ASSESSMENT REPORT
HIV/AIDS M & E SYSTEM
National Coordination Council
for HIV/AIDS & TB
of the Republic of Moldova
Chisinau
May 2011
M & E system assessment report 2011, Republic of Moldova
CONTENTS
List of abbreviations
Executive Summary ………………………………………………………………………………………………………….3
Background ………………………………………………………………………………………………………………………4
Overview of the Governance Structures for the HIV Response………………………………………….7
Description of the National HIV M&E system…………………………………………………………………….8
Assessment Methodology..…...………………………………………………………………………………………..11
Assessment Results………………………………………………………………………………………………………… 12
1. Organizational Structures of HIV M&E Functions .………………………………………………………12
2. Human Capacity for Multi-Sector HIV M&E …………………………………………………………………14
3. Partnerships to Plan, Coordinate and Manage the Multi-Sector HIV M&E System……… 16
4. National, Multi-Sector HIV M&E Plan ………………………………………………………………………….17
5. Costed, National, Multi-Sector HIV M&E Work Plan ……………………………………………………18
6. Communication, Advocacy and Culture for HIV M&E ………………………………………………….19
7. Routine HIV Programme Monitoring …………………………………………………………………………. 20
8. Surveys and Surveillance …………………………………………………………………………………………….21
9. National and Sub-National HIV Databases …………………………………………………………………..22
10. Supportive Supervision and Data Auditing ………………………………………………………………..23
11. HIV Evaluation and Research Agenda ………………………………………………………………………..24
12. Data Dissemination and Use ……………………………………………………………………………………..26
Challenges and priorities for action ……………………………………………………………………………….28
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M & E system assessment report 2011, Republic of Moldova
LIST OF ABBREVIATIONS
AIDS
ANC
ARV
BCC
BSS
CBO
CRIS
CSW
DHS
FBO
GFATM
HIV
HMIS
IAs
IDU
IEC
M&E
M&E TWG
MICS
MoE
MoH
MoIA
MoLSPF
MoYS
MSM
NAC
NAP
NCC
NCHM
NCPI
NGO
PEP
PLHA
PMTCT
RH
STI
TB
TOR
UA
UN
UNAIDS
UNGASS
UN
VCT
WHO
Acquired Immune Deficiency Syndrome
Antenatal clinic
Anti-retroviral treatment
Behavioral Change Communication
Behavioral Surveillance Survey
Community Based Organization
Country Response Information System
Commercial Sex Workers
Demographic and Health Survey
Faith-Based Organization
Global Fund for AIDS, Tuberculosis, and Malaria
Human Immunodeficiency Virus
Health Management Information System
Implementing Agencies
Injecting Drug User
Information, Education and Communication
Monitoring and Evaluation
M & E Technical Work Group
Multiple Indicator Cluster Survey
Ministry of Education
Ministry of Health
Ministry of Internal Affairs
Ministry of Labour, Social Protection, and Family
Ministry of Youth and Sports
Men Having Sex with Men
National AIDS Center
National AIDS Program
National Coordination Council for HIV/AIDS and TB
National Center for Health Manangement
National Composite Policy Index
Non-governmental Organization
Post Exposure Prophylaxis
Persons Living With HIV/AIDS
Prevention of Mother-to-Child Transmission
Reproductive Health
Sexually Transmitted Infection
Tuberculosis
Terms of Reference
Universal Access
United Nations
Joint United Nations Program on HIV/AIDS
United Nations General Assembly Special Session on HIV and AIDS
United Nations
Voluntary Testing and Counselling
World Health Organization
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M & E system assessment report 2011, Republic of Moldova
EXECUTIVE SUMMARY
The Republic of Moldova has an immature National HIV M&E system in
process of establishment since 2004. A mid-term review (MTR) of the National
HIV/AIDS Programme (NSP) 2006 – 2010 has been completed in March 2009, the
National HIV M&E system assessment being an integral part of the Review and occurring
via participatory self-assessment in November 2008. The main findings have been
reviewed and recommendations updated during the Response Analysis that acted as the
final evaluation for the 2006-2010 NAP. The M&E system assessment findings have
served as basis for the development of the National M&E Plan as an integral part of the
NAP 2011 – 2015, approved by Government Decision in December 2010. The
assessment of the M&E system strengthening actions, as well as the identifications of
gaps for the development of corrective actions under the new M&E Operational Manual
and 2011 – 2012 M&E costed workplan, have occurred through a participatory selfassessment of the M&E system in April 2011.
In the light of alignment of National HIV M&E system of the National
HIV/AIDS Programme and the M & E of the GFATM grant, there is buy-in at highest
level and commitment of stakeholders to assess the existing National HIV M&E system,
identify gaps and address them in a concerted and holistic manner. The 2008 and 2011
assessments have represented a comprehensive participatory process, applying the 12
components standardized tool approved by MERG1. The 2010 review has represented a
desk review, findings being discussed broadly and recommendations formulated
through broad consultations.
The methodology of the participatory assessment included a multi-stakeholder
assessment workshop with 4 distinct groups of stakeholders representing different
institutions and levels of the M & E system, each applying a comprehensive tool for
assessing the status of national HIV M&E systems, developed based on the
Organisational Framework for Functional M & E Systems endorsed by MERG. The
workshop has been preceded by a comprehensive desk review, undertaken by staff of
the National AIDS Center, and of the M&E of National Programmes Unit if the National
Center for Health Management, with technical assistance and facilitation from the
UNAIDS M&E Adviser.
This report finds that human resources, operationalization of the national
database, and particularly, supportive supervision and data quality assurance, are key
areas to be enhanced. The strengths and weaknesses per each component have been
identified, and key recommendations for action put forth and endorsed through
consensus of stakeholders participating at the assessment workshop.
This report concludes that the standardization of all aspects of the
system, augmentation of capital and capacity, and monitoring and evaluation of the
system itself are necessary steps towards the improvement of the system as a whole. All
“12 Components Monitoring and Evaluation System Assessment Tool. Geneva: UNAIDS, March 2009”;
“12 Components Monitoring & Evaluation System Assessment. Guidelines to Support Preparation,
Implementation and Follow-Up Activities”, UNAIDS 2010
1
4
M & E system assessment report 2011, Republic of Moldova
aspects of the system must have explicitly stated deliverables that include budgets,
timeframes and implementing partners, as well as clear actions for implementation.
