meet PEPFAR’s reporting requirements, which involves the collection of data for nine PEPFAR monitoring, evaluation and reporting OVC essential survey indicators. Two additional indicators were included. This was a cross-sectional study of 99 beneficiary households, randomly selected from a list of beneficiary households in the study areas. Although the survey was not designed to assess the effectiveness of the MWENDO OVC project, it is useful for identifying potential needs and program gaps. It complements a panel study of MWENDO OVC beneficiaries, available here. Find other materials from Round 2 are here. Materials related to Round 1 can be found here.
Monitoring the Outcomes of Orphans and Vulnerable Children Programs in Kenya: Findings from 2016–2018 Panel Data: Timiza 90 Irit Sinai, Clement O. Odour, Dennis Akeyo, Cheikh M. Faye, Damazo T. Kadengye, Nelson Langat 2019 English KENYA OVC programs, Orphans and Vulnerable Children, PEPFAR, Indicators, Monitoring, OVC This report presents findings from a panel study of beneficiary households receiving services from the Timiza 90 project in Western Kenya. Timiza 90 is a United States President’s Emergency Plan for AIDS Relief (PEPFAR) project funded through the United States Centers for Disease Control and Prevention and is implemented by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) Kenya. Project activities are being implemented in Kisumu, Siaya, and Homa Bay Counties in Western Kenya through five local implementing partners. This study was undertaken by MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID) and PEPFAR—at the request of PEPFAR and the USAID Kenya mission. This 2018–2018 panel study was designed to meet PEPFAR’s monitoring, evaluation, and reporting requirements, which include standard indicators. PEPFAR encourages the collection of data on these indicators every two years. This panel study compared results from Round 1 (2016) and Round 2 (2018, with the same households). It measured changes in the well-being of OVC beneficiaries over the two years using nine essential survey indicators required by PEPFAR and two supplemental indicators. Find other materials from Round 2 are here. Materials related to Round 1 can be found here.
Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Kenya: Comparison of 2016 and 2018 Findings from the Panel Study of the Walter Reed Program/Henry Jackson Foundation Medical Research International Project MEASURE Evaluation 2019 English KENYA Orphans and vulnerable children, Monitoring, PEPFAR, Indicators, OVC, OVC programs This panel study was designed to assess changes in outcomes of programs for orphans and vulnerable children (OVC), using the standardized essential survey indicators launched by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) in 2014, as part of its monitoring, evaluation, and reporting guidance. MEASURE Evaluation, funded by the United States Agency for International Development and PEPFAR, collected data from beneficiaries of the Walter Reed Program/Henry M. Jackson Foundation Medical Research International (WRP/HJFMRI) project. In Round 1 of this panel study, conducted in late 2016, 353 caregivers of OVC beneficiaries enrolled in WRP/HJFMRI OVC programs were interviewed. Of that group, 329 (93.2%) were interviewed again in Round 2, conducted in 2018. The caregivers were asked about themselves, their households, and all children under age 18 who were under their care (1,136 children in Round 1, and 1,026 in Round 2). Find other materials from Round 2 are here. Materials related to Round 1 can be found here.
Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Kenya: Comparison of 2016 and 2018 Findings from the Timiza 90 Panel Study MEASURE Evaluation 2019 English KENYA PEPFAR, Monitoring, OVC programs, Indicators, OVC, Orphans and vulnerable children This panel study was designed to assess changes in outcomes of programs for orphans and vulnerable children (OVC), using the standardized essential survey indicators launched by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) in 2014, as part of its monitoring, evaluation, and reporting guidance. MEASURE Evaluation, funded by the United States Agency for International Development and PEPFAR, collected data from beneficiaries of the Timiza 90 OVC programs in western Kenya. In Round 1 of this panel study, conducted in late 2016, 209 caregivers of OVC beneficiaries enrolled in Timiza 90 were interviewed. Of that group, 184 (88%) were interviewed again in Round 2, conducted in 2018. The caregivers were asked about themselves, their households, and all children under age 18 who were under their care (718 children in Round 1 and 654 in Round 2). Find other materials from Round 2 are here. Materials related to Round 1 can be found here.
Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Kenya: Comparison of 2016 and 2018 Findings from the MWENDO Cross-Sectional Study MEASURE Evaluation 2019 English KENYA Orphans and Vulnerable Children, PEPFAR, Indicators, Monitoring, OVC This cross-sectional survey was designed to assess the current status of programs for orphans and vulnerable children (OVC), using the standardized essential survey indicators (ESI) launched by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) in2014, as part of its monitoring, evaluation, and reporting guidance. PEPFAR requires ESI data to be collected every two years. MEASURE Evaluation, funded by the United States Agency for International Development (USAID) and PEPFAR, collected data from beneficiaries of the USAID-funded APHIAplus and Mwendo projects, in western Kenya. In the first round, conducted in 2016, 426 caregivers of OVC beneficiaries enrolled in APHIAplus Western Kenya were selected for interview from all households served by the project in the region, using a cluster sampling design. The 2018 survey was done independently of the previous survey. It consisted of interviews with 99 caregivers randomly selected from households that were not part of the 2016 survey and were served by three local implementing partners working with the Mwendo project. In both rounds, caregivers were asked about themselves, their households, and all children under age 18 years who were under their care (1,438 children in 2016 and 386 in 2018). Find other materials from Round 2 are here. Materials related to Round 1 can be found here.
Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Kenya: Comparison of 2016 and 2018 Findings from the MWENDO Panel Study MEASURE Evaluation 2019 English KENYA OVC, Orphans and Vulnerable Children, Indicators, OVC programs, PEPFAR, Monitoring This panel study was designed to assess changes in outcomes of programs for orphans and vulnerable children (OVC), using the standardized essential survey indicators launched by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) in 2014, as part of its monitoring, evaluation, and reporting guidance. MEASURE Evaluation, funded by the United States Agency for International Development (USAID) and PEPFAR, collected data from beneficiaries of the USAID-funded APHIAplus and MWENDO projects, in western Kenya. In Round 1 of this panel study, conducted in 2016, 426 caregivers of OVC beneficiaries enrolled in APHIAplus Western Kenya were interviewed. Of that group, 377 (88.5%) whose enrollment had since shifted from APHIAplus to MWENDO were interviewedagain for Round 2, conducted in 2018. The caregivers were asked about themselves, their households, and all children under age 18 who were under their care (1,438 in Round 1 and 1,348 in Round 2). Find other materials from Round 2 are here. Materials related to Round 1 can be found here.
Male Case-Finding Assessment in Namibia: Final Report Mswia, R., Reynolds, Z., & Watson-Grant, S. 2019 English HIV/AIDS, HIV, Men, ART, HIV prevention, Testing, Namibia The 2017 Namibia Population-Based HIV Impact Assessment (NAMPHIA) report and other country reports have indicated that men 20 to 39 years of age have the lowest coverage of antiretroviral therapy in the country. The objective of this study, conducted by MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—was to explore the factors affecting barriers to and facilitators of HIV testing and prevention services among young men in Namibia. In keeping with the USAID and PEPFAR goals of controlling the epidemic, the study aimed to determine the right places, the right times, and the right ways to engage young men in these services, and to make recommendations on improving this engagement based on the primary data collected. 
Role of Male Sex Partners in HIV Risk of Adolescent Girls and Young Women in Mozambique Jenifer Chapman, Nena do Nascimento, and Mahua Mandal 2019 English HIV, AGYW, Sexual Behavior, Young Women, Adolescent Girls, HIV prevention Adolescent girls and young women (AGYW) ages 15–24 years are disproportionately affected by HIV/AIDS, particularly in East and Southern Africa. One strategy to reduce HIV among AGYW, proposed through the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) Initiative, is to prevent and manage HIV among their male sexual partners. To implement this strategy and reach men, programs need information about AGYW's potential sexual partners at the local level. To support DREAMS programming in Mozambique, we undertook a study to characterize this population of men in 3 districts with ongoing DREAMS programming. In mid-2017 we conducted 15 focus group discussions with AGYW (N=102) and a venue-based intercept survey of men (N=1,140). Male sexual partners of AGYW who took the survey were diverse in age, education level, and socioeconomic status. Older AGYW focus group participants sought partners who could provide for them financially. Multiple sexual partnerships and inconsistent condom use were widely reported, with AGYW emphasizing that gender norms disempowered them from negotiating condom use. Reported condom use varied by AGYW and male-partner demographic characteristics, as well as by their relationship type. Condom use rates were much higher than national and regional estimates. AGYW who were less educated/not-in-school, were pregnant, or single mothers were particularly disempowered in sexual relationships. Less educated men were less likely to use condoms than educated men, and condom use was least likely in marriage. Study findings underscore the importance of reaching the diversity of male sexual partners of AGYW with HIV services as part of a strategy to reduce HIV risk among AGYW. They also support an enhanced focus on female-controlled HIV prevention methods that do not require negotiation with a male partner and special efforts to reach out-of-school/less educated AGYW, as well as pregnant AGYW and single mothers.
Assessment of Drivers of HIV Outcomes Zulfiya Charyeva, Allison Davis, Lauren Morris, Nena do Nascimento, Jenifer Chapman, Daan Velthausz, Rotafina Donco 2019 English MOZAMBIQUE OVC programs, OVC, ART, MIS, PEPFAR In Mozambique, more than a million children are HIV-positive or otherwise vulnerable because of HIV. In response to this crisis, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) funds programs that serve orphans and vulnerable children (OVC) affected by HIV. These programs employ caseworkers who provide services to OVC and their families to their reduce vulnerability to HIV—such as by linking OVC to HIV testing services and HIV-positive children and adults to HIV care. PEPFAR seeks to understand how the operationalization of case management can be improved to increase knowledge of HIV status and encourage retention on antiretroviral therapy. The COVida program was the context of this study. COVida supports roughly 300,000 OVC and caregivers per year to access high-quality comprehensive services nationally. The purpose of this study was to learn more about the features of the COVida case management system and to make recommendations for improving the effectiveness and efficiency of case management in improving beneficiary outcomes. The study also estimated costs of conducting case work and identified the cost drivers of case management. It produced evidence-informed, actionable recommendations to programs in Mozambique on how to shift their strategies, and ultimately, their resources, to optimally balance quality and cost.
Rwanda’s Improved Services for Vulnerable Populations Project: Impact Evaluation. End Line Report Fehringer, J., Lance, P., Ndirangu, K., Benson, A., Angeles, G., Parker, L., Foley, S., Gobin, S., Varela, V.C., Morris, L., Cannon, A., Iskarpatyoti, B. 2019 English Africa, RWANDA Evaluation, Data, Vulnerable populations, Rwanda MEASURE Evaluation, funded by the United States Agency for International Development, conducted a cluster-randomized impact evaluation of the “Improved Services for Vulnerable Populations” (ISVP) project, led by Global Communities in Rwanda. There were three treatment groups: Household economic strengthening (HES-only) group, which provides a core platform of financial interventions Full ISVP group, which supplements the core platform of HES interventions with health, education, and skills-building services Control group, receiving no ISVP interventions The evaluation covered 12 districts. Initial data collection took place in mid-2017 and end line data collection in late 2018/early 2019. Methods were quantitative surveys at both time points of the same households and key informant interviews at end line with 36 community leaders and eight program staff. Final household survey sample sizes were 1,374 for full ISVP, 1,270 for HES-only, and 1,169 for control. We estimated program impact using difference-in-differences estimation and conducted qualitative thematic analysis. Results showed that, despite contamination and data collection timing limitations, the program was still able to effect significant change in health and economic strengthening. Each program group saw positive impact for seven outcomes and negative impact for one; the full ISVP also trended positive for an eighth outcome. If initial data collection had taken place prior to program start, the full ISVP likely would have shown impact on at least two other outcomes, outperforming HES-only. Access a related summary report.
An Assessment of the Actionable Drivers of HIV Outcomes: A Study of the COVida Case Management System in Three Provinces in Mozambique MEASURE Evaluation 2019 English OVC, HIV, Mozambique, Orphans and Vulnerable Children, HIV care, PEPFAR In Mozambique, more than a million children are HIV-positive or otherwise vulnerable because of the virus. In response to this crisis, the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) fund programs that serve orphans and vulnerable children (OVC) affected by HIV. These programs employ case workers who provide services to OVC and their families to reduce their vulnerability to HIV, such as linking OVC to HIV testing services and HIV-positive children and adults to HIV care. PEPFAR seeks to understand how case management can be improved to increase knowledge of HIV status and encourage retention on antiretroviral therapy. COVida is a USAID-funded OVC program in Mozambique that supports roughly 300,000 OVC and caregivers per year to access high-quality comprehensive services nationally. The USAID- and PEPFAR-funded MEASURE Evaluation project conducted a study of COVida in 2019 to learn more about the features of the program’s case management system, with a view to making recommendations on how to improve the system’s effectiveness and efficiency and—ultimately—beneficiary outcomes. The study also estimated the costs of conducting casework and identified the cost drivers of case management. It produced evidence-informed, actionable recommendations for programs in Mozambique on how to shift their program implementation strategies and, ultimately, their resources to optimally balance quality and cost. This brief shares more.
Evaluating Programs for Prevention of Mother-to-Child Transmission of HIV Using Process Tracing: Guide and Sample Protocol Bobrow, E. A., Munson, A.J., & Davis, H. B. 2019 English HIV, HIV prevention, Transmission, PMTCT This guide offers the following resources: Information and references on previous evaluations of the Partnership for HIV-Free Survival (PHFS) conducted by MEASURE Evaluation Background information on our concept and rationale for using the process tracing method to evaluate the PHFS approach Information about the process tracing method as we understand it to be applied to public health evaluations A sample protocol that can be adapted to evaluate prevention of mother-to-child transmission (PMTCT) of HIV programs in other countries using process tracing, including specific language from our protocol on evaluating PHFS using process tracing Natural audiences for this guide are evaluators or researchers interested in the innovative method of process tracing in public health evaluations, in partnership with other stakeholders, such as government and nongovernmental implementers of PMTCT programs. We highly recommend that investigators develop protocols in a participatory manner, involving partners at the local, national, and international levels, and in conjunction with donors. It is essential to have input from key stakeholders, and to follow their guidance, particularly in designing procedures to inform and contact study participants in a culturally appropriate way. Careful planning and participation will help facilitate use of the generated evidence to improve programs and policies.
Helpful Hints: Expedited Data Quality Assessment MEASURE Evaluation 2019 English Data quality assessment, Assessment, Data quality, Data An expedited data quality assessment (EDQA) is a novel method of organizing patient records and cleaning data found in patient files and health facility registers. Its advantages are that it can be done in five to six weeks rather than several months, and can serve as an intervention by allowing for correction of the data when source documents are found to be incomplete or inconsistent. This new method has been used when stakeholders (researchers, implementing partners, etc.) need to clean patient files and to use these files to determine what patients may have been lost to follow-up for completing HIV treatment and care. EDQA is similar to standard data quality assessments (DQAs) but is more rapid and intense. An EDQA is conducted in two stages: a pilot or “mini” DQA in selected health facilities to diagnose data quality issues, followed by a data-cleaning intervention to address those issues. An EDQA also assesses the quality of select indicators and diagnoses data reporting challenges. During an EDQA, facility registers are compared to source documents, such as patient files, electronic medical records, and laboratory records. Results from an EDQA can be used to inform strategies for decreasing patient loss to follow-up (LTFU), for improving site-level data quality, and for strengthening data management practices, such as supportive supervision and routine data quality. To decrease LTFU, an EDQA can identify patients who should be contacted through community outreach to encourage them to return for treatment. So far, EDQA has been applied in several countries to an HIV indicator (TX_CURR) that shows the number of adults and children currently receiving antiretroviral therapy. It could be adapted and applied to other HIV indicators, such as continuity of care, prevention of mother-to-child transmission, or similar indicators requiring data from multiple sources. To help implementers know what to expect in an EDQA and to offer help on selecting sites for investigation, this brief shares recommendations.
Helpful Hints: PLACE MEASURE Evaluation 2019 English HIV/AIDS, Geospatial analysis, PLACE, HIV prevention, HIV The Priorities for Local AIDS Control Efforts (PLACE) method is a rapid assessment tool to improve HIV prevention and treatment coverage in areas where HIV transmission is most likely to occur. It was developed for local HIV program managers in resource-poor settings who want to know where to target resources to prevent new infections. The focus of the PLACE method is to identify gaps in current programs and assess whether people most likely to acquire and transmit HIV have been reached with appropriate prevention and treatment services. The PLACE protocol has five steps: To identify high-transmission areas in a given geographic location To identify sites in high-transmission areas where people meet new sexual partners To visit, map, and characterize sites in each area To describe the characteristics of people socializing at these sites To use findings to inform interventions and resource allocation This brief shares recommendations to consider when planning and carrying out a PLACE assessment. Access additional PLACE resources at https://www.measureevaluation.org/resources/tools/hiv-aids/place.
Helpful Hints: Routine Data Quality Assessment MEASURE Evaluation 2019 English RDQA, Routine data, Data quality assessment, Data Quality, Assessment The routine data quality assessment (RDQA) tool has two components: The systems assessment is a qualitative approach to examining the overall structure and functions of a data management and reporting system. The data verification process gauges the timeliness, completeness, and accuracy of data that are collected and reported in the system. The tool’s user manual can be found here: https://www.measureevaluation.org/resources/publications/ms-17-117. This brief shares practical tips on using the tool, based on MEASURE Evaluation’s application of RDQA since 2007 in scores of countries. These hints chiefly apply to the data verification component of the tool.
Best Practices for Gender in the Monitoring and Evaluation of HIV Programs MEASURE Evaluation 2019 English M&E, AGYW, Monitoring, Evaluation, Gender, HIV, HIV prevention Gender is a critical component of efforts to control the HIV epidemic. Gender influences who is vulnerable to HIV and able to seek and access care and treatment, as well as norms around HIV prevention, treatment, and stigma. To reach epidemic control effectively, gender must be considered in HIV programs and policies, and thus in monitoring and evaluation (M&E). MEASURE Evaluation, which is funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief (PEPFAR), created this brief to share best practices in gender M&E for HIV programming. We recommend including gender at every step of monitoring and evaluating the clinical cascade; using qualitative and quantitative gender data to inform and adapt HIV programming; paying special attention to priority populations; and keeping gender-based violence and structural considerations in the forefront of planning and interpretation to ensure advancement toward HIV epidemic control. This brief shares more.
The Importance of Gender in HIV Health Information Systems MEASURE Evaluation 2019 English Gender, Health Information Systems, HIV, HIS, Gender Norms Addressing gender while strengthening HIV health information systems (HIS) ensures equity in access and benefits for women, men, girls, boys, and transgender people. This brief establishes the importance of addressing gender in HIS activities and suggests a series of action points that will promote the integration of gender in HIV HIS and ultimately improve HIV outcomes. Access more briefs in this series.
Using DHIS2 Software to Track Prevention of Mother-to-Child Transmission of HIV: User Manual for the DHIS2 PMTCT Tracker Scott, F., Schmale, A., Moonzwe Davis, L., Johnson, S., & de la Torre, C. 2019 English Antenatal Care, PMTCT, Transmission, Maternal health, HIV prevention, HIV, Postnatal care, DHIS 2 This manual is intended for users of MEASURE Evaluation’s DHIS2 Tracker for Prevention of Mother-to-Child Transmission of HIV (PMTCT) (hereafter called the PMTCT Tracker). Before using this manual, the PMTCT Tracker must be installed. A download link for the sample PMTCT tracker can be found at https://www.measureevaluation.org/resources/pmtct-tracker/ This manual is intended as a reference document for staff using the PMTCT Tracker for data capture, supervision, and reporting. It is also intended to be a training resource for staff who train others on how to use the PMTCT Tracker. Basing the training around the User Manual will ensure that trainees become very familiar with it, making it more likely that the manual is used as a reference after they have returned to their own clinic or facility. Although it is important for a PMTCT Tracker user to work through and become familiar with the entire User Manual during the initial training, the User Manual has also been designed as a “how to” guide for quick reference after training participants become active users of the system. Each “how to” section provides self-contained, step-by-step guidance on carrying out a specific task. This is particularly important in cases in which a user may not be accessing the PMTCT Tracker on a regular basis and thus may need to be refreshed on how to carry out a given task. Section 2 of the User Manual provides background on the PMTCT Tracker and introduces key concepts. Section 3 provides guidance on how to access and navigate the PMTCT Tracker, and Section 4 introduces key aspects of the data capture and audit function. Sections 5 and 6 guide the user through the steps for capturing and reviewing data about the PMTCT care for the mother and child. Section 7 guides the user through the steps for tracking and following up on PMTCT patients, and Section 8 explains how to view the PMTCT dashboards. Although this User Manual is designed for the sample PMTCT Tracker it has been made available as a Word document, as well as a PDF file, so that it can be adapted and tailored for use with specific local implementations of the PMTCT Tracker. The manual is also available for download in Word.  Additional guidance on how to establish a PMTCT tracker in a given country is available in MEASURE Evaluation’s Using DHIS2 Software to Track Prevention of Mother-to-Child Transmission of HIV: Guidance (Version 2) at https://www.measureevaluation.org/resources/publications/ms-18-127 Access the PMTCT tracker resources at https://www.measureevaluation.org/resources/pmtct-tracker/
Priorities for Local AIDS Control Efforts (PLACE) Tool Kit MEASURE Evaluation 2019 English Spatial Analysis, HIV, PLACE, Mapping, Toolkit, HIV/AIDS, HIV prevention The Priorities for Local AIDS Control Efforts (PLACE) method aims to improve our understanding of the drivers of local HIV epidemics, identify gaps in services available to those most likely to acquire and transmit HIV, and provide evidence to support tailored interventions to reduce transmission. Achieving this goal is a challenge because many people don’t know they have the virus, making the local pattern of new infections almost impossible to detect. PLACE was developed by MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—to meet that challenge. The first implementation manual was published in 2005. Since then, the scope of the PLACE method has been broadened. This 2019 update—expanding PLACE from a single manual to a suite of five guidance documents, templates, training slide decks, and other tools—can be used to guide PLACE studies in response to new opportunities. The PLACE Tool Kit incorporates best practices for using new tools in testing for HIV and sexually transmitted infections; new capabilities for geospatial analysis and electronic data collection; and an increased urgency to find people who are unaware that they are HIV-positive and get them on treatment—particularly to find key populations and other vulnerable people who may be at increased risk of transmitting the virus to others if they are not successfully engaged in treatment.    The full collection is also available online at https://www.measureevaluation.org/resources/tools/hiv-aids/place. The related PLACE mapping tool is downloadable at https://www.measureevaluation.org/resources/publications/tl-19-39.
Sexual Orientation and Gender Identity Measures for Global Survey Research: A Primer for Improving Data Quality Glick, J. L. & Andrinopoulos, K. 2019 English Gender, SOGI, Men who have sex with men, Data collection, HIV, Sexual Orientation, Gender Identity, Data, Transgender, MSM Without existing standards for asking questions, data collectors or interviewers may rely on their own perceptions of clients to categorize people as members of a sexual and gender minority (SGM) population. This practice can lower the validity (truthfulness) of data. When self-report of sexual orientation or gender identity is elicited, using categories and terminology that align with the client’s or research participant’s perspective is critical. It is important to understand categories from the “lens,” or perspective, of sexual and gender minorities in each context, rather than universally applying a fixed global set of questions and responses. The purpose of this report is to provide recommendations on how to develop closed-ended survey questions to measure sexual orientation and gender identity (SOGI) that are context specific, while, to the degree possible, also fulfilling global data reporting needs for HIV key populations. The report is written for all actors involved in the design of data-creation activities, including for surveillance, monitoring, evaluation, and broader research purposes. It begins with an overview of the current state of SOGI measurement in HIV programs. Next, it describes an inductive process for generating SOGI questions. The first step is to ensure a good understanding of SOGI concepts and review context-specific literature related to gender and sexuality. The second step is to review existing survey questions and assess their utility for the particular context and HIV-related issue under study. In some cases, a third step of conducting qualitative research may be warranted. The fourth and final step is to assess the potential questions through piloting and cognitive interviewing. The report provides instruction on each recommended step, and guidance on where to access additional information when necessary.
Evaluation of the Effects of HIV-Specific Investments in the Performance of the Health Information System in Côte d’Ivoire: Summary of Results Silvestre, E. and Davis, H. 2019 English HIV, HIS, HIS strengthening, Health Information Systems, Cote d'Ivoire, Evaluation MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—has supported the Government of Côte d’Ivoire to strengthen its health management information system and HIV monitoring and evaluation (M&E) systems since 2004. Working closely with the Ministry of Health and Public Hygiene (Ministère de la Santé et de l’Hygiène Publique [MSHP]), MEASURE Evaluation has performed a leadership role in strategic planning and overall management of the health information systems (HIS). Under MEASURE Evaluation’s Learning Agenda activities, the project conducted an evaluation of HIS investments in Côte d’Ivoire. The evaluation was designed to demonstrate how HIS strengthening investments affect HIS performance, health system outcomes, and public health outcomes. It assessed the broader effects of HIV-specific HIS investments in the overall improvement of the larger health system and how they can improve HIV outcomes. This report shares more.
Integrating Early Childhood Development and Health in Eswatini, Lesotho, and Zimbabwe: A Scale-Up Assessment Cannon, A., Charyeva, Z., Millar, E., Gobin, S., & Morris, L. 2019 English Orphans and Vulnerable Children, HIV/AIDS, OVC, HIV prevention, HIV, PMTCT, Child health, PEPFAR, Children USAID and PEPFAR funded the Orphans and Vulnerable Children Special Initiative, a special initiative for children under five years old affected by the epidemic. It was carried out in Eswatini (formerly Swaziland), Lesotho, and Zimbabwe and integrates early childhood development (ECD) with pediatric HIV treatment or prevention of mother-to-child transmission (PMTCT) of HIV. To prepare for potential scale-up, the United States Agency for International Development (USAID) asked MEASURE Evaluation to assess the scalability of the ECD-integrated intervention in each country. The scale-up assessment had the following objectives: 1.  Describe the intervention package and key beneficiaries and stakeholders. 2.  Assess the interest and readiness of key stakeholders to scale up OVC integrated interventions. 3.  Identify opportunities for and constraints to successful scale-up of OVC integrated interventions. 4.  Develop recommendations for scale-up of OVC integrated interventions. Integrating Early Childhood Development and Health in Eswatini, Lesotho, and Zimbabwe: A Scale-Up Assessment  provides the results from MEASURE Evaluation scale-up assessments of the integrated interventions in Eswatini, Lesotho, and Zimbabwe; suggestions and recommendations related to scaling up these interventions in each country; and our lessons learned from working on these assessments. Whether to scale up an intervention is a decision to be made by local governments and donors in each country, based on factors such as intervention impact, cost, complexity, relevance to the country needs and priorities, ease of implementation, availability of funds, and others. This report aims to help stakeholders in each country design and implement the intervention at scale.
Virtual PLACE Worksheet 2: Stakeholder Consultation Decisions MEASURE Evaluation 2019 English This worksheet is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
PLACE Worksheet 1: National Steering Committee and Stakeholder Engagement MEASURE Evaluation 2019 English Geospatial analysis, PLACE, AIDS, HIV/AIDS, HIV prevention, Key Populations, HIV This worksheet is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
Virtual PLACE (Priorities for Local AIDS Control Efforts): Interviewer Confidentiality Pledge MEASURE Evaluation 2019 English Geospatial analysis, PLACE, AIDS, HIV/AIDS, HIV prevention, Key Populations, HIV This interviewer confidentiality pledge is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
Virtual PLACE Form C: Interview with a User of the Internet, Social Media, and Telephone to Meet Sexual Partners MEASURE Evaluation 2019 English HIV/AIDS, HIV, HIV prevention, Geospatial analysis, AIDS, Key Populations, PLACE This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
Virtual PLACE Form B: Visit to a Virtual Site or Phone Number MEASURE Evaluation 2019 English PLACE, AIDS, HIV, HIV/AIDS, Geospatial analysis, HIV prevention, Key Populations This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
Virtual PLACE Form A: Interview with Community Informants MEASURE Evaluation 2019 English HIV/AIDS, HIV, HIV prevention, Geospatial analysis, AIDS, Key Populations, PLACE This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
Virtual Priorities for Local AIDS Control Efforts (PLACE): Protocol for a Study of Social Media Sites MEASURE Evaluation 2019 English PLACE, AIDS, HIV, HIV/AIDS, Geospatial analysis, HIV prevention, Key Populations This manual describes how to use the Priorities for Local AIDS Control Efforts (PLACE) method for studies involving Internet sites, social media applications, and cellphones. The manual is also available in Word.  Access the full PLACE Tool Kit at https://www.measureevaluation.org/place. 
Virtual PLACE Form C Fact Sheet for Informed Consent to Participate in an Interview about Internet, Social Media, and Telephone Use MEASURE Evaluation 2019 English Geospatial analysis, PLACE, AIDS, HIV/AIDS, HIV prevention, Key Populations, HIV This fact sheet is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
Virtual PLACE Form A Fact Sheet for Informed Consent by a Community Informant MEASURE Evaluation 2019 English Geospatial analysis, PLACE, AIDS, HIV/AIDS, HIV prevention, Key Populations, HIV This fact sheet is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
PLACE Form 3-5: Dried Blood Spot Tracking Form MEASURE Evaluation 2019 English Geospatial analysis, PLACE, AIDS, HIV/AIDS, HIV prevention, Key Populations, HIV This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
PLACE Form 3-4: Tester Venue Summary Form for Patron/Worker Interviews MEASURE Evaluation 2019 English PLACE, AIDS, HIV, HIV/AIDS, Geospatial analysis, HIV prevention, Key Populations This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
PLACE Form 3-3: Interviewer Outcome Log for Form C Interviews MEASURE Evaluation 2019 English HIV, Geospatial analysis, HIV/AIDS, Key Populations, AIDS, PLACE, HIV prevention This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
PLACE Form 3-2: Supervisor Form C Summary Form for a Specific Venue MEASURE Evaluation 2019 English Key Populations, AIDS, Geospatial analysis, PLACE, HIV prevention, HIV, HIV/AIDS This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
PLACE Form 3-1: Supervisor District Summary Form for Form C MEASURE Evaluation 2019 English PLACE, AIDS, HIV, HIV/AIDS, Geospatial analysis, HIV prevention, Key Populations This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
PLACE Form 2-1: Supervisor Summary Form for Interviews with Venue Informants MEASURE Evaluation 2019 English HIV, Geospatial analysis, HIV/AIDS, Key Populations, AIDS, PLACE, HIV prevention This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
PLACE Form 1-2: Supervisor Summary Form for Community Informant Interviews MEASURE Evaluation 2019 English PLACE, AIDS, HIV, HIV/AIDS, Geospatial analysis, HIV prevention, Key Populations This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
PLACE Form 1-1: Interviewer Tally Sheet for Community Informant Interviews MEASURE Evaluation 2019 English HIV, Geospatial analysis, HIV/AIDS, Key Populations, AIDS, PLACE, HIV prevention This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
PLACE Template for a List of Priority Prevention Areas MEASURE Evaluation 2019 English PLACE, AIDS, HIV, HIV/AIDS, Geospatial analysis, HIV prevention, Key Populations This template is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
Priorities for Local AIDS Control Efforts (PLACE): Quality Checklist for Form C MEASURE Evaluation 2019 English HIV/AIDS, Key Populations, PLACE, AIDS, Geospatial analysis, HIV, HIV prevention This checklist is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
Priorities for Local AIDS Control Efforts (PLACE): Quality Checklist for Form B MEASURE Evaluation 2019 English Geospatial analysis, PLACE, AIDS, HIV/AIDS, HIV prevention, Key Populations, HIV This checklist is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
Priorities for Local AIDS Control Efforts (PLACE): Quality Checklist for Form A MEASURE Evaluation 2019 English HIV/AIDS, Key Populations, PLACE, AIDS, Geospatial analysis, HIV, HIV prevention This checklist is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
Priorities for Local AIDS Control Efforts (PLACE): Master Venue List MEASURE Evaluation 2019 English HIV/AIDS, Key Populations, PLACE, AIDS, Geospatial analysis, HIV, HIV prevention The Priorities for Local AIDS Control Efforts (PLACE) method employs a master list of each venue identified by community informants. This list becomes the sampling frame for selecting venues for Form B and Form C interviews. The Master Venue List is created from the template provided after all the community  informant interviews (Form A) are completed.  The full PLACE Tool Kit is available at https://www.measureevaluation.org/place. 
Template for a District Summary Spreadsheet for Use with the PLACE QGIS Mapping Tool  MEASURE Evaluation 2019 English HIV, Geospatial analysis, HIV/AIDS, Key Populations, GIS, AIDS, PLACE, HIV prevention MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief—has developed a free Priorities for Local AIDS Control Efforts (PLACE) QGIS Mapping Tool. As of July 2019, the tool offered base map information and data templates for 14 countries: Angola, Burundi, Côte d’Ivoire, the Democratic Republic of the Congo, Ghana, Haiti, Kenya, Malawi, Mozambique, Rwanda, South Africa, eSwatini, Tanzania, and Uganda. QGIS is a free and full-featured geographic information system (GIS). The mapping tool was designed to work specifically with the PLACE protocol (a sample is available here: https://www.measureevaluation.org/resources/tools/hiv-aids/place). The tool can be downloaded on the MEASURE Evaluation website at https://www.measureevaluation.org/resources/tools/hiv-aids/place/place-method/the-place-mapping-tool-a-plug-in-for-gis.
PLACE Readiness Assessment Tool MEASURE Evaluation 2019 English PLACE, AIDS, HIV, HIV/AIDS, Geospatial analysis, HIV prevention, Key Populations This readiness assessment tool is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
Priorities for Local AIDS Control Efforts (PLACE): Fieldwork Implementation Guide MEASURE Evaluation 2019 English PLACE, AIDS, HIV, HIV/AIDS, Geospatial analysis, HIV prevention, Key Populations This guide is one part of a bigger package: the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit. The tool kit is available on the website of MEASURE Evaluation (a project funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief), here: https://www.measureevaluation.org/place. The guide is also available is Word.
Priorities for Local AIDS Control Efforts (PLACE): Data Use Agreement MEASURE Evaluation 2019 English HIV/AIDS, HIV, HIV prevention, Geospatial analysis, AIDS, Key Populations, PLACE This data use agreement is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
Priorities for Local AIDS Control Efforts (PLACE) Results Report Template MEASURE Evaluation 2019 English Key Populations, PLACE, AIDS, HIV/AIDS, HIV, HIV prevention, Geospatial analysis These guidelines should help you write a preliminary Priorities for Local AIDS Control Efforts (PLACE) report and maintain some consistency in content and format. The resource is also available in Word.  The full Priorities for Local AIDS Control Efforts (PLACE) Tool Kit is available at https://www.measureevaluation.org/place. 
Priorities for Local AIDS Control Efforts (PLACE): Interviewer Confidentiality Pledge MEASURE Evaluation 2019 English Geospatial analysis, PLACE, AIDS, HIV/AIDS, HIV prevention, Key Populations, HIV This interviewer confidentiality pledge is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
PLACE Form C: Interview with a Patron or Worker MEASURE Evaluation 2019 English Geospatial analysis, PLACE, AIDS, HIV/AIDS, HIV prevention, Key Populations, HIV This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
PLACE Form B: Interview with a Venue Informant MEASURE Evaluation 2019 English PLACE, AIDS, HIV, HIV/AIDS, Geospatial analysis, HIV prevention, Key Populations This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
PLACE Form A: Interview Instructions MEASURE Evaluation 2019 English HIV/AIDS, Key Populations, PLACE, AIDS, Geospatial analysis, HIV, HIV prevention This form is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
Priorities for Local AIDS Control Efforts (PLACE): Sample Protocol MEASURE Evaluation 2019 English Geospatial analysis, PLACE, AIDS, HIV/AIDS, HIV prevention, Key Populations, HIV This Sample PLACE Protocol is a template that can be adapted to support studies using the PLACE method in a variety of contexts. The protocol assumes a typical application of the PLACE method. It has sections on study rationale, objectives, methods, and data analysis. This resource is available for download in Word. The full PLACE Tool Kit is available at https://www.measureevaluation.org/place.
Priorities for Local AIDS Control Efforts (PLACE): Protocol Decisions Manual MEASURE Evaluation 2019 English HIV/AIDS, Key Populations, PLACE, AIDS, Geospatial analysis, HIV, HIV prevention This “Protocol Decisions Manual” is a guide for adapting the PLACE Sample Protocol (available with the full PLACE tool kit at https://www.measureevaluation.org/resources/tools/hiv-aids/place) to your local context. It explains the decisions that must be made along the way: where to implement PLACE, the specific objectives, fieldwork considerations, sample size, ethics, mapping readiness, selection of key indicators, and methods for data analysis and use. It also provides tools and worksheets to document those protocol decisions.  This resource is also available in Word.
