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Building M&E Capacity of
Community Based Programs in
          Tanzania
            Dawne Walker
        MEASURE Evaluation
      Resident Advisor, Tanzania
            January 2012
What do community programs
provide?
 Training and capacity-building
 Support to households
 Support to individuals
 Home-based care
 Community awareness-raising
 …
How are these services provided?

 Directly by international Implementing
  Partners (IPs)
 Through subgrants to civil society
  organizations (CS0s) and smaller NGOs
 By unpaid community volunteers
What are community programs
required to report?
 Number of eligible clients who received food and/or
  nutrition services
 Number of eligible OVC who received a minimum of
  one CORE care service
 Number of eligible adults and children provided with
  home-based care services
 Number of vulnerable households with at least one
  OVC/MVC or PLHIV provided a minimum of one
  economic opportunity/strengthening support
MEASURE Evaluation approach to
M&E capacity-building
Three-step process:
  1. Assessment
  2. Training, mentoring and technical
     assistance
  3. Re-assessment
Community-based
   programs are
    expected to
      produce
 comparable data
 to facility-based
  programs, but
      without
    comparable
     physical
infrastructure and
human resources
Multiple levels of data quality
issues
 Data collection
 Data entry
 Data analysis and use
Responding to the special needs
of community-based programs
 Shortcomings of trace-and-verify
  methodology
 Developed Community Trace and Verify
  (CTV)
Community Trace and Verify (CTV)
 Covers minimum package of services
 Short (10-minute) survey of caretakers
 LQAS
  sampling
  methodology
 Pass-fail
  scoring
005 Does [Name] have a birth certificate?       Yes…1
                                                No…2                             → 007
                                                Don’t know …3
006 Could you show us the birth certificate?    Yes, birth certificate shown…1
                                                No…2
007 Is the family enrolled with the Community   Yes…1
    Health Fund?                                No…2                             → 011
                                                Don’t know …3                    → 011
008 Does the family have a Community Health     Yes…1
    Fund card?                                  No…2                             → 009
                                                Don’t know …3                    → 009
009 Could you show me the community health      Yes, card shown…1                → 011
    fund card?                                  No…2
010 Could you show me the receipt?              Yes, receipt shown…1
                                                No…2
011 Have you heard about the Most Vulnerable    Yes…1
    Child Committee?                            No…2
                                                Don’t know …3
012 Has [Name] been visited by a Most           Yes…1
    vulnerable Child Committee member or        No…2                             → 014
    Volunteer in the past six months?           Don’t know …3                    → 014
CTV in Practice
 Piloted with Africare
 Introduced to WEI
 TA to other OVC IPs
 Incorporated into the Department of Social
  Welfare MVC M&E Plan
Responding to the special needs
of community-based programs
 Fostering data demand and use
 Developing participatory monitoring and
  evaluation (PM&E)
Participatory M&E

Low literacy tool
 Community identifies priorities
 Establishes progress indicators
 CBO assists with regular monitoring
Establishing priorities

       Seed (lowest priority)


       Sapling


       Tree


       Fruiting tree (highest priority)
Step 1: Vote

          Objectives/ Values


Community Home based Care Service
                                          2   4   3   1
 Providers availability when needed
Clients recovery from lost to follow up   4   0   2   4
PLWHA trained on nutritional aspects
                                          3   3   3   1
      and food preparation
    Availability of pain killer drugs     4   2   3   1

   Availability of antifungal drugs       1   0   7
                                                      2
     PLWHA received economic
                                          2   3   2   3
       strengthening support
 Stigma and discrimination has been
                                          5   2   3   0
              reduced
Step 2: Score and rank

                                                 Average        % Highest priority
          Objectives/ Values
                                          Score        Rank     Score        Rank

Community Home based Care Service
                                           2.3             8    10%            8
 Providers availability when needed
Clients recovery from lost to follow up    2.8             3    40%            2
PLWHA trained on nutritional aspects
                                           2.2             9    10%            9
      and food preparation
    Availability of pain killer drugs      2.1             10   10%           10
   Availability of antifungal drugs        3.0             2    20%            5
     PLWHA received economic
                                           2.6             6    30%            4
       strengthening support
 Stigma and discrimination has been
                                           1.8             12    0%           12
              reduced
Participatory M&E

 Easy to implement
 Creates community
  ownership of information
 Sets the stage for follow-
  up
Measurable changes

 Increased M&E
  budgets
 More M&E staff
 IPs conducting their
  own DQAs
 Supportive
  supervision and
  capacity building
Challenges abound!

