Monitoring and Evaluating Community System
Strengthening
Current CSS Indicators and Approaches
Round 11 regional Workshop, Nairobi, Kenya
August 19, 2011
Monitoring & Evaluation
Outline of the presentation
1. Overview of CSS indicators review; rational, objectives,
process and approach;
2. The indicator set;
3. Developing M&E frameworks for CSS programs and
linking these to the Global Fund proposal;
4. Program review and evaluations
Review rational and process
 27 indicators from May 2010 release not incorporated into RD 10
proposals;
 Preparing for Round 11 launch;
 Solicit implementer’s feedback
 Assess applicability of the indicators at regional and country
level;
 To assess the comprehensiveness in measuring community
systems strengthening;
 Determine whether existing alternatives can be recommended;
 Assess existing or anticipated challenges measuring the
recommended indicators;
 Coordinated by TGF but conducted by a partner representative
Technical working group
 Regional consultations with constituencies
Results overview
1. A set of 29 indicators – all process and output level
2. Two categories - CORE and additional
3. While many are process and output level, core indicators
will indicate improvements in the system over time as
proxy measures of system/service quality
4. Shows the linkage to health outcomes as presented in a
holistic health system approach
5. Clearly identified gaps in the CSS M&E framework for
further development;
1. Field testing and Validation
2. QoS framework development – Programs and
Community system
CSS Output/Process Level Indicators by SDA
10 CORE INDICATORS
Core component 1: Enabling environments and advocacy
SDA 1: Monitoring and
documentation of community and
government interventions
Number of community based organisations and/or
networks that have meaningfully participated in joint
national programme reviews or evaluations in the last 12
months (1.1)
SDA 2: Advocacy, Communication Number of community-led advocacy campaigns that saw
and Social mobilisation
a targeted policy change or can clearly document
improved implementation of an existing (targeted) policy
within 2 years of the start of the advocacy campaign
(2.1)
Core component 2: Community networks, linkages, partnerships and coordination
SDA 3: Building community
linkages, collaboration and
coordination
Number and percent of community based HIV, TB and
malaria service organisations with referral protocols in
place that monitor completed referrals according to
national guidelines (3.1)
CSS Output/Process Level Indicators by SDA
10 CORE INDICATORS
Core component 3: Resources and capacity building
SDA 4: Human resources: skills
building for service delivery,
advocacy and leadership
Number and percentage of staff members and
volunteers currently working for community based
organisations that have worked for the organisation for
more than 1 year (4.1)
SDA 5: Financial resources
Number and percentage of community based
organisations that have a sound financial management
system, which is known and understood by staff and
consistently adhered to (5.1)
SDA 6: Material resources –
infrastructure and ` (including
medical and other products &
technologies)
Number and percentage of community based
organisations reporting no stock-out of HIV, TB or
Malaria essential commodities according to program
implementation focus during the reporting period (6.1)
CSS Output/Process Level Indicators by SDA
10 CORE INDICATORS
Core component 4: Community activities and service delivery
SDA 7: Community based
activities and services – delivery,
use and quality
Number and percentage of community based
organisations that deliver services for malaria, TB and
HIV according to national or international accepted
service delivery standards (7.1)
Core component 5: leadership and organizational strengthening
SDA 8: Management,
accountability and leadership
Number and percentage of staff members of communitybased organisations with written terms of reference and
defined job duties (8.1)
CSS Output/Process Level Indicators by SDA
10 CORE INDICATORS
Core component 6: Monitoring & Evaluation and Planning
SDA 9: Monitoring & evaluation,
evidence-building
Number and percentage of community based
organisations that submit timely, complete and accurate
financial and programmatic reports to the nationally
designated entity according to nationally or
internationally recommended standards and guidelines
(where such guidelines exist) (9.1)
SDA 10: Strategic planning
Number and percentage of community based
organisations with a developed strategic plan covering 2
to 5 years (10.1)