BACKGROUND
Aiming at having an efficient AIDS-response, the Republic of Moldova has
committed to the Declaration of Commitment and has embarked on building and
strengthening the 3 Ones. The National Programme on Prevention and Control of
HIV/AIDS/STIs in its successive cycles 2006-2010 and 2011 – 2015, was aligned to
national strategic frameworks and to international commitments Moldova has
embraced. The NAP had clear linkages to the MDG-centered National Development
Strategy 2008 – 2012, which represents a tool for the integration of the strategic
frameworks under implementation, as well as a device for alignment between the
budgeting process and the policy framework, and absorption of external technical and
financial assistance..
A set of indicators has been developed and agreed by all stakeholders to support
monitoring and evaluation, and the technical groups have developed a log-frame to
support the implementation of the National Programme. Target setting has dully taken
into account Universal Access principles and interventions were designed using human
rights-based approaches and focusing on most affected and most marginalized
communities. The normative framework at national level also includes relevant Laws,
strategies and programmes, as well as Ministerial orders and decrees mandating
stakeholders in the national response. In 2007 the Parliament of the Republic of
Moldova has approved the Law on Prevention of HIV/AIDS; ammmendments are
currently underway to ensure consistency with international recommendations of
observance of human rights and ensuring universal access.
There is a single National Coordination entity - the National Coordination Council
in the area of TB/HIV which includes government stakeholders, representatives of
people living with HIV, NGOs as well as international community. The NCC is a decisionmaking body having 14 functional working groups which enhance coordination and
capitalize upon the value added of joint efforts of all key stakeholders from different
sectors, and a permanent Secretariat. There is a joint HIV/TB M&E TWG and a TWG on
HIV Epidemiological Surveillance, which bring together key actors in M&E system
strengthening.
There is a concept endorsed by the government for building one comprehensive
national M&E system. The National Monitoring and Evaluation System is Governmentbased and Government-led. The Department for M&E of National Health Programs (M &
E Unit), as a subdivision of the National Center of Health Management of the Ministry of
Health of the Republic of Moldova, represents the gate-keeper to the One national
monitoring and evaluation mechanism at the country level; the National AIDS Center
coordinated NAP monitoring and participates jointly with the M&E Unit in system
strengthening endeavours as key national implementers. The National Center of Health
Management reports vital statistics data and public health related data to the National
Statistics Bureau, the main data collection and analysis institution at central level.
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M & E system assessment report 2011, Republic of Moldova
The M&E system is designed to collect information to support the activities and
outcomes of the initiatives, taken by the Government of Moldova to fight against this
disease (Cercone, 2003). The outputs are intended to serve wider govermental needs
for reporting on the health dimensions at national and international levels. The M&E of
NAP is based on the nationally-agreed upon set of indicators which have been
developed based on international definitions by all stakeholders to support monitoring
and evaluation. Regular UNGASS and Universal Access reporting occurs with all proper
consultations and in-country validation and consensus building. The framework for the
M&E system is constituted by the National M&E Plan and Operational Manual,
structures around the NAP results framework and unified national indicator set.
In order to strengthen the national M & E system, assessments have been carried
out in the framework of the end-programme review of the previous cycles of the NAP,
as well as in the framework of developing proposals to GFATM, where resources have
been earmarked for ensuring the functionality of the M & E system. Institutional and
professional capacity building for the M & E Unit has been provided for under Round 1
and Round 6 GFATM projects. The monitoring of the Global Fund grant performance has
been aligned into the general practice of the M&E Department to reduce overlap and
double reporting
As part of the mid-term review of the NAP, carried out in 2008 - 2009, with the
purpose to evaluate the NAP implementation, to identify gaps and to further develop
the NAP to fulfill quality criteria for validation and to serve as a proper framework for
the national response, the assessment of the M & E system has been planned and
carried out in November 2008 according to the Organisational Framework for 12
components of a functional M & E system2, as part of a piloting exercise of the
assessment tool developed by MERG. The main findings have been reviewed and
recommendations updated during the Response Analysis that acted as the final
evaluation for the 2006-2010 NAP. The M&E system assessment findings have served as
basis for the development of the National M&E Plan as an integral part of the NAP 2011
– 2015, approved by Government Decision in December 2010. The assessment of the
M&E system strengthening actions, as well as the identifications of gaps for the
development of corrective actions under the new M&E Operational Manual and 2011 –
2012 M&E costed workplan, have occurred through a participatory self-assessment of
the M&E system in April 2011.
In the light of alignment of National HIV M&E system of the National
HIV/AIDS Programme and the M & E of the GFATM grant, there is buy-in at highest
level and commitment of stakeholders to assess the existing National HIV M&E system,
identify gaps and address them in a concerted and holistic manner. The 2008 and 2011
assessments have represented a comprehensive participatory process, applying the 12
components standardized tool approved by MERG3. The 2010 review has represented a
“Organizing Framework for a Functional National HIV Monitoring and Evaluation System” (UNAIDS,
2008).
3
“12 Components Monitoring and Evaluation System Assessment Tool. Geneva: UNAIDS, March 2009”;
“12 Components Monitoring & Evaluation System Assessment. Guidelines to Support Preparation,
Implementation and Follow-Up Activities”, UNAIDS 2010
2
6
M & E system assessment report 2011, Republic of Moldova
desk review, findings being discussed broadly and recommendations formulated
through broad consultations.
The methodology of the participatory assessment included a multi-stakeholder
assessment workshop with 4 distinct groups of stakeholders representing different
institutions and levels of the M & E system, each applying a comprehensive tool for
assessing the status of national HIV M&E systems, developed based on the
Organisational Framework for Functional M & E Systems endorsed by MERG. The
workshop has been preceded by a comprehensive desk review, undertaken by staff of
the National AIDS Center, and of the M&E of National Programmes Unit if the National
Center for Health Management, with technical assistance and facilitation from the
UNAIDS M&E Adviser.