Priorities for Local AIDS Control Efforts (PLACE): Overview of the Tool Kit and the Method It Supports MEASURE Evaluation 2019 English Geospatial analysis, PLACE, AIDS, HIV/AIDS, HIV prevention, Key Populations, HIV This tool kit is a comprehensive resource for the design and implementation of the Priorities for Local AIDS Control Efforts (PLACE) method. MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—developed the method to increase local capacity to understand the drivers of local HIV epidemics, identify gaps in services among those most likely to acquire and transmit HIV, and provide evidence to support tailored interventions to reduce HIV transmission. The full PLACE collection is available at https://www.measureevaluation.org/place. MEASURE Evaluation published an implementation manual in 2005. Since then, the scope of the PLACE method has been broadened in response to new tools in testing for HIV and sexually transmitted infections, capabilities for geospatial analysis technologies, electronic data collection, and an increased urgency to find people who are HIV-positive—particularly key populations and other vulnerable people who may be at increased risk of transmitting the virus to others if not successfully engaged in treatment.    Thus, the time is right for a 2019 update of the 2005 PLACE manual and tool kit to guide today’s implementation according to best practices long established and new opportunities. Today’s manual takes PLACE’s contribution to HIV epidemic response even further. In addition to providing maps of places to reach people who are at risk of acquiring and transmitting HIV, the method provides data for estimating the size of those populations, for estimating HIV prevention and adherence to treatment, and for estimating standard biobehavioral surveillance indicators. The new PLACE manual offers guidance on linking to care participants in a PLACE study who test positive for HIV. The new manual also has an evidence-informed strategy for ethical implementation of the protocol, including a preliminary readiness assessment that gauges protocol safety and provides guidance on the conditions under which the study should not be implemented. The new tool kit includes a sample protocol that can be adapted for use in any setting, a description of important protocol decisions, and a detailed implementation guide.  This manual is also available in Word. 
Fact Sheet and Consent Form for Participation in the PLACE Study Patron/Worker Interview MEASURE Evaluation 2019 English Key Populations, PLACE, AIDS, HIV/AIDS, HIV, HIV prevention, Geospatial analysis This fact sheet and consent form for patron/worker interviews is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
Fact Sheet for Informed Consent by a Venue Informant MEASURE Evaluation 2019 English HIV/AIDS, HIV, HIV prevention, Geospatial analysis, AIDS, Key Populations, PLACE This fact sheet for informed consent by a venue informant is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place. It is also available in Word.
Fact Sheet for Informed Consent by a Community Informant MEASURE Evaluation 2019 English HIV/AIDS, Key Populations, PLACE, AIDS, Geospatial analysis, HIV, HIV prevention This fact sheet for informed consent by a community informant is intended to be used with the Priorities for Local AIDS Control Efforts (PLACE) Tool Kit, available at https://www.measureevaluation.org/place.  It is also available in Word.
Comprendre l’influence des investissements dans le système d’information sanitaire sure les résultats de l’action sanitaire en Côte d’Ivoire : Etude qualitative Silvestre, E., Davis, H., & Wood, F. 2019 French HIS, Information system, Health Information Systems, Cote d'Ivoire L'information sanitaire est une des six fonctions essentielles d'un système de santé avec la prestation de services, les ressources humaines pour la santé, les produits médicaux, vaccins et technologies, le financement, et le leadership et la gouvernance (Figure 1, source : Agence des États-Unis pour le développement international [USAID], 2015). Les investissements réalisés dans un de ces domaines exerceront un impact sur d'autres fonctions essentielles du système de santé et seront affectés par celles-ci. L'évaluation des effets à grande échelle des investissements dans les systèmes d'information sanitaire (SIS) spécifiques au VIH sur l'amélioration globale du système de santé au sens large peut expliquer en quoi ces investissements peuvent aboutir à de meilleurs résultats en matière de lutte contre le VIH. Des investissements importants ont été réalisés dans le SIS de la Côte d'Ivoire au cours des dix dernières années. En 2018, ces investissements ont été évalués pour mieux comprendre la manière dont ils affectaient le degré de performance du système, ses résultats et la santé publique. L'évaluation consistait en un examen documentaire aboutissant à un rapport de triangulation (MEASURE Evaluation, 2018) et une étude qualitative soutenue par les parties prenantes essentielles à l'échelle nationale et dont nous présentons les résultats ici.
Measuring the Quality of HIV/AIDS Client-Level Data Using Lot Quality Assurance Sampling (LQAS) Boone, D., Cloutier, S., & Lins, S. 2019 English Data, HIV/AIDS, Data collection, HIV, Data Quality, LQAS Tools and methods for assessing data quality have significantly advanced, in part by the need for good HIV/AIDS data to inform programs. Most of the existing tools, however, focus on aggregate data at subnational levels. Very few tools measure the quality of data at the primary source– individual client documents at health facilities and beneficiary documents for community-based programs. Reviewing the quality of data in these types of documents is time consuming and resource intensive. A triage system using lot quality assurance sampling (LQAS), a rapid survey method, can be implemented to identify acceptable or unacceptable source documents using a small sample of records. Measuring the Quality of HIV/AIDS Client-Level Data Using Lot Quality Assurance Sampling (LQAS) was developed to describe how to sample HIV/AIDS client or beneficiary records and classify them according to quality, with a quantifiable level of confidence. The LQAS method saves time, effort, and resources while yielding statistically sound results with quantifiable confidence and error. The intended audience for this guide is supervisory staff. When used as part of a routine system of data quality assurance, LQAS will improve HIV/AIDS data in source documents, allowing for improved client and beneficiary management. Since data quality issues will be identified and resolved at the source, aggregate data that are reported to national programs will be more accurate. A companion Excel tool—the LQAS Triage System Data Collection and Analysis Tool—is available at https://www.measureevaluation.org/resources/publications/tl-19-51. 
PRISM: Performance of Routine Information System Management Series MEASURE Evaluation 2019 English RHIS, PRISM, Performance of Routine Information System Management, Tools, Routine Health Information Systems, Health Information Systems Using data to make evidence-informed decisions is still weak in most low- and middle-income countries. Especially neglected are data produced by routine health information systems (RHIS)—the data collected at public, private, and community-level health facilities and institutions. When routine data are lacking, or are not used, the results can be lower-quality services, weak infection prevention and control responses, lack of skilled health workers available where they are needed, and weak supply chains for drugs and equipment. These factors contribute to poor health outcomes for people. MEASURE Evaluation, which is funded by the United States Agency for International Development (USAID), has provided technical and financial assistance to strengthen RHIS for more than 15 years. We have contributed to best practices at the global level and to the strengthening of RHIS data collection, data quality, analysis, and use at the country level. One of the project’s mandates is to strengthen the collection, analysis, and use of these data for the delivery of high-quality health services. We developed the Performance of Routine Information System Management (PRISM) Framework and suite of tools in 2011 for global use in assessing the reliability and timeliness of an RHIS, in making evidence-based decisions, and in identifying gaps in an RHIS so they can be addressed and the system can be improved. With USAID’s support, we have revised the PRISM Tools and developed other elements, based on the PRISM Framework, to create a broad array of materials: the “PRISM Series.” This new, more comprehensive PRISM Series is useful for designing, strengthening, and evaluating RHIS performance and developing a plan to put the results of a PRISM assessment into action. Access the full collection, older versions of the PRISM tools, and additional resources at https://www.measureevaluation.org/resources/tools/health-information-systems/prism 
HIS Stages of Continuous Improvement Toolkit MEASURE Evaluation 2019 English Toolkit, Health Information Systems, HIS strengthening, HISS, HIS Strong health information systems (HIS) can collect, analyze, and use high-quality, timely data to strengthen health service delivery. A functioning HIS gets the right information into the right hands at the right time, enabling policymakers, managers, and individual service providers to make informed choices about everything from patient care to national budgets. Despite a growing emphasis on strengthening HIS and measuring how information systems contribute to improved health outcomes, understanding is limited on what interventions will work to improve HIS in various stages of development. The HIS Stages of Continuous Improvement (SOCI) Toolkit was collaboratively designed to help countries or organizations holistically assess, plan, and prioritize interventions and investments to strengthen an HIS. The assessment measures current and desired HIS status across five core domains of an HIS, and 39 subcomponents, and maps a path toward improvement—thus assisting countries in ensuring the right information is available to the right people at the right time. HIS are essential not only to monitor and improve national and subnational programs, but also to demonstrate country progress on a global level. This tool aligns with World Health Organization efforts to strengthen country HIS and capacities to monitor universal health coverage and health Sustainable Development Goals.  The HIS SOCI Toolkit was jointly developed by the United States Centers for Disease Control and Prevention (CDC), the Health Data Collaborative digital health and interoperability working group, and the USAID-funded MEASURE Evaluation project. The toolkit also responds to one of MEASURE Evaluation’s Learning Agenda questions.  The full collection is also available online at https://www.measureevaluation.org/his-strengthening-resource-center/his-stages-of-continuous-improvement-toolkit
Strategies for Geographic Targeting Using the Priorities for Local AIDS Control Efforts (PLACE) Method: Scorecards and Other Tools MEASURE Evaluation 2019 English HIV, PLACE, HIV prevention, Geography, Mapping After collecting data using MEASURE Evaluation’s Priorities for Local AIDS Control Efforts (PLACE) method, countries and stakeholders can use the innovative methods and visualization strategies presented in this manual to identify core geographic areas with relatively high levels of untreated HIV. The scorecards and maps such as those prepared in this study help countries improve their efforts to reach people who have HIV but who do not know their status, people have not yet achieved viral suppression, and people who are suitable candidates for pre-exposure prophylaxis. Access the full collection of Priorities for Local AIDS Control Efforts (PLACE) method resources at https://www.measureevaluation.org/place
Malaria Epidemic Preparedness and Response Review and Planning Workshops: January‒March 2019 Ministry of Health, Republic of Kenya 2019 English Epidemic preparedness and response (EPR) is one of the key strategic approaches to controlling malaria in Kenya. In collaboration with MEASURE Evaluation, Kenya's National Malaria Control Programme (NMCP) organised seven EPR workshops targeting county and sub-county malaria control and disease surveillance coordinators. The workshops were conducted for 127 sub-counties in 26 counties that fell in the epidemic-prone areas of the western highland and seasonal transmission zones. A total of 320 health managers from the 26 counties and 127 sub-counties were trained. For the first time, the 2019 EPR planning and review workshops included sub-county malaria control and disease surveillance coordinators. The evaluations conducted during the workshops revealed important gaps in overall EPR training and monitoring. The workshops resulted in several recommendations to improve future EPR planning and review workshops and epidemic monitoring across all levels.
Synthesis of Routine Health Information System Architecture Profiles of the U.S. President's Malaria Initiative (PMI) Priority Countries MEASURE Evaluation 2019 English RHIS, Health Information Systems, Malaria, Routine Health Information Systems MEASURE Evaluation developed two-page summary profiles of routine health information systems (RHIS) that capture malaria data in 17 of the countries supported by the U.S. President’s Malaria Initiative (PMI): Angola, Benin, Burkina Faso, Cameroon, Côte d’Ivoire, Ghana, Kenya, Liberia, Madagascar, Mali, Mozambique, Niger, Rwanda, Senegal, Sierra Leone, Uganda, and Zambia. Looking across the profiles, this synthesis identifies the commonalities, strengths, challenges, and gaps, and suggests priority areas to focus on further strengthening.
Snapshot of the Strength of the Health Information System as a Source of HIV Data MEASURE Evaluation 2019 English HIV data, Health information systems, Data, HIV, HIS Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time. MEASURE Evaluation, funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief, prepared 13 briefs to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic. Access the full collection of briefs online at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data
Children in Adverse Situations Indicators and Survey Tools Hellen, Jacqueline; Parker, Lisa 2019 English Household surveys provide useful data on the vulnerabilities faced by children in the general population, but often miss children who may be exposed to extreme adversity, such as children of female sex workers, street children, and children working in mines. Globally, data on these populations are limited. The Children in Adverse Situations Indicators and Survey Tools help countries or organizations assess and strengthen their information base on well-being outcomes of children of female sex workers, street children, and children working in mines. We have developed a holistic set of standard outcome indicators and corresponding survey tools deemed essential to expand the evidence base of these invisible children, to better understand their needs. The collection is also available online at www.measureevaluation.org/our-work/ovc/children-in-adverse-situations-indicators-and-survey-tools/children-in-adverse-situations-survey-tools
LQAS Triage System: Data Collection and Analysis Tool MEASURE Evaluation 2019 English Data Quality, Sampling, Health Information Systems, LQAS, Data collection, Tool, Data The Lot Quality Assurance Sampling (LQAS) Triage System is a method for assessing the completeness of data elements in source documents using a sample of client records. Concordance of data elements across data sources can also be assessed. Please see the guidance document "Measuring the Quality of HIV/AIDS Client-Level Data Using Lot Quality Assurance Sampling"  for more details and directions, here: www.measureevaluation.org/resources/publications/ms-19-176 
Monitoring the Outcomes of Orphans and Vulnerable Children Programs in Kenya: Findings from 2016–2018 Panel Data: MWENDO Project Irit Sinai, Clement O. Odour, Dennis Akeyo, Cheikh M. Faye, Damazo T. Kadengye, Nelson Langat 2019 English KENYA OVC, Indicators, PEPFAR, Orphans and vulnerable children, Monitoring, OVC programs This report presents findings from a panel study of beneficiary households receiving services from Making Well-Informed Efforts to Nurture Disadvantaged Orphans & Vulnerable Children (MWENDO), in Western Kenya. MWENDO is a five-year project funded by the United States Agency for International Development (USAID) and implemented by Catholic Relief Services that provides an umbrella of services to orphans and vulnerable children (OVC). This study was undertaken by MEASURE Evaluation—a project funded by USAID and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—at the request of PEPFAR and the USAID Kenya mission. This 2016–2018 panel study was designed to meet PEPFAR’s monitoring, evaluation, and reporting requirements, which include standard indicators. PEPFAR encourages the collection of data on these indicators every two years. When MWENDO began implementing OVC programs in 2017, it took over the support of OVC beneficiaries from its predecessor project—AIDS, Population and Health Integrated Assistance Plus Program, Western Kenya, known as APHIAplus. The panel study compared results from Round 1 (2016, APHIAplus beneficiaries) and Round 2 (2018, with the same households, now MWENDO beneficiaries). It measured changes in the well-being of OVC beneficiaries over the two years using nine essential survey indicators required by PEPFAR and two supplemental indicators. Find other materials from Round 2 are here. Materials related to Round 1 can be found here.
Seven Steps to EnGendering Public Health Evaluations: Training Instructions MEASURE Evaluation 2019 English Evaluation, Gender, Health programs, Public Health, Training Because international development increasingly focuses on gender, evaluators need a better understanding of how to measure and incorporate gender—including its economic, social, and health dimensions—in their evaluations. This interactive training, consisting of a presentation and this tool, will help participants learn to better evaluate programs with gender components. This tool is to be used with the associated training presentation, 7 Steps to EnGendering Evaluations of HIV programs with Adolescent Girls and Young Women. It provides instructions for carrying out the training, including suggested group activities.
Improving GEND_GBV Data Quality to Enhance PEPFAR Program Performance MEASURE Evaluation 2019 English Gender-based violence, Data Quality, GBV, HIV, Gender, PEPFAR, HIV prevention Gender-based violence (GBV) is a key driver of the HIV epidemic. Preventing and responding to GBV is essential to meeting PEPFAR’s 95-95-95 goals. High-quality GBV data are vital to decision making to improve GBV and HIV programs. This job aid focuses on improving GEND_GBV data quality to enhance PEPFAR program performance. To access the GEND_GBV Rapid Data Quality Review Tool and related resources, visit www.measureevaluation.org/resources/gend_gbv-rapid-data-quality-review-tool.
Community Event-Based Surveillance of Priority Human and Zoonotic Diseases in Senegal: Suggestions for a Model One Health Project MEASURE Evaluation 2019 English Africa, SENEGAL Senegal, GHSA, Surveillance, Community-Based Surveillance, One Health, Global health security, Community, Global Health Security Agenda A United States Agency for International Development (USAID)–supported Global Health Security Agenda (GHSA) activity for community event-based surveillance (CEBS) of zoonotic diseases with a One Health approach was launched in Senegal and implemented from September 2017 through June 2019. The activity was part of the USAID-supported MEASURE Evaluation Phase IV project under the GHSA Action 2 package. The activity focused on CEBS of eight prioritized infectious human and six zoonotic diseases in Senegal. This activity is a follow-on implementation of CEBS in four pilot districts (Tambacounda, Koumpentoum, Podor, and Pété) in two regions of Senegal. The establishment of the pilot CEBS was accomplished by training community health volunteers to detect these diseases as soon as they occurred in their respective communities and to send text messages to the nearest health or veterinary post. The objective of the activity was early detection and response to limit the possibility of any large-scale outbreak of the disease. The experience gained during this pilot forms the basis for recommendations for a model CEBS with a One Health approach for Senegal and perhaps other countries.
Partenaires sexuels masculins d’adolescentes et de jeunes femmes en Haïti : Comportements sexuels à risque, utilisation des services liés au VIH et violence de la part du partenaire MEASURE Evaluation 2019 French Sexual Behavior, Haiti, HIV, PEPFAR, HIV prevention, Young Women, Adolescent Girls, AGYW L’objectif de cette étude, soutenue par l’Agence des Etats-Unis pour le développment international (USAID) et le Plan d’urgence du Président américan pour la lutte contre le SIDA (PEPFAR), était de fournir des informations du point de vue des partenaires sexuels masculins de filles adolescentes et de jeunes femmes (FAJF) pouvant faciliter l’élaboration de programmes de lutte contre le VIH ciblant les hommes. Les sujets examinés comprenaient les comportements sexuels à risque, l’utilisation des services de dépistage et de traitement du VIH et la dynamique des relations sexuelles, y compris la violence du partenaire intime. L’étude a été réalisée à la demande de l’USAID, en partenariat avec le Ministère de la Santé publique et de la Population (MSPP). Une enquête sociale et comportementale transversale a été menée auprès de 500 partenaires masculins de FAJF1 dans la région de Delmas à Port-au-Prince (PaP) et de 300 partenaires masculins à St. Marc entre les mois de février et mars 2019. Les personnes interrogées ont été recrutées sur la base d’un échantillonnage piloté par les répondants. L’analyse inclut des calculs fréquentiels et bidimensionnels des poids d’échantillonnage de population ajustés ayant été conçus sous RDS Analyst. This brief is also available in English. Access a related report and presentation. 
Male Sexual Partners of Adolescent Girls and Young Women in Haiti: Sexual Risk Behavior, HIV Service Use and Partner Violence MEASURE Evaluation 2019 English AGYW, Young Women, Haiti, Adolescent Girls, HIV prevention, Sexual Behavior, PEPFAR, HIV This study sought to provide information from the perspective of male sexual partners of adolescent girls and young women (AGYW) in Haiti, to inform HIV programming there for men. It examined sexual risk behavior, use of HIV testing and treatment services, and the dynamics of sexual relationships, including intimate partner violence. MEASURE Evaluation— funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief—conducted the study in partnership with the Ministry of Public Health and Population (MSPP), at USAID’s request and as one component of PEPFAR’s DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) project. Understanding factors that contribute to HIV risk and service use among male sexual partners of AGYW supports USAID’s goal of controlling the epidemic in Haiti and globally. A cross-sectional social and behavioral survey was administered to 500 male partners of AGYW1 in the Delmas area of Port-au-Prince and to 300 male partners in St. Marc in February–March 2019. Respondents were recruited using respondent-driven sampling (RDS). Results were analyzed using frequency and bivariate calculations that were adjusted using population sampling weights constructed in RDS Analyst. This brief shares more and is also available in French. Access a related report and presentation. 
Male Sexual Partners of Adolescent Girls and Young Women in Haiti: A Survey of HIV Risk Behavior, HIV Service Use, and Partner Violence Andrinopoulos, K., Felker-Kantor, E., Michel, J., Francoise, K., & Desinor, O. 2019 English PEPFAR, Adolescent Girls, Young Women, HIV prevention, Haiti, HIV, AGYW The goal of this study was to support the achievement of the 95-95-95 targets of the United States President's Emergency Plan for AIDS Relief (PEPFAR) by providing a robust understanding of HIV sexual risk behavior, HIV testing, and HIV treatment from the perspective of adult male sexual partners of adolescent girls and young women (AGYW). in Haiti. The research objectives were to: Describe and identify modifiable determinants of HIV risk behavior and risky sexual partnerships. Describe normative beliefs about HIV risk behavior, sexual partnerships, and HIV service use and their influence on personal HIV risk behavior. Describe current HIV service use and preferences for HIV testing, determinants of HIV testing uptake, and, among HIV-positive participants, antiretroviral therapy treatment uptake and adherence. Male sexual partners of AGYW are an important population to reach with effective HIV services in Haiti. The results of this study indicate a critical need to increase men’s knowledge of HIV treatment, access to condoms, and use of HIV testing services. Efforts to decrease physical and sexual violence and to better understand the role of equity in decision making with sexual partners are also needed. Additional research is warranted among HIV-positive men to understand how to link and retain them in care and to decrease the risk of transmission to their sexual partners. HIV interventions in Haiti should use peer social norms to promote behaviors among men and should be tailored to their preferences by locating services in community settings and in places where men are more likely to socialize. HIV programs can effectively use social networks to reach high-risk heterosexual men and refer them to programs. Future studies to characterize the male partners of AGYW should consider using RDS to recruit participants. Access a related research brief in English or French and a PowerPoint presentation. 
Renforcer la surveillance communautaire basée sur les événements au Sénégal MEASURE Evaluation 2019 French Global health security, Zoonotic, Senegal, One Health, Global health, Global Health Security Agenda Avec l’appui de l’USAID, MEASURE Evaluation a aidé le Sénégal à mettre en place un système de Surveillance à Base Communautaire (SBC) des 8 maladies prioritaires humaines dans 4 districts pilotes depuis 2016. Ce système a permis aux acteurs communautaires d’identifier précocement les maladies au sein de la communauté et d’informer à temps l’infirmier responsable de la zone pour une réponse rapide. En 2017, MEASURE Evaluation a révisé le système de SBC pour inclure les 6 zoonoses prioritaires et adopter une approche « Une Seule Santé » qui tient compte d’autres secteurs non traditionnels de la santé. L’approche Une Seule Santé met l’accent sur la collaboration multisectorielle et le partage de l’information entre les parties prenantes à tous les niveaux ; et permet une réponse rapide aux évènements liés à l’interface homme-animal-environnement pour prévenir la propagation des maladies.
Strengthening Community Event-Based Surveillance in Senegal MEASURE Evaluation 2019 English Africa, SENEGAL GHSA, Global health, Global health security, One Health, Global Health Security Agenda, Zoonotic, Senegal Since 2016, with the support of the United States Agency for International Development (USAID), MEASURE Evaluation has assisted Senegal to set up a community event-based surveillance (CEBS) system to monitor the eight priority human diseases in four pilot districts. This system has enabled community stakeholders to identify diseases when they emerge in the community and to inform the nurse in charge of the area to enable rapid response to disease threats. In 2017, MEASURE Evaluation revised the CEBS system to include Senegal’s six priority zoonotic diseases and adopt a “One Health”  approach that involves other non-traditional health sectors. The One Health approach focuses on multisectoral collaboration and information sharing among stakeholders at all levels. It also allows for rapid response to events —illnesses that emerge in the human-animal-environment interface—to prevent the spread of disease. This brief shares more. 
Measuring Outcomes among Children in Adverse Situations Indicators and Survey Tools Hellen, Jacqueline; Parker, Lisa 2019 English Africa, Asia, Latin America and the Caribbean Household surveys, such as the Demographic and Health Survey and the Multiple Indicator Cluster Survey, provide useful data on the vulnerabilities faced by children in the general population, but they often miss children who may be exposed to extreme adversity, such as children of female sex workers (FSWs), street children, and children working in mines. Globally, there are limited data on children living outside of traditional households, such as those living in the context of sex work or mining, or outside the care and protection of a primary caregiver, such as those living on the streets (Clay, et al., 2012). Service delivery organizations supporting these children also rarely share information and best practices in order to measure outcomes and performance. Although research has shed some light on the vulnerabilities and needs of children living in such adverse situations, until now, no standardized indicators have been released to guide practitioners in measuring the extent of their risk to HIV. The goal of the Children in Adverse Situations Indicators and Survey Tools—available at https://www.measureevaluation.org/our-work/ovc/children-in-adverse-situations-indicators-and-survey-tools—is to answer the following question: “What improvements in well-being outcomes can be attributed to programs supporting children of FSWs, street children, and children working in mines?” The indicators and tools were specifically developed to expand the evidence base required by child welfare systems and programs in low- and middle-income countries to systematically reduce the vulnerability of these specific populations. The Children in Adverse Situations Indicators and Survey Tools help countries or organizations assess and strengthen their information base on well-being outcomes of children in these populations. This suite consists of a holistic set of standardized outcome indicators and corresponding survey tools that have been deemed essential to ensuring more effective sharing of outcome data both in and between countries and programs and to expanding the evidence base of these invisible children to better understand their needs.
Data Quality Assessment (DQA) for HIV Program Indicators in Burundi: Final Report Boone, D., Bisore, S., Hypax, M. Rwantabagu, J.P., & Ly, M. 2019 English DQA, Indicators, Data, Data Quality, HIV, Burundi, HIV data, Data quality assessment The Office of HIV/AIDS at the U.S. Agency for International Development (USAID) has allocated resources to address the data quality of HIV and AIDS indicators through the MEASURE Evaluation project. The Programme National de Lutte Contre le SIDA et les Infections Sexuellement Transmissibles (PNLS/IST) (National HIV/AIDS Control Program in Burundi) and other donors and partners have also contributed resources to assessing and improving data quality for HIV in Burundi. A joint effort was made to plan and implement a joint data quality assessment (DQA) of 80 percent of the patients active on treatment in Burundi. This report summarizes the findings of the DQA and provides recommendations for follow-up. The primary objective of the DQA was to investigate data quality issues concerning the number of people currently receiving antiretroviral therapy (ART) at a sample of health facilities representing 80 percent of patients actively on treatment in Burundi. The activity aimed to improve the accuracy and reliability of future data submissions to PEFPAR and the Ministry of Health (MOH). The assessment follows a pilot test in November 2018 to validate new assessment tools and methods. The assessment aimed to validate reported values for priority indicators at 147 sites, including sites supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). In addition, the assessment aimed to validate a proposed methodology for evaluating the quality of data in source documents, and program quality indicators. The so-called Lot Quality Assurance Sampling (LQAS) Triage System is a methodology to sample patient records within health facilities to gauge the completeness of the data, as well as the coherence of data between different data sources.  This report presents the findings of the assessment, which include systematic data quality problems affecting “Currently on ART” (TX_CURR), “Newly initiated on ART” (TX_NEW), and “Percentage of Viral Load Suppressed” (TX_PVLS). The report provides recommendations for actions that can be undertaken independently to improve data quality.
Implementing Event-Based Surveillance in Burkina Faso: Using the “One Health” Approach Connolly, A.M., Sawadogo, I., Geers, E., & Eugene, M.Y.B. 2019 English Surveillance, One Health, Global Health Security Agenda, Burkina Faso, Global health, Global health security, GHSA Recent outbreaks of Middle East respiratory syndrome, avian influenza, and Ebola virus disease have put local, national, regional, and global focus on the ability of countries to effectively detect and respond to emergent public health issues. Many of the outbreaks have involved zoonotic diseases: those that spread between animals and humans. These outbreaks led countries to develop new intervention strategies through the Global Health Security Agenda (GHSA) launched in 2014. The GHSA aims to strengthen both the global capacity and nations’ capacity to prevent, detect, and respond to threats from infectious diseases, facilitated by a multilateral and multisectoral approach. MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID)—has been working in Burkina Faso since March 2018 in partnership with the Ministry of Animal and Fisheries Resources (MRAH); the Ministry of Health (MS); and the Ministry of the Environment, Green Economy and Climate Change (MEEVCC) to strengthen the country’s ability to detect and respond to diseases with epidemic and epizootic potential using a “One Health” approach. One Health is a collaborative, multisectoral, transdisciplinary approach that works at the local, regional, national and global levels to monitor and control public health threats and to learn how diseases spread among people, animals, and their shared environment (One Health). In Burkina Faso, each of the ministries responsible for human and animal health and the environment has a system of disease monitoring. At the Ministry of Health, the integrated disease surveillance and response (IDSR) system ensures the surveillance of diseases, including those with epidemic potential. At MRAH, surveillance of and response to animal diseases are coordinated by the Epidemiological Surveillance Network of Animal Diseases (RESUREP). MEEVCC does not have a surveillance system, but for the purpose of monitoring animals in parks and protected areas, ecological monitoring forms have been implemented to collect information on wild animals, including about their health. Starting in 2017, MEASURE Evaluation joined other partners in assisting Burkina Faso to enhance its surveillance system as part of the project’s overarching objective to support the government in strengthening its health information system (HIS). MEASURE Evaluation’s specific objectives for HIS strengthening are: (1) to aid the government in strengthening its early-warning system by developing a community-level EBS system for diseases with epidemic and epizootic potential; (2) to strengthen the collection, analysis, and use of routine health data; (3) to strengthen the country’s capacity to manage the HIS; and (4) to develop an electronic platform to aid in the identification, notification, and follow-up of all diseases under surveillance by the Ministry of Animal Resources and the Ministry of Health. MEASURE Evaluation has assisted at the national level in developing a One Health approach to event-based surveillance (EBS) that is suited to the Burkina Faso context. To test this approach, the Center-South Region was chosen as the intervention zone. This region has three provinces: Zoundwéogo, Nahouri, and Bazèga. Nahouri, whose capital is Po, was chosen to pilot EBS activities using the One Health approach. This report shares more on the One Health approach in Burkina Faso.
Glosario de Términos para la Evaluación Grupal del MECAT MEASURE Evaluation 2019 Spanish Capacity Assessment, Monitoring, Evaluation, MECAT Este es un glosario de términos para evaluación grupal del MECAT.  Más: https://www.measureevaluation.org/pima/m-e-capacity/
Conjunto de herramientas de diagnóstico de la capacidad de monitoreo y evaluación (MECAT). Evaluación grupal MEASURE Evaluation 2019 Spanish Capacity Assessment, Monitoring, Evaluation, MECAT, MEASURE Evaluation PIMA Los datos generados por este diagnóstico se utilizarán para elaborar planes capacitación para reforzar la capacidad de la división para realizar sus funciones de MyE. Más: https://www.measureevaluation.org/pima/m-e-capacity/
Diagnóstico individual de la herramienta de diagnóstico de la capacidad de monitoreo y evaluación (MECAT) MEASURE Evaluation 2019 Spanish Capacity Assessment, Monitoring, Evaluation, MECAT Para aquellos en cargos de MyE: Considere cada declaración en la herramienta y use la escala para calificar su propio nivel de competencia. Se trata de una auto-diagnóstico con el objetivo de identificar sus necesidades personales de desarrollo de capacidades, por lo que es importante que reflexione críticamente sobre su nivel de competencia y no subestime ni sobrevalore su nivel de competencia. Al final del  diagnóstico individual, resuma sus fortalezas y debilidades clave y enumere las acciones concretas que se deben tomar (por ejemplo, capacitación a corto/largo plazo, capacitación en el trabajo/fuera del trabajo, y/u otro enfoque de desarrollo de capacidades) para fortalecer competencias específicas consideradas críticas para su desempeño laboral y un cronograma para lograr mejoras. MECAT: https://www.measureevaluation.org/pima/m-e-capacity/
Implementing the Monitoring and Evaluation Capacity Assessment Toolkit in Central America: Adjustments and Lessons Learned MEASURE Evaluation 2019 English Monitoring, Evaluation, MECAT, Capacity Assessment, MEASURE Evaluation PIMA Worldwide, the use of health system data to guide decisions on how resources are allocated is rising rapidly. Ministries of health and national health programs are seeking ways to ensure that the quality of health system data is reliable. As a result, data collection, collation, reporting, and use are increasingly scrutinized, and efforts to strengthen health information systems (HIS) must focus on improved health program monitoring and evaluation (M&E). To help meet this need, MEASURE Evaluation and its Kenya associate award, MEASURE Evaluation PIMA (both funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief), developed the Monitoring and Evaluation Capacity Assessment Toolkit (MECAT). The MECAT was used in Kenya to set baselines for beneficiary national programs and 17 target counties. Since then, it has been adapted for use in other countries to help health management and development professionals make decisions, monitor progress, and design capacity-building interventions for sustained HIS improvements. Recently the toolkit was implemented in four Central American countries—Guatemala, Honduras, Panama, and El Salvador—to assess each country’s capacity for M&E of HIV programs. This brief shares more. Access MECAT resources at https://www.measureevaluation.org/pima/m-e-capacity/. 
Community-Based Indicators for HIV Programs: Data Use Cases MEASURE Evaluation 2019 English HIV, Indicators, Community-based health information systems, Data, Community, Data use, Community-based, HIV/AIDS MEASURE Evaluation reached out to implementing organizations to learn about instances where community-based HIV data for key indicators informed programmatic actions, plans, or decisions, ideally leading to associated changes in resource allocation or beneficiary outcomes. The data use examples provided in this brief detail cases where data collected for indicators in this collection have been used to inform decisions that led to reallocation of project inputs or that could be attributed to improved outputs or outcomes.  Access the full "Community-Based Indicators for HIV Programs" collection at www.measureevaluation.org/community-based-indicators. 
Community-Based Indicators for HIV Programs: Home-Based Care MEASURE Evaluation 2019 English HIV/AIDS, HIV, Community-based, Indicators, Community-based health information systems, Community, HBC MEASURE Evaluation reached out to PEPFAR (United States President’s Emergency Plan for AIDS Relief)—and other donor-supported programs implementing at the community level that support home-based care activities, including LINKAGES—to obtain data collection tools. The tools received are those used by community workers in Nigeria, Ethiopia, South Africa, Uganda, Kenya, Côte d’Ivoire, the Democratic Republic of the Congo, and Botswana to track and monitor community home-based care and services. The most common data elements in these tools were incorporated into the indicators in this collection. Access the full "Community-Based Indicators for HIV Programs" collection at www.measureevaluation.org/community-based-indicators. 
Community-Based Indicators for HIV Programs: HIV Prevention MEASURE Evaluation 2019 English HIV/AIDS, HIV, HIV prevention, Community-based, Indicators, Community-based health information systems, Community MEASURE Evaluation reached out to PEPFAR (United States President’s Emergency Plan for AIDS Relief)—and other donor-supported programs implementing programs at the community level that support HIV prevention activities among key populations, including LINKAGES—to obtain data collection tools. The tools received are used by community workers in Nigeria, Ethiopia, South Africa, Uganda, Kenya, Côte d’Ivoire, the Democratic Republic of the Congo, and Botswana to track and monitor community HIV prevention interventions. The most common data elements among these tools were incorporated into the indicators in this collection. Access the full "Community-Based Indicators for HIV Programs" collection at www.measureevaluation.org/community-based-indicators. 
Community-Based Indicators for HIV Programs: Key Populations MEASURE Evaluation 2019 English HIV/AIDS, Key Populations, KP, Community, Indicators, Community-based health information systems, HIV, Community-based MEASURE Evaluation reached out to PEPFAR (United States President’s Emergency Plan for AIDS Relief)—and other donor-supported programs implementing programs at the community level to support key populations, including the PEPFAR-funded LINKAGES—to obtain data collection tools. The tools received are used by community workers in Nigeria, Ethiopia, South Africa, Uganda, Kenya, Côte d’Ivoire, the Democratic Republic of the Congo, and Botswana to track and monitor outreach provided to key populations—including testing, sensitization trainings, and behavior change communication activities. The most common data elements among these tools were incorporated into the indicators in this collection. Access the full "Community-Based Indicators for HIV Programs" collection at www.measureevaluation.org/community-based-indicators. 