CSS Output/Process Level Indicators by SDA
19 ADDITIONAL INDICATORS
Core component 1: Enabling environments and advocacy
SDA 1: Monitoring and
documentation of community and
government interventions
Number of community based organisations and/or
networks that have documented and publicized barriers
to equitable access to health services and/or
implementation of national AIDS, TB and Malaria
programming during the last 12 months (1.2)
Core component 2: Community networks, linkages, partnerships and coordination
SDA 3: Building community Number and percentage of community based
linkages,
collaboration
and organisations that are represented through membership
coordination
in national or provincial level technical or coordination
policy bodies of disease programmes and providing
feedback to communities (3.2)
Number and percentage of community based
organizations that implemented at least one documented
feedback mechanism with the community they serve in
the last 6 months (3.3)
CSS Output/Process Level Indicators by SDA
19 ADDITIONAL INDICATORS
Core component 3: Resources and capacity building
SDA 4: Human resources: skills
building for service delivery,
advocacy and leadership
Number and percentage of community health workers
currently working with community based organisations
who received training or re-training in HIV, TB or malaria
service delivery according to national guidelines (where
such guidelines exist) during the last national reporting
period (4.2)
Number and percentage of community based
organisations that received supportive supervision in
accordance with national guidelines (where such
guidelines exist) in the last 3/6 months (4.3)
Number and percentage of volunteers working with
community based organisations that are provided with
incentives (4.4)
CSS Output/Process Level Indicators by SDA
19 ADDITIONAL INDICATORS
Core component 3: Resources and capacity building
SDA 5: Financial resources
Number and percentage of community based
organisations that have core funding secured for at least
2 years (5.2)
SDA 6: Material resources –
infrastructure and ` (including
medical and other products &
technologies)
Number and percentage of community based
organisations that keep accurate data for inventory
management according to national or international policy
(6.2)
Number and percentage of community based
organisations with staff or volunteers that are
responsible for stock management trained or re-trained
in stock (inventory) management in the past 12 months
(6.3)
Number and percentage of community based
organisations that maintain adequate storage conditions
and handling procedures for essential commodities (6.4)
CSS Output/Process Level Indicators by SDA
19 ADDITIONAL INDICATORS
Core component 4: Community activities and service delivery
SDA 7: Community based
activities and services – delivery,
use and quality
Number and percentage of community based
organisations that implemented activities contributing to
the national disease strategic plan as documented by
their plans and reports to the national designated entity
(7.2)
Number and percentage of people that have access to
community-based HIV, TB or malaria services in a
defined area (7.3)
Core component 5: leadership and organizational strengthening
SDA 8: Management,
accountability and leadership
Number and percentage of community based
organisations with staff in managerial positions who
received training or re-training in management,
leadership or accountability during the last reporting
period (8.2)
Number and percentage of community based
organizations that received technical support for
institutional strengthening in accordance with their
CSS Output/Process Level Indicators by SDA
19 ADDITIONAL INDICATORS
Core component 6: Monitoring & Evaluation and Planning
SDA 9: Monitoring & evaluation, Number and percentage of community based
evidence-building
organisations with at least one staff member in charge
of M&E (9.2)
Number and percentage of community based
organisations with at least one staff member in charge
of M&E who received training or re-training in M&E
according to nationally recommended guidelines (where
such guidelines exist) during the last national reporting
period (9.3)
Number and percentage of community based
organisations using standard data collection tools and
reporting formats to report to the national reporting
system (9.4)
Number and percentage of community based
organisations conducting documented reviews of their
own programme performance according to their strategic
plan in accordance to national reporting cycle (9.5)