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M & E system assessment report 2011, Republic of Moldova
OVERVIEW OF THE GOVERNANCE STRUCTURES FOR THE HIV RESPONSE
In the Republic of Moldova, the national response is coordinated by the National
Coordination Council, an inter-ministerial decision-making body with Deputy Ministerlevel representation, as well as representation from the civil society and development
international organizations (bilateral and multilaterals), instituted based on Government
Decree No 825 on 03.08.2005, and with its mandate and composition broadened as of
2010 (Government Decision No 375 of May 10, 2010). The NAP mandates different public
institutions at national and sub-national levels to act as key stakeholders tasked with its
implementation. At technical level, the Ministry of Health chairs the NCC and maintains
the NCC Secretariat, having also a leading role in implementation of the NAP.
In the health sector, there are three main institutions with responsibilities in
HIV/AIDS at central level:
1.
National AIDS Centre – a Department of the Centre of Preventive Medicine
within the Ministry of Health, the central level public institution tasked with the coordination
and support in the implementation, as well as the monitoring of the NAP. An HIV/AIDS
Department has been institutionalized within the National AIDS Center, unifying the
HIV/AIDS sector through unique oversight, decision making and policy development.
2.
Infectious Diseases Hospital – responsible for the treatment of PLHA. The
Hospital is subordinated to the Ministry of Health.
3.
The National Centre of Health Management, an institution within the Ministry of
Health, responsible for monitoring and evaluation of national health programmes, as
well as with data validation and data quality audits.
The National Centre of Health Management is a governmental institution founded
by the Decision of the Government of Republic of Moldova No. 387 from 25.04.97 "On
the foundation of the Scientific and Practical Centre of Public Health and Health
Management" and reorganized in National centre of Health Management by the
Decision of the Government of Republic of Moldova No. 1247 from 16.11.2007 „ On the
National Centre of Health Management". The M & E Unit has been established in 2004
and is tasked with M & E of all health policies; currently M & E of the National
Programme on HIV/AIDS, National TB Programme, and the Drug Observatory are
operational areas of the Unit.
The National Public Health Center, AIDS Centre is a governmental institution
founded following the adoption of the Law Nr.1513-XII from 16.06.93 on the sanitaryepidemiological safety for population.
The in-patient treatment facility for AIDS patients is based on the Infectious
Diseases Hospital and represents the first AIDS treatment facility in the country.
Treatment has now been decentralized to regional treatment centers. A palliative care
unit is expected to be established in 2010. At local level, patient monitoring and case
management is entrusted to infectious diseases specialists at primary healthcare level.
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M & E system assessment report 2011, Republic of Moldova
DESCRIPTION OF THE NATIONAL HIV M&E SYSTEM
The M & E system in Moldova is an immature system in the process of being established
since 2004. Following the approval of the recommendations of the Washington
Conference organized by the UNAIDS and the main donors in HIV/AIDS from April 25,
2004, regarding the necessity to implement “The Three Ones” Principle, the Ministry of
Health of Moldova, together with its partners, created the concept building one
comprehensive national M&E system. The National Monitoring and Evaluation System is
Government-based and Government-led. The National AIDS Center is tasked with the
routine NAP monitoring and internal data quality controls. The joint HIV/TB TWG for
M&E and its operational level sub-group on HIV represent mechanisms for coordination
and partnerships in M&E with the aim to coordinate multisectorial NAP M&E,
programme evaluations, and to strengthen the M&E system functioning, also serving as
an ongoing assessment mechanism for the system performance. The Department for
M&E of National Health Programs (M & E Unit), as a subdivision of the National Center
of Health Management of the Ministry of Health of the Republic of Moldova, represents
the data quality control and external audit mechanism, also acting as a technical hub
supporting M&E processes of all national programmes. The National Center of Health
Management reports vital statistics data and public health related data to the National
Statistics Bureau, the main data collection and analysis institution at central level.
The M&E system is designed to collect information to support the activities and
outcomes of the initiatives, taken by the Government of Moldova to fight against HIV.
The outputs are intended to serve wider Govermental needs for reporting on the health
dimensions at national and international levels. The national indicator set includes
internationally-agreed upon indicators (UNGASS, Universal Access Reporting, Dublin
Declaration indicators), indicators reported upon to GFATM and other outcome and
process national indicators as specified in the National M&E Plan.
The financing of M&E aims to constitute around 10% of the NAP budget. Currently, there is an
over-reliance on donor funding and insufficient allocations from the public system.
The routine health data collection system includes HIV case registration, data on geographic and
gender distribution, socio-economic status, ways of transmission. A 2nd generation surveillance
system is under development, providing for collection of behavior and prevalence data every 2
years for various groups (IDUs, FSWs, MSM, PLHIV). Population-based surveys are also carried
out – RHS (1997), DHS (2005), MICS (2000, 2011), KAP biannual surveys (2006, 2008, 2010).
The data flows within the HIV M&E system are structured around verticals and
horizontal reporting based on the national indicator set.
a. Existent reporting verticals, automated
Example: Reporting on STIs (STI component, SIME HIV/STI)
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M & E system assessment report 2011, Republic of Moldova
Local/territoria
l STI Specialist
Automated
reporting
system
NHMC,
SIME HIV/STI
National
database
NCDV – data
validation
STI component
Automated
data importing
to SIDATA
b. Existent reporting verticals, automated systems missing
Example: Prevention activities implemented by the health system
Public Medical
Institutions
Raion Public
Health Centers
National
Public Health
Center
Family Doctors
Center
SIDATA national
database
c. Verticals in process of institutionalization
Example: Prevention activities implemented by NGOs
Local NGO
SIDATA national
database
Validation – prevention
specialist, NAC
Local NGO
d. horizontal data flows (intersectorial)
Example: Social assistance services
Local NGO
SIDATA national
database
Validation – MpLSPF
Local NGO
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M & E system assessment report 2011, Republic of Moldova
Data sources
The routine health data collection system includes HIV and STI case registration and HIV clinical
monitoring registration, HIV testing information and blood donors screening registration.4
HIV case registration occurs when the person undergoes two positive ELISA tests and one
confirmatory Western Blot test. A paper form that includes personal and epidemiologic
information is completed by the local epidemiologist. The papers forms are then sent to the
National AIDS Center, where after validation, are entered into the unified electronic database
SIME-HIV.