Community-Based Indicators for HIV Programs: Prevention of Mother-To-Child Transmission MEASURE Evaluation 2019 English HIV/AIDS, Community, PMTCT, Indicators, HIV prevention, Community-based health information systems, HIV, Community-based MEASURE Evaluation reached out to PEPFAR (United States President’s Emergency Plan for AIDS Relief)—and other donor-supported programs that implement programs, at the community level, to support prevention of mother-to-child transmission activities—to obtain data collection tools. The tools collected are those used by community workers in Nigeria, Ethiopia, South Africa, Uganda, Kenya, Côte d’Ivoire, the Democratic Republic of the Congo, and Botswana to monitor household care and services provided to mothers and their infants and conduct behavior change communication activities for pregnant women and mothers (of infants) living with HIV. The most common data elements among these tools were incorporated into the indicators in this collection. Each indicator is accompanied by a definition. These definitions were specifically designed to inform data collection by community programs and agents. Access the full "Community-Based Indicators for HIV Programs" collection at www.measureevaluation.org/community-based-indicators. 
Community-Based Indicators for HIV Programs: Vulnerable Children MEASURE Evaluation 2019 English Vulnerable children, HIV/AIDS, OVC, HIV, Orphans and Vulnerable Children, Community-based, Indicators, Community-based health information systems, Community Community-based programs link many families to health and social services. These programs ensure that HIV-positive children have access and adhere to treatment and that HIV-positive caregivers can meet the needs of their children. MEASURE Evaluation supports efforts to improve routine monitoring systems and collect information for case management, program monitoring, and identification of beneficiaries by vulnerable children programs. This collection of indicators is an important element of MEASURE Evaluation’s work to build capacity to monitor and evaluate community-based vulnerable children programs.  Access the full "Community-Based Indicators for HIV Programs" collection at www.measureevaluation.org/community-based-indicators. 
Successful Support for Better HIV Data MEASURE Evaluation 2019 English DATIM, PEPFAR, HIS, Data, Accountability, HIV, Health Information Systems A major objective of MEASURE Evaluation, funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR), has been to improve health information systems, and the data they contain, to contribute to control of the HIV epidemic in the countries where the project works. PEPFAR is focused on data-driven decision making to ensure that programs addressing the epidemic are deployed where they are most needed and that they have measurable impact. The Data for Accountability, Transparency and Impact (DATIM) software system was developed to organize HIV data from monitoring, evaluation, and reporting (MER) of programs; Site Improvement through Monitoring System (SIMS) assessments; Evaluation Standards of Practice; Surveys, Surveillance, Research, and Evaluations (SRE) activities; and expenditure analyses. MEASURE Evaluation has advanced this crucial PEPFAR aim in two primary ways: (1) supporting DATIM implementation, management, and capacity building; and (2) increasing the capacity of country health information systems (HIS) and their enabling environments (governance, management, skills, etc.) at global, regional, and country levels, especially in PEPFAR countries. This brief shares more.
Botswana Comprehensive Care for OVC MEASURE Evaluation 2019 English Africa, BOTSWANA Since 2016, the Botswana Comprehensive Care and Support for Orphans and Vulnerable Children (BCCOVC) Project—funded by the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—has supported the Government of Botswana (GOB) to deliver social services in seven PEPFAR priority sites. The BCCOVC project is implemented by Project Concern International (PCI) and builds on the previous PCI-implemented Tsela Kgopo OVC and Gender project (2011–2016). It supplements the core package of GOB services for orphans and vulnerable children (OVC): provision of food, school uniforms, clothes, shoes, and toiletry items to orphaned and vulnerable youth. Its goals are to increase uptake of HIV testing and other reproductive health services, strengthen economic opportunities for young people, and improve educational outcomes. Access related resources here: https://www.measureevaluation.org/resources/evaluation-of-services-for-orphans-and-vulnerable-youth-in-botswana.
Botswana Comprehensive Care for OVC: Teen Club MEASURE Evaluation 2019 English Africa, BOTSWANA Since 2016, the Botswana Comprehensive Care and Support for Orphans and Vulnerable Children (BCCOVC) Project—funded by the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—has supported the Government of Botswana (GOB) to deliver social services in seven PEPFAR priority sites. The BCCOVC project is implemented by Project Concern International (PCI) and builds on the previous PCI-implemented Tsela Kgopo OVC and Gender project (2011–2016). It supplements the core package of GOB services for orphans and vulnerable children (OVC): provision of food, school uniforms, clothes, shoes, and toiletry items to orphaned and vulnerable youth. Its goals are to increase uptake of HIV testing and other reproductive health services, strengthen economic opportunities for young people, and improve educational outcomes. Access related resources here: https://www.measureevaluation.org/resources/evaluation-of-services-for-orphans-and-vulnerable-youth-in-botswana.
Evaluation of Services for Orphans and Vulnerable Youth in Botswana: Qualitative Findings 2019 English Africa, BOTSWANA OVC programs, Orphans and Vulnerable Children, Children, Orphans and vulnerable children, Africa, OVC, Evaluation, Botswana Since 2011, the Botswana Comprehensive Care and Support for Orphans and Vulnerable Children (BCCOVC) project—funded by the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—has supported the Government of Botswana (GOB) to deliver high-quality social services in seven sites that PEPFAR has designated for priority. The GOB’s core package of services for orphans and vulnerable children (OVC) consists of psychosocial support and provision of food, school uniforms, clothes, shoes, and toiletry items. BCCOVC services supplemented this core package of services with the goals of increasing uptake of HIV testing and other reproductive health services, improving adherence to antiretroviral therapy (ART), strengthening economic opportunities for youth, and improving the rate of school completion. To provide the evidence necessary to plan and implement services for the unique needs of adolescent OVC, the United States Agency for International Development (USAID) and the GOB requested that MEASURE Evaluation, with support from PEPFAR, evaluate how PEPFAR- and GOB-supported OVC interventions in Botswana affect the educational, economic, and health outcomes of adolescent OVC. The evaluation used both quantitative and qualitative methods. This brief describes the main findings from the qualitative component of the evaluation. Access related resources here: https://www.measureevaluation.org/resources/evaluation-of-services-for-orphans-and-vulnerable-youth-in-botswana.
Indicator Matrix and Guidance for Monitoring and Evaluating Programs Serving Orphans and Vulnerable Children MEASURE Evaluation 2019 English Child Health, Children, OVC programs, OVC, Orphans and Vulnerable Children The United States President’s Emergency Plan for AIDS Relief (PEPFAR) engaged the United States Agency for International Development (USAID)- and PEPFAR-funded MEASURE Evaluation project to develop and support the rollout of an overarching matrix that outlines the pathway to better outcomes for children affected by HIV. PEPFAR assembled a team of experts from its partner agencies and MEASURE Evaluation to design an indicator matrix that maps the current required PEPFAR orphans and vulnerable children (OVC) indicators and complements them with additional recommended foundational, process, output, and outcome indicators and the newly established PEPFAR global OVC graduation benchmarks (https://www.measureevaluation.org/resources/publications/tl-18-20). The team’s work resulted in these two resources: Monitoring and Evaluating Programs Serving Orphans and Vulnerable Children: An Indicator Matrix Using the Indicator Matrix for Monitoring and Evaluating Programs Serving Orphans and Vulnerable Children: Guidance The OVC indicator matrix has the following uses: Guide OVC program stakeholders to measure what matters and to consider repurposing or selecting new or custom indicators that better inform project performance Provide sample indicators that can be used to measure how OVC projects are contributing to the global 95-95-95 targets and prevention and mitigation goals Demonstrate relationships among PEPFAR’s reporting requirements The matrix consists of 12 tables, each of which focuses on a key project objective and contains a set of foundational, process, output, and outcome indicators that can be used to measure progress in achieving the respective objective. The companion guidance manual introduces the matrix—explaining its purpose and how it can be used. It describes the process that may be followed for selecting indicators from the matrix and adapting and operationalizing them. It includes several helpful tools: for example, a sample agenda for a workshop to prioritize the indicators and a table that aligns the eligible essential OVC services with the matrix. Access the full collection at https://www.measureevaluation.org/our-work/ovc/indicator-matrix-and-guidance-for-monitoring-and-evaluating-programs-serving-orphans-and-vulnerable-children
GEND_GBV Rapid Data Quality Review Tool MEASURE Evaluation 2019 English Gender-based violence, Data quality, GBV, Gender, Data, Tool This tool is designed to identify data collection and reporting gaps to improve GEND_GBV data quality, and should be used by implementing partners (IPs), PEPFAR country teams, and/or USAID/Washington. It is also available in Excel and Word.  Access related resources at https://www.measureevaluation.org/resources/gend_gbv-rapid-data-quality-review-tool/
GEND_GBV Rapid Data Quality Review Tool (Excel Version) MEASURE Evaluation 2019 English Data Quality, Gender, GBV, Gender-based violence, Data Quality Review This tool is designed to identify data collection and reporting gaps to improve GEND_GBV data quality, and should be used by implementing partners (IPs), PEPFAR country teams, and/or USAID/Washington. It is also available in PDF and Word.  Access related resources at https://www.measureevaluation.org/resources/gend_gbv-rapid-data-quality-review-tool/
Evaluation of Services for Orphans and Vulnerable Youth in Botswana: Quantitative Findings MEASURE Evaluation 2019 English Africa, BOTSWANA OVC programs, Orphans and Vulnerable Children, PEPFAR, Children, OVC, Evaluation, Botswana Since 2016, the Botswana Comprehensive Care and Support for Orphans and Vulnerable Children (BCCOVC) Project—funded by the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—has supported the Government of Botswana (GOB) to deliver social services in seven PEPFAR priority sites. The BCCOVC project is implemented by Project Concern International (PCI) and builds on the previous PCI-implemented Tsela Kgopo OVC and Gender project (2011–2016). It supplements the core package of GOB services for orphans and vulnerable children (OVC): provision of food, school uniforms, clothes, shoes, and toiletry items to orphaned and vulnerable youth. Its goals are to increase uptake of HIV testing and other reproductive health services, strengthen economic opportunities for young people, and improve educational outcomes. With support from the United States Agency for International Development (USAID), the USAID- and PEPFAR-funded MEASURE Evaluation project led an evaluation to determine whether OVC beneficiaries who have participated in one to two years of OVC services from the GOB and BCCOVC project have better health, economic, and educational outcomes than do OVC beneficiaries who received only the GOB’s OVC services. The study employed a two-arm quasi-randomized design. Data were collected from 2,358 youth in September–December, 2018, through household visits, with follow-up phone calls to 206 Form 5 students in February 2019 to collect data on educational outcomes. Quantitative data were analyzed to explore bivariate associations between the study arm and primary and secondary outcomes. Multivariate logistics and linear regressions were used to examine study outcomes, controlling for age, sex, school status, orphanhood, and primary caregiver. Results from the quantitative portion of the study are presented here. The study also had a qualitative component whose results are summarized in a brief available here: Access related resources here: https://www.measureevaluation.org/resources/evaluation-of-services-for-orphans-and-vulnerable-youth-in-botswana. The full report on the evaluation is also available on this web page.
Community-Based Indicators for HIV Programs MEASURE Evaluation 2019 English CBIS, HIV/AIDS, Community, Community-based health information systems, HIV, Community-based Information from community-based health programs is important for understanding what HIV programs are doing to test, treat, and retain in care people who are living with HIV. To provide standard measures of performance, MEASURE Evaluation developed a collection of community-based indicators that help programs to inform HIV programming at the community level. The Community-Based Indicators for HIV Programs collection includes detailed indicator definitions, data use cases for selected indicators, additional resources, and a means to submit an indicator or make recommendations. The online version of the collection is available at https://www.measureevaluation.org/community-based-indicators.
Evaluation of Services for Orphans and Vulnerable Youth in Botswana: Final Report Mandal, M., Cannon, A., Parker, L., Halldorsdottir, I., & Millar, E. 2019 English Africa, BOTSWANA Evaluation, Botswana, Orphans and Vulnerable Children, Children, OVC, OVC programs This evaluation—conducted by MEASURE Evaluation, a project funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—aimed to understand how orphans and vulnerable children (OVC) programming by the Government of Botswana (GOB) and the PEPFAR-funded Botswana Comprehensive Care and Support for Orphans and Vulnerable Children (BCCOVC) project prepares older youth to be healthy, productive young adults. It examined the effect of services on the educational, economic, and health outcomes of older youth graduating from the programs.This mixed-methods evaluation was a one-time quasi-experimental study, with the intervention group receiving services from the BCCOVC project and the GOB and a comparison group receiving services from the GOB only. The primary outcomes were as follows: Youth who sat for and passed the Botswana General Certificate of Secondary Education exam (i.e., received a score of 36 points or higher) in 2018 Youth who had basic financial literacy Youth who had an HIV test in the past 12 months and knew their test results The BCCOVC project had mixed success in improving HIV and health, economic strengthening, and education outcomes. It had some effect on HIV/health and economic strengthening outcomes but none on education outcomes. Qualitative data revealed youth perspectives around accessing HIV testing and treatment, awareness of gender-based violence, the importance of education, and economic challenges and aspirations. HIV-positive respondents reported that teen clubs provided support and improved adherence. Adolescent OVC are an important population to support as they transition to adulthood, and additional research is needed to understand how services reach them. Access related resources here: https://www.measureevaluation.org/resources/evaluation-of-services-for-orphans-and-vulnerable-youth-in-botswana.
USAID Ghana's Strengthening the Care Continuum Project: Midterm Assessment Elizabeth Sutherland, Abby Cannon, Samuel Day, Justice Nonvignon, Shaylen Foley, Brittany Schriver Iskarpatyoti, Kwasi Torpey 2019 English Ghana, Continuity of Care, Key Populations, KP, HIV This study was a midterm performance assessment of the United States Agency for International Development (USAID Strengthening the Care Continuum Project in Ghana. This project is designed to provide and scale up accessible, high-quality HIV services to Ghana’s key populations (KPs)—men who have sex with men, female sex workers, and transgender people—and promote transition of service provision to the Government of Ghana. The study used primary and secondary data collection: reviews of program data, client and provider surveys, focus group discussions with service providers, and key informant interviews with stakeholders at the national and local service-delivery levels. It also drew on chart abstraction data for KPs enrolled in case management services, as well as costing data for the service delivery modalities undertaken by the Care Continuum project. The study found that the Care Continuum project is well regarded by clients, providers, and stakeholders for the services it provides. The study also noted the project’s contributions to a policy environment more favorable to high-quality HIV service delivery for KPs. Chart abstraction and program data reveal that retention of KPs in care and treatment programs is a challenge in Ghana. Gender could be better integrated in services for KPs, who are highly vulnerable to gender-based violence. Finally, costs per beneficiary of the “new” intervention modalities, case management, and the healthy living platform are high, in part, because of the recent rollout of these interventions. As these modalities scale up and serve more people, costs per beneficiary should decrease—a clear benefit, especially if scale-up brings improvements in retention in care and treatment of HIV-positive KPs.
Gender and HIV Key Populations: A Summary of Evidence-Based Interventions MEASURE Evaluation 2019 English HIV/AIDS, PEPFAR, HIV, Gender, Key Populations, KP A gender analysis is an important planning tool for the development of effective HIV interventions to reach the 95-95-95 targets of the United States President’s Emergency Plan for AIDS Relief (PEPFAR). These goals are that by 2020, 95 percent of all people living with HIV will know their status, 95 percent of all those with diagnosed HIV infection will receive sustained antiretroviral therapy (ART), and 95 percent of all those receiving ART will have viral suppression. Beginning in 2014, PEPFAR guidance for conducting a gender analysis included a focus on these populations key to the epidemic: men who have sex with men (MSM), people who use drugs, transgender people, and sex workers (PEPFAR, 2014). Mapping to “actionable” programmatic recommendations based on the findings of a gender analysis is arguably the most important and difficult step for PEPFAR operating units. For key populations, gender is but one component of their identity that contributes to social marginalization and increased vulnerability to acquiring the virus. HIV-related interventions for key populations have typically emphasized human rights more broadly, rather than specific gender-related barriers to reaching the targets. For this reason, it can be difficult for PEPFAR teams to design interventions that deal with the gender-related factors identified in their gender analyses. To address this need, MEASURE Evaluation—a project funded by the United States Agency for International Development and PEPFAR—conducted a literature review of HIV interventions acting on a gender-related factor for key populations. This brief summarizes the methods used for the review and presents a table that lists HIV interventions addressing a gender-related factor, organized by key population.
Scale-Up Assessment for the Mphatlalatsane Project—“Early Morning Star”—in Lesotho MEASURE Evaluation 2019 English Lesotho, PMTCT, Orphans and Vulnerable Children, OVC, Child health, Children, HIV, Scale-up The HIV epidemic has a profound effect on children in sub-Saharan Africa, where more than 15.1 million children have lost one or both parents. In 2014, as part of its orphans and vulnerable children (OVC) programming, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) announced a special initiative for children under five years old affected by the epidemic. The initiative funded interventions and research in southern Africa (Lesotho, Eswatini [formerly Swaziland], and Zimbabwe) to generate data on successful approaches that result in improved health, to establish evidence to improve and inform programming, and to determine the potential for program scale-up. The programs integrated OVC programming with pediatric treatment and prevention of mother-to-child transmission (PMTCT) of HIV. Evaluations of each intervention generated data on successful approaches that improve health and early childhood development outcomes; the evaluations also established evidence to improve programs. However, evidence of effectiveness is not enough to ensurethat interventions become part of routine program implementation elsewhere. Achieving that end requires early planning and strong advocacy from multiple stakeholders. To prepare for potential scale-up after the results of the evaluation become available (scaleup pertains to efforts to reach more people with a proven practice, more quickly and more effectively), the United States Agency for International Development (USAID) asked its funded project—MEASURE Evaluation—to assess the scalability of the ECD-integrated intervention in each country. This document outlines intervention and assessment results in Lesotho. The Mphatlalatsane project, or “Early Morning Star,” was implemented by Management Sciences for Health (MSH), in partnership with Stellenbosch University, University College London, and Oxford University. The aim was to increase HIV testing and treatment while improving early childhood development outcomes in the mountainous Mokhotlong District. The project was implemented through existing early childhood care and development (ECCD) centers to evaluate the intervention in a remote and hard-to-reach region. This brief summarizes the background, data collection methods, analysis, findings, and recommendations of this scale-up assessment.
Enabling and Expanding the Scope of Public Health Decision Making in Uganda to Reduce Maternal Mortality: Concept Note and Use Case Kumar, M., Kim, T. E., Millar, E., Ongechi, K. S., & Weiss, W. 2019 English Uganda, MCH, Public Health, Maternal health, Maternal mortality In Uganda, the maternal mortality ratio (MMR) was 336 maternal deaths per 100,000 live births in the seven-year period preceding the 2016 Uganda Demographic and Health Survey (UDHS) (Uganda Bureau of Statistics [UBOS] & ICF, 2018). This is a notable decrease from the MMR of 438 maternal deaths per 100,000 live births in the seven-year period preceding the 2011 UDHS (UBOS & ICF International, 2012). Even so, the country’s MMR is still much higher than the target for 2030 set by Sustainable Development Goal (SDG) 3 (United Nations [UN], 2015): fewer than 70 maternal deaths per 100,000 live births globally, and around 111 for Uganda (UN, 2015). Much work needs to be done in Uganda to close this significant gap and achieve the SDG 3 there. A major cause of maternal mortality is postpartum hemorrhage (PPH) (Partnership for Maternal, Newborn & Child Health, 2011). Deaths owing to hemorrhage at a facility could perhaps be attributed to a stockout of uterotonics or lack of a provider trained to give a uterotonic. Typically in the low- and middle -income countries, a health management information system (HMIS) does not provide data on stockouts and training of health staff, yet these are important data elements. Data on maternal complications and cause of maternal mortality are also vital but rarely collected. These are important for understanding what types of complications and causes of death are most common in a particular area, which is helpful when planning trainings and delivery of commodities. As can be seen, preventing maternal mortality involves many aspects of a health system, and thus data from the different elements are needed to inform programs and policies. The PPH use case presented in this document shows that typically, policymakers and program managers make two types of decisions, and these are based on the sources of data they use for decision making.
Digital data ethics in low- and middle-income countries: The road ahead Sam Wambugu, James C. Thomas, Denise Johnson, Christina Villella 2019 English Privacy, Digital Health, Data security, EHealth, Data ethics, Data Background: Digital health contributes to strong health information systems, facilitating improved access to healthcare and quality of care, and decreased health system costs. Health data are at risk of tampering by malicious actors or inadvertent access if stored on porous and poorly maintained information systems. The thoughtful application of information technology in the health sector requires the careful integration of legal, technological, medical, and societal perspectives to safeguard the privacy of individuals and populations. Methods: With support from the United States Agency for International Development (USAID), MEASURE Evaluation conducted an assessment of health data security, privacy, and confidentiality practices through a literature review and key informant interviews with stakeholders in the health sector in Kenya and Tanzania. Results: Stakeholders in the two countries expressed a keen interest in the need to address the issues of data security, privacy, and confidentiality. All agreed that digital health data ethics, including security and privacy, are important but are uncharted territory in these countries. The study revealed several issues: inadequate capacity to effectively implement secure information systems; weak or non-existent legal frameworks for data protection; and lack of a dedicated unit in ministries of health, with appropriately skilled staff, to oversee data ethics. Participants in Kenya and Tanzania called for the establishment of an institutional framework for data governance that would oversee digital health data ethics issues. Conclusions: Maintaining client confidentiality in the digital era is difficult, especially in the health sector where data are among the most sought-after by hackers. Study participants in Kenya and Tanzania stated that they need tools and expertise to help assess the preparedness of existing systems and their conformity with the changing digital health landscape; and awareness raising among health policy planners and decision makers on the need for guidance on digital data ethics. Discussions on these topics and lessons from digital health projects provide important evidence for developing or updating national digital health frameworks. This article highlights the importance of bringing data ethics to the forefront of efforts to integrate digital health in health service delivery management in low- and middle-income countries.
Impact Evaluation of the Mayer Hashi II Project in Bangladesh Rahman, M., Curtis, S., E-Ijdi, R., Haider, M., Imam, A., Ahmed, A., Bloom, S. 2019 English BANGLADESH, Asia Family Planning, Child Mortality, Child survival, Contraception, Reproductive Health, Child Health, Bangladesh, Children, Impact Evaluation The USAID-supported Mayer Hashi Phase II (MH-II) project, implemented during October 2013 through September 2018 aimed to increase the use of effective family planning (FP) and reproductive health services, with a focus on the informed and voluntary use of long-acting reversible contraceptives (LARCs) and permanent methods (PMs). This external impact evaluation was conducted by MEASURE Evaluation to determine the impact of the MH-II project on LARC and PM use at the population level. The evaluation used household, provider, and facility surveys conducted in 2015 and 2017 in early (Phase I) and late (Phase III) implementation districts supplemented by qualitative interviews with district family planning managers in 2017 to contextualize results. There were no increases in LARC and PM use or in intention to use LARCs and PMs at the population level in Mayer Hashi Phase I or Phase III program areas by 2017. The percentage of providers who were trained in LARCs and PMs and PPFP increased notably in both Phase I and Phase III areas, but changes in intermediate outcomes hypothesized along the program pathway were not realized. Contextual analysis identified chronic system weaknesses in provision of LARCs and PMs outside of the scope of the MH-II project and persistent low demand for LARCs and PMs as impediments to widespread increases in the use of LARCs and PMs. Future programs focusing on LARCs and PMs need to consider these larger system constraints in their design and in setting their expected outcomes. They also need to further engage the private sector given its growing role in health care.
Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Kenya: Report on a Workshop to Disseminate 2016–2018 Findings Sinai, I., Odour, C., Akeyo, D., & Kadengye, D. 2019 English Monitoring, Workshop, OVC programs, Kenya, OVC, Orphans and Vulnerable Children In 2018, the orphans and vulnerable children (OVC) team of the United States President’s Emergency Plan for AIDS Relief (PEPFAR)/Kenya requested assistance from the United States Agency for International Development (USAID) and the USAID- and PEPFAR-funded MEASURE Evaluation project to conduct three panel studies and one cross-sectional survey for three ongoing PEPFAR OVC projects in western Kenya: Making Well-Informed Efforts to Nurture Disadvantaged Orphans & Vulnerable Children (MWENDO), a USAID-funded project of Catholic Relief Services; the Timiza 90 project of the United States Centers for Disease Control and Prevention (CDC); and the Walter Reed Program/Henry M. Jackson Foundation Medical Research International (WRP/HJFMRI) HIV project funded by the United States Department of Defense. This was the second round of data collection. MEASURE Evaluation completed the first one in 2016. In the three panel studies (one for each project) the same beneficiary households who were interviewed in 2016 were again interviewed. The main objective for the repeat survey was to evaluate the progress of the OVC projects over the two-year period. In addition, an independent cross-sectional survey (conducted for MWENDO only) was designed to provide a snapshot of the current status of MWENDO beneficiaries in areas not included in the 2016 survey. Fieldwork for the surveys was undertaken in October and November 2018. MEASURE Evaluation conducted a workshop in Kisumu, Kenya, on March 20–21, 2019, to disseminate the results from the 2018 surveys. On the first day, program managers from the three projects met to review the findings from the four surveys and compare them with the 2016 findings. They discussed the findings extensively and brainstormed their implications. They then began developing management response plans for their projects. On the second day, they were joined by national- and county-level representatives from Kenya’s Department of Children Services and managers of other PEPFAR-supported OVC projects in Kenya. Findings were again shared, this time including recommendations developed on the first day. The three implementing partners then continued working on their management response plans, while participants from the Department of Children Services and representatives from other OVC programs established recommendations for improving other OVC activities in Kenya based on the findings. The groups then reconvened in plenary and presented their final work. This report summarizes the two-day workshop. Find other materials from Round 2 are here. Materials related to Round 1 can be found here.
Assessing Scale-Up Potential for the Zimbabwe Expanded IMPACT Project MEASURE Evaluation 2019 English ZIMBABWE OVC, OVC programs, PMTCT The HIV epidemic has a profound effect on children in sub-Saharan Africa, where more than 15.1 million children have lost one or both parents. In 2014, as part of its orphans and vulnerable children (OVC) programming, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) announced a special initiative for children under five years old affected by the epidemic. The initiative funds interventions and research in Lesotho, Eswatini (formerly Swaziland), and Zimbabwe that integrate early childhood development (ECD) with pediatric HIV treatment or prevention of mother-to-child transmission of HIV (PMTCT). Evaluations of each intervention generate data on successful approaches that improve health and early childhood development outcomes; the evaluations also establish evidence to improve programs. However, evidence of effectiveness is not enough to ensure that interventions become part of routine program implementation elsewhere. Achieving that end requires early planning and strong advocacy from multiple stakeholders. To prepare for potential scale-up after the results of the evaluation become available (scale-up pertains o efforts to reach more people with a proven practice more quickly and more effectively), the United States Agency for International Development (USAID) asked MEASURE Evaluation to assess the scalability of the ECD-integrated intervention in each country. (MEASURE Evaluation is a project funded by USAID and PEPFAR.) This document outlines interventions and assessment results in Zimbabwe.
Creating a Culture of Data Use in Tanzania: Assessing Health Providers’ Capacity to Analyze and Use Family Planning Data Mackfallen G. Anasel, Idda L. Swai, Orest S. Masue 2019 English TANZANIA Data Quality, Qualitative Evaluation, Family Planning, Data use, Maternal health, Routine Health Information Systems, Routine data, Maternal and child health, DHIS 2 Tanzania has embarked on extensive health planning reforms that require all districts and selected health facilities to collect, process, analyze, and use data for informed decision making. To support these reforms, the Government of Tanzania, in collaboration with development partners, has invested heavily in strengthening its health management information system and connecting all local government authorities to DHIS 2, a web-based software for analyzing, reporting, and disseminating data for health programs. However, data quality issues continue to affect the planning process. The information used in priority setting for family planning (FP) and maternal and child health is incomplete or inaccurate, and staff capacity to analyze and set priorities is questionable. The objectives of this study were to understand health providers’ capacity to analyze collected FP data and to document available evidence of health service providers using the collected data in their planning processes. The study employed a qualitative design to understand FP providers’ experiences with analyzing and using FP data for decision making.
Renforcer et améliorer les systèmes d’information sanitaire Progrès en Côte d’Ivoire MEASURE Evaluation 2019 French Health Information Systems, Cote d'Ivoire, HIS strengthening, Health Systems Strengthening, HIS Un système national d’information sanitaire (SNIS) est la pierre angulaire de la capacité d’un pays à rassembler des données afin de comprendre les problèmes de santé. En Côte d’Ivoire, le projet MEASURE Evaluation—financé par l’Agence des Etats-Unis pour le développement international (USAID)—travaille avec le Ministère de la Santé et de l’Hygiène Publique (MSHP) et ses partenaires de mise en oeuvre depuis 2004 pour renforcer la performance et la gestion du SNIS. Le projet appuie la gouvernance du SNIS (environnement propice), le développement et déploiement d’outils et de produits qui répondent aux besoins en information sanitaire (génération de l’information) et le renforcement des capacités des utilisateurs du SNIS (l’élément humain). Tous ces éléments sont nécessaires à la performance du SNIS. Ce document donne un aperçu du travail accompli en vue de renforcer le système d’information sanitaire (SIS) de la Côte d’Ivoire jusqu’à la date de juin 2019.
Strengthening and Improving Health Information Systems: Progress in Côte d’Ivoire MEASURE Evaluation 2019 English HISS, Cote d'Ivoire, HIS, HIS strengthening, Health Information Systems, Health Systems Strengthening A national health information system (HIS) is the backbone for a country’s capacity to gather data to understand health issues. In Côte d’Ivoire, MEASURE Evaluation—funded by the United States Agency for International Development—has worked since 2004 with the Ministry of Health and Public Hygiene (MSHP) and implementing partners to strengthen the performance and management of the country’s HIS. The project supports the governance of the HIS (enabling environment), the development and rollout of tools and products that respond to health information needs (information generation), and capacity development of HIS users (the human element). All of these elements are necessary for HIS performance. This document provides a snapshot of the work accomplished to strengthen HIS in Côte d’Ivoire as of June 2019.
Conjunto de herramientas del diagnóstico de la capacidad para monitoreo y evaluación: Guía de uso MEASURE Evaluation PIMA 2019 Spanish M&E, MECAT, Capacity Assessment, MEASURE Evaluation PIMA, Monitoring, Evaluation El conjunto de herramientas de diagnóstico de la capacidad de monitoreo y evaluación (MECAT— por su sigla en inglés) es un conjunto de herramientas para orientar a las organizaciones1 mediante un proceso que evalúa la capacidad actual de MyE de una organización, identifica brechas e indica áreas para fortalecer la capacidad de la organización a fin de mejorar sus sistemas de MyE. El proceso de diagnóstico de MECAT utiliza cuatro métodos y herramientas de apoyo: (1) diagnóstico grupal; (2) diagnóstico individual; (3) entrevistas con informantes clave; y (4) una revisión de la documentación correspondiente. Con este enfoque, las organizaciones, los programas y equipos nacionales y subnacionales de salud pueden evaluar con exactitud las fortalezas y deficiencias de los programas, y planificar los pasos necesarios para fortalecer las funciones de MyE.
Descripción de la herramienta de evaluación de la capacidad de monitoreo y evaluación MEASURE Evaluation 2019 Spanish MECAT, M&E, Monitoring, Evaluation, Capacity Assessment En todo el mundo, el uso de datos del sistema de salud para orientar las decisiones sobre cómo se asignan los recursos está aumentando rápidamente, y los ministerios de salud y programas nacionales de salud están buscando formas para garantizar que la calidad de los datos del sistema de salud sea confiable. Como resultado, la recopilación de datos, compaginación, informes y uso están cada vez más bajo escrutinio, y los esfuerzos para fortalecer los sistemas de información de salud (SIS) deben centrarse en la mejora del monitoreo y la evaluación (MyE) de programas de salud, comenzando con evaluaciones de línea basal relativas a la capacidad y el rendimiento estandarizadas. Para ayudar a satisfacer esta necesidad, MEASURE Evaluation, el proyecto emblemático de fortalecimiento de MyE y SIS de la Agencia de los Estados Unidos para el Desarrollo Internacional, y su premio asociado en Kenia, MEASURE Evaluation PIMA, (MEval-PIMA) han desarrollado un proceso y un conjunto de herramientas para llevar a cabo una evaluación de línea basal estándar de capacidad de MyE. El diseño de esta evaluación se enmarca en los “12 componentes” utilizado por el Programa Conjunto de las Naciones Unidas sobre el VIH/SIDA (ONUSIDA) para fortalecer los sistemas de MyE en todo el mundo (ONUSIDA, 2009; ONUSIDA, 2010). MEval-PIMA lo utilizó por primera vez en Kenia para fijar líneas basales en programas nacionales beneficiarios y en 17 territorios objetivo. Desde entonces el conjunto de herramientas se ha adaptado para su uso en evaluaciones en otros países para ayudar a los profesionales administrativos y de salud a tomar decisiones, monitorear el progreso, y diseñar intervenciones de capacidades para el constante mejoramiento de SIS. El conjunto de herramientas de evaluación de la capacidad de monitoreo y evaluación (MECAT—por su sigla en inglés) es una serie de herramientas para orientar a las organizaciones a través de un proceso que evalúa la capacidad actual de MyE de una organización1, identifica brechas e indica áreas para fortalecer la capacidad de la organización a fin de mejorar el sistema de MyE. Monitoring and Evaluation Capacity Assessment (MECAT) Toolkit
Quality of Tuberculosis Services Assessment in Nigeria: Report Kolawole Oyediran 2019 English NIGERIA Service delivery, TB, Assessment, Tuberculosis, Quality of care According to the 2018 Global Tuberculosis Report released by the World Health Organization (WHO), tuberculosis (TB) is the tenth leading cause of death and is the leading cause of death from a single infectious agent. Heads of state committed to ambitious targets aimed at eliminating TB during the first-ever United Nations High-Level Meeting on Tuberculosis conducted in September 2018 at the United Nations General Assembly. WHO has identified 30 countries where the TB burden is high, including Nigeria. The 2016 National Health Policy highlights TB as a priority public health challenge and targets “reduction in the tuberculosis prevalence rate and the tuberculosis mortality rate in Nigeria by ensuring universal access to high-quality, client-centered TB/leprosy diagnosis and treatment services.” Service quality remains a concern and has received very limited attention in the TB research agenda in Nigeria. Only a few studies, focused on small geographic areas, have been implemented or published, and there has been no prior nationwide study of the quality of TB services in Nigeria. Studies show that good quality of care in TB services helps patients and their families address their health needs safely and effectively. Therefore, to enhance TB service use, there is a need to assess and improve the quality of TB services. A Quality of TB Services Assessment (QTSA) was conducted by MEASURE Evaluation in Nigeria to assess the quality of TB services in randomly selected health facilities. Its purpose was to identify where services were of high quality and where there were gaps and to ensure that TB patients were receiving the care that they deserve. The QTSA assessed three domains of quality of care: the structure of the health facility, the service delivery process, and the outcomes of service delivery. The results were used to develop programs or interventions to improve TB service delivery. The QTSA tools adapted for use in Nigeria are available here: https://www.measureevaluation.org/resources/publications/tl-19-42 QTSA documents for other countries are available here: https://www.measureevaluation.org/our-work/tuberculosis/quality-of-tb-services-assessments
Quality of Tuberculosis Services Assessment in Nigeria: Tools MEASURE Evaluation 2019 English NIGERIA Quality of care, TB, Tool, Service delivery, Tuberculosis The Quality of Tuberculosis Services Assessment (QTSA) is conducted with the support of four tools: the Facility Audit, the Provider Interview, the Patient Interview, and the Record Review. MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID)—developed these four tools with the assistance of colleagues at USAID.  The tools exist in a generic format that is adaptable to any country wishing to conduct a QTSA. For instance, some countries may have different names for their health administrative units (e.g., district, province, ward, or woreda) or the name of their TB registers (e.g., TB patient logbook or TB confirmed cases register). They are customized to fit the country priorities and context in which they will be used. The generic QTSA tools are available at the following link: https://www.measureevaluation.org/resources/publications/tl-19-41/    This document presents only the pilot QTSA tools adapted for use in Nigeria. It provides detailed information about the structure and content of the tools. More information on the QTSA purpose, methods, or results can be found in the individual QTSA reports.  Nigeria’s QTSA report is available here: https://www.measureevaluation.org/resources/publications/tr-19-361/ QTSA documents for other countries are available here: https://www.measureevaluation.org/our-work/tuberculosis/quality-of-tb-services-assessments
Mali: A Statistical Yearbook, in Time MEASURE Evaluation 2019 English DHIS 2, Health Information Systems, HIS, Mali Population health statistics derived from high-quality data in a national health information system (HIS) can reliably track health service coverage or gaps in services and the success or shortcomings of government efforts to improve health for its citizens. Use of this information can inform smart decisions about health policies, suggest programs to curtail or scale up, and guide allocation of scarce resources. In Mali, however, the power of its HIS had not been fully realized. Statistical yearbooks that could have provided compiled data from the prior year were typically only validated in the last quarter of the year following—a full nine months after the fact. This meant the yearbook was less relevant for timely decision making and developing operational plans. In fact, the 2017 statistical yearbook was not even developed—because financial resources weren’t available. That changed in 2019. For the first time, Mali successfully produced validated records of the prior year’s health data before April 30—thanks to a cooperative effort mounted by the Mali Ministry of Health (MOH) with support from MEASURE Evaluation, funded by the United States Agency for International Development (USAID). MEASURE Evaluation helped mobilize financial resources, including help from PSI, for a national validation workshop to aid in developing the yearbooks. Building on Mali’s successful national deployment of DHIS 2 (in only 16 months) as the national health data platform for all health levels, MEASURE Evaluation was able to: (1) support regional activities to compile data, (2) harmonize data from the regions and other multiple sources, and (3) support the national level to help avoid delays that had hampered this work in the past. The two most notable achievements were: (1) the statistical yearbook was produced in timely fashion, developed with all stakeholders, taking into account data from the local health information system (SLIS), the epidemiological surveillance system, and the hospital information system (SIH); and (2) when the data is disseminated, it will provide feedback to field managers and make it possible to measure progress and identify areas for improvement. This brief shares more.