CSS Output/Process Level Indicators by SDA
19 ADDITIONAL INDICATORS
Core component 6: Monitoring & Evaluation and Planning
SDA 10: Strategic planning
Number and percentage of community based
organisations that are implementing a budgeted annual
work plan (10.2)
Developing M&E frameworks for CSS programs
• In country consultations to include the CSS programs and
M&E into national strategies – national M&E plan
• View CSS programs as part of the overall health system
Refer to HSS/CSS complementarity
• Link CSS interventions to health results and therefore have
a comprehensive results framework refer to - CSS results
framework
– Show direct linkage to health service delivery
• Link M&E framework to the Global Fund grant through the
proposal Performance Framework (select from the national M&E
plan or an equivalent)
Example of the complementarity between the Health and community
System
INPUTS (HSS/CSS)
ACTIONS
HSS SDA: Health
Workforce
-Health worker retention
Training & education
HSS SDA: Procurement &
Supply Chain Management
-Distribution of ACTs,
LLINs and laboratory
equipment & diagnostics
CSS SDA: Service
availability, use and
quality
-Demand creation through
community mobilization
for LLIN use, involvement
in PMTCT, follow up of
mothers and babies in
communities and creating
awareness of available
PMTCT services
OUTPUT
% of facilities with
capacity (ready) to
provide ACT
treatment to
malaria cases
(drugs, trained
staff & guidelines,
& diagnostic s)
Facilities reporting
no stock outs of
ACTs/LLINs
Increase “inpatient &
outpatient visits”
(e.g., people
accessing ACTs)
OUTCOME
% of children
under
five/pregnant
women that
slept under a
LLIN the
previous night
% of
uncomplicated
malaria cases
receiving
appropriate
treatment
IMPACT
Annual
parasite
incidence rate
Outcome Level Indicators
Malaria
1.
Suspected malaria cases that have
laboratory diagnosis/ Children under-5
with fever (household survey) that
received laboratory diagnosis
2.
Uncomplicated malaria cases receiving
appropriate treatment
3.
Women who received two or more doses
of IPT during their last pregnancy
Tuberculosis
1.
Case notification rate
2.
Treatment success rate
Outcome Level Indicators
Maternal, New-born and Child
Health
1.
Proportion of women attending
antenatal care
2.
Proportion of institutional deliveries
3.
Children who received DTP3
4.
Children fully immunised
5.
Drop out between DTP1 and DTP3
coverage (%)
6.
Equity in immunisation coverage
(Difference in DTP3 coverage in lowest
wealth quintile and coverage in highest
wealth quintile) (%)
HIV/AIDS
1.
Proportion of
adults/children with
advanced HIV infection
receiving ART
2.
HIV-positive pregnant
women who receive
ART for PMTCT
Impact Level Indicators
Health Status
Financial Risk Protection
1. Neonatal mortality
2. Mortality due to major cause of death
3. Child mortality
4. Maternal mortality ratio
5. ART survival rate
6. PMTCT transmission rate
7. Confirmed malaria cases
8. Inpatient confirmed malaria cases
9. Future deaths averted
The ratio of household out-ofpocket as payments for health
to total expenditure on health
CSS indicators recommended data sources
•
•
•
Administrative records: organizational routine source documents.
– The records will defer by indicator and organisation and therefore need
to be defined at the planning stage.
– Examples: Activity reports, policy documents, monitoring reports,
supervision checklists, client registers, training records.
Institutional Surveys/Assessments: periodic data collection exercises
– gather information on defined aspects of the organisation usually related
to performance and or quality standards.
– These are commonly implemented by the national level designated
entity with oversight responsibility for community based activities and
services.
– either as part of routine supervision or as an exclusive exercise.
– Require predefined service standards and checklists
Population-based survey - representative sample from population
– commonly implemented by the national level designated program
authority with the involvement of all partners.
– CSS implementers are encouraged to participate as much as possible
in the planning and execution of the surveys.
20
Program reviews and evaluation
• CSS programs need to plan and conduct periodic program evaluations
• CSS programs encouraged to include impact outcome indicators to
demonstrate contribution to health results
• Tracking of relevant core indicators to track improvement in the
community system
– For Periodic reviews, the core indicators will be assessed along with the grant
impact outcome indicator performance