HIV clinical monitoring data is under the joint responsibility of the local ID physician, regional
ARV treatment centers and the ARV department at the ID Hospital at central level. The data
collected are related mainly to clinical and treatment monitoring. The unified SIME-HIV/STI
database is yet to be fully operationalized.
HIV testing data is collected in two separate data flows. Data regarding the number of HIV tests
performed are registered by the centers of preventive medicine and centralized by the National
AIDS Center. Data regarding the people counseled and tested in VCT centers is collected in an
electronic database maintained by the NCHM M&E Unit and the National AIDS Center.
Blood donors HIV screening data is registered in a separate electronic database of the National
Center of Blood Transfusion. Any positive case is then reported to the National AIDS Center who
is responsible for follow-up and HIV case registration.
STI case reporting is part of the RDVD M&E system and is based on SIME-HIV/STI, STI
component. The system is a vertical one in terms of distribution of tests and reporting.
Programme data is generated by various implementers who provide services to various
populations groups. For example, harm reduction routine statistics data are collected by NGOs
implementing harm reduction programs and an M&E officer Soros Foundation validates data.
There is no national entity responsible for centralization of program indicators collected by
various national and international entities.
Given the passive reporting nature of the routine health statistics, all data sources are limited to
registering inputs and only those new cases that have accessed the public health system,
therefore estimation methods need to be used to evaluate the actual numbers of HIV and STI
prevalence in the population or sizes of various MARPs.
Outcome indicators collection system includes 2nd generation sentinel surveillance and
population-based surveys. The 2nd generation surveillance system provides biannual collection
of behavior and prevalence data from various groups (IDUs, FSWs, MSM, PLHA, MARA, inmates).
Since year 2004, three rounds of BSS have been conducted thus far. Youth KAP surveys have
4
Scutelniciuc et al. 5-year evaluation. Republic of Moldova. Health Impact Evaluation Study Area 3. HIV/AIDS Report.
Chisinau 2008. In print.
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M & E system assessment report 2011, Republic of Moldova
been conducted in years 2006, 2008, 2010. Population-based surveys have been also carried out
by various entities: RHS (1997), DHS (2005), MICS, Studies on Knowledge, Attitudes and
Practices related to HIV/AIDS among general population (AFEW, USAID PHHP).
Internationally, standards and guidelines have been developed for HIV and AIDS
monitoring and evaluation systems. These have been documented in a series of M&E
manuals: UNAIDS National AIDS Programs: A Guide to Monitoring and Evaluation
(UNAIDS 2000); Monitoring the Declaration of Commitment on HIV and AIDS: Guidelines
on Construction of Core Indicators (UNAIDS 2002); National AIDS Councils: Monitoring
and Evaluation Operations Manual (UNAIDS/World Bank 2002), Organizational
Framework for 12 components of a functional M&E system, endorsed in 2007 by
development partners and constituting a multi-agency common vision of what
constitutes a fully functional M&E system.
The Moldova M & E system shall be strengthened and prioritized for enhanced
functionality and cost-efficiency in evidence-informed strategic planning for the national
response to HIV and AIDS.
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M & E system assessment report 2011, Republic of Moldova
ASSESSMENT METHODOLOGY
To avoid duplication of effort and fragmented support, development partners have
taken deliberate steps towards a unified M&E approach, culminating with the multiagency endorsement in 2007 of an organizing framework for a national, multi-sectoral
HIV M&E system, based on a common vision for what constitutes a fully functional M&E
system and concerted actions to strengthen the system that would capture the data for
the national HIV response and measure the achievement of HIV response objectives,
hence contributing to programme improvement This framework describes twelve
components of an HIV M&E system and some key performance elements against which
to judge implementation progress. A single tool to assess the status of national HIV M&E
systems, based on the Organisational Framework has been developed by Technical
Work Groups under the auspices of MERG, and Moldova has been selected to pilot the
assessment tool in November 2008. This tool has been the product of a comprehensive
review and consolidation of existing assessment tools; based on feedback from
countries piloting the tool, the latter was revised and endorsed by the global M&E
Reference Group for HIV and AIDS (MERG). On April 1 – 2, 2011, a participatory selfassessment workshop has taken place in Moldova, bringing together national
stakeholders from different levels of the Moldovan M&E system to apply the 12
Components Monitoring and Evaluation System Strengthening Tool in assessing the
overall performance of the national HIV M&E system. The workshop has been preceded
by a complex desk review. The methodology allowed for an interactive and participatory
approach, allowing for reflection, discussion and consensus building around the current
strengths and weaknesses of the national HIV M&E system and what should be done to
improve the system.
The assessment covered the following 12 core areas:
People, partnerships and planning:
1. Organizational structures with HIV M&E functions;
2. Human capacity for HIV M&E;
3. Partnerships to plan, coordinate, and manage the HIV M&E
system;
4. National multi-sectoral HIV M&E plan;
5. Annual national wide HIV M&E work plan;
6. Advocacy, communications, and culture for HIV M&E.
Collecting, verifying, and analyzing data:
7. Routine HIV program monitoring;
8. Surveys and surveillance;
9. National and sub-national HIV databases;
10. Supportive supervision and data auditing;
11. HIV evaluation and research.
Using data for decision-making:
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M & E system assessment report 2011, Republic of Moldova
12. Data dissemination and use.
For the workshop, participants have been divided into small groups which corresponded
to their role in the national HIV response. The purpose has been for each group to focus
on the assessment items that are relevant to their specific roles and responsibilities in
M&E. The 4 intersectorial groups represented:
- the National Coordination Council with its coordination, technical and
operational structures (including the contributions of other Ministries to the
national M&E system)
- the Ministry of Health and National AIDS Center, the latter representing the
institution tasked with coordination of NAP implementation and monitoring
- NGO and other umbrella networks
- Local public administration
The National HIV M&E assessment has represented a diagnostic exercise that enables
stakeholders in HIV M&E to identify strengths and weaknesses in the current system
and recommend actions to maintain its strengths and improve its weaknesses. With this
information in hand, the Operational Manual aimed to provide the implementation
mechanisms for the National M&E Plan, has been developed through a participatory
process.