 Pressure to expand services vs. attention to
  M&E
 Data collection: the weak link in the chain
 Overly-ambitious targets
 High-level demands for detailed reporting
  data
Can (should?) community
programs ever report monthly?
Alternatives to the facility model
    Simple forms for case management
    Semi-annual or annual cluster-sample
     surveys to track coverage
    Representative population surveys to
     measure changes in status
MEASURE Evaluation is a MEASURE project funded by the U.S.
 Agency for International Development and implemented by the
Carolina Population Center at the University of North Carolina at
Chapel Hill in partnership with Futures Group International, ICF
 Macro, John Snow, Inc., Management Sciences for Health, and
 Tulane University. Views expressed in this presentation do not
 necessarily reflect the views of USAID or the U.S. Government.
   MEASURE Evaluation is the USAID Global Health Bureau's
primary vehicle for supporting improvements in monitoring and
   evaluation in population, health, and nutrition worldwide.

         Visit us online at http://www.cpc.unc.edu/measure

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Building M&E Capacity of Community Based Programs in Tanzania

  • 1. Building M&E Capacity of Community Based Programs in Tanzania Dawne Walker MEASURE Evaluation Resident Advisor, Tanzania January 2012
  • 2. What do community programs provide?  Training and capacity-building  Support to households  Support to individuals  Home-based care  Community awareness-raising  …
  • 3. How are these services provided?  Directly by international Implementing Partners (IPs)  Through subgrants to civil society organizations (CS0s) and smaller NGOs  By unpaid community volunteers
  • 4. What are community programs required to report?  Number of eligible clients who received food and/or nutrition services  Number of eligible OVC who received a minimum of one CORE care service  Number of eligible adults and children provided with home-based care services  Number of vulnerable households with at least one OVC/MVC or PLHIV provided a minimum of one economic opportunity/strengthening support
  • 5. MEASURE Evaluation approach to M&E capacity-building Three-step process: 1. Assessment 2. Training, mentoring and technical assistance 3. Re-assessment
  • 6. Community-based programs are expected to produce comparable data to facility-based programs, but without comparable physical infrastructure and human resources
  • 7. Multiple levels of data quality issues  Data collection  Data entry  Data analysis and use
  • 8. Responding to the special needs of community-based programs  Shortcomings of trace-and-verify methodology  Developed Community Trace and Verify (CTV)
  • 9. Community Trace and Verify (CTV)  Covers minimum package of services  Short (10-minute) survey of caretakers  LQAS sampling methodology  Pass-fail scoring
  • 10. 005 Does [Name] have a birth certificate? Yes…1 No…2 → 007 Don’t know …3 006 Could you show us the birth certificate? Yes, birth certificate shown…1 No…2 007 Is the family enrolled with the Community Yes…1 Health Fund? No…2 → 011 Don’t know …3 → 011 008 Does the family have a Community Health Yes…1 Fund card? No…2 → 009 Don’t know …3 → 009 009 Could you show me the community health Yes, card shown…1 → 011 fund card? No…2 010 Could you show me the receipt? Yes, receipt shown…1 No…2 011 Have you heard about the Most Vulnerable Yes…1 Child Committee? No…2 Don’t know …3 012 Has [Name] been visited by a Most Yes…1 vulnerable Child Committee member or No…2 → 014 Volunteer in the past six months? Don’t know …3 → 014
  • 11. CTV in Practice  Piloted with Africare  Introduced to WEI  TA to other OVC IPs  Incorporated into the Department of Social Welfare MVC M&E Plan
  • 12. Responding to the special needs of community-based programs  Fostering data demand and use  Developing participatory monitoring and evaluation (PM&E)
  • 13. Participatory M&E Low literacy tool  Community identifies priorities  Establishes progress indicators  CBO assists with regular monitoring
  • 14. Establishing priorities Seed (lowest priority) Sapling Tree Fruiting tree (highest priority)
  • 15. Step 1: Vote Objectives/ Values Community Home based Care Service 2 4 3 1 Providers availability when needed Clients recovery from lost to follow up 4 0 2 4 PLWHA trained on nutritional aspects 3 3 3 1 and food preparation Availability of pain killer drugs 4 2 3 1 Availability of antifungal drugs 1 0 7 2 PLWHA received economic 2 3 2 3 strengthening support Stigma and discrimination has been 5 2 3 0 reduced
  • 16. Step 2: Score and rank Average % Highest priority Objectives/ Values Score Rank Score Rank Community Home based Care Service 2.3 8 10% 8 Providers availability when needed Clients recovery from lost to follow up 2.8 3 40% 2 PLWHA trained on nutritional aspects 2.2 9 10% 9 and food preparation Availability of pain killer drugs 2.1 10 10% 10 Availability of antifungal drugs 3.0 2 20% 5 PLWHA received economic 2.6 6 30% 4 strengthening support Stigma and discrimination has been 1.8 12 0% 12 reduced
  • 17. Participatory M&E  Easy to implement  Creates community ownership of information  Sets the stage for follow- up
  • 18. Measurable changes  Increased M&E budgets  More M&E staff  IPs conducting their own DQAs  Supportive supervision and capacity building
  • 19. Challenges abound!  Pressure to expand services vs. attention to M&E  Data collection: the weak link in the chain  Overly-ambitious targets  High-level demands for detailed reporting data
  • 20. Can (should?) community programs ever report monthly? Alternatives to the facility model  Simple forms for case management  Semi-annual or annual cluster-sample surveys to track coverage  Representative population surveys to measure changes in status
  • 21.
  • 22. MEASURE Evaluation is a MEASURE project funded by the U.S. Agency for International Development and implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill in partnership with Futures Group International, ICF Macro, John Snow, Inc., Management Sciences for Health, and Tulane University. Views expressed in this presentation do not necessarily reflect the views of USAID or the U.S. Government. MEASURE Evaluation is the USAID Global Health Bureau's primary vehicle for supporting improvements in monitoring and evaluation in population, health, and nutrition worldwide. Visit us online at http://www.cpc.unc.edu/measure