From Fragile to Resilient Health Systems: A Journey to Self-Reliance MEASURE Evaluation 2019 English Global Health Systems Strengthening, self-reliance, Health System Preventable disease, emerging infectious disease, extreme weather-related disasters due to urbanization and environmental degradation, and complications of pregnancy and childbirth still claim far too many lives and challenge the ability of health systems to cope. Meanwhile, shrinking investments, flat country health budgets, population pressures, and complex emergencies challenge the global ability to achieve the United Nations’ Sustainable Development Goals. Some of the world’s experts were convened by the United States Agency for International Development (USAID), which funds MEASURE Evaluation, to take on the topic at its conference in Washington, DC, in March 2019 at a meeting, From Fragile to Resilient Health Systems: A Journey to Self-Reliance. The group addressed multiple factors affecting how health systems are able to respond to routine health challenges and emergencies. For example, what percentage of the health burden are caused by natural and man-made disasters? Or is resilience equally or differentially important at household, community, and institutional or governmental levels? Other topics included consideration of what sectors should contribute to health system resilience and how to measure progress. The meeting gathered experts from USAID, the World Health Organization, the U.S. Department of State, the USAID mission in the Democratic Republic of the Congo, the Bill & Melinda Gates Foundation, the World Bank, UNICEF, Save the Children, World Vision, International Rescue Committee, Johnson & Johnson, GlaxoSmithKline, Johns Hopkins University, Finland’s International Affairs Ministry, Harvard University, Carnegie Mellon University, and MEASURE Evaluation—with all of those perspectives shared in this report. Videos of the presentations given at the meeting are online on MEASURE Evaluation’s YouTube channel at https://www.youtube.com/user/measureevaluation.
L’alignement d’éléments de données pour des programmes VIH cohérents : Réussite en Côte d’Ivoire MEASURE Evaluation 2019 French Africa, COTE D'IVOIRE HIS, Interoperability, HIV/AIDS, HIV, HIV data, OVC programs, HIV care, HIS strengthening, PLHIV, OVC En Côte d’Ivoire, deux bases de données existent pour les programmes liés aux VIH. Le premier programme vient en aide aux orphelins et enfants vulnerables (OEV). Le deuxième programme, DREAMS, (“Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe”) est destiné aux adolescentes et jeunes femmes à risque de contracter le VIH. Ces deux programmes n’ont pas été lancés au même moment et ont donc été construits en utilisant des bases de données séparées. Le problème qui se pose à présent—maintenant que ces deux programmes fonctionnent en proximité l’un de l’autre à travers la Côte d’Ivoire—est que les plateformes d’information respectives des deux programmes ne peuvent pas communiquer entre elles. MEASURE Evaluation, financé par l’Agence des Etats-Unis pour le développement international (USAID) et le Plan d’urgence du Président américain pour la lutte contre le SIDA (PEPFAR), fournira un appui pour le développement d’une liaison entre les bases de données OEV et DREAMS. Une fois ceci fait, les gestionnaires des programmes visant les enfants, adolescents et jeunes adultes pourront plus facilement discerner quelles personnes sont atteintes par leurs interventions et découvrir qui reçoit de l’aide deux fois et qui en contrepartie ne reçoit aucune aide.
L’intégration des systèmes d’information en Côte d’Ivoire améliorera la performance du système sanitaire MEASURE Evaluation 2019 French COTE D'IVOIRE EMIS, HMIS, HIV, HIS strengthening En Côte d’Ivoire en 2004, le plan national de développement sanitaire n’était aligné à aucun cadre de suivi-évaluation; les prestataires de soins ne pouvaient pas suivre les clients d’un service à un autre de manière fiable; les districts sanitaires n’étaient pas capables de mesurer les tendances des maladies et les décideurs au niveau national ne pouvaient ni connaître la qualité ni la couverture des services sanitaires. Cette situation était due d’une part à la non-standardisation des outils de collecte de données et le manque de vérifications de la qualité et de la complétude des données. D’autre part, cette situation était due à la fragmentation des systèmes de gestion des données qui servaient uniquement certains aspects du système sanitaire et non l’ensemble des services de santé. Le projet MEASURE Evaluation, financé par l’Agence des Etats-Unis pour le développement international et le Plan d’urgence du Président américain pour la lutte contre le SIDA, travaille en Côte d’Ivoire depuis 15 ans. La Côte d’Ivoire a maintenant un système national de gestion des données sanitaires—DHIS 2—déployé et utilisé à travers le pays, ainsi qu’un système d’information de gestion logistique électronique utilisé par les clients de la nouvelle pharmacie de santé publique. Cette réalisation est l’aboutissement de nombreuses étapes entreprises par la Côte d’Ivoire.
MEASURE Evaluation Phase IV HIV TA Extender Achievements MEASURE Evaluation 2019 English HIS, HIV prevention, HIV, Health information systems, HIV data, HIV/AIDS In response to USAID’s request to support USAID missions and the USAID’s Office of HIV/AIDS, MEASURE Evaluation implemented a service package focused on monitoring and evaluation, health information systems strengthening, orphans and vulnerable children, adolescent girls and young women, and prevention of mother-to-child transmission of HIV. The goal was to deliver urgent short-term, strategic technical assistance to implement PEPFAR’s Country Operational Plan 2018.
Integrating Data Systems in Côte d’Ivoire Will Improve Health System Performance MEASURE Evaluation 2019 English AFGHANISTAN HIV, HIS strengthening, HMIS, EMIS In Côte d’Ivoire in 2004, the national health strategic plan was not aligned to a monitoring and evaluation framework; health providers could not reliably track clients from one service to another; health districts could not measure disease trends; and national policy makers could not know health service quality or coverage. In part, this situation was caused by non-standardized data collection tools and the lack of checks on data quality and completeness. It was also a result of fragmented data management systems that served one aspect of healthcare but not the full spectrum of health services. This brief outlines the work of MEASURE Evaluation, funded by the United States Agency for International Development and the U.S. President's Emergency Plan for AIDS Relief, to help Côte d’Ivoire address these health data needs. Côte d’Ivoire now has a national health data management system—DHIS2—deployed and used nationwide and an electronic logistics management and supply chain system used by clients of the new public health pharmacy.
Two Things Are Not Always Better, but Two Things that Can Relate Are an Improvement MEASURE Evaluation 2019 English Africa, COTE D'IVOIRE HIS, Interoperability, HIV/AIDS, HIV, HIV data, OVC programs, HIV care, HIS strengthening, HIV PREV, PLHIV, OVC In Côte d’Ivoire, two databases exist for HIV-related programs. One of the programs benefits orphans and vulnerable children (OVC). The other program, DREAMS, (“Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe”) is for adolescent girls and young women at risk for HIV. These two programs originated years apart, and their databases are separate. The problem now—as both programs are operating in proximity to each other across Côte d’Ivoire—is that their separate information platforms can’t talk to each other.  MEASURE Evaluation, funded by the United States Agency for International Development and the U.S. President’s Emergency Plan for AIDS Relief, is supporting development of a link between the OVC and DREAMS databases. This brief outlines the process for developing this link and expected results of these efforts.
Improving GEND_GBV Data Quality: Methods for Assessment MEASURE Evaluation 2019 English Data Quality, Gender-based violence, Data, Gender, GBV To better understand the data quality challenges, gaps, and successes of implementing partners (IPs) in capturing and reporting the PEPFAR MER indicator GEND_GBV, the United States Agency for International Development (USAID) and MEASURE Evaluation collaborated to conduct a rapid assessment of the collection and reporting of GEND_GBV in three countries. This brief describes the process that was taken to collect and analyze data. It can be used by IPs, USAID missions, and USAID/Washington to guide future rounds of data collection and GEND_GBV data improvements. Access a related improvement action strategy and webinar recording.
Improving GEND_GBV Data Quality: Improvement Action Strategy MEASURE Evaluation 2019 English Data Quality, GBV, Gender, Gender-based violence, Data To better understand the data quality challenges, gaps, and successes of implementing partners (IPs) in capturing and reporting the PEPFAR MER indicator GEND_GBV, the United States Agency for International Development (USAID) and MEASURE Evaluation collaborated to conduct a rapid assessment of the collection and reporting of GEND_GBV in three countries. This document highlights common misconceptions and errors experienced in reporting GEND_GBV and provides actionable suggestions for improving GEND_GBV reporting. Watch a webinar recording and access a related brief.
L’évolution de la stratégie de surveillance « Une seule santé » au Burkina Faso MEASURE Evaluation 2019 French Global health security, Surveillance, Burkina Faso, Infectious disease Le Burkina Faso s’est résolu à renforcer les capacités de ses systèmes de surveillance pour la santé humaine, animale (domestique et sauvage) et environnementale. Cet engagement s’est matérialisé par une démonstration du pays à se préparer pour faire face aux menaces sanitaires d’ordre humain, animal (domestique et sauvage) et environnemental, à les prévenir, à les détecter et à riposter. Il s’est agi également d’être en mesure d’anticiper et de réduire les impacts de ces potentielles menaces sur le développement social, culturel et économique du pays. Ce rapport décrit l’évolution de la stratégie de surveillance « Une seule santé » au Burkina Faso.
A Manual for Routine Monitoring of the Alternative Care System in Ghana MEASURE Evaluation 2019 English GHANA Routine Health Information Systems, Routine data, Alternative Care, manual Globally, there are multiple efforts to reform child welfare systems to promote better care for children, with attention to preventing unnecessary separation of children from their families and ensuring the provision of alternative care for children deprived of parental care. In Ghana, the need for a strong monitoring and evaluation (M&E) system has been identified as necessary to provide timely, reliable, and accurate information to assess whether approaches and interventions are effective, to improve accountability and learning, and to inform planning and monitoring decisions about policies and programs. For example, data on children in formal alternative care can help identify the need for new childcare services and allow policymakers and service providers to make evidence-based decisions about care to better design and manage care reform programs, resulting in better outcomes for children. The purpose of this manual is to provide guidance on how to collect and report data on children in formal alternative care in a standardised way, and to analyse, present, and make the data available for use. The manual describes the necessary data management procedures, and the roles and responsibilities of different stakeholders for generating high-quality data on alternative care. The guidelines present a range of indicators for alternative care, the sources of information, the frequency of reports on alternative care, and monitoring and review structures. As with all M&E manuals, it is intended to be a working document.
The PLACE Mapping Tool MEASURE Evaluation 2019 English Geographic Information Systems, Mapping, PLACE, QGIS, Spatial Analysis, GIS The Priorities for Local AIDS Control Efforts (PLACE) method mapping tool allows users to produce the planning and coverage maps they need, even with limited knowledge of a geographic information systems (GIS).  Because the tool works as a plug-in with QGIS (a popular free and open-source GIS program), a researcher can use it to import data and display them in a basic fashion on a computer screen and in a printout. The tool also allows a GIS technician to work with the data later, if need be. The tool can handle two types of geographic data: Planning data (such as census or population data or HIV prevalence data, usually shown as a percentage or priority score, by district) Prevention/outreach targeting data (discrete locations, such as venues where key populations gather, or information about condom distribution) Output is generated automatically both as a PDF, which includes title and legend information that the user can customize, and a QGIS file, which can be used for further customization, future display, or further spatial analysis. Learn more.
Questions as an Organizing Framework for Health Information Systems James C. Thomas, Manish Kumar 2019 English Health Information Systems, Health Services, HIS, Data, Information systems A country’s health services are guided by an information system that reveals which health services are most needed and where. Among its many uses, a health information system (HIS) can show which programs are effective, and it can help a country coordinate with neighboring countries in combatting an epidemic that crosses their borders. The flow of data used for these purposes resembles a vast watershed that gives rise to a river—unconnected rivulets that coalesce together to form increasingly large flows. Individual data elements originate in a wide variety of institutions and settings. The data collectors add counts of individual patients or vials of medicine into aggregate numbers and send them to district, provincial, and national offices. The reach of an HIS is broad, ideally extending into any place where people are living. It is composed of subsystems designed to focus on components as disparate as patient diagnoses and the availability of hospital beds. Each subsystem has its own paper forms for data collection or, increasingly, its own digital system for data collection, storage, and analysis. It is difficult to see an HIS as a whole or to understand it due to its complexity. This obscures which components most need strengthening and compromises the coordination and collaboration essential to establishing a strong HIS. A framework that shows how the parts fit together and function toward a larger purpose can lessen the confusion. A variety of frameworks has been proposed in the last 10 years or so to serve this purpose. In this paper we describe those frameworks, identify their limitations, and propose a new framework that is more informative and helpful. The frameworks previously proposed were based on a set of systems, a means of informing programs, and levels of health system governance. The system we propose is based on questions that an HIS needs to address.
Geographic access to emergency obstetric services: a model incorporating patient bypassing using data from Mozambique Emily B Keyes, Caleb Parker, Seth Zissette, Patricia E Bailey, Orvalho Augusto 2019 English Maternal health, Obstetric care, Maternal mortality, Obstetrics, Geography, Geospatial analysis, Mozambique Introduction: Targeted approaches to further reduce maternal mortality require thorough understanding of the geographic barriers that women face when seeking care. Common measures of geographic access do not account for the time needed to reach services, despite substantial evidence that links proximity with greater use of facility services. Further, methods for measuring access often ignore the evidence that women frequently bypass close facilities based on perceptions of service quality. This paper aims to adapt existing approaches for measuring geographic access to better reflect women’s bypassing behaviour, using data from Mozambique. Methods: Using multiple data sources and modelling within a geographic information system, we calculated two segments of a patient’s time to care: (1) home to the first preferred facility, assuming a woman might travel longer to reach a facility she perceived to be of higher quality; and (2) referral between the first preferred facility and facilities providing the highest level of care (eg, surgery). Combined, these two segments are total travel time to highest care. We then modelled the impact of expanding services and emergency referral infrastructure. Results: The combination of upgrading geographically strategic facilities to provide the highest level of care and providing transportation to midlevel facilities modestly increased the percentage of the population with 2-hour access to the highest level of care (from 41% to 45%). The mean transfer time between facilities would be reduced by 39% (from 2.9 to 1.8 hours), and the mean total journey time by 18% (from 2.5 to 2.0 hours). Conclusion: This adapted methodology is an effective tool for health planners at all levels of the health system, particularly to identify areas of very poor access. The modelled changes indicate substantial improvements in access and identify populations outside timely access for whom more innovative interventions are needed.
Best practices in availability, management and use of geospatial data to guide reproductive, maternal, child and adolescent health programmes Yordanos B Molla, Kristine Nilsen, Kavita Singh, Corrine Warren Ruktanonchai, Michelle M Schmitz, Jennifer Duong, Florina Serbanescu, Allisyn C Moran, Zoe Matthews, Andrew J Tatem 2019 English Geospatial analysis, Child health, Newborn health, Maternal health, Reproductive Health, Adolescent health The commentary provides a set of considerations and some examples for reproductive, maternal, newborn, child and adolescent health (RMNCAH) programmes that wish to use geospatial data.
Geospatial analysis for reproductive, maternal, newborn, child and adolescent health: gaps and opportunities Zoe Matthews, Barbara Rawlins, Jennifer Duong, Yordanos B Molla, Allisyn C Moran, Kavita Singh, Florina Serbanescu, Andrew J Tatem, Kristine Nilsen 2019 English Maternal health, Adolescent health, Geospatial analysis, Newborn health, Child health, Reproductive Health Reproductive, maternal, newborn, child and adolescent health (RMNCAH) indicators, such as the maternal mortality ratio, often serve as a litmus test for health system performance, because women’s and children’s health lies at the core of any health system.1The health and survival of women and children does not depend on a single intervention, but on packages of interventions delivered at all levels of the health system. Mapping and tracking RMNCAH therefore captures changes in wider health system performance. But mapping has traditionally been the domain of disease-specific tracking, providing useful, but limited snapshots of progress embedded in vertical intervention mechanisms. Although disease-specific spatial mapping and research are effective ways to identify geographic inequities and to inform service provision, geographic and spatial analyses of RMNCAH have the potential to provide a broader perspective. But such analyses, especially for routine RMNCAH care provision, have been underused despite their potential to inform programmes and policies in low/middle-income countries. This commentary also argues that visualisation of RMNCAH data provides a potent social accountability and decision-making tool. Given the topic’s importance, a supplement on the use of geographic information systems (GIS) in RMNCAH is long overdue.
How MEASURE Evaluation Has Benefitted PEPFAR and Ministries of Health MEASURE Evaluation 2019 English Capacity Building, PEPFAR, HIS, Data, Health information systems, HIS strengthening, Data use, DATIM The President’s Emergency Plan for AIDS Relief (PEPFAR) aims to achieve epidemic control by taking effective interventions to scale, applying a continuous learning approach to program performance, and intensifying efforts to identify HIV/AIDS cases. MEASURE Evaluation’s work has advanced PEPFAR’s aim in two primary ways: Supporting the implementation, management, and capacity building of the Data for Accountability, Transparency and Impact Monitoring (DATIM) system, and Increasing the capacity of health information systems (HIS) and improving enabling environments for HIS improvement at global, regional, and country levels—especially in PEPFAR countries. MEASURE Evaluation’s direct contributions to the implementation of DATIM and leveraging DATIM resources are extensive. Our work encompasses data exchange, help desk support to enhance system and data use, and capacity building for DATIM users, as well as administration and oversight of a constellation of DATIM subcontractors. This brief shares more.
Three Government Ministries— One Health Eric Geers 2019 English Global health security, Surveillance, Burkina Faso, One Health Surveillance for diseases with epidemic potential in Burkina Faso has traditionally involved the Ministry of Health (MOH) for human diseases and the Ministry of Animal Resources and Fisheries (MRAH) for animal diseases. The surveillance system was largely passive, relying principally on staff at health and veterinary facilities to report cases seen at their facilities. In 2017, the MOH in Burkina Faso mounted a pilot training project in three districts to explore expanded surveillance in communities, using community health agents (agents de santé de base communautaire, or ASBCs). MEASURE Evaluation, funded by the United States Agency for International Development (USAID), built on this test project by layering in a multisectoral, One Health surveillance approach, training additional agents working outside of the health sector in these communities. To implement a One Health approach, MEASURE Evaluation worked with national, regional, provincial, and district technical representatives from three government ministries: The MOH, the MRAH, and the Ministry of Environment, Green Economy and Climate Change. This brief shares more.
Diagnóstico de las Capacidades en Monitoreo y Evaluación Sistema de Información de Salud de VIH en El Salvador MEASURE Evaluation 2019 Spanish HIS, HIV, El Salvador, MECAT, Capacity Assessment, Monitoring, Evaluation Los esfuerzos que El Salvador ha realizado desde el diagnóstico de los Sistemas de Información en Salud (SIS), en el marco de la iniciativa mundial de la Red de la Métrica de Salud (RMS o HMN por sus siglas en inglés: Health Metrics Network) en el 2006, han surtido efectos importantes. Los esfuerzos para contar con SIS fuertes han sido liderados desde el Ministerio de Salud (MINSAL) con la participación de instituciones que generan estadísticas sanitarias y el apoyo de organismos cooperantes. El enfoque de estas acciones se ha centrado en el apoyo que se brinda a la gestión y evaluación de las políticas de los servicios de salud para asegurar el uso óptimo de recursos en ayuda a la toma de decisiones. El compromiso de elevar los niveles de salud de la población y la limitación de recursos ratifica la necesidad de poder contar con un SIS sólido, que funcione de forma sistémica, en un proceso que reúna, comparta, analice y favorezca la utilización de la información, preocupación que se ha materializado en el desarrollo de planes de fortalecimiento a corto, mediano y largo plazo que han contribuido a la toma de buenas decisiones. El MINSAL está a cargo del Sistema Único de Información en Salud (SUIS) en el que se articulan diferentes subsistemas los cuales generan en línea y tiempo real, reportes que determinan ser un sistema sumamente rápido que contribuye en forma expedita a la toma de decisiones por parte de los gerentes de la institución, y de actores ligados al sector sanitario. Como parte de la estrategia regional del Plan de Emergencia del Presidente de los Estados Unidos para el Alivio del Sida (PEPFAR) y la Agencia de los Estados Unidos para el Desarrollo Internacional (USAID) en Centroamérica, MEASURE Evaluation implementa actividades de fortalecimiento de los SIS en VIH teniendo como contraparte a los ministerios de salud de la región. Para poder contar con un SIS que, utilizando datos de calidad, genere reportes que faciliten la toma de buenas decisiones, enfocados en alcanzar las metas de eliminación del VIH para el 2030, se requiere valorar el estado del rendimiento y la capacidad de monitoreo y evaluación (MyE) del sistema en áreas funcionales clave. Para ello, es necesario llevar a cabo un diagnóstico de este sistema, que en forma rápida permita elaborar una propuesta de plan de acción para reducir las brechas identificadas por áreas de capacidad. En el presente documento se describen los antecedentes, objetivos, metodología, resultados, discusión, recomendaciones y conclusiones del Diagnóstico de las Capacidades de MyE del SIS del VIH en El Salvador.
Diagnóstico de las Capacidades en Monitoreo y Evaluación Sistema de Información de Salud de VIH en Honduras MEASURE Evaluation 2019 Spanish MECAT, HIV, HIS, Monitoring, Evaluation, Capacity Assessment, Honduras Honduras ha venido llevando a cabo un proceso de reforma en la salud en pro de aumentar los efectos de la promoción y prevención en salud para el bienestar de la población, acorde con las recomendaciones de la Organización Panamericana de la Salud (OPS). La respuesta a la epidemia del VIH no elude dicha reforma, que implica un abordaje sistémico en el que los ajustes al sistema de información en salud están incluidos, como elemento fundamental en la generación de evidencias de la efectividad de las intervenciones estratégicas impulsadas por la Secretaría de Salud (SESAL). Como parte de la estrategia regional de Plan de Emergencia del Presidente de los Estados Unidos para el Alivio del Sida (PEPFAR) y la Agencia de los Estados Unidos para el Desarrollo Internacional (USAID) en Centroamérica, MEASURE Evaluation implementa actividades de fortalecimiento del Sistema de Información en Salud (SIS) en VIH teniendo como contraparte a los ministerios de salud de la región. La asistencia técnica encargada a MEASURE Evaluation en Honduras para poder contar con un SIS que, utilizando datos de calidad, genere reportes que faciliten la toma de buenas decisiones, que se enfoquen en alcanzar las metas de eliminación del VIH al 2030, requiere valorar el estado del rendimiento y la capacidad de monitoreo y evaluación (MyE) del sistema en áreas funcionales clave. Para ello, es necesario llevar a cabo un diagnóstico de este sistema, que en forma rápida permita elaborar una propuesta de plan de acción para reducir las brechas identificadas por áreas de capacidad. En el presente documento se describen los antecedentes, objetivos, metodología, resultados, discusión, recomendaciones y conclusiones del Diagnóstico de las Capacidades de MyE del SIS del VIH en Honduras, realizado en mayo de 2018.
Diagnóstico de las Capacidades en Monitoreo y Evaluación Sistema de Información de Salud de VIH en Panama MEASURE Evaluation 2019 Spanish HIV, HIS, MECAT, Monitoring, Evaluation, Capacity Assessment Panamá desde que realizó el diagnóstico de los Sistemas de Información en Salud (SIS), en el marco de la iniciativa mundial de la Red de la Métrica de Salud (RMS o HMN por sus siglas en inglés: Health Metrics Network) en el 2006, viene haciendo esfuerzos para contar con SIS fuertes, liderados por el Ministerio de Salud (MINSA) con la participación de instituciones que generan estadísticas sanitarias y el apoyo de organismos cooperantes. El enfoque de estas acciones ha estado en el apoyo que se brinda a la gestión y evaluación de laspolíticas de los servicios de salud para asegurar el uso óptimo de los recursos. La limitación de los recursos disponibles ratifica la necesidad de poder contar con un SIS sólido, funcionando de forma sistémica, en un proceso que reúna, comparta, analice y favorezca la utilización de la información, preocupación que se ha materializado en el desarrollo de planes de fortalecimiento a corto, mediano y largo plazo que contribuyan a la toma de buenas decisiones. Como parte de la estrategia regional del Plan de Emergencia del Presidente de los Estados Unidos para el Alivio del Sida (PEPFAR) y la Agencia de los Estados Unidos para el Desarrollo Internacional (USAID) en Centroamérica, MEASURE Evaluation implementa actividades de fortalecimiento de los SIS en VIH teniendo como contraparte a los ministerios de salud de la región. Para poder contar con un SIS que, utilizando datos de calidad, genere reportes que faciliten la toma de buenas decisiones, enfocados en alcanzar las metas de eliminación del VIH al 2030, se requiere valorar el estado del rendimiento y la capacidad de monitoreo y evaluación (MyE) del sistema en áreas funcionales clave. Para ello, es necesario llevar a cabo un diagnóstico de este sistema, que en forma ágil permita elaborar una propuesta de plan de acción para reducir las brechas identificadas por áreas de capacidad. En el presente documento se describen los antecedentes, objetivos, metodología, resultados, discusión, recomendaciones y conclusiones del Diagnóstico de las Capacidades de MyE del SIS del VIH en Panama.
La surveillance à temps réel au niveau communautaire Un SMS pour identifier de façon précoce MEASURE Evaluation 2019 French Infectious disease, Surveillance, Senegal, Zoonotic, Information system mInfoSanté est un système d’alerte précoce (SAP) basé sur l’application opensource RapidPro. Il a été introduit au Sénégal en 2015, à la suite de l’épidémie de la maladie à virus Ebola en Afrique de l’Ouest en 2014, par le Centre des Opérations d’Urgence Sanitaire (COUS) du Ministère de la Santé et de l’Action Sociale (MSAS) avec l’appui de l’UNICEF pour faciliter le suivi des cas et la communication d’urgence. mInfoSanté, introduit au début sous l’appellation « mEbola », est utilisé à ce jour au Sénégal au niveau des districts sanitaires et des postes de santé dans sept régions pour la surveillance épidémiologique et la communication d’urgence. Avec le soutien de l’Agence des Etats-Unis pour le développement international (USAID), le project MEASURE Evaluation a adopté mInfoSanté pour la surveillance à base communautaire (SBC) des maladies et zoonoses prioritaires dans une approche « Une Seule Santé » dans six districts sanitaires de deux régions (Saint-Louis et Tambacounda).
Une Seule Santé en marche au niveau communautaire La Surveillance à base communautaire des zoonoses prioritaires dans une approche « Une Seule Santé » MEASURE Evaluation 2019 French Senegal, Infectious disease, Surveillance, Zoonotic Le Programme de Sécurité Sanitaire Mondiale (PSSM), est un partenariat de plus de 60 pays, organisations internationales et parties prenantes non-gouvernementales visant à renforcer la capacité des pays à mieux prévenir, détecter et riposter aux menaces des maladies infectieuses, et à élever la sécurité sanitaire mondiale au rang de priorité nationale et mondiale. Au Sénégal, le Haut Conseil de la Sécurité Sanitaire Mondiale (HCSSM), coordonne la mise en oeuvre du PSSM depuis 2015. En 2016, MEASURE Evaluation, Financée par l’Agence des États-Unis pour le développement international (USAID), a aidé à la mise en place d’un système de surveillance à base communautaire (SBC) dans quatre districts pilotes en collaboration avec le Ministère de la santé du Sénégal. Par la suite, un nouveau financement de l’USAID, a permis d’étendre ce system de surveillance pour inclure les zoonoses prioritaires et adopter une approche Une Seule Santé dans les mêmes districts et deux additionnels. Ces zoonoses prioritaires sont la rage, la grippe aviaire zoonotique, la tuberculose bovine, l’anthrax, les fièvres Hemorragiques (Marburg et Ebola) et la Fièvre de la Vallée du Rift. Cette initiative met l’accent sur la collaboration multisectorielle et le partage de l’information entre les parties prenantes à tous les niveaux. Ce système de surveillance permet une prise en charge des évènements liés à l’interface homme-animal-environnement.
La Boîte à Outils sur la Maturité de l’Interopérabilité des Systèmes d’Information Sanitaire : Guide de l’utilisateur MEASURE Evaluation 2019 French Health Information Systems, Toolkit, Interoperability, HIS, Health Systems Strengthening La Boîte à outils sur la maturité de l’interopérabilité des systèmes d’information sanitaire comprend un modèle de maturité relatif à l’interopérabilité des systèmes d’information sanitaire (SIS), soit un outil évaluant le degré de maturité, et ce guide destiné aux utilisateurs du modèle et de l’outil. Le but de la Boîte à outils sur la maturité de l’interopérabilité des SIS est de permettre aux MS, à leurs partenaires de mise en oeuvre et à d’autres parties prenantes de déterminer les principaux domaines d’interopérabilité et les niveaux de maturité requis pour atteindre les objectifs d’interopérabilité des SIS. En recourant à une approche fondée sur un modèle de maturité, nous cherchons à déterminer les facteurs essentiels à la mise en place de SIS matures et interopérables, à les évaluer et à créer un parcours de développement pour nous appuyer sur un (ou des) système(s) solide(s) (maturité). Cette boîte à outils est tenue à la disposition des pays sous la forme de bien public afin d’atteindre les buts et objectifs de renforcement de leurs SIS. Alors qu’il est possible de créer des systèmes interopérables intersectoriels, cette boîte à outils a pour but d’améliorer la performance d’un SIS propre à un ministère de la Santé. La Boîte à outils sur la maturité de l’interopérabilité des SIS est disponible en ligne sur https://www.measureevaluation.org/resources/ tools/health-information-systems-interoperability-toolkit.
Implementing Nigeria's Master Facility List: Software Requirements Specifications MEASURE Evaluation 2019 English NIGERIA RHIS, Routine data, Routine Health Information Systems, electronic health management information system, EMIS, health management information system The purpose of this document is to describe Nigeria’s Health Facility Registry (HFR) in detail: the purpose and features of the system, the interfaces of the system, what the system will do, the constraints under which it must operate, and how the system will react to external stimuli. This document is intended to help both developers and end users understand the HFR’s functional and nonfunctional requirements. Other resources to support the implementation of Nigeria’s Master Facility List are available here: https://www.measureevaluation.org/countries/nigeria/toolkit-for-implementing-the-health-facility-registry-in-nigeria/
Implementing Nigeria's Master Facility List: Results of User Acceptance Testing MEASURE Evaluation 2019 English NIGERIA MFL, Master facility list, health management information system, HMIS, electronic health management information system The development of Nigeria's Health Facility Registry (HFR) and processes for the management of the national Master Facility List (MFL) was a priority of Nigeria’s National Health Information System Strategic Plan (2014–2018). The MFL is a list of health facilities with administrative information that can be used to identify and contact the facility as well as services provided at that facility. The MFL’s shortcomings included the lack of processes and an associated information system to facilitate the ongoing management of health facility data. The development of the HFR addressed these gaps. The HFR was also designed to facilitate the easy identification of health facilities and will serve as a primary source for different information systems to get data on health facilities. User acceptance testing (UAT) is a critical phase in the software development process. During UAT, a system’s clients test whether the system can handle required tasks under real-world scenarios and according to agreed-on specifications. The first UAT of the HFR was conducted on December 12, 2017, based on initial system requirements. In 2018, MEASURE Evaluation continued to improve the HFR, making major enhancements and developing the second version of the system (HFR 2.0). In collaboration with the Federal Ministry of Health (FMOH), MEASURE Evaluation also developed standard operating procedures (SOPs) in October 2018 for managing the facilities in the HFR. Following the validation of the SOPs by the MFL technical working group, approval workflows were prepared to ensure the proper addition, update, and deletion of facilities according to the SOPs for the HFR. Because of the major system improvements, another UAT was needed to ensure that all functionalities worked as expected. MEASURE Evaluation and the FMOH conducted a workshop from March 27–29, 2019, to review the system and perform the UAT. Other resources that support Nigeria’s MFL are available here: https://www.measureevaluation.org/countries/nigeria/toolkit-for-implementing-the-health-facility-registry-in-nigeria/
Health Facility Registry Data Collection Form for Hospitals and Clinics MEASURE Evaluation 2019 English NIGERIA Master facility list, electronic health management information system, MFL, health management information system, HMIS The Health Facility Registry (HFR) is a customized, open source, web-based application that allows users to access the Master Facility List (MFL): a list of all healthcare facilities, public and private, in Nigeria. In addition to government stakeholders who oversee facility management and the provision of healthcare services, additional stakeholders who may be interested include the authorities responsible for budgeting and allocation, human resource managers, those overseeing supply chain management, insurance companies, researchers assessing health system performance, and donors planning coverage for public health interventions. The system requires Internet connectivity to be accessed and is available to the general public. This is the form used to collect data from hospitals and clinics for entry into Nigeria's HFR and inclusion in the national MFL. Other resources that support Nigeria’s MFL are available here: https://www.measureevaluation.org/countries/nigeria/toolkit-for-implementing-the-health-facility-registry-in-nigeria/
Implementing Nigeria's Master Facility List: Manual for Public Access to the Health Facility Registry MEASURE Evaluation 2019 English NIGERIA Master facility list, MFL, electronic health management information system, HMIS The Health Facility Registry (HFR) is a customized, open source, web-based application that allows users to access the Master Facility List (MFL): a list of all healthcare facilities, public and private, in Nigeria. In addition to government stakeholders who oversee facility management and the provision of healthcare services, additional stakeholders who may be interested include the authorities responsible for budgeting and allocation, human resource managers, those overseeing supply chain management, insurance companies, researchers assessing health system performance, and donors planning coverage for public health interventions. The system requires Internet connectivity to be accessed and is available to the general public. The purpose of this manual is to provide a broad overview of the functions of the system that are available to anyone who is interested in querying the MFL. A complementary manual for HFR administrators reviews the additional functions required for curating the MFL, including adding new facilities, modifying records for existing facilities, and signaling the closure of facilities. Other resources that support Nigeria’s MFL are available here: https://www.measureevaluation.org/countries/nigeria/toolkit-for-implementing-the-health-facility-registry-in-nigeria/
Implementing Nigeria's Master Facility List: Manual for the Administration of the Health Facility Registry MEASURE Evaluation 2019 English NIGERIA HMIS, MFL, electronic health management information system, Master facility list The Health Facility Registry is a customized, open source, web-based application that allows users to access the Master Facility List (MFL): a list of all healthcare facilities, public and private, in Nigeria. In addition to government stakeholders who oversee facility management and the provision of healthcare services, additional stakeholders who may be interested include the authorities responsible for budgeting and allocation, human resource managers, those overseeing supply chain management, insurance companies, researchers assessing health system performance, and donors planning coverage for public health interventions. The system requires Internet connectivity to be accessed and is available to the general public.  The purpose of this manual is to provide a broad overview of the functions that are available to administrators of the system who will add new facilities, modify records for existing facilities, and signal the closure of facilities. In addition, we will provide an overview of the workflows for the verification, validation, and publication of these requests. A complementary manual is available for public, nonadministrative users who want to query the MFL: “Implementing Nigeria’s Master Facility List: Manual for Public Access to the Health Facility Registry.” This and other resources that support Nigeria’s MFL are available here: https://www.measureevaluation.org/countries/nigeria/toolkit-for-implementing-the-health-facility-registry-in-nigeria/
Implementing Nigeria's Master Facility List: Software Design of the Health Facility Registry MEASURE Evaluation 2019 English NIGERIA Master facility list, HMIS, electronic health management information system, MFL The health facility registry (HFR) for Nigeria’s Federal Ministry of Health was developed as an open-source web portal for displaying and exporting data on all hospitals, clinics, imaging centers, and laboratories in the country. These data constitute Nigeria’s Master Facility List (MFL). Here we present the designs used or intended to be used to create the portal. A companion document—Implementing Nigeria’s Master Facility List: Software Requirements Specifications—provides the designs’ specifications. That and other resources that MEASURE Evaluation—funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief—has developed to support the implementation of Nigeria’s MFL are available here: https://www.measureevaluation.org/countries/nigeria/toolkit-for-implementing-the-health-facility-registry-in-nigeria/ This document provides a detailed description of the software architecture of the HFR system and will serve as a road map showing future developers how the HFR was designed and implemented. It specifies the structure and design of some of the modules discussed in the Software Requirements Specifications, cited above. It also displays some of the use cases that were transformed into sequence diagrams and use-case diagrams. 