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M & E system assessment report 2011, Republic of Moldova
ASSESSMENT RESULTS:
Component 1. Organizational Structures with HIV M&E Functions. Strengths and
weaknesses, steps to be done
Rating: Mostly
Component description
The National M & E system has important functions at central, regional (raion/district)
and service provision levels. While functions congregating at central level are better
developed, the regional and service provision levels need to be strengthened in a
holistic manner.
In addition to public entities, approximately 40 international and domestic NGOs
working in the field of HV/AIDS and TB in Moldova make an invaluable contribution to
the national response, particularly in the areas of service provision and prevention.
NGOs also manage and implement the majority of activities supported from the Global
Fund grants and other international donors. Bilateral and multilateral donors are also
among stakeholders in the national response. The diversity of actors, and the
participatory strategic planning, implementation, monitoring and evaluation processes
of the NAP imperatively request a clear vision of the levels of the multi-sectoral
comprehensive M & E system, of the roles stakeholders play within the system hereto,
and of the data flows. Clear implementation benchmarks and reporting are imperative
components of M&E system strengthening interventions.
At national level, the intersectorial nature of the M&E system for HIV and TB is
coordinated by the M&E TWG that is composed of stakeholders from multiple sectors
and levels. The new Experts Oversight Committee in process of institutionalization
within the NCC may represent an important mechanism for oversight of implementation
of the National M&E Plans for HIV and TB NAPs.
Within the health system, there are two main entities with the mandate to monitor and
evaluate policies and programs:
- The Division for the Policy Analysis, Monitoring and Evaluation within the
Ministry of Health, staffed with 4 persons
- The M & E Unit of the National Center of Health Management, the main entity at
technical level around which the national M & E of Health Programmes system is
structured. The M & E Unit is staffed with four permanent employees – 2 M & E
specialists and 2 IT specialists, and additionally, 2 part time positions. A shortage
is attested in human resources that are expected to cover all health
programmes; hence, HIV specific M&E units are involved in other tasks and
responsibilities outside the mandate of the NAP.
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M & E system assessment report 2011, Republic of Moldova
-
The National AIDS Center has a Coordination of NAP division instituted as of
2009, that includes a M&E specialist and some other thematic specialists with
M&E functions (communication & prevention, VCT, treatment, partnerships &
capacity building specialists).
The Infectious Diseases Hospital and the Republican Dermato-Venerological Dispensary
do not have full time M & E units; M & E functions are distributed among personnel that
have other primary roles and responsibilities according to their job descriptions (2 such
staff units have been identified within the IDH and 3 within RDVD). The National
Narcology Dispensary is equipped with one unit whose functions include data
aggregation and control, while the National Blood Transfusions Center includes 2 units
with similar functions. The respective M & E units are also mandated with HIV M & E.
National Health Accounts are in the incipient stage of development, hence monitoring
of expenditures in relation to program results is complicated. There are allocations for
M&E of HIV/AIDS from public sources (including direct budget support from donors) to
the National Center of Health Management.
Vacancies in M&E units are not easily filled, important line institutions like the NCHM,
NBTC and IDH having unfilled positions at the time of this M&E system assessment.
There is a limited pool of people with background and experience in M&E and those
existing may be more keep to apply to programme positions. There are fluctations in
availability of human resources and hence recruiting procedures are frequently stalled
(it has taken 2 successive recruitments to hire the M&e speciaist for the NAC, who has
been on board for less than 10 monhts; the follow up recruitment yielded low
participation).
At the central level, other Ministries lack a specific mandate in HIV M & E. The Ministry
of Labour, Social Protection, and Family, due to its leading role in 2008 in revitalizing the
social services TWG, has assumed M & E functions under NAP – the HIV focal point, that
also has competencies in M & E, sits in the Equal Opportunities and Violence Prevention
Division. Other Ministries do not have a mandate for HIV M & E; staff/units with primary
responsibilities in HIV M & E are difficult to justify in the context of a concentrated
epidemic like Moldova. There are Divisions for Analysis and M&E of Policies within all
Ministries, staffed with 5 units, that have broad M&E functions and a standards TOR
across all Ministries. If appropriately trained, these Divisions could institute/act as HIV
M&E focal points within respective Ministries. As to the profile of such M&E staff,
database administrators and/or epidemiologists are lacking within other Ministries.
At sub-national level, there are rayon (district) multidisciplinary commissions for
HIV/AIDS with varying degree of functionality, established to monitor territorial
programmes for implementation of raion level interventions under the overall NAP
umbrella. There are certain M&E actions established within such territorial HIV
programmes at level of raions and municipalities. Frameworks at community level are
lacking. The commission acts as coordinating body for district-level implementation and
16
M & E system assessment report 2011, Republic of Moldova
monitoring of HIV interventions; membership is unremunerated and additional to
primary job responsibilities. There are poor capacities and limited motivation, as well as
no formal mechanisms for fulfilling the M & E mandate. Deputy mayors and specialists
within health structures of municipal local public administration have M&E functions in
their mandate; however functions lack specificity and staff lack competencies in the
area. At raion level, health-specific structures are lacking within LPA; M&E functions
could be attributed to raion public health centers.
While umbrella organizations are involved in routine program monitoring, the mandate
for HIV M & E, provided for in the NAP, is not clearly defined at organizational level and
there is no formally appointed unit or division and very limited human resources for that
purpose (ex. Soros Foundation – 2 M & E officer; no staff with sole or primary M & E
responsibilities in other umbrellas).
At service provision level, there are certain HIV and HIV M & E responsibilities attributed
to different persons/units within medical facilities at primary healthcare level – the
infectionist, the family doctor, the statistics division. NGO / service providers often do
not have specifically-appointed M & E personnel, M & E responsibilities being part of the
work load of service implementers. Due to shortage of human resources and time, these
responsibilities are frequently limited/formal in nature. Capacities are limited.