Editor's Notes

  1. Depending on the setting, community programs provide a range of assistance and services.Training for LGAs, CSOs and volunteersEconomic, nutritional and psychosocial support to households made vulnerable by HIV and AIDSIndividual support to eligible children and othersHome-based care Community awareness-raising around HIV prevention, care and support, child protection and other social and legal issues
  2. In the name of sustainability, USAID/Tanzania is pushing for less direct service delivery by international IPs and more local CSO involvement.CSOs typically cover a district and are located in the district capital.Day-to-day services in the communities are typically provided by unpaid community volunteers.
  3. Most of these have to be disaggregated by age and sex
  4. Assessment: Rely primarily on the Data Quality Assessment approachM&E systems, procedures, staff in placeInformation flow and consolidation from service point to HQInformation audit: trace-and-verify, compares services data captured at delivery point with data reported up the chainTraining, mentoring and technical assistanceWorkshops tailored to DQA results, group IPs by service areas and common M&E issues.Individualized mentoring and capacity-building plansGIS, DDU workshops for advanced IPsRe-assessment: mini-DQAWere changes seen in areas selected for strengthening?
  5. Data collection:Primary data collectors are often unpaid volunteersLow literacy levels and aggregation skills of primary data collectorsData entry:Transport issues to get the data from village level to ward/districtStorage/filing issuesLack of time to input data into databases due to workloadLack of computers or computer knowledgeData analysis and use:Lack of understanding as to why the data are collected and how they can be important to them
  6. Spot checks during Data Quality Assessments revealed that OVC were not receiving the services written in the registers (poor data quality for the routine data)There is little systematized supervision/checks of volunteers who delivered services to OVC
  7. Uses low literacy toolsTakes a day to implement the first time Creates ownership of information at community levelSets the stage for progress monitoring for quarterly or semi-annual follow-up