Implementing Nigeria's Master Facility List: Harmonization with the National Health Management Information System Facility List MEASURE Evaluation 2019 English NIGERIA Master facility list, HMIS, electronic health management information system, MFL The purpose of the Health Facility Registry (HFR) is to serve as the unique source for health facility data: contact information, geocoordinates, services offered, and composition of health providers. During the development of a monitoring and evaluation framework for the implementation of Nigeria’s master facility list, a technical working group prioritized the integration of the HFR with the national health management information system. The goal of this is to allow facility updates with appropriate approvals to be pushed by means of an application programming interface from the HFR to the DHIS 2.  This report documents experience with the first step toward this integration—aligning the administrative units and health facility names between the two information systems. To that end, the Federal Ministry of Health in collaboration with its technical partners—the Health Information Systems Program and MEASURE Evaluation—initiated the health facility alignment process in October 2018. Different types of discrepancies were observed, and valiant efforts were made to seek verification of health facilities by state authorities. Unfortunately, remote reconciliation of discrepancies proved challenging. Even so, as a result of this activity, both the HFR and the DHIS 2 have been updated to include 41,454 facilities. Other resources to support the implementation of Nigeria’s Master Facility List are available here: https://www.measureevaluation.org/countries/nigeria/toolkit-for-implementing-the-health-facility-registry-in-nigeria/
Implementing Nigeria's Master Facility List: Guidelines MEASURE Evaluation 2019 English NIGERIA MFL, Master facility list Healthcare services in Nigeria are provided by thousands of public and private health facilities around the country. The Government of Nigeria and other health system stakeholders routinely require information about the distribution of health facilities and the services that they offer. The most recent nationwide effort to list the health facilities in Nigeria was completed in 2013.  The World Health Organization defines a master facility list (MFL) as “a complete listing of health facilities in a country (both public and private) and is comprised of a set of identification items for each facility . . . and basic information on the service capacity of each facility.” Previous MFLs in Nigeria lacked processes for continuous updating or an information system to manage the MFL across states. They collected only a few parameters and several projects continued to create separate lists for their own purposes.  To ensure that Nigeria's MFL could be used across different applications, it had to be continuously accessible and up-to-date. Therefore, a health facility registry (HFR) was developed to manage the MFL. The HFR has built-in processes to address the continuous status changes of individual health facilities. It will facilitate the integration and interoperability of different applications being deployed for the national health information architecture in the country. This document presents the definitions of the information contained in the MFL. It is an implementation guide on how to use this information. Other resources developed by MEASURE Evaluation (a project funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to support the implementation of the MFL in Nigeria are available here: https://www.measureevaluation.org/countries/nigeria/toolkit-for-implementing-the-health-facility-registry-in-nigeria/
Use of Routine Health Information System Data to Evaluate Impact of Malaria Control Interventions in Zanzibar, Tanzania from 2000 to 2015 Ashton, R., Bennett, A., Al-Mafazy, A.-W., Abass, A. K., Msellem, M. I., McElroy, P. . . . Bhattarai, A. 2019 English TANZANIA malaria, Zanzibar, Disease prevention, Malaria control, RHIS, HMIS Background Impact evaluations allow countries to assess public health gains achieved through malaria investments. This study uses routine health management information system (HMIS) data from Zanzibar to describe changes in confirmed malaria incidence and impact of case management and vector control interventions during 2000–2015. Methods HMIS data from 129 (82%) public outpatient facilities were analyzed using interrupted time series models to estimate the impact of artemisinin-based combination therapy (ACT), indoor residual spray, and long-lasting insecticidal nets. Evaluation periods were defined as pre-intervention (January 2000 to August 2003), ACT-only (September 2003 to December 2005) and ACT plus vector control (2006–2015). Findings After accounting for climate, seasonality, diagnostic testing rates, and outpatient attendance, average monthly incidence of confirmed malaria showed no trend over the pre-intervention period 2000–2003 (incidence rate ratio (IRR) 0.998, 95% CI 0.995–1.000). During the ACT-only period (2003–2005), the average monthly malaria incidence rate declined compared to the pre-intervention period, showing an overall declining trend during the ACT-only period (IRR 0.984, 95% CI 0.978–0.990). There was no intercept change at the start of the ACT-only period (IRR 1.081, 95% CI 0.968–1.208), but a drop in intercept was identified at the start of the ACT plus vector control period (IRR 0.683, 95% CI 0.597–0.780). During the ACT plus vector control period (2006–2015), the rate of decline in average monthly malaria incidence slowed compared to the ACT-only period, but the incidence rate continued to show an overall slight declining trend during 2006–2015 (IRR 0.993, 95% CI 0.992–0.994). Interpretation This study presents a rigorous approach to the use of HMIS data in evaluating the impact of malaria control interventions. Evidence is presented for a rapid decline in malaria incidence during the period of ACT roll out compared to pre-intervention, with a rapid drop in malaria incidence following introduction of vector control and a slower declining incidence trend thereafter.
Enquêtes qualitatives sur les motivations des Comités de Veille et d’Alerte Communautaire impliqués dans la surveillance des maladies infectieuses au Sénégal Diop, D., Ba, A., Nguimfack, J., Moreland, S., & Sukumaran, S. 2019 French Global health security, Senegal, Infectious disease, Surveillance, Global health Contexte : les récentes épidémies de maladies infectieuses en Afrique ont fait ressortir le rôle important de la communauté dans la surveillance des maladies notamment dans la détection précoce et la réponse rapide. Le Ministère de la Santé et de l’Action Sociale (MSAS) du Sénégal avec l’appui de ses partenaires dont MEASURE Evaluation a initié en 2016 la phase pilote de la surveillance à base communautaire. Cette activité est venue s’ajouter au paquet de services des acteurs communautaire de santé (ACS) qui intervenaient dans la santé maternelle et néonatale. C’est dans ce contexte que MEASURE Evaluation a mené une étude évaluative de la motivation des membres des Comités de Veille et d’Alerte Communautaire (CVAC) impliqués dans la surveillance épidémiologique. Objectifs : cette étude avait pour objectifs, d’identifier les facteurs qui motivent et ceux qui démotivent les membres de CVAC dans leur rôle d’acteurs communautaires de santé (ACS) en général et dans la recherche et la notification des maladies prioritaires en particulier ; et de formuler des recommandations sur les moyens de renforcer la motivation des CVAC dans leur activité de surveillance communautaire. Matériels et méthodes : huit focus groups ont été réalisés dans les postes de santé sélectionnés dans les districts sanitaires de Tambacounda, Koumpentoum, Podor, et Pété. Les données ont été collectées avec un questionnaire individuel et un guide d’entretien structuré en thèmes. Les données du questionnaire individuel ont été analysées sous SPSS. Les focus groups ont été enregistrés sur des dictaphones puis transcrites. Les données transcrites ont été traitées avec le logiciel Atlas.ti. Cette étude a obtenu un avis éthique et scientifique favorable du Comité National d’Éthique pour la Recherche en Santé et l’autorisation administrative du MSAS. Chaque participant a signé un consentement avant le démarrage des focus groups. Résultats : 65 membres de CVAC au total ont participé à l’étude. L’enquête sociodémographique a montré que les membres de CVAC sont majoritairement jeunes avec une moyenne d’âge de 35 ans, mariés pour la plupart (83 %), avec une proportion plus élevée de femmes (sex-ratio 0,5), et scolarisés (55 % ont été jusqu’au niveau secondaire). En ce qui concerne le niveau de connaissance des langues, la langue la plus parlée est le pulaar (58 %), cependant le français reste la langue la plus écrite (71 %) et la plus lue (68 %). Pour ce qui est des facteurs de motivation, ils sont essentiellement symboliques et relationnels. Il s’agit de la reconnaissance communautaire et institutionnelle, des formations reçues et des outils de travail mis à leur disposition, et du suivi par les personnels de santé (ICP et superviseurs). S’agissant des facteurs de démotivation, le principal grief est lié aux moyens de travail (outils de gestion, de sensibilisation, et téléphones portables). Il s’ajoute à cela le manque de considération sociale et institutionnelle que certains CVAC ont pu ressentir et l’incapacité des membres de CVAC à répondre aux sollicitations des populations (consultations médicales, médicaments, argent, etc.). Au regard des résultats de l’étude, il a été formulé comme recommandations d’assurer aux CVAC une reconnaissance institutionnelle et un suivi régulier par les personnels de santé, et de leur doter d’objets de reconnaissance unique et de téléphones portables plus performants et en plus grande quantité.
Formation sur la surveillance basée sur les évènements dans la communauté, District de Pô, Région Centre-Sud, Burkina Faso Issaka Sawadogo, Marie Yolande Eugene, Allison Connolly, Serge Nzietchueng et Eric Geers 2019 French Avec le financement de l’Agence des Etats-Unis pour le développement international (USAID), MEASURE Evaluation a aidé le gouvernement du Burkina Faso à renforcer son système de surveillance des maladies en utilisant l'approche « Une Seule Santé ». Le renforcement de la surveillance communautaire a été un aspect essentiel de l’amélioration du système de surveillance. Pour soutenir cet effort, une formation en cascade sur la surveillance basée sur les événements inhabituels (SBE) a été organisée du 3 au 13 décembre 2018 à Manga, le chef-lieu de la région du Centre-Sud, et à Pô, dans la province de Nahouri. Des membres du personnel du Ministère de la Santé (MS), du Ministère des Ressources Animales et Halieutiques (MRAH) et du Ministère de l'Environnement, de l'Économie Verte et du Changement Climatique (MEEVCC) ont pris part à cette formation. Les objectifs de la formation étaient les suivants: établir un pool de formateurs régionaux et provinciaux dans le cadre de l’approche « Une Seule Santé » et renforcer les capacités des agents des points de prestation et des acteurs communautaires des trois ministères de sorte qu’ils soient en mesure de conduire des activités SBE dans la communauté.
Réalisations de l’implémentation de la surveillance basée sur les évènements au Burkina Faso, région Centre-Sud selon le modèle “Une Seule Santé” Issaka Sawadogo, Marie Yolande Eugene, Allison Connolly, Serge Nzietchueng et Eric Geers 2019 French Global health security, Surveillance, Burkina Faso, Information systems MEASURE Evaluation a été contractée en octobre 2017 par l’Agence des Etats-Unis pour le développement international (USAID) pour supporter les activités de renforcement des systèmes de surveillance au Burkina Faso. Ce projet vient soutenir les ministères en charge de la santé, des ressources animales et halieutiques et de l’environnement, de l’économie verte et du changement climatique pour apporter une réponse efficace aux menaces de santé publique. Objectifs : Renforcer le système de surveillance des maladies au Burkina Faso en utilisant l'approche « Une Seule Santé » Améliorer la disponibilité de données sanitaires de qualité à tous les niveaux du système de santé Accroître la coordination multisectorielle et la capacité de gestion du système d'information de surveillance face aux épidémies majeures Améliorer la capacité des ministère
Data for Impact: Semiannual Report Summary Data for Impact 2019 English D4I, Data use, Data Quality, Data for Impact, Data Data for Impact (D4I) is a new 5-year cooperative agreement funded by the United States Agency for International Development and primed by the University of North Carolina at Chapel Hill. The project began in September 2018 and has reported accomplishments made during its first nine months in a one-page infographic. The infographic outlines project goals and objectives, country uptake of project expertise, and a broad look at some of the work done to date.
Sustaining the Impact: Population and Reproductive Health MEASURE Evaluation 2019 English Reproductive Health, Population, Family Planning MEASURE Evaluation develops measures, tools, and guides to support strong data collection and monitoring and evaluation by family planning program implementers, donors, and stakeholders. MEASURE Evaluation conducts research and evaluation to inform program and policy decision making, develops methods to improve health information systems, and builds local capacity to conduct research. This brief shares more.
Quality of Tuberculosis Services Assessment in the Philippines: Tools MEASURE Evaluation 2019 English PHILIPPINES Tuberculosis, Tool, Quality of care, Service delivery, TB The Quality of Tuberculosis Services Assessment (QTSA) is conducted with the support of four tools: the Facility Audit, the Provider Interview, the Patient Interview, and the Register Review. MEASURE Evaluation—a project funded by the United States Agency for International Development (USAID)—developed these four tools with the assistance of colleagues at USAID.  The tools exist in a generic format that is adaptable to any country wishing to conduct a QTSA. For instance, some countries may have different names for their health administrative units (e.g., district, province, ward, or woreda) or the name of their TB registers (e.g., TB patient logbook or TB confirmed cases register). They are customized to fit the country priorities and context in which they will be used.  The generic QTSA tools are available at the following link: https://www.measureevaluation.org/resources/publications/tl-19-41/   This document presents only the QTSA tools adapted for use in the Philippines. It provides detailed information about the structure and content of the tools. More information on the QTSA purpose, methods, or results can be found in the individual QTSA reports.  The Philippines’ QTSA report is available here: https://www.measureevaluation.org/resources/publications/tr-19-350/ QTSA documents for other countries are available here: https://www.measureevaluation.org/our-work/tuberculosis/quality-of-tb-services-assessments
Quality of Tuberculosis Services Assessment in the Philippines: Report Soumya Alva and Suzanne Cloutier 2019 English PHILIPPINES Tuberculosis, Service delivery, TB, Quality of care According to the 2018 Global Tuberculosis Report released by the World Health Organization (WHO), tuberculosis (TB) is the tenth leading cause of death and is the leading cause of death from a single infectious agent. Heads of state committed to ambitious targets aimed at eliminating TB during the first-ever United Nations High-Level Meeting on Tuberculosis conducted in September 2018 at the United Nations General Assembly. WHO has identified 30 countries where the TB burden is high, including the Philippines. The country has one of the most severe epidemics, with an estimated 500 new cases per 100,000 population. This rate is higher than the 150 to 400 per 100,000 population in most of the 30 high-burden TB countries. In response, the Philippines has enacted a TB law, which called for the creation of a national strategic plan. The Republic of Philippines National Tuberculosis Control Program responded with the Philippine Strategic TB Elimination Plan, running from 2017 to 2022. Studies show that good quality of care in TB services helps patients and their families address their health needs safely and effectively. Therefore, to enhance TB service use, there is a need to assess and improve the quality of TB services. A Quality of TB Services Assessment (QTSA) was conducted by MEASURE Evaluation in the Philippines to assess the quality of TB services in randomly selected health facilities. Its purpose was to identify where services were of high quality and where there were gaps and to ensure that TB patients were receiving the care that they deserve. The QTSA assessed three domains of quality of care: the structure of the health facility, the service delivery process, and the outcomes of service delivery. The results were used to develop programs or interventions to improve TB service delivery. The QTSA tools adapted for use in the Philippines are available here: https://www.measureevaluation.org/resources/publications/tl-19-38 QTSA documents for other countries are available here: https://www.measureevaluation.org/our-work/tuberculosis/quality-of-tb-services-assessments
Suivi des résultats des programmes du PEPFAR pour les orphelins et les enfants vulnérables en RDC Résultats de l'enquête 2017 du Projet ELIKIA MEASURE Evaluation 2019 French Le Projet ELIKIA améliore les services et les passerelles pour les enfants affectés par le VIH et le SIDA. Cette initiative, qui vient en aide à près de 10 000 orphelins et enfants vulnérables (OEV), est mise en oeuvre par un consortium regroupant l'Education Development Center (EDC), Catholic Relief Services (CRS), Palladium et Caritas. La mise en œuvre du projet ELIKIA en RDC a débuté en septembre 2016 avec les objectifs suivants : 1. Réduire la vulnérabilité économique des ménages cibles de manière à ce qu'ils puissent répondre aux besoins élémentaires des enfants placés sous leur garde ; 2. Accroître l'utilisation de services essentiels par les orphelins et autres enfants vulnérables cibles et leur ménage ; 3. Renforcer les systèmes de protection sociale au niveau provincial et des districts.
Suivi des résultats du programme PEPFAR pour les orphelins et enfants vulnérables en République Démocratique du Congo: Résultats de l’enquête du Projet ELIKA 2018 Walter Obiero, Patrick Kayembe, Michelle Winner 2019 French DRC, OVC, Evaluation, PEPFAR Le VIH frappe particulièrement la tranche de la population active, ceux âgés de 15 à 55 ans. Ces hommes et femmes laissent des orphelins dont le futur est compromis si les communautés ne s’impliquent pas. Le Plan d’urgence du président américain pour la lutte contre le sida (PEPFAR) collabore avec le gouvernement de la République Démocratique du Congo (RDC) pour renforcer les services aux orphelins et enfants vulnérables (OEV) et ceux qui en prennent soin. Le soutien du PEPFAR est axé sur la fourniture d'un ensemble complet d'interventions de base comprenant des soins de santé et des références pour la nutrition, la vaccination, la planification familiale et le viol, ainsi que le dépistage, les soins et traitement du VIH y compris les conseils visant l’adhérence à la thérapie antirétrovirale (ART), la promotion de la parentalité positive, l’encadrement des ménages à problème dans les formations « maison fidèle », la fourniture d'un soutien psychosocial aux ménages affectés, les activités de renforcement économique des ménages, telles que l'épargne et les transferts monétaires, la protection sociale par la référence pour l’obtention de l’acte de naissance et un soutien éducatif pour les enfants. Reconnaissant la nécessité de mieux comprendre les effets de ses programmes sur le bien-être des OEV, PEPFAR a exigé en 2014 la production de rapports afin de suivre les résultats des projets dans les pays où il soutient les OEV. L'exigence implique la collecte de données sur neuf indicateurs clés des résultats, appelés indicateurs essentiels d'enquête (IEE) sur les OEV. En RDC, le projet ELIKIA a démarré en avril 2016 avec le financement du PEPFAR. Ce rapport présente les résultats de l'enquête organisée par l’Ecole de Santé Publique de l’Université de Kinshasa (ESP-UNIKIN) en partenariat avec MEASURE Evaluation. Au moment de l'enquête, le projet ELIKIA dans la province du Haut-Katanga en partenariat avec quatre partenaires locaux, fournissait des services à environ 2000 ménages hébergeant environ 9000 enfants bénéficiaires dans la ville de Lubumbashi. Un échantillon aléatoire de 528 ménages a été sélectionné du registre des bénéficiaires, registre consolidé après l’exercice de vérification et traçage. A l’issue de la descente sur terrain, 495 ménages ont être retrouvés et les tuteurs de 2432 enfants bénéficiaires ont été interviewés sur eux-mêmes et sur les enfants dont ils avaient la charge. Les outils d'enquête et la méthodologie utilisés ont suivi les directives précédemment élaborées par MEASURE Evaluation pour le compte de PEPFAR pour la collecte des IEE-OEV. Les résultats des neuf IEE et les indicateurs supplémentaires demandés par USAID/RDC, présentés sous forme tabulaire ci-dessous, ont fourni un aperçu du bien-être des enfants et des ménages desservis par ELIKIA en début de l’année 2018. L’étude indique les domaines où les efforts devront être faits pour améliorer le bien-être des OEV.
Sustaining the Impact: Orphans and Vulnerable Children MEASURE Evaluation 2019 English OVC, Monitoring, Evaluation, Orphans and Vulnerable Children, OVC programs, Systems strengthening, HIV, PEPFAR Through programming for orphans and vulnerable children (OVC), the United States President’s Emergency Plan for AIDS Relief (PEFPAR) aims to mitigate the multidimensional and acute impacts of HIV and AIDS on children, by providing holistic, community-based care and support services. Strengthening the systems that support vulnerable children and families ensures that children living with HIV receive the services they need and that children who are affected do not acquire the virus. MEASURE Evaluation’s strategic approach MEASURE Evaluation improves programs for OVC by improving the quality and accessibility of data on programs and target populations. MEASURE Evaluation is building OVC monitoring and evaluation (M&E) capacity globally by developing indicators and tools, evaluating programs, triangulating data, and providing technical assistance and mentoring. Our recent work includes a suite of activities covering routine monitoring, costing, size estimation, social service system strengthening, outcomes monitoring, and national OVC M&E system strengthening. This brief shares more.
Quality of family planning services in HIV integrated and non-integrated health facilities in Malawi and Tanzania Michael A. Close, Janine Barden-O’Fallon, and Carolina Mejia 2019 English Malawi, Quality of care, Family Planning, Tanzania, HIV Background: The integration of family planning (FP) and HIV-related services is common in sub-Saharan Africa. Little research has examined how FP quality of care differs between integrated and non-integrated facilities. Using nationally representative data from Malawi and Tanzania, we examined how HIV integration was associated with FP quality of care. Methods: Data were drawn from Service Provision Assessments (SPAs) from Malawi (2013–2014) and Tanzania (2014–2015). The analytic sample was restricted to lower-level facilities in Malawi (n = 305) and Tanzania (n = 750) that offered FP services. We matched SPA measures to FP quality of care indicators in the Quick Investigation of Quality (QIQ). We conducted bivariate and multivariate analyses of 22 QIQ indicators to examine how integration status was related to individual QIQ indicators and overall FP quality of care at the facility- and client-level. Results: The prevalence of HIV integration in Malawi (39%) and Tanzania (38%) was similar. Integration of HIV services was significantly associated (p < 0.05) with QIQ indicators in Malawi (n = 3) and Tanzania (n = 4). Except for one negative association in Tanzania, all other associations were positive. At the facility-level, HIV integration was associated with increased odds of being at or above the median in FP quality of care in Malawi (adjusted odd ratio (OR) = 2.24; 95% confidence interval (CI) = 1.32, 3.79) and Tanzania (adjusted OR = 2.10; 95% CI = 1.37, 3.22). At the client-level, HIV integration was not associated with FP quality of care in either country. Conclusion: Based on samples in Malawi and Tanzania, HIV integration appears to be beneficially associated with FP quality of care. Using a spectrum of FP quality of care indicators, we found little evidence to support concerns that HIV integration may strain facilities and providers, and adversely impact quality outcomes. Rather, it appears to strengthen FP service delivery by increasing the likelihood of stocked FP commodities and achievement of other facility-level quality indicators, potentially through HIV-related supply chains. Further research is needed to assess FP quality of care outcomes across the various platforms of FP integration found in sub-Saharan Africa.
Data for Impact: What's the cost of evaluations and other surveys? Data for Impact 2019 English D4I, Evaluation, Data for Impact A core principle of Data for Impact (D4I) is to help countries focus on their knowledge gaps in health and to consider the full range of options to address those issues. The primary types of evaluations in D4I’s scope are process, outcome, impact, and economic evaluations and implementation science and operations research. D4I also conducts outcome monitoring surveys and implements formative studies to aid in intervention design and implementation. When planning any of these investigations, cost is an important consideration that may help determine the decision to do or plan for an evaluation or study. Cost is dependent on many factors, including objective, design, method, sample size, geographic scope, and local context. Other factors that affect cost are, for example, the front-end work required to plan an evaluation or study—which can be substantial. This resource shares details to consider.
Facilitators, best practices and barriers to integrating family planning data in Uganda’s health management information system Stephen Ojiambo Wandera, Betty Kwagala, Olivia Nankinga, Patricia Ndugga, Allen Kabagenyi, Bridgit Adamou, and Benjamin Kachero 2019 English Data, HMIS, Family Planning, Uganda, Health information systems BackgroundHealth management information systems (HMIS) are instrumental in addressing health delivery problems and strengthening health sectors by generating credible evidence about the health status of clients. There is paucity of studies which have explored possibilities for integrating family planning data from the public and private health sectors in Uganda’s national HMIS. This study sought to investigate the facilitators, best practices and barriers of integrating family planning data into the district and national HMIS in Uganda. MethodsWe conducted a qualitative study in Kampala, Jinja, and Hoima Districts of Uganda, based on 16 key informant interviews and a multi-stakeholder dialogue workshop with 11 participants. Deductive and inductive thematic methods were used to analyze the data. ResultsThe technical facilitators of integrating family planning data from public and private facilities in the national and district HMIS were user-friendly software; web-based and integrated reporting; and availability of resources, including computers. Organizational facilitators included prioritizing family planning data; training staff; supportive supervision; and quarterly performance review meetings. Key behavioral facilitators were motivation and competence of staff. Collaborative networks with implementing partners were also found to be essential for improving performance and sustainability. Significant technical barriers included limited supply of computers in lower level health facilities, complex forms, double and therefore tedious entry of data, and web-reporting challenges. Organizational barriers included limited human resources; high levels of staff attrition in private facilities; inadequate training in data collection and use; poor culture of information use; and frequent stock outs of paper-based forms. Behavioral barriers were low use of family planning data for planning purposes by district and health facility staff. ConclusionFamily planning data collection and reporting are integrated in Uganda’s district and national HMIS. Best practices included integrated reporting and performance review, among others. Limited priority and attention is given to family planning data collection at the facility and national levels. Data are not used by the health facilities that collect them. We recommend reviewing and tailoring data collection forms and ensuring their availability at health facilities. All staff involved in data reporting should be trained and regularly supervised.
Special Initiative for Orphans and Vulnerable Children Assessing the Scalability of an Early Childhood Development-Integrated Intervention in Eswatini MEASURE Evaluation 2019 English Eswatini, Orphans and vulnerable children, OVC, PMTCT, HIV The HIV epidemic has a profound effect on children in sub-Saharan Africa, where more than 15.1 million children have lost one or both parents. In June 2014, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) announced, as part of its orphans and vulnerable children (OVC) programming, a special initiative for children under age five affected by the epidemic. The initiative funds interventions and research in southern Africa—Lesotho, Eswatini (formerly Swaziland), and Zimbabwe—to generate data on approaches that improve health. Its goals are to establish evidence to improve and inform programming and determine the potential for program scale-up. The programs integrate OVC programming with pediatric treatment and prevention of mother-to-child transmission (PMTCT) of HIV. Outcome evaluations of each intervention in the three countries seek to examine both early childhood development (ECD) and clinical aspects of interventions for a more holistic understanding of children’s needs. Evaluations of each intervention generate data on successful approaches that improve health and establish evidence to improve programs. However, evidence of effectiveness is not enough to ensure that interventions become part of routine program implementation elsewhere. Achieving that end requires early planning and strong advocacy from multiple stakeholders. To prepare for potential scale-up once the results of the evaluation become available, the United States Agency for International Development (USAID) asked its funded project—MEASURE Evaluation—to assess the scalability of the ECD-integrated intervention in each country. Scale up pertains to deliberate efforts to use a proven practice to reach more people more quickly and more effectively, to bring about lasting change. This document concerns itself solely with Eswatini. The Eswatini program, implemented by mothers2mothers (m2m), trains “mentor mothers” to provide good quality early childhood development (ECD) services for vulnerable children ages 0–2 years and their parents and caregivers. 
Vulnerabilidad al VIH y uso de servicios entre trabajadoras sexuales haitianas en la República Dominicana: Resultados de entrevistas a profundidad en Santo Domingo y Puerto Plata Katherine Andrinopoulos, Erica Felker-Kantor, and Jessica Brewer 2019 Spanish DOMINICAN REPUBLIC, HAITI Sex Workers, HIV, HIV data, HIV/AIDS Las trabajadoras sexuales (TRSX) haitianas son una población importante para el VIH en la República Dominicana (RD), con una prevalencia estimada del VIH de 5,4% en comparación con 0,7% a nivel nacional. A pesar del mayor riesgo de contraer el VIH entre este grupo hay una brecha en el acceso y la utilización de los servicios relativos al VIH. Un estudio reciente en Santo Domingo mostró que sólo el 36,8% de las TRSX haitianas recibieron condones y lubricantes en los últimos seis meses, y sólo al 34,1% le habían hecho la prueba por el VIH en los últimos 12 meses. Actualmente, el modo principal de prestación de servicios del VIH para haitianas en la RD es a través de unidades móviles para hacerles la prueba del VIH. La investigación en la RD ha mostrado que las intervenciones multiniveles para TRSX, guiado por un enfoque de empoderamiento de la comunidad, son efectivas para aumentar el uso del condón y la adherencia al tratamiento contra el VIH. Adaptar este tipo de intervención para construir sobre las unidades móviles existentes y adaptarla a la experiencia de Haití, las TRSX pueden aumentar el uso de servicios relacionados con el VIH entre este grupo. El propósito de este estudio fue proporcionar información descriptiva sobre las necesidades específicas del servicio del VIH (prevención, pruebas, tratamiento y retención) de las TRSX haitianas en la RD que se pueden utilizar para adaptar las intervenciones de este grupo.
Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Namibia Comparison of 2016 and 2018: Findings from the Project HOPE Namibia Panel Study MEASURE Evaluation 2019 English Orphans and vulnerable children, Namibia, Monitoring, Data, PEPFAR, OVC MEASURE Evaluation—funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—conducted a study of PEPFAR-funded programs for orphans and vulnerable children (OVC) in Namibia, using PEPFAR’s monitoring, evaluation, and reporting (MER) essential survey indicators (ESI). The study focused on the work of Project HOPE Namibia (PHN) and was designed to answer these two questions: (1) What is the well-being of OVC in PHN’s PEPFAR-funded OVC projects in six districts of Namibia? (2) Has the well-being of these children improved over time? In Round 1 of this panel study, conducted in 2016, caregivers of OVC in 591 households were interviewed to assess the well-being of the children in their care. Of that group, caregivers in 545 PHN-beneficiary households were interviewed again in 2018, for Round 2, after verification of their status with PHN’s updated records and a community trace-and-verify exercise. We asked the caregivers about the PHN program services received or accessed and/or activities offered that aimed to improve the health and well-being of OVC in the household. Data collection used standard questionnaires programmed into an electronic data capture system. We measured OVC well-being by analyzing these data using the nine MER ESI. This poster shares more. Access the related Monitoring the Outcomes of Orphans and Vulnerable Children Programs in Namibia: Findings from 2016–2018 Panel Data, Project HOPE Namibia report.
Monitoring the Outcomes of Orphans and Vulnerable Children Programs in Namibia: Findings from 2016–2018 Panel Data, Project HOPE Namibia Robert Mswia and Lizl Stoman 2019 English OVC, Data, Orphans and vulnerable children, Monitoring, PEPFAR This report presents panel data on outcomes of a program implemented by Project Health Opportunities to People Everywhere (HOPE) Namibia (PHN) and its partners to improve the well-being of orphans and vulnerable children (OVC) and beneficiary households in Namibia. These findings will support evidence-informed strategy, programming, and resource allocation by Namibian stakeholders: the United States President’s Emergency Plan for AIDS Relief (PEPFAR)/Namibia, the Namibian government (Ministry of Health and Social Services [MOHSS] and Ministry of Gender and Child Welfare [MGECW]), implementing partners, and others. They will also contribute to PEPFAR’s global evidence base on the effectiveness of PEPFAR’s OVC programming. In 2014, PEPFAR introduced a set of outcome indicators for OVC programs, referred to as monitoring, evaluation, and reporting (MER) essential survey indicators (ESI), with the requirement that these indicators be collected every two years by a research organization external to the OVC program. These outcome indicators reflect internationally-accepted developmental milestones and collectively measure the holistic well-being of children over time. A standardized survey methodology and tools have been developed to collect these data in countries where PEPFAR is supporting OVC programs. MEASURE Evaluation conducted the first round of the MER OVC ESI in November 2016 and the second round in September 2018 for PHN.
Scale to Track the Stages of Development of Community-Based Health Information Systems MEASURE Evaluation 2019 English Global Community-based health information systems, Tool Governments and/or organizations can use this scale to assess, plan, and prioritize activities and investments to strengthen community-based health information systems (CBHIS). The tool can help governments and/or organizations determine at what stage their CBHIS is and what should be in place to get it to the next stage. Then they can use the tool to reassess the system’s status every one or two years.  The scale outlines seven domains: leadership and governance, system design, system management, data sources, data quality, and data use. Under each domain is a series of components with detailed descriptions of CBHIS maturity for each component across five stages. The scale can be used to develop a plan to strengthen the overall system and as an advocacy tool for investment to strengthen a given domain’s components.  The United States Agency for International Development (USAID)-funded MEASURE Evaluation project designed this tool as part of a broad effort to improve the health information systems of low- and middle-income countries: a crucial step toward stronger health systems generally and, ultimately, better health outcomes.   Access a related guide.
Analyzing, Interpreting, and Communicating Routine Family Planning Data in South Sudan Tobijo Denis Sokiri Moses, Zakaria Kenneth Kaunda, and Wani Bessensio Ezeron 2019 English SOUTH SUDAN family planning, Data use, Routine data, Routine Health Information Systems South Sudan’s modern contraceptive prevalence rate stands at just 2.7 percent, with an unmet need for modern family planning (FP) at 30.8 percent. Multiple barriers contribute to low FP uptake in South Sudan: inadequate data collection tools and insufficient analysis, interpretation, and communication of data. Research from the Democratic Republic of the Congo shows that improved management of FP data enables stronger ownership of program results at the health facility and community levels, empowering community members and providers to increase FP uptake. The purpose of the study was to explore how effectively FP data in the routine health information system (RHIS) are analyzed, interpreted, and communicated, and it discusses barriers to RHIS data use and ownership in two states in South Sudan, to inform policy and programmatic decision making. The study used a cross-sectional observational design with quantitative and qualitative approaches to data collection and analysis. Data were collected from 178 health facilities across 17 counties in two states in South Sudan: Central Equatoria and Western Equatoria.
Using the Indicator Matrix for Monitoring and Evaluating Programs Serving Orphans and Vulnerable Children: Guidance MEASURE Evaluation 2019 English Africa, Asia, Global, Latin America and the Caribbean PEPFAR, MER, OVC, OVC programs, Orphans and Vulnerable Children The United States President’s Emergency Plan for AIDS Relief (PEPAR) aims to mitigate the multidimensional and acute impact of HIV and AIDS on children through the provision of holistic, community-based care and support services. PEPFAR’s approach to orphans and vulnerable children (OVC) programming focuses on socioeconomic and health promotion, and access to interventions that reduce vulnerability, contribute to primary prevention of HIV, and support access to and retention in treatment. Focusing on improving the ability of OVC programs to measure their impact, PEPFAR assembled a team of experts from its partner agencies and MEASURE Evaluation to design an indicator matrix that maps the current required PEPFAR OVC indicators and complements them with additional recommended foundational, process, output, and outcome indicators and the newly established PEPFAR Global OVC Graduation Benchmarks. The purpose of this document is to describe the indicator matrix and guide PEPFAR country teams and implementing partners (IPs) to select custom indicators for performance monitoring. The document can also support the development or revision of current monitoring and evaluation (M&E) plans. The OVC indicator matrix is available at: https://www.measureevaluation.org/resources/publications/tl-19-36.
Monitoring and Evaluating Programs Serving Orphans and Vulnerable Children: An Indicator Matrix MEASURE Evaluation 2019 English Asia, Latin America and the Caribbean, Global, Africa Orphans and Vulnerable Children, OVC programs, OVC, MER, PEPFAR This matrix is intended to help United States President’s Emergency Plan for AIDS Relief (PEPFAR) country teams and implementing partners select custom indicators for performance monitoring, in addition to the MER OVC indicators. The matrix has the following aims: Help stakeholders in programs for orphans and vulnerable children (OVC) to measure what matters, and to consider repurposing or selecting new or “custom” indicators that will better inform project performance Provide sample indicators that can be used to measure how OVC projects are contributing to the global 95-95-95 and prevention targets Demonstrate the relationships among PEPFAR’s reporting requirements A companion to the matrix—“Using the Indicator Matrix for Monitoring and Evaluating Programs Serving Orphans and Vulnerable Children: Guidance,” available at https://www.measureevaluation.org/resources/publications/ms-19-167—explains how to use this tool.