Across levels, access to external technical assistance has been assessed from average to
good, however the needs for technical assistance have been indicated as not
fully/timely assessed.






Gaps and weaknesses identified
Availability of HIV M&E staff: limited within health sector and practically lacking
within other sectors of the national response. Database administrators and
epidemiologists are particularly missing from intersectorial M&E structures.
At level of other Ministries and raion/local level, there is a limited mandate in HIV
M&E.
Terms of reference for M&E positions at all levels are not reflecting clearly
responsibilities associated with each of the 12 components.
Motivation of M&E personnel is limited, as salaries (particularly those paid in the
public sector) are small, and professional growth opportunities – scarce.
M & E responsibilities frequently an afterthought; no capacities or additional
motivation for appointed M & E focal points
Current human resources may be insufficient due to increasing complexity and
multisecorality of the HIV M & E system
Recommendations for further action
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M & E system assessment report 2011, Republic of Moldova









Fragmentation of M&E responsibilities under NAP could be addressed by
mandating the NCC Experts Oversight Committee to act as an oversight
mechanism for National HIV M&E Plan and Workplan implementation.
All institutions across sectors and levels ought to be mandated to fulfill their
responsibilities according to the National M&E Plan.
Reporting on the National HIV M&E Plan/Workplan implementation towards the
NCC needs to be instituted (currently reporting towards the M&E TWG only).
Divisions for Analysis and M&E of Policies need to be involved in capacity
strengthening endeavors, including capacity building in HIV and M&E; regular
information flows from Ministries towards the national M&E system need to be
formalized.
Support to sector-specific Information Systems development could represent
viable mechanisms for regular data flows and monitoring contributions towards
NAP implementation of other Ministries/sectors.
M&E specific responsibilities, structured around the 12 components, need to be
instituted within all sectors/institutions acting as stakeholders in the national HIV
response
At sub-national level, instituting vertical reporting on territorial programmes
implementation could be done via the centers for public health; a unit with M&E
responsibilities needs to be instituted with local public authorities, particularly
within municipal level health authorities
Mandating municipal level health authorities with HIV M&E, and instituting a HIV
M&E focal point within the respective structures, would institutionalize
responsibilities and contribute towards sustainable capacities
The technical assistance plan needs to be reviewed based on a new TA needs
assessment among national partners.
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M & E system assessment report 2011, Republic of Moldova
Component 2. Human Capacity for Multi-sector HIV M&E. Strengths and weaknesses,
steps to be done
Rating: Partial
Component description
The assessment has identified a shortage of qualified human resources at all levels of
the national M & E system, ad-hoc approaches to capacity building, potential for overlap
of capacity building due to limited communication and lack of a central database of
events (with the notable exception of www.aids.md and www.ccm.md that have
dynamic events platforma) and excessive reliance on external technical assistance that
curtails sustainability. An inventory of the existing capacity, however limited it may be,
as well as avenues for capacity building, is missing. Capacity assessments, somewhat
tangential, have been carried out in the process of GFATM Round 8, 9 and 10 proposal
formulation, as well as MTR 2008 and RA 2010 of the NAP.
There is a Capacity Building Strategy developed for the period 2010 – 2013 that contains
a good SWOT analysis and an assessment of needs and barriers for involvement in
capacity building for various groups of stakeholders. While the strategy provides for a
hierarchy of results, these are not measurable, ways to track progress over time are not
built in, and there is no costed Plan of Actions that could operationalize the Strategy.
Curricula for modules on M & E as part of HIV distance learning and the Master in Public
Health programme are under development. In order to be able to build supportive
supervision and mentoring mechanism, the capacity of the staff of the NAC and NCHM
M & E unit, as well as other key staff responsible for supervising the data collection and
aggregation process and levels, also needs to be strengthened.
Human Capacity Building Plans exist at various line institutions, however they are
developed without proper consultations and gaps in M&E-related skills and
competencies are not properly addresses within such plans. While shortages of
epidemiologists, IT specialists and database managers in key entities have bee attested,
there are no remedial strategies in place, in part due to difficulties to identify resources
to expand further the entities’ organigrams/available human resources.
A nationally-endorsed M&E training curriculum is missing, even though there is a
training plan maintained by MoH for all capacity building events in HIV, including in HIV
M&E. A national database in resources trained in HIV, trainers and other technical
service providers is under development by the M&E Unit of the NCHM, with the aim to
avoid duplication and assure complementarity.
A barrier identified in human resources strengthening is the limited motivation and
professional growth of M & E staff. For example, the public service inventory does not
include the position of specialist in M & E in the list of professions, hence the motivation
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M & E system assessment report 2011, Republic of Moldova
to pursue an education in M & E is limited. However, an opportunity encouraging
capacity building in M&E for staff in the health sector is the requirement of 400 hours of
in-training/refresher training within a 5 year period in order to be accredited/receive
qualification.
Gaps and weaknesses identified
At the stage of Capacity Building Strategy development, the capacity needs and
gaps have been assessed somewhat superficially, without proper involvement of
stakeholders at all levels
 Human resources plans within various entities are not developed in a
participatory manner and hence important areas of competences are missing
 In the reporting period, there was no nationally agreed-upon curriculum of
trainings in HIV M&E. In 2011, based on a mapping exercise undertaken by MoH,
a training plan has been developed that includes HIV M&E capacity building
events. However, the training plan does not substitute a full-fledged curriculum.
 M&E capacity building is still offered on ad-hoc basis; institutionalization within
the curricula of a higher education institution is yet to occur
 At sub-national level there is insufficient coverage with training, capacities in
M&E are limited

•
•
•
•
•
•
•
•
Recommendations for further action
Regularly applying post-training and post-workshop questionnaires/feedback
forms, as an assessment of capacity needs and gaps; centralized analysis of such
forms before developing subsequent training plans
A formal assessment of capacity gaps and needs among stakeholders at different
levels and with different competencies, as a prerequisite for the refresh and
upgrade of the Capacity Building Strategy
Complementing the Capacity Building Strategy with a logframe with time-bound
targets, and developing a Plan of Actions for its implementation; allotting
financial resources and establishing responsibilities for the implementation of
the Plan of Actions
Building capacities across sectors (within education, defense, penitentiary
sectors) – the good practice of applied sector specific training, as in the case of
MoLSPF, should be replicated with other line Ministries
Greater involvement of local public administration and strengthening capacities
of local level M&E personnel
Operationalizing the unique HIV training information system, with the option to
filter people trained, facilitators and technical support capacities, and trainings
under the M&E heading
Enhancing transparency of the application process for participation in capacity
building events
Institutionalization of education in M&E based on the School of Public Health
and other higher education institutions
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M & E system assessment report 2011, Republic of Moldova
Component 3. Partnerships to plan, coordinate and manage the multi-sector HIV M&E
system. Strengths and weaknesses, steps to be done
Rating: Mostly
Component description
There is a joint TWG on M & E for HIV and TB, and a TWG on Surveillance under the
auspices of the National Coordination Council. Formal TORs are under development,
based on the NCC Operational Manual that is yet to be approved by the NCC. The
mandates of both TWG need to be clearly spelled out in the TOR to avoid overlap in
competencies. The National M&E Plan outlines ambitious expectations of the M&E TWG
as the coordination entity for M&E Plan/Workplan implementation, hence the TOR of
the M&E TWG need to dully reflect such responsibilities.
The membership of the TWG on M & E has been reviewed in late March – early April to
broaden the participatory nature of the TWG, making it intersectorial and adding some
NGO and representatives of sub-national stakeholders (Transnistria) as formal members
with voting rights. International development partners actively participate in the
National M&E TWG, both as members and invitees. A list of relevant stakeholders has
been compiled in process of revising the membership of the TWG, and it serves as basis
for inviting non-member stakeholders to meetings of interest. A plan of issues to be
discussed at M&E TWG meetings for each of the quarterly meetings planned for 2011
has also been approved. However, membership currently being more on decisionmaking rather than technical level, it may represent a barrier in fulfilling the very
technical functions vested by the National M&E Plan on the respective TWG. An
operational sub-committee of HIV M&E is to be created based on the TORs currently
under revision, to handle the technical responsibilities and avoid overstretching the
M&E TWG Secretariat - the M&E Unit of the NCHM with its limited human resources.
Ordinary meetings are to be held on a quarterly basis as outlined in the TWG plan.
Meetings can be convened on an ad-hoc basis should the need arise. In the reporting
period, meetings of the M&E TWG convened regularly, even monthly, as there have
been a number of decisions to be made regarding National Programmes for HIV and TB
logframes, indicators sets and M&E frameworks. Decisions are made via a consensus
building process. Minutes of the TWG meetings are taken and placed on the NCC
website (www.ccm.md). Information pertaining to the TWG work is disseminated also
through the NCC Bulletin. However, as of yet there is no formal mechanism to follow up
on the decisions of the TWG. The NCC Operational Manual to be soon approved shall
specify oversight over TWG functions and will redress this weakness.
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M & E system assessment report 2011, Republic of Moldova
There are well developed mechanisms (circulation of minutes and posting them to the
public domain, e-newsletters, NCC bulletin) to communicate about HIV M&E activities
and decisions.
At sub-national level, an M&E TWG is in process of being established in Transnistria
region. As of now, the membership is limited to Tiraspol AIDS Center and raion centers
of hygiene, with notable exception of the Ministry of Justice penitentiary department.
There are no regional/local NGO represented.



Gaps and weaknesses identified
TORs of the TWG are still under development; these ought to be developed in
consultations with the HIV Surveillance TWG to delimitate clearly mandates and
scope of actions for both TWG and avoid overlaps
The membership is at decision-making level, making it difficult to have in place a
truly technical mechanism actually performing the tasks of a WG; the joint HIV/TB
scope also limits the capacity of the TWG to operationalize its tasks and
responsibilities under the National HIV M&E Plan
There are no formal mechanisms as of yet to ensure follow-up to the decisions of
the TWG
•
•
•
•
•
•
•
Recommendations for further action
Establishing an HIV M&E operational sub-committee as part of the joint HIV/TB
M&E TWG; clearly determining the TOR for both the sub-committee and the
TWG.
Periodical participatory revision of the TOR (once every 2 years), in line with the
M&E National Plan and Operational Manual, and the NCC Operational Manual
Ensuring functionality of all coordination roles, tasks and responsibilities
provided for in the National M&E Plan
Instituting mechanisms for monitoring TWG members’ participation (based on
physical presence at the meetings, number of issues raised/presented, share of
consultative processes in which the respective member has been involved)
Enhanced cooperation and partnerships among M&E staff within different
entities, including NGO
Including representatives of local public administration from key regions as
formal members of the TWG
Expanding partnerships and raion and local levels
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M & E system assessment report 2011, Republic of Moldova
Component 4. National, mulit-sectoral HIV M&E Plan. Strengths and weaknesses,
steps to be done
Rating: Mostly
Component description
The National M & E Plan 2006 – 2010 has been developed based on the NAP and has
also been used as basis for the M & E Plan for the GFATM Round 6 grant. It has been
revised based on the findings of the 2008 M&E system assessment and complemented
to provide background on all the 12 components. The National M&E Plan for the 2011 –
2015 NAP has been developed through participatory strategic planning approaches as
part and parcel of NAP development. The NAP results framework have served as bases
for determining the definitions of the indicators set, including measurement
methodology (numerators/denominators), reference to international M&E guidelines,
data sources, disaggregations, frequency of data collection, responsible institution and
partners, for impact, outcome and process indicators; impact and outcome indicators
also had baselines and targets established. Indicators to monitor progress &
performance of the M&E system are also included in the M&E plan. Another notable
component of the National M&E Plan is the list of roles and responsibilities of various
stakeholders per thematic area of the programme, formalizing data flows and data
validation responsibilities. Perhaps the most notable achievement is having the National
M&E Plan approved as an annex of the NAP, by Government Decision. Currently the
National M&E Plan truly represents the normative framework for the Moldovan M&E
system.