Lessons in Health Information System Strengthening: What Worked in the Democratic Republic of the Congo MEASURE Evaluation 2019 English Health data, Health Information Systems, HIS strengthening, Health Systems Strengthening, Data Quality, Democratic Republic of Congo, Malaria, Health System, HIS Since 2014, MEASURE Evaluation has supported the National Malaria Control Program (NMCP) of the Democratic Republic of the Congo (DRC) to streamline and improve malaria data collection, reporting, management, and use, at all levels of the health system. Our approach prioritized building local capacity within nine provinces targeted by the President’s Malaria Initiative (PMI). It was driven by the need to intervene where data are generated, to promote good-quality data that could be used to make policy and service delivery decisions. Our support has contributed to the following improvements: Rollout of the electronic routine health information platform, DHIS 2, in all 178 health zones in nine PMI-targeted provinces More than 400 staff trained at the national, provincial, health zone, and health facility levels in areas such as monitoring and evaluation (M&E) and the collection, reporting, and analysis of data Development of HIS management resources such as the NMCP’s strategic and M&E plans, malaria M&E guidelines, and data collection tools Development of nationally validated indicators and an NMCP central database, both of which are integrated in DHIS 2 Establishment of 77 centers of excellence (COEs) 1 in three PMI provinces Implementation of (1) supportive supervision visits at the health facility, health zone, and provincial levels; (2) establishment of the MEASURE Evaluation Routine Data Quality Assessment (RDQA) Tool as a primary method to assess quality of routine data at the health zone and facility levels; and (3) data review meetings at all levels of the health system Improved routine data timeliness and completeness at the health facility (COEs) and provincial level (PMI targeted provinces) Development of M&E technical working groups and a malaria task force at the national and provincial levels to coordinate M&E and surveillance activities, address service delivery priorities, and improve data quality Because MEASURE Evaluation Phase IV is coming to a close, we sought to document the outcomes of our work with the NMCP, by interviewing staff at the national, provincial, health zone, and health facility levels. The objective of this document is to summarize lessons learned through this data collection effort and highlight effective health information system (HIS) strengthening interventions and their outcomes in the DRC.
Measuring Outcomes among Children of Female Sex Workers Supported by PEPFAR Programs: Indicator List MEASURE Evaluation 2019 English Global Children, Child health, OVC, Vulnerable children This indicator list is part of the Children in Adverse Situations Indicators and Survey Tools.
Measuring Outcomes among Street Children and Children Working in Mines Who Are Supported by PEPFAR Programs: Indicator List MEASURE Evaluation 2019 English Global Children, Child health, OVC, Vulnerable children This indicator list is part of the Children in Adverse Situations Indicators and Survey Tools. 
MEASURE Evaluation: Questionnaire for Street Children and Children Working in Mines, Ages 0 to 13 (Administered to the Person Most Knowledgeable or the Caregiver) MEASURE Evaluation 2019 English OVC, Children, Child health, Vulnerable children This resource is part of the Children in Adverse Situations Indicators and Survey Tools. It is also available for download in Word.
MEASURE Evaluation: Questionnaire for Adolescent Street Children and Adolescent Children Working in Mines (Ages 14 to 17) MEASURE Evaluation 2019 English Child health, Children, OVC, Vulnerable children This resource is part of the Children in Adverse Situations Survey Tools. It is also available for download in Word.
MEASURE Evaluation: Questionnaire for Female Sex Worker Caregivers, Ages 18 and Older MEASURE Evaluation 2019 English Children, Child health, OVC, Vulnerable children This resource is part of the Children in Adverse Situations Indicators and Survey Tools. It is also available for download in Word.
MEASURE Evaluation: Questionnaire for Children (Ages 0 to 9) of Female Sex Workers (Administered to the FSW Caregiver) MEASURE Evaluation 2019 English OVC, Children, Child health, Vulnerable children This resource is part of the Children in Adverse Situations Indicators and Survey Tools.  It is also available for download in Word.
MEASURE Evaluation: Questionnaire for Adolescent Children (Ages 10 to 17) of Female Sex Workers MEASURE Evaluation 2019 English OVC, Children, Child health, Vulnerable children This resource is part of the Children in Adverse Situations Survey Tools. It is also available for download in Word.
Community-Based Health Information System Guide: Approaches and Tools for Development Dawne Walker 2019 English Global HMIS, Environment, HIS strengthening, CBHIS, Community-based health information systems, HIS A community-based health information system (CBHIS) is a dynamic system that includes information on how data are collected, how they flow, how to assess and improve their quality, and how they are used. This system involves collection, management, and analysis of data on health and related services provided to communities outside of facilities. Historically, health management information systems (HMIS) have been fragmented, owing to siloed funding and programs. Frequently, CBHIS and national HMIS do not have standardized data elements, which has hampered efforts to harmonize systems and include community health data in the national HMIS. This guide does not cover specifics of the CBHIS and its different components. MEASURE Evaluation, which is funded by the United States Agency for International Development and the United States President’s Emergency Fund for AIDS Relief, developed this guide to focus instead on approaches, tools, and action items for developing areas under the enabling environment to work towards a harmonized health information system. We will look in depth at how to develop areas under leadership and governance, system design, and system management. Access a related tool.
Evaluating Integration of Early Childhood Development Interventions in the m2m Program in Eswatini: Summary of the Results Health Communication Capacity Collaborative 2019 English PMTCT, Children, Evaluation, HIV, ART, Eswatini, Swaziland In 2014–2015 many countries—including Swaziland (now Eswatini)—introduced the World Health Organization’s Option B+ strategy of lifelong antiretroviral therapy (ART) for women diagnosed with HIV to prevent mother-to-child transmission (PMTCT) of the virus during pregnancy and breastfeeding. While PMTCT regimens were known to be highly effective, there was some concern that the growing population of HIV- and ART-exposed but uninfected children could be at risk of poorer outcomes, including developmental ones. The United States Agency for International Development (USAID), through the United States President’s Emergency Plan for AIDS Relief (PEPFAR), proposed testing whether an early child development (ECD) intervention integrated in antenatal care/PMTCT programs could optimize outcomes in this population. ECD programs designed to promote responsive parenting-and-child early learning opportunities have been shown to have significant effects in improving the cognitive and motor skills of children ages 0–24 months, particularly among those with delayed development and malnutrition in low- and middle-income countries (LMICs). USAID chose Eswatini as a site to test the effectiveness of such an intervention in the context of a national PMTCT program. It asked mothers2mothers (m2m) to implement the ECD program and the Health Communication Capacity Collaborative (HC3), also funded by USAID, was tasked with conducting an independent evaluation. USAID asked MEASURE Evaluation to edit and format this brief to promote dissemination of the evaluation’s findings, as part of its work developing a USAID-funded regional learning platform for research on orphans and vulnerable children.
Kenya Malaria Programme Review 2018 National Malaria Control Programme, Ministry of Health 2019 English Malaria, Kenya The Malaria Programme Review (MPR) is a periodic joint programme management process for reviewing the progress and performance of a malaria programme in the context of national health and development plans. It is aimed at improving performance or redefining the programme’s strategic direction and focus. In 2009, Kenya conducted a comprehensive MPR of the National Malaria Strategy (NMS) 2001−2010. The ensuing recommendations led to the development of the NMS 2009−2017 with its goal set as the reduction of morbidity and mortality caused by malaria by two-thirds of the 2007/2008 levels by 2017. Subsequently in 2014, a mid-term review of the NMS 2009−2017 was done and this led to some key modifications. First, the initial period of the strategy was extended by one year to 2018 as part of the alignment to the health sector strategy 2013−2018. Secondly, the strategy was renamed Kenya Malaria Strategy (KMS) 2009−2018 in line with the devolution of health service delivery roles and responsibilities from national to county governments. Finally, the KMS objectives and strategies were amended for better performance and to align to the devolved status of the health services. The period of the revised KMS 2009–2018 ends in 2018. The strategy was hence due for an end-term review, which was undertaken in the MPR 2018. The overall objective of the MPR was to undertake an evidence-based review of the country malaria situation and acomprehensive performance review of the KMS against its set targets.
Adolescent-Friendly Health Services in Public Health Facilities in Lusaka, Zambia Theresa Nkole, Mukatimui Kalima Munalula, and Joseph Mumba Zulu 2019 English Adolescent health, Sexual Behavior, Contraceptive Use, and Reproductive Health, Sexually Transmitted Infections (STIs) Adolescents have healthcare needs that are distinct from adult needs, particularly in the area of sexual reproductive health (SRH) and rights. In Zambia, adolescents and young people represent 40 percent of the population. To increase adolescents’ access to and use of health services, the Ministry of Health developed National Standards and Guidelines for Provision of Adolescent-Friendly Health Services (AFHS) in 2009. Despite the recognition of the rights of young people to SRH information and services, adolescents still face challenges in accessing healthcare in public health institutions. Previous studies, particularly in Zambia, have focused on whether making facilities more youth-friendly will increase access and use. Because the government has already instituted AFHS, we sought to assess adherence to the standards and guidelines to identify the challenges, successes, and opportunities for strengthening adherence to the standards, thereby improving provision of AFHS and adolescent health outcomes. This cross-sectional study was carried out in six public health facilities in Lusaka District, Zambia. Data collection entailed 11 focus group discussions (FGDs) with 70 adolescent girls and boys ages 10 to 19 years. The FGDs were intended to get information on adolescents’ perceptions of how services are provided. Interviews were also conducted with health facility staff and community members. There were 123 total study participants.
Pregnancy Decisions and HIV Testing among Adolescent Girls and Young Women Enrolled in the DREAMS Initiative in Northern Uganda: Qualitative Report Irit Sinai, Danielle Stein, Eve Namisango, Ismael Ddumba-Nyanzi, Lisa Marie Albert, Michelle Li 2019 English HIV, AGWY, Young women, PEPFAR, Pregnancy, DREAMS, Adolescent Girls Adolescent reproductive health is a major social issue in Uganda. According to the 2016 Uganda Demographic and Health Survey, 25 percent of adolescents ages 15−19 are already mothers or pregnant with their first child, leading to substantial negative consequences for the health, education, and economic development of these young mothers, their children, and their communities. Adolescent girls and young women (AGYW) are also at a particularly high risk for acquiring HIV. The Determined, Resilient, Empowered, AIDS-free, Mentored, Safe (DREAMS) initiative in Uganda attempts to change these dynamics, by educating AGYW and empowering them to delay their first pregnancy, space subsequent pregnancies, and avoid risky behaviors that can lead to early pregnancy and HIV acquisition. DREAMS is a global health initiative funded by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and implemented by private implementing partners in 10 countries in sub-Saharan Africa, including Uganda. This study assessed the effects of DREAMS program interventions on decisions relating to the timing of pregnancies and sexual and reproductive health-related behaviors. Because of the interaction between HIV and pregnancy risk, we also looked at the effects of DREAMS on HIV prevention and testing, and on risky behaviors that can lead both to early pregnancy and contracting HIV. The DREAMS initiative delivers a core integrated package of life skills and economic strengthening interventions addressing health, social, and structural factors associated with AGYW’s HIV risk. The initiative also seeks to prevent unplanned pregnancies. DREAMS began work in Uganda in 2015 and as of 2018 operates in 11 districts. The objective of this qualitative study by MEASURE Evaluation—funded by the United States Agency for International Development (USAID) and PEPFAR—was to examine the influence of DREAMS interventions on perceptions and behaviors of AGWY in northern Uganda. Access the related quantitative report.
HIV Testing and Pregnancy Delay among Adolescent Girls and Young Women Enrolled in the DREAMS Initiative in Northern Uganda: Quantitative Report Karen Foreit, Veronica Varela, Chris Bernard Agala, Michelle Li, Lisa Marie Albert 2019 English Pregnancy, Adolescent Girls, Uganda, Young Women, AGWY, HIV In 2015, the United States President’s Emergency Plan for AIDS Relief (PEFAR) launched a targeted initiative—Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe Women (DREAMS)—to reduce HIV incidence among adolescent girls and young women (AGYW) ages 10 to 24 years in ten sub-Saharan African countries, including Uganda. The program provides HIV testing along with other interventions to address the structural drivers that directly and/or indirectly increase AGYW’s HIV risk, depending on beneficiaries’ characteristics. DREAMS’ strategy aims to provide combinations of services (known as a “layering” approach”) tailored to meet the different needs of five priority subpopulations or “segments” of AGYW: High-risk, in-school Pregnant Married Have given birth by age 15 Involved in transactional sex DREAMS currently operates in 11 districts in Uganda. In 2018, three years after program launch, the United States Agency for International Development (USAID)/Uganda asked MEASURE Evaluation to conduct secondary analyses of routinely-collected program data to assess the impact of the DREAMS initiative in four districts in Northern Uganda: Gulu, Lira, Omoro, and Oyam. The aim of this study is to assess the impact of the DREAMS initiative with the following objectives: Objective 1: Assess the influence of the family planning (FP) component of DREAMS on delay of subsequent pregnancies and contraceptive uptake among beneficiaries who had given birth by age 15, and Objective 2: Quantify the coverage of HIV testing and retesting and compare HIV retesting among beneficiaries who were reported to have received family planning services with those who were not reported to have received family planning. Access a related qualitative report.
A Guide to the Fundamentals of Economic Evaluation in Public Health Scott Moreland, Shaylen Foley, Lauren Morris 2019 English Global Public Health, Economic evaluation Managers and decision makers in public health face choices in a world with limited resources. This Guide to the Fundamentals of Economic Evaluation in Public Health presents an overview of methods and tools that can help to inform public health decisions based on economic principles. Although the guide’s perspective is economic, the principles address health outcomes. The guide is intended for public health program planners, managers, and funders who are not familiar with economic evaluation but want to become familiar with its fundamentals. Some chapters provide more detail than others, especially in areas that may not be well known to many audiences: costing, cost-effectiveness analysis, and cost-benefit analyses. This is not a textbook; the intention is for readers to become familiar with the basic principles of economic evaluation; know when to use economic evaluation methods; be able to read an economic evaluation report; and be able to understand, at a general level, the approaches used and the conclusions reached. The guide will help program managers/decision makers know which approach is the most appropriate to use. Evaluations of public health interventions, programs, or strategies look at their effectiveness in achieving the intended goal of improved health outcomes. Economic evaluation provides an additional element of understanding the cost factors of an intervention. The guide presents the main tools and approaches used in economic evaluation. Throughout the guide, the authors have strived to provide concrete, real-world examples and case studies. Where judged to be appropriate, mathematical examples of the required calculations are given. The limitations of each approach as well as any ethical considerations are also discussed. Access a related webinar recording.
Zimbabwe: Snapshot of the Strength of the Health Information System as a Source of HIV Data MEASURE Evaluation 2019 English ZIMBABWE, Africa AIDS, Africa, Zimbabwe, HIV/AIDS, Health Information Systems, HIS Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time. This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic. Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. 
Zambia: Snapshot of the Strength of the Health Information System as a Source of HIV Data MEASURE Evaluation 2019 English Africa, ZAMBIA AIDS, HIS, Africa, Zambia, HIV/AIDS, Health Information Systems Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time. This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic. Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. 
Tanzania: Snapshot of the Strength of the Health Information System as a Source of HIV Data MEASURE Evaluation 2019 English Africa, TANZANIA AIDS, HIS, Africa, Tanzania, HIV/AIDS, Health Information Systems Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time. This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic. Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. 
Rwanda: Snapshot of the Strength of the Health Information System as a Source of HIV Data MEASURE Evaluation 2019 English Africa, RWANDA AIDS, Rwanda, Africa, HIV/AIDS, Health Information Systems, HIS Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time. This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic. Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. 
Namibia: Snapshot of the Strength of the Health Information System as a Source of HIV Data MEASURE Evaluation 2019 English Africa, NAMIBIA Namibia, HIS, HIV/AIDS, Health Information Systems, Africa, AIDS Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time. This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic. Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. 
Malawi: Snapshot of the Strength of the Health Information System as a Source of HIV Data MEASURE Evaluation 2019 English Africa, MALAWI Health Information Systems, HIS, HIV/AIDS, Africa, AIDS, Malawi Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time. This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic. Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. 
Lesotho: Snapshot of the Strength of the Health Information System as a Source of HIV Data MEASURE Evaluation 2019 English Africa, LESOTHO AIDS, Africa, Lesotho, HIV/AIDS, Health Information Systems, HIS Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time. This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic. Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. 
Kenya: Snapshot of the Strength of the Health Information System as a Source of HIV Data MEASURE Evaluation 2019 English Africa, KENYA Health Information Systems, Kenya, HIS, HIV/AIDS, Africa, AIDS Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time. This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic. Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. 
Haiti: Snapshot of the Strength of the Health Information System as a Source of HIV Data MEASURE Evaluation 2019 English HAITI, Latin America and the Caribbean Latin America, Health Information Systems, Haiti, HIS, HIV/AIDS, AIDS Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time. This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic. Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. 
Kingdom of Eswatini: Snapshot of the Strength of the Health Information System as a Source of HIV Data MEASURE Evaluation 2019 English Africa, SWAZILAND Kingdom of Eswatini, AIDS, Africa, Swaziland, HIV/AIDS, Health Information Systems, HIS Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time. This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic. Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. 
Côte d’Ivoire: Snapshot of the Strength of the Health Information System as a Source of HIV Data MEASURE Evaluation 2019 English Africa, COTE D'IVOIRE AIDS, HIS, Africa, Cote D’Ivoire, HIV/AIDS, Health Information Systems Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time. This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic. Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. 
Uganda: Snapshot of the Strength of the Health Information System as a Source of HIV Data MEASURE Evaluation 2019 English UGANDA, Africa AIDS, Africa, Uganda, HIV/AIDS, Health Information Systems, HIS Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time. This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic. Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. 
Botswana: Snapshot of the Strength of the Health Information System as a Source of HIV Data MEASURE Evaluation 2019 English Africa, BOTSWANA AIDS, Africa, Botswana, HIV/AIDS, Health Information Systems, HIS Health information systems (HIS) are important tools in combatting the HIV epidemic, from the individual to the population level. Electronic health records contain individual patient information that helps clinicians provide high-quality care and can improve continuity of care across services and institutions. Laboratory information systems improve the submission of lab tests and the receipt of results. Logistic information systems can help forecast the need for medications and other commodities and reduce stockouts of antiretroviral drugs and other medications. Routine health information systems are used to compile this information for reports from facilities to the national level. Data use at all levels of the health system is necessary to monitor coverage of HIV interventions and progress toward targets. And finally, population-level surveys provide information on changes in behavior and HIV prevalence every few years; these data are needed to assess the impact of HIV programs over time. This is one of 13 briefs prepared by MEASURE Evaluation (funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief) to document the strength of a country’s HIS as a source of reliable data for efforts to control the HIV epidemic. Access the full collection of briefs at www.measureevaluation.org/our-work/health-information-systems/snapshot-of-the-strength-of-the-health-information-system-as-a-source-of-hiv-data. 
Caring for Armenia's Vulnerable Children: Institutionalizing a Platform for Cross-Sector Collaboration MEASURE Evaluation 2019 English ARMENIA Alternative Care, care reform In Armenia, the MEASURE Evaluation project—funded by the United States Agency for International Development (USAID) and USAID’s Displaced Children and Orphans Fund—facilitated development of a governance structure for the reform of national policies and systems for the care of vulnerable children: “national care reform.” The governance structure was a country core team (CCT) established by Armenia’s Ministry of Labor and Social Affairs in June 2017. Team members represent government partners and other stakeholders. Their task is to develop and strengthen the country’s leadership in assessing and ultimately accelerating national care reform. This brief explains the structure and roles of this CCT and the team’s usefulness as a platform for collaboration. Read more about MEASURE Evaluation's work on alternative care for children here. Read more about MEASURE Evaluation's work in Armenia here.
MEASURE Evaluation’s Strategy to Respond to National Malaria Control Program Needs in Surveillance, Monitoring, and Evaluation 2019 English Africa, Asia, Latin America and the Caribbean PMI, National Malaria Control Program, Malaria control, Malaria, Malaria Surveillance The Malaria Technical Area (MTA) of the United States Agency for International Development-funded MEASURE Evaluation project—with support from the President’s Malaria Initiative (PMI)—has increased its country presence in priority countries to provide direct technical support to national malaria control programs (NMCPs). This support is provided through a MEASURE Evaluation-appointed malaria resident advisor (MRA). MRAs have extensive experience in malaria surveillance, monitoring, and evaluation (SME), and their responsibilities consist of overseeing MEASURE Evaluation’s in-country work, developing close relationships with the NMCP, and liaising with the MTA headquarters staff. Depending on the scope of the country’s portfolio, additional SME staff may provide support to the MRA and form the rest of the in-country team. Each MRA has a tailored set of duties and challenges related to the needs of his or her assigned country’s NMCP. Although each MRA works to achieve the same goal of supporting the NMCP, there is limited direct interaction across countries. To promote the exchange of MRA experiences and lessons learned, MEASURE Evaluation hosted a meeting in October 2017 under the theme, “MEASURE Evaluation’s Malaria Technical Area: Transitioning to effective NMCP leadership in generating and using malaria information.” This four-day “cross-fertilization” meeting brought together MRAs and NMCP staff from the Democratic Republic of the Congo (DRC), Liberia, Madagascar, and Mali to discuss approaches and experiences in providing effective support to NMCPs. The meeting objectives were as follows: Understand MTA in-country activities and how they link with NMCP needs in SME Review country strategies to support NMCPs and identify best practices Develop a platform to optimize and utilize team expertise across countries This report summarizes the meeting, synthesizes best practices and lessons learned from providing technical support to NMCPs and collaborating with stakeholders, and presents a strategy for continued cross-country exchange of expertise and experience.
A Menu of Tools for Data Quality Assessment and Review MEASURE Evaluation 2019 English Data, Data quality, tools Robust systems are essential to track progress toward health objectives, such as the United Nations Sustainable Development Goals, and to support evidence-based decision making. Different approaches may be followed, to assess and improve data quality and data management and to make informed decisions for planning to improve quality and to achieve expected health outcomes. This document presents a menu of options for data quality assessment and is meant to provide guidance on which approach would be the most suitable for the data and system to be assessed. The scope of the assessment and the depth of data to be collected will depend on the purpose of the assessment. Data quality assessments will focus on one or more dimensions of data quality, such as accuracy, completeness, reliability, timeliness, confidentiality, precision, and integrity.
Strengthening the Performance of Kenya’s Health Information System: Improvements in Data Quality and Use at the County Level Millar, E. 2019 English HIS, MEASURE Evaluation PIMA, Capacity Assessment, Kenya, HIS strengthening, Learning Agenda, HISS, MECAT, Monitoring, Evaluation To shed light on how to strengthen HIS to meet the needs of the health sector, particularly by improving data quality and data use available for decision making, we studied the MEASURE Evaluation PIMA (MEval-PIMA) project's efforts to strengthen the organizational, technical, and behavioral components of routine health information systems in Kenya through participatory approaches with the county health management teams (CHMTs). Although the context of this study is specific to Kenya, we aimed to learn from the processes used for HIS strengthening within regional units of the health sector. In 2014, MEVAL-PIMA undertook an assessment of M&E capacity in CHMTs from 17 counties using the MEVAL-PIMA-developed Monitoring and Evaluation Capacity Assessment Toolkit (MECAT) (https://www.measureevaluation.org/pima/m-e-capacity). The assessment sought to identify the status of behavioral, organizational, and technical capacity in the use of data for programming. Baseline scores were used to identify priorities and inform interventions and to establish a benchmark for measuring progress in project M&E. Shortly after the baseline assessments, changes in funding priorities led MEVAL-PIMA to shift their work to a subset of 10 counties identified as high-priority in the areas of reproductive health, malaria, HIV/AIDS, or a combination of the three. Because MEVAL-PIMA conducted baseline assessments in 17 counties but then ended up working in only 10 counties, a good opportunity arose to capitalize on these initial investments and study the effect over time in comparison and intervention counties. Thus, this study aimed to assess how MEVAL-PIMA-supported interventions affected changes in data quality and data use compared with the comparison county. 
Exploring gaps in monitoring and evaluation of male engagement in family planning Bridgit M. Adamou, Brittany S. Iskarpatyoti, Chris B. Agala, Carolina Mejia 2019 English Male Engagment, Men, Family Planning, Evaluation, Indicators, Monitoring Background: Male engagement is becoming more common in family planning (FP) strategies and interventions, yet effective monitoring and evaluation (M&E) of this approach lags. This review sought to understand how male engagement in FP is defined, identify gaps in M&E of male engagement and make recommendations. Methods: We conducted key informant interviews and a desk review of peer-reviewed articles and gray literature, including national FP strategies and policies.  We then facilitated an online forum with experts in the field of male engagement in FP to provide feedback on our proposed indicators for male engagement in FP to reach consensus on and validate key indicators. Results: Although there is no universal definition of male engagement in FP, the most common definition is the inclusion of men in FP programming as FP clients, supportive partners, and agents of change. The most common approach was engaging men as clients exclusively, followed by engaging men as partners. Few papers reported on programs that engaged men across the full spectrum of the definition. There’s significant variation in the degree to which male engagement in FP is included in M&E, planning, and approaches. Few programs reported findings disaggregated by sex and by contraceptive method, making it difficult to determine the effect of programming on male use of methods. There is a dearth of indicators for measuring male engagement in FP in national strategies and policies. Other gaps are a lack of core indicators for male engagement, qualitative indicators, and indicator reference sheets for many commonly used indicators. Among over 100 indicators being used to monitor and evaluate male engagement in FP, 15 key indicators were identified and validated, with accompanying guidance. Conclusions: As programming for male engagement in FP increases, coordinated efforts should be made to improve the systems that collect, analyze, and use data.
Thinking Strategically About Nutrition: Key Issues in the Context of HIV and Tuberculosis David K. Hales 2019 English TB, Nutrition, HIV, Strategic thinking, Tuberculosis The primary purpose of this document is to encourage a more robust dialogue on the value and process of thinking strategically about nutrition, particularly at the national level. This dialogue should involve the full range of stakeholders who have—or should have—an interest in the multisectoral benefits of an effective national nutrition program: government representatives from relevant ministries (e.g., health, agriculture, social services, and economic development), civil society representatives, funding organizations, and individual and community beneficiaries of nutrition programs. MEASURE Evaluation, funded by the United States Agency for International Development (USAID), originally designed this document to explore the links between nutrition and HIV and tuberculosis (TB), because such a significant amount of development funding flows to these two diseases. However, as the global response to HIV and TB continued to evolve, it became increasingly clear that looking beyond these links to the larger strategic role of nutrition was equally important. References to the links between nutrition and HIV and TB are included in this document, because they are valuable examples of how an integrated approach is inherently more strategic, beneficial, and cost-effective. The issues, questions, and discussion points presented here are designed to help spark more-strategic discussions about the larger role of nutrition in improving the overall quality of life for individuals, families, and communities. They can also facilitate discussions about specific approaches to engage stakeholders and build broader support for nutrition, including the design and implementation of multilateral and bilateral initiatives.
Performance of Routine Information System Management (PRISM) User's Kit: Analyzing Data from a PRISM Assessment MEASURE Evaluation 2019 English Information System, Routine Health Information Systems, Data, Health Information Systems, Health data, PRISM, Performance of Routine Information System Management, RHIS One of the mandates of the United States Agency for International Development (USAID)-supported MEASURE Evaluation project is to strengthen the collection, analysis, and use of routine health information system (RHIS) data for the delivery of high-quality health services. We developed the Performance of Routine Information System Management (PRISM) Framework and suite of tools in 2011 for global use in assessing the reliability and timeliness of an RHIS, in making evidence-based decisions, and in identifying gaps in an RHIS so they can be addressed and the system can be improved. With USAID’s support, we have revised the PRISM Tools and developed other elements, based on the PRISM Framework, to create a broad array of materials: the “PRISM Series,” available here: https://www.measureevaluation.org/prism. This new, comprehensive PRISM Series is useful for designing, strengthening, and evaluating RHIS performance and developing a plan to put the results of a PRISM assessment into action. To support the use of the PRISM Tools, we have developed a User’s Kit, which consists of three manuals in addition to this one: Preparing and Conducting a PRISM Assessment, available here: https://www.measureevaluation.org/resources/publications/ms-18-140/ Using SurveyCTO to Collect and Enter PRISM Assessment Data, available here: https://www.measureevaluation.org/resources/publications/ms-18-143/ Moving from Assessment to Action, available here: https://www.measureevaluation.org/resources/publications/ms-18-142/ The User’s Kit guides all aspects of a PRISM assessment. This manual—the third in the series—provides indicator breakdowns, step-by-step instructions, calculation tables, and an answer guide to the problem-solving questions of the Organizational and Behavioral Assessment Tool (OBAT)—including graphic representations and open-ended questions—for analysis of all PRISM data into indicators and scores.
Orphans and Vulnerable Children Caregiver Questionnaire Optional Module 7: Participation in Savings Groups MEASURE Evaluation 2019 English OVC, Orphans and vulnerable children This module on participation in savings groups is designed to be used with the caregiver questionnaire developed for MEASURE Evaluation's Orphans and Vulnerable Children survey toolkit.
Orphans and Vulnerable Children Caregiver Questionnaire Optional Module 5: Attitudes about HIV and AIDS MEASURE Evaluation 2019 English OVC, Orphans and vulnerable children This module on attitudes about HIV and AIDS is designed to be used with the caregiver questionnaire developed for MEASURE Evaluation's Orphans and Vulnerable Children survey toolkit.
Orphans and Vulnerable Children Caregiver Questionnaire Optional Module 4: Decision Making and Gender Roles MEASURE Evaluation 2019 English OVC, Orphans and vulnerable children This module on decision making and gender roles is designed to be used with the caregiver questionnaire developed for MEASURE Evaluation's Orphans and Vulnerable Children survey toolkit.
Orphans and Vulnerable Children Caregiver Questionnaire Optional Module 3: Household Dietary Diversity MEASURE Evaluation 2019 English OVC, Orphans and vulnerable children This module on household dietary diversity is designed to be used with the caregiver questionnaire developed for MEASURE Evaluation's Orphans and Vulnerable Children survey toolkit.
Orphans and Vulnerable Children Caregiver Questionnaire MEASURE Evaluation 2019 English OVC, Orphans and vulnerable children The caregiver questionnaire is intended for use as one of the orphans and vulnerable children (OVC) survey tools developed by MEASURE Evaluation, with support from the OVC technical working group of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The caregiver questionnaire addresses the household and the caregiver. Access additional modules.
Questionnaire for Orphans and Vulnerable Children Ages 10‒17 Years Optional Module 2: HIV Treatment and Disclosure MEASURE Evaluation 2019 English Global Orphans and vulnerable children, OVC This module on HIV treatment and disclosure is designed to be used with the questionnaire for children ages 10-17 years developed for MEASURE Evaluation's Orphans and Vulnerable Children survey toolkit.
Questionnaire for Orphans and Vulnerable Children Ages 10‒17 Years Optional Module 1: Dietary Diversity MEASURE Evaluation 2019 English OVC, Orphans and vulnerable children This module on dietary diversity is designed to be used with the questionnaire for children ages 10-17 years developed for MEASURE Evaluation's Orphans and Vulnerable Children survey toolkit.
Questionnaire for Orphans and Vulnerable Children Ages 0‒9 Years Optional Module 2: Individual Dietary Diversity MEASURE Evaluation 2019 English OVC, Orphans and vulnerable children This module on individual dietary diversity is designed to be used with the questionnaire for children ages 0-9 years developed for MEASURE Evaluation's Orphans and Vulnerable Children survey toolkit.
Questionnaire for Orphans and Vulnerable Children Ages 0‒9 Years Optional Module 1: Immunizations MEASURE Evaluation 2019 English OVC, Orphans and vulnerable children This module on immunizations is designed to be used with the questionnaire for children ages 0-9 years developed for MEASURE Evaluation's Orphans and Vulnerable Children survey toolkit.
Orphans and Vulnerable Children Caregiver Questionnaire Optional Module 6: HIV Treatment and Disclosure MEASURE Evaluation 2019 English OVC, Orphans and vulnerable children This module on HIV treatment and disclosure is designed to be used with the caregiver questionnaire developed for MEASURE Evaluation's Orphans and Vulnerable Children survey toolkit.
Questionnaire for Orphans and Vulnerable Children Ages 10‒17 Years MEASURE Evaluation 2019 English Global Orphans and vulnerable children, OVC The questionnaire for orphans and vulnerable children (OVC) ages 10-17 years is intended for use as one of the OVC survey tools developed by MEASURE Evaluation, with support from the OVC technical working group of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The questionnaire for children ages 10-17 years is administered directly to children with their informed assent and parental consent. Access additional modules.
Questionnaire for Orphans and Vulnerable Children Ages 0‒9 Years MEASURE Evaluation 2019 English OVC, Orphans and Vulnerable Children The questionnaire for orphans and vulnerable children (OVC) ages 0-9 years is intended for use as one of the OVC survey tools developed by MEASURE Evaluation, with support from the OVC technical working group of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The questionnaire for children ages 0-9 years is administered to the caregiver. Access additional modules.
Haitian Female Sex Workers in the Dominican Republic: A Qualitative Study of HIV Vulnerability and Service Use Katherine Andrinopoulos, Erica Felker-Kantor, Jessica Brewer 2019 English Haiti, Key Populations, HIV, Sex Workers Haitian female sex workers (FSWs) are an important key population for HIV in the Dominican Republic (DR), with an estimated HIV prevalence of 5.4 percent (Centers for Disease Control and Prevention [CDC] & the University of San Francisco Center for AIDS Prevention Studies [UCSF CAPS], 2015) compared to a 0.7 percent national rate (Joint United Nations Programme on HIV/AIDS [UNAIDS], 2017). Despite the higher HIV risk among this group, there is a gap in its access to and use of HIV services. A recent study in Santo Domingo showed that only 36.8 percent of Haitian FSWs had received condoms and lubricants in the past six months, and only 34.1 percent had tested for HIV in the past 12 months (CDC & UCSF CAPS, 2015). Currently, the main mode of HIV-service provision for Haitians in the DR is through mobile HIV-testing units. Research in the DR has shown that multilevel interventions for FSWs, guided by a community empowerment approach, are effective for increasing condom use (Kerrigan et al., 2006) and HIV-treatment adherence (Kerrigan et al., 2016). Adapting this type of intervention to build on the existing mobile units and tailoring it to the experience of Haitian FSWs may increase HIV-service use among this group. The purpose of this study was to provide descriptive information on the specific HIV-service needs (prevention, testing, treatment, and retention) of Haitian FSWs in the DR that can be used to tailor interventions for this group. This report shares the study findings and provides recommendations. 
Îngrijirea alternativă a copilului Buletin informativ: Martie 2019 MEASURE Evaluation 2019 Romanian ROMANIA Alternative Care, Orphans and Vulnerable Children Acesta este cel de-al treilea buletin informativ ”Îngrijirea Alternativă a Copilului”. Publicația oferă actualizări cu privire la activitățile la nivel de țară desfășurate începând cu luna octombrie 2018: Utilizarea constatărilor din cadrul evaluărilor reformei naționale a sistemului de îngrijire Activități de mentorat legate de monitorizare și evaluare Informații din țările vizate privind contribuțiile vizitelor în teren la înțelegerea provocărilor în ceea ce privește calitatea și utilizarea datelor Informații actualizate asupra funcționării sistemelor informaționale
ԵՐԵԽԱՆԵՐԻ ԱՅԼԸՆՏՐԱՆՔԱՅԻՆ ԽՆԱՄՔ Լրատու: Մարտ 2019 MEASURE Evaluation 2019 Armenian ARMENIA Ձեր ուշադրությանն ենք ներկայացնում «Երեխաների այլընտրանքային խնամք» ամսագրի 3-րդ համարը: Այս համարը պարունակում է տեղեկատվություն 2018թ. հոկտեմբերից մինչ օրս տարբեր երկրներում իրականացված գործողությունների վերաբերյալ, մասնվորապես՝ Երկրների այլընտրանքային խնամքի համակարգի բարեփոխումների մասնակցային ինքնագնահատման արդյունքների կիրառում Մշտադիտարկմանն ու գնահատմանը (ՄԳ) ուղղված մենթորական գործունեություն Դիտարկումներ ընտրված երկրներում իրականացված մարզային այցելություններից, որը թույլ կտա հասկանալ տվյալների որակի և կիրառման հետ կապված դժվարությունները։ Նորություններ տեղեկատվական համակարգերի աշխատանքի վերաբերյալ։
Testing a Client Tracker for the Prevention of Mother-to-Child Transmission of HIV in Zimbabwe: Findings and Lessons Learned Allison Schmale, Lwendo Moonzwe, Francesca Scott, Samuel Johnson, Cristina de la Torre 2019 English PMTCT, HIV, Maternal health, HIV prevention, Zimbabwe, Child health This brief summarizes the findings and lessons learned from testing a client tracker for prevention of mother-to-child transmission of HIV (PMTCT) programs. MEASURE Evaluation developed the PMTCT Tracker on the DHIS 2 platform based on previously developed guidance. We subsequently tested the PMTCT Tracker in a health clinic in Zimbabwe to identify any issues that needed to be fixed or improved. In this report, we describe the PMTCT Tracker and present findings from the testing exercise. Findings from the testing exercise were used to refine the PMTCT Tracker before making it publicly available. Access related guidance.
Understanding the Influence of Health Information System Investments on Health Outcomes in Côte d’Ivoire: A Qualitative Study MEASURE Evaluation 2019 English Health System, Cote d'Ivoire, HIS strengthening, HISS, Health Information Systems, HIS Health information is one of the six core functions of a health system, along with service delivery; human resources for health; medical products, vaccines, and technologies; financing; and leadership and governance. Investments in any one of these areas will affect and be affected by the other core functions of the health system. Assessing the broader effects of investments in HIV-specific health information systems (HIS) on the overall improvement of the larger health system can help explain how these investments can lead to improved HIV outcomes. There have been substantial investments in Côte d’Ivoire’s HIS over the past decade. In 2018 these investments were evaluated to contribute to an understanding of how HIS strengthening investments affect HIS performance, health system outcomes, and public health outcomes. The evaluation consisted of a document review with a resulting triangulation report (MEASURE Evaluation, 2018), and a qualitative study informed by key stakeholders in the country, the results of which are presented in this report.
Rapid Costing Assessment of USAID-Funded Structural and Behavioral HIV Prevention Activities Part II: Results of a Quantitative Cost Analysis Stacie Gobin, Shaylen Foley 2019 English HIV prevention, Cost analysis, HIV, Data, Cost The United States President’s Emergency Plan for AIDS Relief has seen great variation in the unit expenditure data reported from partners implementing behavioral and structural HIV prevention programs, impacting the effective use of resources and challenging accurate budget planning. This activity was developed to improve understanding of the processes used to report costs and provide unit expenditure estimates of specific behavioral and structural HIV prevention interventions, with the long-term goal of helping the United States Agency for International Development better capture the costs of multifaceted HIV prevention programs and improve resource management. Cost information is difficult to access and quantify, because financial systems rarely contain the required cost information. One issue is the lack of systematic collection of cost data. Additionally, few institutions have systems capable of apportioning central costs to local activities or departments. Unlike health and social care systems in high-income countries, with formal assessment frameworks that incorporate economic evaluations, low- and middle-income country contexts present several limitations in conducting economic evaluation and applying the results to policymaking. This paper describes challenges in collecting, analyzing, and interpreting cost data in structural and behavioral HIV prevention programs and offers recommendations to meet them.
Performance of Routine Information System Management (PRISM) Toolkit: PRISM Tools MEASURE Evaluation 2019 English Information System, PRISM, HISS, Performance of Routine Information System Management, RHIS, Toolkit, Health Information Systems, Routine Health Information Systems MEASURE Evaluation developed the Performance of Routine Information System Management (PRISM) Framework and suite of tools in 2011 for global use in assessing the reliability and timeliness of an RHIS, in making evidence-based decisions, and in identifying gaps in an RHIS so they can be addressed and the system can be improved. The framework acknowledges the broader context in which RHIS operate. It also emphasizes the strengthening of RHIS performance through a system-based approach that sustains improvements in data quality and use. With USAID’s support, MEASURE Evaluation has revised the PRISM Tools and developed other elements, based on the PRISM Framework, to create a broad array of materials: the “PRISM Series.” This new, more comprehensive PRISM Series is useful for designing, strengthening, and evaluating RHIS performance and developing a plan to put the results of a PRISM assessment into action. The revised “PRISM Tools”—the PRISM Series’ core document—offers the following data collection instruments: the RHIS Overview Tool, the Performance Diagnostic Tool, the Electronic RHIS Performance Assessment Tool, the Management Assessment Tool, the Facility/Office Checklist, and the Organizational and Behavioral Assessment Tool. These PRISM tools can be used together to gain an in-depth understanding of overall RHIS performance, to establish a baseline, and to rigorously evaluate the progress and effectiveness of RHIS strengthening interventions every five years, contributing to the national RHIS strategic planning process. Each PRISM tool can also be used separately for in-depth analysis of specific RHIS performance areas and issues. The resource is also available as a downloadable Word file. Access additional PRISM resources.
Alternative Care for Children Newsletter: March 2019 MEASURE Evaluation 2019 English UGANDA, ARMENIA, MOLDOVA, REPUBLIC OF, GHANA Systems strengthening, Data Quality, Alternative Care, Data use, Information systems, M&E The March 2019 Alternative Care for Children Newsletter provides updates on country-level activities since October 2018. It covers the following: The use of findings from the national care reform assessments Mentorship activities related to monitoring and evaluation Insights from select countries on the contributions of field-level site visits, to allow an understanding of challenges in data quality and use Updates on information systems work Learn more about MEASURE Evaluation’s alternative care work here.
Scale for Measuring the Health Information System Stages of Continuous Improvement MEASURE Evaluation 2019 English HIS, Health Information Systems, SOCI Countries or organizations can use this scale to assess, plan, and prioritize investments to strengthen a health information system (HIS), based on where the HIS is now and where they want it to be. The scale outlines five domains, 13 associated components, and 39 subcomponents, spelling out attributes of improvement across five stages of progress toward a high-functioning system. The scale can be used to develop a roadmap for HIS improvement aligned with an HIS strategic plan or a health systems plan. Access the full toolkit.
Mapping the Stages of MEASURE Evaluation's Data Use Continuum to DHIS 2: An Example from the Democratic Republic of the Congo MEASURE Evaluation 2019 English DHIS 2, Data informed, DDU, Data use The use of good-quality health data for decision making is the key output of strengthened health information systems (HIS) and a cornerstone of a well-functioning health system. Data use is defined as “the analysis, synthesis, interpretation, and review of data as part of decision-making processes, regardless of the source of data” (Nutley & Reynolds, 2013). MEASURE Evaluation, which is funded by the United States Agency for International Development, has developed the data use continuum, which describes how data are used both to strengthen HIS and to improve health programs. DHIS 2 is an electronic platform for the collection and analysis of health data. The Ministry of Health of the Democratic Republic of the Congo (DRC) adopted DHIS 2 as the country’s national health information system. The government began to pilot and roll out the system subnationally in 2014, scaling it up countrywide over three years. The U.S. President’s Malaria Initiative funded MEASURE Evaluation to conduct an assessment in 2017 that highlighted several barriers to  the use of malaria data at multiple levels of the health system in the country. This assessment informed a series of interventions to strengthen the use of DHIS 2. This brief documents the key phases of the data use continuum and describes the ways in which the rollout and implementation of DHIS 2 in the DRC facilitated the use of data to improve the HIS and health programs.
“Every Newborn-BIRTH” protocol: observational study validating indicators for coverage and quality of maternal and newborn health care in Bangladesh, Nepal and Tanzania Louise T Day, Harriet Ruysen, et al. 2019 English Data, Newborn health, Maternal health, Health care, DHIS 2, Tanzania, Nepal, Maternal and child health, Health data, Bangladesh, MCH Background: To achieve Sustainable Development Goals and Universal Health Coverage, programmatic data are essential. The Every Newborn Action Plan, agreed by all United Nations member states and >80 development partners, includes an ambitious Measurement Improvement Roadmap. Quality of care at birth is prioritised by both Every Newborn and Ending Preventable Maternal Mortality strategies, hence metrics need to advance from health service contact alone, to content of care. As facility births increase, monitoring using routine facility data in DHIS2 has potential, yet validation research has mainly focused on maternal recall surveys. The Every Newborn – Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study aims to validate selected newborn and maternal indicators for routine tracking of coverage and quality of facility-based care for use at district, national and global levels. Methods: EN-BIRTH is an observational study including >20000 facility births in three countries (Tanzania, Bangladesh and Nepal) to validate selected indicators. Direct clinical observation will be compared with facility register data and a pre-discharge maternal recall survey for indicators including: uterotonic administration, immediate newborn care, neonatal resuscitation and Kangaroo mother care. Indicators including neonatal infection management and antenatal corticosteroid administration, which cannot be easily observed, will be validated using inpatient records. Trained clinical observers in Labour/Delivery ward, Operation theatre, and Kangaroo mother care ward/areas will collect data using a tablet-based customised data capturing application. Sensitivity will be calculated for numerators of all indicators and specificity for those numerators with adequate information. Other objectives include comparison of denominator options (ie, true target population or surrogates) and quality of care analyses, especially regarding intervention timing. Barriers and enablers to routine recording and data usage will be assessed by data flow assessments, quantitative and qualitative analyses. Conclusions: To our knowledge, this is the first large, multi-country study validating facility-based routine data compared to direct observation for maternal and newborn care, designed to provide evidence to inform selection of a core list of indicators recommended for inclusion in national DHIS2. Availability and use of such data are fundamental to drive progress towards ending the annual 5.5 million preventable stillbirths, maternal and newborn deaths.
Referral patterns through the lens of health facility readiness to manage obstetric complications: national facility-based results from Ghana Patricia E. Bailey, John Koku Awoonor-Williams, Victoria Lebrun, Emily Keyes, Mario Chen, Patrick Aboagye and Kavita Singh 2019 English Ghana, Emergency services, Maternal mortality, Obstetrics, Referral system Introduction: Countries with high maternal and newborn mortality can benefit from national facility level data that describe intra-facility emergency referral patterns for major obstetric complications. This paper assesses the relationship between referral and facilities’ readiness to treat complications at each level of the health system in Ghana. We also investigate other facility characteristics associated with referral. Methods: The National Emergency Obstetric and Newborn Care Assessment 2010 provided aggregated information from 977 health facilities. Readiness was defined in a 2-step process: availability of a health worker who could provide life-saving interventions and a minimum package of drugs, supplies, and equipment to perform the interventions. The second step mapped interventions to major obstetric complications. We used descriptive statistics and simple linear regression. Results: Lower level facilities were likely to refer nearly all women with complications. District hospitals resolved almost two-thirds of all complicated cases, referring 9%. The most prevalent indications for referral were prolonged/obstructed labor and antepartum hemorrhage. Readiness to treat a complication was correlated with a reduction in referral for all complications except uterine rupture. Facility readiness was low: roughly 40% of hospitals and 10% of lower level facilities met the readiness threshold. Facilities referred fewer women when they had higher caseloads, more midwives, better infrastructure, and systems of communication and transport. Discussion: Understanding how deliveries and obstetric complications are distributed across the health system helps policy makers contextualize decisions about the pathways to providing maternity services. Improving conditions for referral (by increasing access to communication and transport systems) and the management of obstetric complications (increasing readiness) will enhance quality of care and make referral more effective and efficient.
The Cost of Case Management in Orphans and Vulnerable Children Programs: Findings from Zambia MEASURE Evaluatio 2019 English OVC programs, Zambia, Case management, Orphans and vulnerable children, OVC, Cost management The USAID- and PEPFAR-funded MEASURE Evaluation project conducted a six-country study for insight on current approaches to case management delivery and the cost of those approaches. This brief outlines the findings from the Zambia Family project in Zambia, implemented by Expanded Church Response, five partners, and 73 community-based organizations. The complete study report—The Cost of Case Management in Orphans and Vulnerable Children Programs: Results from a Mixed-Methods, Six-Country Study—is available at https://www.measureevaluation.org/resources/publications/tr-19-327/.
The Cost of Case Management in Orphans and Vulnerable Children Programs: Findings from Tanzania MEASURE Evaluation 2019 English OVC programs, Orphans and vulnerable children, Case management, Tanzania, OVC, Cost management The USAID- and PEPFAR-funded MEASURE Evaluation project conducted a six-country study for insight on current approaches to case management delivery and the cost of those approaches. This brief outlines the findings from the Kizazi Kipya project, in Tanzania, which Pact implements in collaboration with five partners and 48 civil society organizations. The complete study report—The Cost of Case Management in Orphans and Vulnerable Children Programs: Results from a Mixed-Methods, Six-Country Study—is available at https://www.measureevaluation.org/resources/publications/tr-19-327/.
The Cost of Case Management in Orphans and Vulnerable Children Programs: Findings from Rwanda MEASURE Evaluation 2019 English Cost management, Rwanda, OVC, OVC programs, Case management, Orphans and vulnerable children The USAID- and PEPFAR-funded MEASURE Evaluation project conducted a six-country study for insight on current approaches to case management delivery and the cost of those approaches. This brief outlines the findings from the Turengere Abana program in Rwanda. The complete study report—The Cost of Case Management in Orphans and Vulnerable Children Programs: Results from a Mixed-Methods, Six-Country Study—is available at https://www.measureevaluation.org/resources/publications/tr-19-327/.
The Cost of Case Management in Orphans and Vulnerable Children Programs: Findings from Uganda MEASURE Evaluation 2019 English Uganda, OVC programs, Case management, Orphans and vulnerable children, OVC, Cost management The USAID- and PEPFAR-funded MEASURE Evaluation project conducted a six-country study for insight on current approaches to case management delivery and the cost of those approaches. This brief outlines the findings from the Better Outcomes for Children and Youth project, in Uganda, which is implemented by World Education/Bantwana, in collaboration with four partner organizations and seven local civil society organizations. The complete study report—The Cost of Case Management in Orphans and Vulnerable Children Programs: Results from a Mixed-Methods, Six-Country Study—is available at https://www.measureevaluation.org/resources/publications/tr-19-327/.
The Cost of Case Management in Orphans and Vulnerable Children Programs: Findings from South Africa MEASURE Evaluation 2019 English Cost management, South Africa, OVC, OVC programs, Case management, Orphans and vulnerable children The USAID- and PEPFAR-funded MEASURE Evaluation project conducted a six-country study for insight on current approaches to case management delivery and the cost of those approaches. This brief outlines the findings from the Government Capacity Building and Support project, in South Africa, which Pact implemented with support from three partners and the South African Department of Social Development. The complete study report—The Cost of Case Management in Orphans and Vulnerable Children Programs: Results from a Mixed-Methods, Six-Country Study—is available at https://www.measureevaluation.org/resources/publications/tr-19-327/.
The Cost of Case Management in Orphans and Vulnerable Children Programs: Findings from Nigeria MEASURE Evaluation 2019 English Cost management, OVC, Nigeria, OVC programs, Case management, Orphans and vulnerable children The USAID- and PEPFAR-funded MEASURE Evaluation project conducted a six-country study for insight on current approaches to case management delivery and the cost of those approaches. This brief outlines the findings from the Systems Transformed for Empowered Actions and Enabling Responses (STEER) project, in Nigeria. The complete study report—The Cost of Case Management in Orphans and Vulnerable Children Programs: Results from a Mixed-Methods, Six-Country Study—is available at https://www.measureevaluation.org/resources/publications/tr-19-327/.
Evaluating the performance of Côte d'Ivoire's RHIS in August 2018 (Evaluation de la performance du SISR de la Côte d’Ivoire en août 2018) Edwige Bosso, Franck Olivier Ba-Gomis, Léontine Gnassou, Félix Mominé Malé, Aoua Camara Aka, Alain Koukou; Adama Sanogo Pongathié, Alimou Barry, Jeanne Chauffour 2019 French HIS, RHIS, HISS, Health System, Cote d'Ivoire, Health Information Systems, PRISM Following two performance evaluations of Côte d'Ivoire's routine health information system (RHIS) in 2008 and 2012, the Ministry of Health and Public Hygiene (MSHP) launched a number of interventions to strengthen the RHIS. In 2018, a follow-up evaluation of the RHIS was conducted to assess the impact of these interventions. This new evaluation was conducted in 234 health facilities, 24 districts, 12 health regions, and the central level represented by the Directorate for Information and Health Data (DIIS) using the PRISM tools revised in 2018. Results at the peripheral level (health facilities and districts) show that data quality is still weak at the facility level, although it has improved at higher levels (districts, regions, and the central level), as have data management procedures. Data use is weak at the health facility level and moderate at higher levels (districts, regions, and the central level). In light of the results of this new study, future interventions to strengthen the RHIS should focus on health facilities -- the loci of production of all national health data -- that determine the overall quality of the health system in Côte d'Ivoire. French: Après les évaluations de la performance du système d’information sanitaire de routine (SISR) réalisées en 2008 et 2012, des interventions de renforcement ont été mises en œuvre par le Ministère de la Santé et de l’Hygiène Publique (MSHP). Ainsi, une nouvelle évaluation du SISR a été réalisée pour apprécier l’impact de ces interventions. Cette évaluation a été menée avec les outils du PRISM révisés en 2018 et a concerné 234 formations sanitaires (FS), 24 districts, 12 régions sanitaires et le niveau central représenté par la Direction de l’Informatique et de l’Information Sanitaire (DIIS). Les résultats au niveau périphérique (FS et districts) montrent que la qualité des données reste faible au niveau des FS, mais qu’elle s’est améliorée aux niveaux supérieurs (districts, régions et niveau central), de même que les procédures de gestion des données. L’utilisation des données est faible au niveau des FS et moyenne aux niveaux supérieurs (districts, régions et niveau central). A la lumière des résultats de cette étude, les interventions de renforcement du SISR devraient se focaliser sur les FS qui sont le lieu de production initiale de toutes les données et qui déterminent la qualité globale du système.
Tool for Assessing and Monitoring National Alternative Care Systems 2019 English Global Alternative Care, Child health, Child Health, Care for children, Children, Child survival Ensuring children grow up in protective family care, free from deprivation, exploitation, and danger is a priority for many countries. Significant improvements have been made in government systems and policies related to the well-being and development of vulnerable children, with particular attention to preserving and facilitating children's access to appropriate, protective, and permanent family care. The United States Agency for International Development (USAID) Displaced Children and Orphans Fund (DCOF), along with several other stakeholders, invest in strengthening government systems to ensure family-based care for children around the world. MEASURE Evaluation, with support from USAID/DCOF, developed this tool to support countries as they assess, address, and monitor national care system reform. This tool applies the United Nations (UN) Guidelines for the Alternative Care of Children. The structure of the tool follows a framework that covers key areas of caring for children outside of family care: foster care, residential care, supervised independent living, kinship care, other forms of informal care, adoption, and family reunification and system deinstitutionalization. This tool also has questions related to preventing unnecessary child-family separation, which is a critical component of keeping children in family-based care. The tool applies a system strengthening framework. We present system components that are commonly agreed upon to be critical to sustainably and effectively strengthening national systems.
Data for Impact: The D4I Approach to Data Use Data for Impact 2019 English Data visualization, Data use, Date use, D4I Data for Impact, a five-year cooperative agreement funded by the United States Agency for International Development (USAID), helps countries mobilize the power of data to improve programs, policies, and—ultimately—health outcomes. D4I prioritizes data use in everything we do. At the beginning of an evaluation or assessment, we plan for data use by identifying and engaging all potential data users or stakeholders with an interest in the findings.
Data for Impact Approach to Institutional Strengthening Data for Impact 2019 English D4I, Data use Data for Impact, a five-year cooperative agreement funded by the United States Agency for International Development (USAID), helps countries mobilize the power of data to improve programs, policies, and—ultimately—health outcomes. This approach document focuses on strengthening individual and institutional capacity to generate evidence for health decision making and to receive direct funding from USAID. At the foundation of this approach is our belief that individuals and institutions have existing capacity, and they should lead in their own capacity strengthening.
Using DHIS 2 Software to Collect Health Data in Bangladesh Tahmina Begum, Shaan Muberra Khan, Jannatul Ferdous, Muhammad Masud Parvez, Aminur Rahman, Feroza Akhter Kumkum, and Iqbal Anwar 2019 English DHIS 2, HIS, HMIS Accurate and high-quality data are important for improving program effectiveness and informing policy. As part of Bangladesh’s district health information system, which allows data to be entered at the community level and analyzed at the central, state, and district levels, the country adopted the web-based platform DHIS 2 in 2009. In Bangladesh, real-time health service use data, with particular attention to reproductive, maternal, newborn, child, and adolescent health (RMNCAH), are available from the community level to the tertiary hospital level. However, health data are being underused for health planning purposes, because of poor data quality and reporting. The main objective of this study was to understand the user’s perceptions of and experiences with using DHIS 2 to collect and analyze RMNCAH data in Bangladesh and to identify facilitators and barriers to using these data at different levels of the healthcare system. The study used three qualitative research methods. Insights from this study are expected to contribute to the development of effective strategies for successful DHIS 2 implementation and, ultimately, the design of a responsive health management information system in Bangladesh.
The Cost of Case Management in Orphans and Vulnerable Children Programs Results from a Mixed-Methods, Six-Country Study Stacie Gobin, Shaylen Foley 2019 English Case management, Cost-effectiveness, OVC programs, Orphans and vulnerable children, Cost, OVC Little is known about how much it costs to implement services for orphans and vulnerable children (OVC), such as case management. When cost estimate data are available, the ranges for unit expenditures are strikingly wide and it is difficult to compare across programs or intervention service areas. Case management—a cornerstone of OVC programming and the platform on which OVC services are delivered—is largely conducted by community-based case workers (CWs). Research shows that CWs contribute meaningfully to HIV service delivery, impacting the social determinants of health through the delivery of comprehensive suites of interventions. However, few cost analyses have attempted to disaggregate the costs of case management from other OVC program service areas. To address this gap, the United States Agency for International Development (USAID)- and United States President’s Emergency Plan for AIDS Relief (PEPFAR)-funded MEASURE Evaluation worked with six OVC projects in six countries to gain insight on current approaches to OVC case management, map how costs can be linked to OVC case management activities, and determine the cost of OVC case management. To further inform and strengthen our understanding of the cost data, the study also qualitatively explored the context of the CWs’ experiences related to OVC case management.  Similar to previous studies of the cost of OVC programs, we found wide variations in annual case management costs, the cost per beneficiary, the proportion of total expenditures, and the relative distribution of spending by cost element. The differences were due to the differences in case management modalities and the variation in how implementing mechanisms chose to invest in case management versus in other project service areas. The contextual information provided by the interviews helped bolster and support the cost estimates found in this study. Without the parallel approach of collecting both quantitative and qualitative data, the contextual information to triangulate with the quantitative data would have been lacking, and the validity of the results would have decreased. Access briefs sharing findings from Nigeria, South Africa, Uganda, Rwanda, Tanzania, and Zambia.
Health Information System Stages of Continuous Improvement Toolkit: Workbook MEASURE Evaluation 2019 English SOCI, HIS, Health information systems The Health Information System (HIS) Stages of Continuous Improvement (SOCI) Toolkit measures the status and goals of an HIS across five stages, identifies gaps, and supports the development of roadmaps to improve HIS capabilities related to processes, people, and systems essential for achieving a country’s health goals. This toolkit responds to these research questions: 1. What are the stages of HIS development?2. How can HIS be assessed and their maturity continuously improved to achieve better health outcomes? The toolkit consists of a measurement scale with 39 HIS subcomponents across five stages detailing improvement across each subcomponent, a data collection tool with data analysis tabs, and a user guide. The scale outlines key components of HIS improvement and defines attributes of each subcomponent on a five-point Likert scale. This is the workbook component of the toolkit. Access the full toolkit.
Health Information System Stages of Continuous Improvement Toolkit: User Guide MEASURE Evaluation 2019 English HIS, SOCI, Health information systems This guide is a practical reference for anyone implementing the Health Information Systems Stages of Continuous Improvement Toolkit. It provides step-by-step instructions for implementation, from initial stakeholder engagement through dissemination of results. Access the full toolkit.
Graduation Sustainability Assessment Tool for Orphans and Vulnerable Children Programs MEASURE Evaluation 2019 English Orphans and Vulnerable Children, OVC This is the tool to assess whether graduated households are maintaining or improving their well-being after graduation. Also available in Word.
Graduation Benchmarks Assessment Tool for Orphans and Vulnerable Children Programs MEASURE Evaluation 2019 English Orphans and Vulnerable Children, OVC This is the tool by which households will be assessed for graduation from OVC projects. The tool provides guidance on which of the eight benchmarks should be assessed for which households or for which members of the household; provides questions for each benchmark to be answered by the caseworker carrying out the assessment; and contains instructions for scoring and determining whether the household is ready for graduation. Also available in Word. The scoring sheet is also available in Word in A4 size and Letter size.
Graduation Verification Assessment Tool for Orphans and Vulnerable Children Programs MEASURE Evaluation 2019 English OVC, Orphans and Vulnerable Children This is the tool to assess the process by which households are graduated from programs. Also available in Word. 
Graduation Benchmarks Indicator Reference Sheets for Orphans and Vulnerable Children Programs MEASURE Evaluation 2019 English OVC, Orphans and Vulnerable Children The United States President’s Emergency Plan for AIDS Relief (PEPFAR) has established eight global minimum benchmarks that must be met for households to graduate from programs for orphans and vulnerable children (OVC). For each benchmark, an indicator reference sheet describes how the benchmark is defined and measured.
Graduation Data Quality and Sustainability Assessment for Orphans and Vulnerable Children Programs MEASURE Evaluation 2019 English OVC, Orphans and Vulnerable Children, Data Quality The objective of the data quality assessment is to assess the process by which households are graduated from programs and to support program improvement. The objective of the sustainability assessment is to assess whether graduated households are maintaining or improving their well-being after graduation. The document includes a method for carrying out graduation data quality and sustainability assessments and describes tools for carrying out these assessments. Access the related Graduation Verification Assessment Tool and Graduation Sustainability Assessment Tool resources. 
Impact of the Bangladesh Nongovernmental Organization Health Service Delivery Project Siân Curtis, Mizanur Rahman, Sharad Barkataki, Nitai Chakraborty 2019 English Contraception, family planning, Maternal Health, Antenatal Care The Nongovernmental Organization Health Service Delivery Project (NHSDP) was a flagship health service delivery project in Bangladesh funded by the United States Agency for International Development. NHSDP supported the delivery of an essential service package of reproductive, maternal, and child health services through a network of local nongovernmental organization (NGO) clinics that primarily targeted the poor and underserved in rural and urban areas. The purpose of this evaluation was to monitor project outcomes and determine the impact of the NHSDP intervention on selected family planning and maternal and newborn health outcomes. The findings of this impact evaluation will inform the design and implementation of the next phase of the NGO service delivery program.
Mapping a Path to Improve Uganda’s Health Information System Using the Stages of Continuous Improvement Toolkit MEASURE Evaluation 2019 English Health Information Systems, HIS strengthening, HIS, Health Systems Strengthening, Uganda, SOCI A strong health information system (HIS) gets the right data in the right hands at the right time, enabling effective decision making to strengthen health systems and improve health outcomes. To strengthen a country-level HIS, the first step is to assess what gaps exist and what actions are needed to improve the HIS to better meet the health system’s information needs. Uganda’s Ministry of Health (MOH) is committed to ongoing strengthening efforts in HIS coordination and governance, especially through the development of an HIS strategic framework. To develop a framework for the HIS, the MOH carried out an assessment to describe the status of the country’s HIS and map a path forward. The assessment enabled key stakeholders to determine elements of the HIS that need attention and priorities for progress to an HIS that is well-equipped to meet Uganda’s health information needs. The MOH wanted to better understand essential components of HIS strengthening, determine the status of the country’s HIS, and identify the desired or goal status of the HIS across each essential component. Thus, a leadership team representing the ministry and supported by the United States Agency for International Development (USAID)-funded MEASURE Evaluation implemented the HIS Stages of Continuous Improvement (SOCI) Toolkit.1 Key stakeholders gathered for a two-day workshop to apply the tool to the HIS. They used the results to design a road map of actions needed for the HIS to progress. In mid-2019, Uganda will share an HIS strategy that will complement the 2018 eHealth strategy and provide a framework for the country’s HIS, moving forward. The process has been and will continue to be guided by the HIS/Data Management thematic technical working group (TWG) of the MOH and MOH leadership, through the Division of Health Information and Planning Department.
Evaluation of a School-Based Sexuality and HIV-Prevention Activity in South Africa: Midline Qualitative Report Mkhwanazi, N., Mandal, M., Biehl, H., & Durno, D. 2019 English Youth, HIV prevention, AGYW, Evaluation, HIV, South Africa With support from the United States Agency for International Development (USAID) and in partnership with the South African National Department of Basic Education (DBE), the MEASURE Evaluation project is conducting an impact evaluation of the implementation of scripted lesson plans (SLPs) and supporting activities that were developed to increase the rigor and uniformity of a life skills program for in-school youth. The evaluation’s nested qualitative study explores the perceptions and acceptance of, and the comfort with the sexuality and HIV prevention education activity; and identifies the structural facilitators and barriers that affect the implementation of the activity at multiple levels. The evaluation’s qualitative component was implemented in six schools across three districts. Qualitative data were collected from male and female learners in Grade 10 and from the parents/guardians of learners, Life Orientation (LO) educators, members of school governing bodies, and members of school management teams. More learners in intervention schools than in control schools showed high interest in sexuality education. Learners in intervention schools could recall specific lessons compared with those in control schools, although respondents had limited ability to specify how they applied the knowledge gained to their own lives. Parents were generally comfortable knowing that their children were learning about sexuality and about HIV and pregnancy prevention in schools, but were not familiar with the content. LO educators in control schools said that they were not comfortable teaching the sexuality education part of the LO curriculum, but also reported that they found the LO guide useful. By contrast, LO educators in intervention schools reported that they did not find the LO guide helpful.
Advances in Solutions for Data Quality Jim Thomas and David Boone 2019 English For data to be useful to improve health outcomes, they must be trusted by data users and program planners. The first page of this brief presents a picture of the global context of data quality—past, present, and future. The second page offers links to data quality resources. The infographic begins with the global goal for data quality. It then outlines the data quality situation in 2013; moves into the next five years, with a list of strategic approaches and progress made (“2014–2018 Advances”); and ends with recommendations of areas on which global players should focus to improve data quality (“Next”). The resources on the second page are categorized by human resources, data use, gender, geospatial data, data quality assessment, digital data, and scale.
Data Quality Assessment (DQA) for HIV Program Indicators in Burundi MEASURE Evaluation 2019 English DQA, Assessment, Data Quality, HIV, Burundi, Data quality assessment As donor funding has increased for disease control and prevention projects in developing countries, so has the need to show a return on investment in the form of public health gains. Monitoring and evaluation of interventions are critical to demonstrate the effectiveness of health programs, but are dependent on data reported by health facilities that are often of poor quality. Resources have been devoted to improving data quality in health and disease programs, yet problems persist as countries struggle to develop and maintain capacity for data management, analysis, and use. The number of patients on treatment is a valuable indicator to monitor the effectiveness of HIV programs; however, treating patients during their lifetimes and accurately recording the results are challenging. Longitudinal treatment records (registers) for patients who return repeatedly for evaluation and treatment need to be summarized periodically in static reports. Counting accurately becomes more difficult as patients come and go from active treatment cohorts, move from one health facility to another, stop treatment because of side effects, or become lost to follow-up. With the advent of “test and start”—an effort to expand the number of HIV-positive people on treatment and reduce the “waiting list” (those enrolled in care but not yet on treatment)—more scrutiny has been given to treatment results. The findings of such examinations have not always met expected standards. The United States Centers for Disease Control and Prevention (CDC) developed a new tool to address the need for data quality assurance for HIV and AIDS program indicators. Although this tool employs methods that are similar to existing tools (e.g., comparison between recounted and reported values, cross-checks between data sources), the CDC tool is more prescriptive about what comparisons and analyses to do and how to conduct them. The Office of HIV/AIDS at the United States Agency for International Development (USAID) has allocated resources to address the data quality of HIV and AIDS indicators through the MEASURE Evaluation project. Several countries have implemented data quality assessments (DQAs) using the new CDC tool, including Burundi. This report summarizes the findings of a preliminary DQA in Burundi using the CDC tool.
PRISM Tools for Community Health Information Systems Tariq Azim, Jeanne Chauffour, Upama Khatri 2019 English CHIS, HISS, PRISM, Community, Health Information Systems, Toolkit, Information System, RHIS, Routine Health Information Systems, Performance of Routine Information System Management MEASURE Evaluation developed the Performance of Routine Information System Management (PRISM) Framework and suite of tools in 2011 for global use in assessing the reliability and timeliness of a rountine health information system (RHIS), in making evidence-based decisions, and in identifying gaps in an RHIS so they can be addressed and the system can be improved.  This resource, PRISM Tools for Community Health Information Systems (PRISM Tools for CHIS), is an adaptation of the PRISM conceptual framework and its associated tools for designing, strengthening, and evaluating RHIS performance. The PRISM conceptual framework emphasizes strengthening RHIS performance through better data quality and improved information use. PRISM broadens the analysis of RHIS performance to include three categories of determinants: behavioral determinants, technical determinants, and organizational determinants. The PRISM framework is as applicable to a community health information system (CHIS) as it is to a national one. PRISM Tools for CHIS is an adaptation of the PRISM Tools specifically intended for evaluating the performance of a CHIS. The resource is also available as a downloadable Word file. Access additional PRISM resources.
Quick Country Start-Up Package for Malaria Surveillance, Monitoring, and Evaluation Training MEASURE Evaluation 2019 English Surveillance, SME, Malaria, Monitoring, Evaluation, Training Since 2010, MEASURE Evaluation has offered a suite of trainings to contribute to the strengthening of country-level malaria surveillance, monitoring, and evaluation (SME) systems. These trainings are supported by the United States Agency for International Development (USAID) and the U.S. President’s Malaria Initiative (PMI) and endorsed by the Roll Back Malaria Monitoring and Evaluation Reference Group (RMB MERG). Activities include annual regional malaria SME workshops in English and French, customized country-specific malaria SME workshops, and online malaria SME courses in English and French. After 10 years of implementation, there is a need for MEASURE Evaluation to document the process based on lessons learned and provide countries with a reference document for implementing these trainings. Furthermore, as the project comes to a close, the reference document will serve as a quick startup guide for future country malaria SME workshop implementation, including step-by-step approaches, practical tools, and trouble shooting. Read a related blog post.
Stakeholder Data Use and Dissemination Planning Tool: An Example from a Research Study in Haiti: Final Report MEASURE Evaluation 2019 English Tool, Stakeholders, Haiti, Engagement, Date use An essential component of any public health research study is the effective translation of scientific findings into knowledge used by policy makers, practitioners, and other scientists. Effective knowledge translation is important to avoid the “know-do gap,” where useful scientific results fail to link to policy or programmatic action. The engagement of stakeholders by researchers is a process that can help prevent the know-do gap. Within the established steps of stakeholder engagement, fostering interaction among stakeholders about data use early in the project life cycle helps researchers plan for the effective dissemination of findings. This brief presents a tool that is administered during study sensitization meetings with stakeholders. Its purpose is to elicit the information needed to develop an effective data use and dissemination plan.
The Importance of Collecting and Using Valid Data on Reaching Partners through Index Testing for HIV: Results and Recommendations MEASURE Evaluation 2019 English Testing, Data use, HIV, Tanzania, PLHIV, Zimbabwe, Data quality Recently, sub-Saharan countries have been incorporating and scaling up index testing as part of HIV testing services (HTS), to increase testing among people living with HIV. Tanzania and Zimbabwe aim for approximately 30 percent of all HIV-positive people who received HTS to be identified through index testing.5, 6 To better understand gaps in index testing and, thus, ways to improve programmatic efforts, MEASURE Evaluation—funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—examined sex and geographic differences in index testing and index testing yield in two countries: Tanzania and Zimbabwe. USAID and PEPFAR implementing partners in both countries provided MEASURE Evaluation with facility-based data covering the last two quarters in FY2018. This brief presents results of our analysis of individual-level data for 5,347 index clients in Zimbabwe and facility-level data for 23,331 index clients in Tanzania.
Third Kenya National Malaria Forum: Malaria Control in Devolved Kenya: Optimising Efforts Towards Elimination Ministry of Health, Kenya 2019 English Kenya, Forum, Malaria The third Kenya National Malaria Forum (KNMF) was held as part of the Malaria Programme Review to bring together experts and stakeholders involved in malaria control, and to address specific needs that were relevant to contributing new knowledge from research and lessons learnt from implementing different malaria control interventions. Previous KNMFs were held to provide an opportunity for researchers, policy makers, and practitioners involved in malaria control to interact and share evidence to inform policy and practice. The third KNMF was held in the backdrop of a Malaria Programme Review, conducted to inform the development of a new Kenya Malaria Strategy (KMS). The meeting was hosted by the National Malaria Control Programme (NMCP), Ministry of Health, with support from partners, including the World Health Organization and the President’s Malaria Initiative, among others. Nearly 200 experts participated in the forum, representing national governments, 47 counties, international organizations and nongovernmental organizations, and academic and research institutions. Overall, the third KNMF provided an opportunity for the steering committee tasked with spearheading the Malaria Programme Review, to learn from the experiences and lessons arising from the implementation of malaria control activities and draw useful insights to inform the development of the next KMS. In addition, it provided an avenue for stakeholders, especially those from research and academia, civil society organizations, and county governments, to contribute ideas and insights into the development of the KMS. This report outlines the approach used in the planning of the third Kenya National Malaria Forum (KNMF) and the objectives and the outcome of the Forum held on 18–19 September, 2018. The report further provides key highlights from each of the presentations and recommendations to inform the development of the next Kenya Malaria Strategy (KMS).
Diagnóstico de la capacidad de monitoreo y evaluación del SIS-VIH (El Salvador) MEASURE Evaluation 2019 Spanish MECAT, Capacity Assessment, El Salvador, Monitoring, Evaluation, HIV Con la presencia de 27 participantes de diversos sectores, la Comisión Nacional contra el VIH (CONAVIH) y el Programa Nacional ITS/VIH/sida (PNS), con la asistencia técnica de PEPFAR|USAID a través de MEASURE Evaluation, realizó el 4 de diciembre de 2018, un taller para valorar las capacidades en monitoreo y evaluación (MyE) del Sistema de Información en Salud (SIS) de VIH de El Salvador, para mejorar la medición de los avances del país en el cumplimento de las metas 90-90-90, a través del fortalecimiento de los SIS, alineadas a las necesidades de gestión de datos nacionales, regionales y mundiales. Se utilizó la Herramienta para evaluar la capacidad de monitoreo y evaluación (MECAT, por sus siglas en inglés: Monitoring and Evaluation Capacity Assessment Toolkit), la cual valora (en una escala del 1 al 10) las 12 áreas de capacidad para un sistema nacional funcional de MyE de VIH propuestas por ONUSIDA. MECAT: https://www.measureevaluation.org/pima/m-e-capacity
Characterizing Male Sexual Partners of Adolescent Girls and Young Women in Mozambique: An Intervention to Promote Data Use William Miller 2019 English MOZAMBIQUE Sexual Behavior, Sexually Transmitted Infections (STIs), DREAMS, Sexual Behavior, Contraceptive Use, and Reproductive Health, AGYW Adolescent girls and young women (AGYW) ages 15–24 have been identified as a population extremely vulnerable to HIV. Whereas other countries in the region are experiencing a decline in HIV prevalence, Mozambique is facing high and sustained prevalence. HIV prevalence is notably higher among women, and this disparity is much starker among youth ages 15–24: the prevalence of HIV among females is more than three times that of males. The United States President’s Emergency Plan for AIDS Relief, through the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) initiative (www.dreamspartnership.org), recognizes the importance of reaching AGYW. In Mozambique, comprehensive AGYW programs under the DREAMS initiative are under way in prioritized locations. One of the programming strategies of DREAMS is to prevent HIV among male sexual partners of AGYW and reduce the infectiousness of those partners who are HIV-positive (by controlling their viral load), thereby reducing HIV incidence among AGYW. This approach requires information about the characteristics of AGYW’s sexual partners―who they are and how they can be reached. This information is lacking in Mozambique. To fill this knowledge gap, the United States Agency for International Development in Mozambique asked MEASURE Evaluation to conduct a study that would characterize men who have recently engaged in sexual activity with AGYW, the relationship dynamics, and factors that influence men’s engagement with HIV and AIDS prevention and care services. This report presents a description of the intervention, preliminary results, and recommendations for others wishing to conduct a similar data use activity.
Maternal postnatal care in Bangladesh: a closer look at specific content and coverage by different types of providers Eunsoo Timothy Kim, Kavita Singh, and William Weiss 2019 English Postnatal care, Maternal Health, Bangladesh Background The first 48 hours after birth is a critical window of time for the survival for both mothers and their newborns. Timely and adequate postnatal care (PNC) is being promoted as a strategy to reduce both maternal and newborn mortality. Whether or not a woman has received a postnatal check within 48 hours has been well studied, however, specific content and type of provider are also important for understanding the quality of the check. The objective of this paper is to understand who receives specific PNC interventions by type of provider in Bangladesh. MethodsData from the 2014 Bangladesh Demographic and Health Survey (DHS) were used to study receipt of specific PNC interventions – breast exam, vaginal discharge exam, temperature check and counseling on danger signs – within 2 days of birth. Descriptive bivariate analyses and regression analyses using generalized estimating equations (GEE) were used to understand if receipt of an intervention differed by socio-economic and health-related factors. A key factor studied was the type of provider of the PNC. ResultsThe proportion of women receiving specific interventions during maternal PNC was mostly low (41.81% for breast exam, 39.72% for vaginal discharge, 82.22% for temperature check, 55.56% for counseling on danger signs and 16.95% for all four interventions). Findings from the regression analyses indicated that compared to having postnatal contact with formal providers (doctors, nurses, midwives and paramedics), having postnatal contact with village doctors was significantly associated with lower probabilities of receiving a breast exam, vaginal discharge exam and receiving all four interventions. PNC provided by NGO workers and other community attendants was significantly associated with a lower probability of receiving a vaginal discharge exam but a higher probability of receiving counseling on danger signs. ConclusionsDuring PNC, women were much more likely to receive a temperature check than counseling on danger signs, breast exams or vaginal discharge exams. Very few women received all four interventions. In the situation where Bangladesh is experiencing a shortage of high-level providers, training more types of providers, particularly informal village doctors, may be an important strategy for improving the quality of PNC.
Data for Impact Starts with High-Quality Data Data for Impact 2019 English Data for Impact, Data visualization, Evaluation, D4I, Data use, Data quality assessment Data for Impact (D4I) works in low-resource settings to ensure that when information is needed, reliable data exist to answer the question. When good-quality data are available, people are able to conduct useful analyses and develop communication strategies and data visualizations that contribute to program and policy decision making.
Assessing Spatial Data Quality Using Five Data Anomalies: Speeding the Process for Master Facility Lists and Other Large Data Sets John Spencer, Becky Wilkes 2019 English Data, MFL, Spatial data, Master facility list, Data Quality With the increased ease of the collection of geographic data coordinates and the desire for accurate country master facility lists (MFLs) comes the need for tools and methods with which to rapidly assess the quality of large spatial data sets. Global health professionals who have had limited training in the use of geographic information systems may need guidance in assessing spatial data. Identifying data quality issues in data sets of this size is challenging, because of the complex relationship between the spatial components and the attributes of the data. Informed by spatial data quality literature, this paper presents a framework for assessing common issues with spatial data and identifies five specific potential data anomalies that can be identified and further investigated to increase the quality of a spatial data set, such as an MFL. Focusing on these five anomalies will provide quantifiable results, which help in planning a practical, effective strategy for corrections. This approach yields not only a list of the locations that need to be corrected, but also feedback on what may be wrong with the data.
Sustainability Planning, Implementation, and Transition: A Case Study from the MEASURE Evaluation–Tanzania Associate Award MEASURE Evaluation–Tanzania 2019 English Tanzania, Sustainability, MEASURE Evaluation Tanzania The MEASURE Evaluation–Tanzania Associate Award (MEval-TZ) operated from 2015 to 2019 with funding from the United States Agency for International Development (USAID), the United States President’s Emergency Plan for AIDS Relief (PEPFAR), and the President’sMalaria Initiative (PMI). Its ambitious goal was to sustainably improve integration and effectiveness of monitoring and evaluation (M&E) systems to strengthen Tanzania’s health information systems (HIS). To achieve this goal, the project implemented activities categorized under three intermediate result areas covering both the Tanzania mainland and Zanzibar at several levels of the health system and with different HIS. To support these goals, the project had a diverse set of activities, ranging from improving national M&E systems to developing a strong network of M&E professionals. The project pursued two crosscutting activities: gender integration and sustainability and collaboration. These aimed to ensure that all project activities benefitted from male and female participation and that they were sustainable. MEval–TZ promoted local capacity building and sustainability as core features of its approach. This brief focuses on the project's sustainability planning, implementation, and transition.
Coverage of Malaria Interventions in Nigeria: Secondary Analysis of Data from National Surveys MEASURE Evaluation 2019 English NIGERIA Malaria, Disease prevention, Malaria control, insecticide-treated nets Malaria is a major public health burden in Nigeria, posing a risk to the entire population. In 2014, the country reported more than 7.8 million confirmed cases of malaria and more than 6,000 malaria deaths. Malaria accounts for approximately 60 percent of outpatient visits and 30 percent of hospitalizations among children under five. Over the past decade, substantial efforts have been made in malaria control by the government and its partners to expand coverage of insecticide-treated nets, conduct intermittent preventive treatment in pregnancy, and improve and scale up malaria case management. To further its efforts to reduce the malaria burden, the National Malaria Elimination Programme (NMEP) and its partners are working to scale up malaria interventions in line with the Nigeria's National Malaria Strategic Plan 2014–2020. To measure progress of malaria control achievements in the past decade in Nigeria and to guide future investments, Nigeria has implemented several population-based surveys, including the Nigeria Malaria Indicator Survey in 2010 and 2015, and the Nigeria Demographic and Health Survey in 2008 and 2013. In response to a request from the President's Malaria Initiative (PMI), MEASURE Evaluation, which is funded by the United States Agency for International Development, conducted this research study to provide further evidence to guide both PMI’s and NMEP’s efforts in malaria program implementation in Nigeria.
Experiences and Perceptions of Health Staff on Applying Information Technology for Health Data Management in Ghana Emmanuel Edum-Fotwe, Mercy Abbey, Ivy Osei, Abraham Hodgson 2019 English GHANA, Africa Family Planning, Reproductive Health, EHealth, Mobile technology User perspectives and experiences are pertinent to the continued use of mobile technologies for health data collection and management. What users experience affects not only what can be accomplished, but also what attracts them to the mobile technology; and what attracts them to the mobile technology affects how willing they are to understand and continue using it. Since 2011, Ghana Health Service—in response to the expanding health information needs for the effective and efficient management of family planning and reproductive and child health service delivery at the district level—has implemented two forms of mobile technology to facilitate health data collection and management in four districts of the Central Region of Ghana. These mobile technologies have been praised for reducing costs and the physical effort required of health staff. The main study objective was to explore and document the experiences and perspectives of health staff and managers in the four districts on use of mobile technology to collect and manage health data in district health systems. 
Data for Impact: The D4I Approach for Strong Health Data Data for Impact 2019 English Data quality assurance, Data use, Data Quality, Data Quality Audit, Data for Impact, Data informed, Data Demand and Use, D4I, Data quality assessment, Data visualization Data for Impact (D4I) is a five-year cooperative agreement funded by the United States Agency for International Development (USAID) that supports countries to mobilize the power of data as actionable evidence that can improve programs, policies, and—ultimately—health outcomes. D4I seeks to achieve the following results: Build strong evidence needed for program and policy decision making through expanded use of existing data sources and with new data generated through innovative research designs and data collection strategies Strengthen individual and organizational capacity to develop evidence for health decision making and to receive direct funding from USAID Facilitate data use to improve global health programs and policies through compelling data visualization and communication strategies.
Legacy Evaluation of the Partnership for HIV-Free Survival: Kenya, Lesotho, Mozambique, South Africa, Tanzania, and Uganda David K. Hales, Heather B. Davis, Alexandra J. Munson, Emily A. Bobrow 2019 English Global, KENYA, LESOTHO, MOZAMBIQUE, SOUTH AFRICA, TANZANIA, UGANDA The Partnership for HIV-Free Survival (PHFS) was designed to use basic quality improvement practices to reduce mother-to-child transmission of HIV and increase child survival through improvements in (1) antiretroviral therapy uptake and retention among HIV-positive pregnant women and mothers, (2) breastfeeding practices, and (3) overall mother-baby care. PHFS was implemented between 2012–2016 in six countries in Eastern and Southern Africa: Kenya, Lesotho, Mozambique, South Africa, Tanzania, and Uganda. PHFS was a joint effort among the United States President’s Emergency Plan for AIDS Relief (PEPFAR), the United States Agency for International Development (USAID), the United Nations Children’s Fund (UNICEF), the World Health Organization, and ministries and departments of health in the participating countries. MEASURE Evaluation—funded by USAID and PEPFAR—conducted a legacy evaluation of PHFS in 2017–2018 in all six countries to review the project’s effects on prevention of mother-to-child transmission (PMTCT) programs and to better understand the critical factors that contributed to improved PMTCT performance in participating health facilities. Access a related webinar recording and resources. 
HIV Risk Assessment Prototype MEASURE Evaluation 2019 English Orphans and Vulnerable Children, Tools, OVC, HIV In this period of limited resources, there is a desire to reduce overall testing costs while strategically targeting for testing people most likely to be HIV-positive. The Office of the Global AIDS Coordinator recommends that an HIV Risk Assessment be applied to all children whose HIV status is unknown, to identify children at risk for HIV infection. MEASURE Evaluation developed an HIV Risk Assessment prototype that implementing partners may adapt to assess risk among orphans and vulnerable children.  The prototype’s purpose is to improve the quality of data collected for reporting to the Data for Transparency and Impact (DATIM) system of the United States President’s Emergency Plan for AIDS Relief (PEPFAR). This is the letter size version of the tool. Download the A4 size. 
Health Information Systems: Analysis of country-level strategies, indicators, and resources Silvestre, E., & Wood, F. 2019 English Health Systems Strengthening, LMICs, Health information systems, HIS, HIS strengthening, HISSM This health information systems (HIS) country profile analysis summarizes the status of the HIS in 39 United States Agency for International Development (USAID) priority countries through 30 indicators. The results are presented for (1) all countries, (2) for United States President’s Emergency Plan for AIDS Relief (PEPFAR) countries, and (3) for focus countries where USAID is working to achieve the goal of preventing child and maternal deaths. The individual country profiles can be accessed at https://www.measureevaluation.org/his-strengthening-resource-center/country-profiles. The report presents: The 30 indicators and their definitions The status of the HIS in the three categories of USAID priority countries for these indicators
Decision Tree to Plan, Implement, Monitor, and Evaluate Programs for Orphans and Vulnerable Children MEASURE Evaluation 2019 English Global Orphans and Vulnerable Children, OVC, M&E A step-wise guide to tools that can help countries plan, implement, monitor, and evaluate programs that address the needs of orphans and vulnerable children. This “decision tree” guides readers through relevant questions and describes how to answer them with ready-made tools. MEASURE Evaluation, funded by the United States Agency for International Development (USAID), works globally in low-resource settings to help countries improve their capacity to collect, analyze, and use health data for better health outcomes for people. The first page provides a graphic guide through a set of questions and appropriate tools. The second page gives an overview of each tool mentioned.
OVC Indicator Matrix: Measuring the Pathway to Better Outcomes for Children Affected by HIV M Cannon, C Fu, M Mendenhall 2019 English HIV, PEPFAR, Orphans and Vulnerable Children, OVC, Child Health, Children The United States President’s Emergency Plan for AIDS Relief (PEPFAR) engaged the United States Agency for International Development (USAID)- and PEPFAR-funded MEASURE Evaluation project to develop and support the rollout of an overarching matrix that outlines the pathway to better outcomes for children affected by HIV. Access the full collection of resources.
Strengthening Health Information Systems in Guinea MEASURE Evaluation 2019 English GUINEA Health Systems Strengthening, health information system strengthening model, Health Information Systems, HISSM, HIS, HISS MEASURE Evaluation, funded by the United States Agency for International Development, has been working with Guinea’s Bureau for Strategy and Development, under the Ministry of Health and Public Hygiene, to update its previously siloed and donor-driven health information collection to a more streamlined system using the electronic DHIS 2 platform. Much of this work strengthens elements of the health information system (HIS) identified in MEASURE Evaluation’s Health Information System Strengthening Model. This brief features a graphic that displays MEASURE Evaluation activities in the model’s “enabling environment” and “information generation” domains to integrate Guinea’s health systems and improve access to high-quality health data. By displaying interventions across the model, we see their strategic interaction, and how this combination of interventions strengthens data quality and data use at all levels of the health system. A table lists additional MEASURE Evaluation activities in Guinea that support HIS strengthening. Because of these interventions, we expect improvements in the quality of the data collected and an increase in the use of HIS data to generate health indicators and statistics and to inform decision making.
Strengthening Health Information Systems in Burundi MEASURE Evaluation 2019 English BURUNDI HISS, health information system strengthening model, Health Information Systems, HISSM, Health Systems Strengthening, HIS MEASURE Evaluation, funded by the United States Agency for International Development, has been working with the Ministry of Health to strengthen Burundi’s monitoring and evaluation system through integration of multiple siloed data collection systems for routine data, HIV/AIDS data, and community-based data. Much of this work to integrate systems requires strengthening elements of the health information system (HIS) identified in MEASURE Evaluation’s Health Information System Strengthening Model (HISSM). This brief features a graphic that depicts MEASURE Evaluation activities in the HISSM’s “enabling environment” and “information generation” domains to improve the integration of Burundi’s health systems and access to high-quality data. By displaying interventions across the model, we see their strategic interaction, and how this combination of interventions strengthens data quality and use at all levels of the health system. A table lists additional MEASURE Evaluation activities that support HIS strengthening in Burundi, by the year in which they began. because of these interventions, we expect improvements in the quality of the data collected and an increase in the use of HIS data to generate health indicators and statistics and to inform decision making.
Strengthening Health Information Systems in Bangladesh MEASURE Evaluation 2019 English BANGLADESH health information system strengthening model, Health Systems Strengthening, HISSM, Health Information Systems MEASURE Evaluation, funded by the United States Agency for International Development, has been working in Bangladesh to support the Program Management and Monitoring Unit at the Ministry of Health and Family Welfare (MOH) to achieve improved strategic planning, assessment, and monitoring and evaluation of health systems and outcomes. A gap that had been identified and strategically addressed in Bangladesh was the lack of systematic population data, especially for rural areas. In order to produce higher-quality data and to support better health sector planning, MEASURE Evaluation has been working with the International Centre for Diarrheal Disease Research, Bangladesh to help the country’s Directorate General of Health Services and the Directorate General of Family Planning to strengthen the routine health information system of the MOH. Much of this work strengthens elements of the health information system (HIS) identified in MEASURE Evaluation’s Health Information System Strengthening Model. This brief features a graphic that depicts MEASURE Evaluation’s activities in the model’s “enabling environment” and “information generation” areas and support of the electronic health management information system. By displaying interventions across the model, we see their strategic interaction, and how this combination of interventions strengthens data quality and data use at all levels of the health system. A table lists additional MEASURE Evaluation activities that support HIS strengthening in Bangladesh, by the year in which they began. Because of these interventions, we expect data quality to improve and the use of HIS data to generate health indicators, statistics, and trends for data-informed decision making to increase. 
Strengthening Health Information Systems in Senegal MEASURE Evaluation 2019 English HIS, Health Information Systems, Senegal, HISS, Health Systems Strengthening MEASURE Evaluation, funded by the United States Agency for International Development, has been working with Senegal’s Ministry of Health and Social Action (MOH) and Division of Health and Social Information System (DHSIS) to improve the quality of the country’s early warning system for disease outbreaks. MEASURE Evaluation has been supporting the MOH’sefforts to achieve a more unified health information system (HIS)—an effort that includes the integration of community-level data and laboratory data to support a more efficient early warning system. Much of this work strengthens elements of the HIS identified inMEASURE Evaluation’s Health Information System Strengthening Model (HISSM), shown to the right. MEASURE Evaluation’s work to support HIS strengthening in Senegal affects the enabling environment for the HIS and information generation—both areas outlined in the HISSM. This fact sheet was updated October 2019.
Strengthening Health Information Systems in Côte d'Ivoire MEASURE Evaluation 2019 English COTE D'IVOIRE Orphans and Vulnerable Children, Cote D’Ivoire, HISS, Health Systems Strengthening, Health Information Systems MEASURE Evaluation, which is funded by the United States Agency for International Development, has been working in Côte d’Ivoire to support health information system (HIS) strengthening and improve the availability and use of high-quality health data. Central to this work are efforts to upgrade and make interoperable several vertical subsystems that manage the country’s patient-level HIV data (SIGDEP 2), data for orphans and vulnerable children (OVC), data from the electronic logistics management system, and routine health data in DHIS 2. This work with the Ministry of Health and the National OVC Program strengthens elements of the HIS identified in MEASURE Evaluation’s Health Information System Strengthening Model (HISSM). The graphic below superimposes on the HISSM descriptions of MEASURE Evaluation’s activities in the enabling environment and information generation areas to support harmonization of information needs and facilitate better data sharing across entities. By displaying key interventions across the model, we see their strategic interaction, and how this combination of interventions works together to strengthen data quality and data use at all levels of the health system. The table beneath the graphic lists additional MEASURE Evaluation activities that support HIS strengthening. Because of these interventions, we expect the quality of the data collected to improve and the use of HIS data to generate health indicators, statistics, and trends for data-informed decision making to increase. 
Strengthening Health Information Systems in Mali MEASURE Evaluation 2019 English MALI HISS, Health Information Systems, Mali, Health Systems Strengthening MEASURE Evaluation, which is funded by the United States Agency for International Development, has been supporting Mali’s Ministry of Health and Public Hygiene (MOH)—especially the National Malaria Control Program and the National Directorate of Health—in the unification of Mali’s health information system (HIS). The goal of this unification is for the HIS to yield better-quality data for effective health system planning and timely response to disease outbreak. Mali’s HIS comprises a system for local (sitebased) health information, the hospital information system, and the epidemiological surveillance system. These systems are managed by different governing bodies and were previously housed on a variety of platforms that were not able to communicate or share data. The local HIS had limitations preventing it from producing malaria-specific information or aiding in the detection of an Ebola outbreak. These limitations led to the creation of additional parallel information systems. These multiple reporting systems and duplicative indicators have resulted in a heavy burden of data collection for healthcare providers. MEASURE Evaluation’s work to support the MOH has strengthened both the “enabling environment” and “information generation” areas of the HIS identified in MEASURE Evaluation’s Health Information System Strengthening Model. This fact sheet superimposes on the HISSM depictions of MEASURE Evaluation’s activities in the enabling environment and information generation areas to support better coordination of Mali’s HIS subsystems. By displaying key interventions across the model, we see their strategic interaction and how this combination of interventions works together to strengthen data quality and data use at all levels of the health system. The table lists additional MEASURE Evaluation activities that support HIS strengthening.
Strengthening Health Information Systems in Nigeria—Developing a Master Facility List MEASURE Evaluation 2019 English NIGERIA Nigeria, Health Systems Strengthening, Health Information Systems, Health data MEASURE Evaluation, which is funded by the United States Agency for International Development, has been working in Nigeria since 2005 to improve the availability of high-quality data to support decision making at all levels of the health system. This work fulfilled two main objectives:  1) Support the Department of Health Planning, Research and Statistics of Nigeria’s Federal Ministry of Health to develop a master facility list to improve data quality and ultimately lead to better coordination of health services 2) Work with the Federal Ministry of Women’s Affairs and Social Development to develop a directory of orphans and vulnerable children (OVC) service providers and build capacity to use OVC data collection tools for the National OVC Management Information System (NOMIS) We have mapped the HIS strengthening interventions to support each objective in two separate fact sheets. Each fact sheet superimposes on the HISSM depictions of MEASURE Evaluation’s activities in the enabling environment and information generation areas to support HIS performance in meeting the specific objective. By displaying key interventions across the HISSM, we see their strategic interaction, and how this combination of interventions works together to strengthen data quality and data use at all levels of the health system. This fact sheet documents MEASURE Evaluation’s work to develop a master facility list to improve data quality and ultimately lead to better coordination of health services. Follow the link to view the related document: Strengthening Health Information Systems in Nigeria—Building an OVC Information System
Strengthening Health Information Systems in Madagascar MEASURE Evaluation 2019 English MADAGASCAR Madagascar, Health Systems Strengthening, Health Information Systems, Health information systems, HISS Madagascar’s health information system (HIS) has faced challenges resulting from multiple vertical reporting systems and disease-surveillance systems that correspond to program-specific needs. In working toward a more unified HIS, Madagascar’s Ministry of Health (MOH) has been collaborating with partners, such as the Directorate for Malaria Control, to integrate reporting systems, reduce reporting redundancies, and address issues related to data quality. As part of this effort, the USAID-funded MEASURE Evaluation has been supporting the development and implementation of an electronic HIS to improve the availability and use of high-quality health data. MEASURE Evaluation’s involvement in the MOH’s efforts to improve the performance of Madagascar’s HIS have strengthened the “enabling environment” and “information generation” areas of the HIS, identified in MEASURE Evaluation’s Health Information System Strengthening Model (HISSM). The illustration on this fact sheet superimposes on the HISSM depictions of MEASURE Evaluation’s activities in the enabling environment and information generation areas to support coordination of vertical information systems and harmonization of data collection. By displaying key interventions across the model, we see their strategic interaction and how this combination of interventions  works together to strengthen data quality and data use at all levels of the health system. 
Strengthening Health Information Systems in the Democratic Republic of Congo MEASURE Evaluation 2019 English CONGO, THE DEMOCRATIC REPUBLIC OF THE Health Systems Strengthening, HIS, Democratic Republic of Congo, Health Information Systems MEASURE Evaluation, which is funded by the United States Agency for International Development, has been working in the Democratic Republic of the Congo (DRC) since 2009. A major ongoing activity is work with the Ministry of Public Health (MOPH) and the National Malaria Control Program to improve data quality and increase the use of malaria information at all levels of the health system. Much of this work with the MOPH strengthens elements of the health information system identified in MEASURE Evaluation’s Health Information System Strengthening Model (HISSM).    This fact sheet superimposes on the HISSM descriptions of MEASURE Evaluation’s activities in each intervention area (enabling environment and information generation) that supported the health ministry’s development of the Centers of Excellence. By displaying these interventions across the model, we can see their strategic interaction and how they combine to strengthen data quality and data use at all levels of the DRC’s health system. Because of these interventions, the health sector in the DRC should collect better-quality data and increase its use of HIS data to generate health indicators and statistics, identify trends, and conduct data-informed decision making. 
FAQ: How Much Will an Evaluation Cost? MEASURE Evaluation 2019 English Global Impact Evaluation, Evaluation, Cost When deciding whether to conduct an evaluation, and when planning for one, it is important to consider cost. The cost of an evaluation is dependent on many factors, including the objectives, design, methods, sample size, geographic scope, and local context for the work. Other factors that affect cost are particular to the process—for example, the front-end work required to plan an evaluation or study is often substantial and should be considered when budgeting.
Building a Strong and Interoperable Digital Health Information System for Uganda MEASURE Evaluation 2018 (Revised in 2019) English UGANDA, East Africa, Africa Interoperability, Africa, EHealth, Technology, HIS, Uganda, Health Information Systems Uganda launched its National eHealth Policy and Strategy in May 2018. Leadership and governance, workforce development, enterprise architecture, health information systems integration, and interoperability are the strategy’s key areas of implementation. Most important, the strategy calls for “harmonized eHealth initiatives at all levels,” given the various digital health information systems (HIS) that have taken root in the country. To understand how to prioritize investments and implementation toward interoperability within these systems, the Ministry of Health (MOH) of Uganda, with support from MEASURE Evaluation—funded by the United States Agency for International Development (USAID)—conducted a readiness assessment of the interoperability of Uganda’s HIS with in-country HIS stakeholders. The assessment team focused on three major domains of an HIS: leadership and governance, human resources, and technology. They used the Health Information System Interoperability Maturity Toolkit, developed in 2017 by MEASURE Evaluation and the Health Data Collaborative’s Digital Health and Interoperability Working Group, with input from digital health stakeholders in Ghana and Kenya. A maturity model measures the ability of an organization or government entity, such as a health ministry, to continuously improve in a specific discipline until it reaches the desired level of development, or maturity. Using the results of the assessment, the team brainstormed activities that Uganda could prioritize to move the country toward a stronger, interoperable digital HIS. This brief describes the assessment process, results, and recommended actions.
Using DHIS2 Software to Track Prevention of Mother-to-Child Transmission of HIV: Guidance (Version 2) Cristina de la Torre, Samuel Johnson, Allison Schmale 2018 (Revised September 2019) English PMTCT, DHIS 2, HIV MEASURE Evaluation has published comprehensive guidance for developing an electronic solution using DHIS 2 to track patients across the prevention of mother-to-child transmission (PMTCT) of HIV continuum of care. Our goal is to increase retention of mothers and their infants through the pregnancy and breastfeeding periods, and to improve linkages and referrals across services. This guidance is customized to address the complexities related to the PMTCT continuum of care, but the approaches for planning, designing, and configuring a patient tracker in DHIS 2 apply to any health program. The guidance includes the following: Instructions for conducting an initial assessment of the environment Description of the decisions that must be made during the planning stage, such as defining the scope of the tracker; the data elements to be collected; and the overall data collection, entry, and management processes Overview of the DHIS 2 Tracker program and the implications for developing a patient tracker Discussion of technological options and issues that must be considered in the configuration process Details on how to achieve a specific configuration for a PMTCT Tracker, including: defining services and potential outcomes, enabling different facilities to schedule visits or mark them as completed, setting up notifications, configuring reports and creating PMTCT indicators from  Access the PMTCT tracker resources at https://www.measureevaluation.org/resources/pmtct-tracker/
Saving Lives, Transforming the Economy: Making “Treat All” Real and Saving 23,000 More Batswana from HIV by 2030 MEASURE Evaluation 2018 English Botswana, HIV prevention, ART, HIV, PLHIV, HIV care, HIV/AIDS, Cost Botswana has a considerable burden of HIV, with the third highest HIV prevalence globally. However, through bold leadership, the country is a global trailblazer in responding to the AIDS epidemic, and is on the cusp of realizing an AIDS-free generation. In June 2016, informed by a rigorous investment analysis, a “Treat All” policy was launched to provide all people living with HIV (PLHIV) in Botswana–regardless of disease state—with free, publicly-financed lifesaving treatment. By “leaving no one behind”—a key principle of Botswana’s National Development Plan 2017–2023 (NDP 11)—this policy shift seeks to optimize investments in the national AIDS response and accelerate progress towards epidemic control, with a view to end AIDS as a public health threat by 2030. To date, the implementation of the “Treat All” policy has focused on providing this free, publicly financed antiretroviral therapy (ART) only to citizens, leaving noncitizens behind. Botswana’s 170,000 noncitizens in residence constitute 7 percent of the country’s total population; of these, an estimated 30,000 are living with HIV. Most noncitizens originate from India, South Africa, Zambia, Zimbabwe, and the United Kingdom, and 80 percent of them are between the ages of 15 and 49: the age group that is most sexually active and economically productive. Only 29 percent of all noncitizens living with HIV are accessing HIV treatment. Recognizing that multiple concurrent partnerships increase the spread of HIV through sexual networks, the government acknowledges that without fully implementing the Treat All strategy, by covering treatment both of citizens and noncitizens, there will be no epidemic control. Rather, the government would face more new HIV infections and a growing HIV expenditure. To address the HIV treatment of noncitizens in Botswana, the government would need an additional total investment of US$18 million for the period 2018 through 2030—an average of US$1.4 million per year. This translates into an additional 1.2 percent of spending on the current ART program (estimated at US$103 million per year) and would help achieve 90-90-90 and 95-95-95 treatment targets by 2020 and 2030, respectively, among the noncitizen population. Treating noncitizens is another way of protecting the citizen population. By treating noncitizens, Botswana can save 22,745 citizens from HIV infection and 1,373 citizens from tuberculosis (TB) infection. The country would also avert 6,741 deaths from AIDS. Compared with treating citizens only, this strategic investment yields 64 percent more new HIV infections averted, at a cost of only 1.2 percent more. Other benefits of enacting a policy change to provide access to HIV treatment for noncitizens are US$112 million in savings on HIV treatment (which the government would incur to treat citizens if infections are not averted) and US$4 million in savings on TB treatment (which would occur among noncitizens living with HIV who are not on treatment). Additionally, US$30 million in productivity gains would accrue to the economy owing to increased productivity yielded by treatment and avoided infections among previously untreated noncitizens living with HIV. Overall, for every U.S. dollar invested in treating noncitizens, the country gets US$8 in return. By not acting now, the government increases the risk of not meeting the Treat All goals for epidemic control. Moreover, the government will incur an additional US$116 million expenditure to treat HIV and TB infections. The country will be exposed to an additional 23,000 new HIV infections among citizens, as well as an economic loss of US$30 million in worker productivity owing to untreated HIV. As a way forward, we recommend investment in treating both citizens and noncitizens through the Treat All program. This will accelerate epidemic control, improve financial sustainability of the Treat All program, and produce long-term healthcare savings. To implement this policy recommendation sustainably, potential pathways are to work with development partners to fund the initial phase of the program, followed by transition to full financing by the Government of Botswana as cost savings are realized.
Health Information Systems Data Use MEASURE Evaluation 2018 English Data use, Health Information Systems, HIS From 2014-2020, MEASURE Evaluation supported interventions to improve data-informed decision in a number of countries. To understand factors that contribute to successful data use in country health information systems, MEASURE Evaluation has published the following resources meant to be used by country governments, programs, and donors working to sustain a culture of informed decision making in health programs.
Health Information System Strengthening Model MEASURE Evaluation 2018 English Data, HIS strengthening, HISSM, Health System, Routine Health Information Systems, Health Systems Strengthening, Health Information Systems, RHIS, HIS, Information systems MEASURE Evaluation’s Health Information System Strengthening Model (HISSM) articulates how country-level health information systems (HIS) in low- and middle-income countries are designed, developed, and implemented to support health systems and improve health outcomes over time. It guides ongoing learning, depicts the elements of an HIS and the relationships among them, and illustrates external influences. The model is useful for countries at both national and subnational levels as a guide for the assessment, planning, and improvement of their HIS. An HIS is broadly defined to encompass health data sources, including health facility and community data collected as part of routine health information systems (RHIS) or health management information systems (HMIS); electronic health records for patient care; population-based data; human resources information; financial information; supply chain information; and surveillance. The HISSM includes every type of information that can be used for decision making in the health sector. This model was developed in collaboration with experts around the globe, using the Health Metrics Network (HMN) Framework as a foundation (HMN, 2008), to address four key objectives: (1) promote HIS as an essential function of a health system, (2) define HIS strengthening, (3) measure HIS performance, and (4) monitor and evaluate HIS interventions.
Monitoring Outcomes of PEPFAR Orphans and Vulnerable Children Programs in Kenya: Dissemination Workshop Susan Settergren and Walter Obiero 2018 English KENYA, Africa OVC, Indicators, Monitoring, Orphans and vulnerable children, OVC programs, PEPFAR In 2016, the orphans and vulnerable children (OVC) team of the United States President’s Emergency Plan for AIDS Relief (PEPFAR)/Kenya requested assistance from MEASURE Evaluation (which is funded by the United States Agency for International Development [USAID] and PEPFAR) to conduct outcome monitoring surveys for three of its ongoing OVC projects in western Kenya: USAID’s AIDS, Population and Health Integrated Assistance plus Western Kenya (APHIAplus) project; the United States Centers for Disease Control and Prevention’s Timiza 90 project; and a project of the United States Department of Defense led by the Walter Reed Program/Henry M. Jackson Foundation Medical Research International. The first round of these household surveys collected data for the nine PEPFAR OVC Essential Survey Indicators and other related information. Reports for the three surveys can be found online here. Round 2 of the surveys occured in  2018. On May 30–31, 2018, MEASURE Evaluation conducted a workshop in Kisumu, Kenya, to disseminate the first round of survey results and facilitate development of project management responses to the findings. This report presents a summary of the two-day workshop.
Gender-Integrated Routine Data Quality Assessment (RDQA+G) Tool MEASURE Evaluation 2018 English Routine data, Gender, Data Quality, Tool, RDQA The gender-integrated routine data quality assessment (RDQA+G) tool is the newest addition to MEASURE Evaluation’s suite of capacity building and self-assessment tools that strengthen the monitoring and evaluation of public health interventions. The RDQA+G builds on the routine data quality assessment (RDQA) tools. It enables national programs or donor-funded projects to evaluate their own data quality with a special focus on gender data (including sex and age disaggregation), while continuing to improve reporting performance and prepare for data quality audits. The RDQA+G facilitates the identification of problem areas for selected indicators related to gende