The disadvantages of that approach are related to Moldovan legal and normative
documents technical requirements. Many of the important details have been only
sketched or left out of the National M&E Plan and ought to be further
described/provided for in the M&E Operational Manual.
Among components well described in the National M&E Plan, through this assessment
there have been identified Component 7 – with clear indicators and defined data flows,
Component 9 – with well described tasks and roles as attributed to national data
depository maintenance and data entry, Component 11 – with research priorities well
described and basis for mid term and final programme evaluation laid out. Component 6
is tangentially touched upon – as information products are listed; there is also a
framework established for the subsequent implementation of Component 10 supportive supervision and data quality assurance. As M&E functions are clearly
distributed among key stakeholders, and the M&E TWG roles and responsibilities are
also traced, components 1 and 3 can also be assessed as specified in the National M&E
Plan. Components less elaborated include – capacity building in M&E (Component 2),
M&E workplanning (Component 5), surveys and surveillance (component 8).
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M & E system assessment report 2011, Republic of Moldova
The National M&E Plan has been developed in a participatory manner, national
consultative processes including national workshops and discussions during TWG
meetings. The M&E plan has also been submitted to line Ministries for review and
endorsement as part of NAP, this constituting a further step in consultations based on
the draft document. Local public administration involvement in the development of the
National M&E plan has been limited – only representatives of Transnistria region,
Chisinau and Balti municipalities, and Comrat (Gagauz-Yeri region) have been involved
to a certain degree in national consultations processes. Subsequent M&E frameworks
development ought to include LPA at least in virtual consultations for enhancing their
subsequent involvement in implementation.
However, in order for the National M&E Plan to become operational, clear
implementation mechanisms ought to be described in the M&E operational Manual to
be developed based on the findings of the respective assessment. An additional step in
implementation of M&E system strengthening as well as entities’ roles and
responsibilities
in
M&E
of
NAP
ought
to
be
represented
by
territorial/sectoral/institutional level M&E plans.
Gaps and weaknesses identified
Due to national legislative/normative technique requirements, the National M&E
Plan is very ascetic, and there are missing blocks of the 12 components in the M &
E Plan
limited participation in the development of the M & E Plan on behalf of LPA; for
certain entities, participation has been less substantial due to capacity limitations
indicators to monitor progress & performance of the M&E system are limited in
number and scope



Recommendations for further action
Territorial/sectoral/institutional level M&E plans are imperative – otherwise the
National M&E Plan will lack important steps in implementation mechanisms
• Greater involvement of LPA in National M&E Plan development could mean
enhanced capacities and motivation for territorial level M&E plans
• Supportive supervision and on-the-job mentoring could represent important
instruments in promoting development of territorial/sectoral/institutional level
M&E plans
• Development of M&E operational Manual is an imperative for operationalization
and establishing of implementation mechanisms for the National M&E plan
•
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M & E system assessment report 2011, Republic of Moldova
Component 5. Costed, National, multi-sector HIV M&E Work Plan. Strengths and
weaknesses, steps to be done,
Rating: Partial
Component description
The National M & E Plan 2011 – 2015 has been operationalized by a costed workplan for
2011-2012, that includes priority actions, roles and responsibilities of stakeholders,
timeframes and budgets. The workplan has been structured based on the 12
components and has been developed based on a mapping of contributions of various
entities – both M&E TWG members and non-member organizations. However, for the
reporting period, there has not been a full-fledged M&E workplan, GFATM Round 6 &
Round 8 and UNAIDS Country office workplans acting as a surrogate. However, M&E
activities funded from other sources have not been reflected. A retrospective mapping
of activities for the period 2009-2010 has preceded the development of the 2011-12
workplan, the latter being largely based on an analysis of achievements against the
previous year's activities. However, an in-depth analysis of progress towards M&E
system strengthening milestones has not occurred since the 2008 self-assessment; the
2010 desk review has looked at system functionality rather than at the cause and effects
of system strengthening actions.
The weaknesses of the 2011-2012 workplan are firstly process driven. While the
mapping of planned activities has been an important prerequisite, the 2 nd step planned
had been the development of results and benchmarks for M&E Plan implementation as
part of M&E Operational Manual, and further revision of the M&E workplan based on
gaps identified through the assessment hereto. However, due to lack of time, it has not
been possible to organize a prioritization session for the M&E wokrplan during the M&E
self-assessment workshop. At a future national workshop, the M&E TWG should come
up with proposed revisions to the M&E workplan, based on a SWOT analysis and actions
needed to achieve M&E system strengthening results. The costs of the M&E work plan
were not included in the Medium Term Expenditure Framework for the reporting
period. The new MTEF make explicit earmarking of funds for the NAP, including M&E
costs; however it reflects only costs and contributions of MoH, other Ministries being
notoriously left out. Resources are only partly available to meet agency-specific M&E
work plan requirements, and the absolute majority of such resources are from donors. A
risk mitigation strategy identified by participants at the workshop is early involvement
of Policies, Economic, and Analysis and M&E Divisions of other Ministries in the M&E
workplanning process, securing their buy-in for further lobbying for inclusion of M&E
related costs under their respective portions of the MTEF.
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M & E system assessment report 2011, Republic of Moldova
Another weakness of the M&E plan is the somewhat generic timeframes, with many
implementation terms pegged as “continuously”, or “1(2) semester” – deadline should
be specified more explicitly.
The mapping process for the 2011-2012 workplan and the M&E calendar 2011 – 2015
development have indicated the need for regular work planning and review of progress
towards planned milestones. It has been possible to identify an overlap planned for
2012 – a KAP survey planned by 2 implementers, and to encourage cooperation among
the two to increase the sample and re-programme remaining funds.
Entity-specific costed M&E work plans exist at level of NGOs and donor organizations;
however these are missing at the level of other Ministries and LPAs. Where they do
exist, entity-specific costed M&E work plans are aligned with national M&E work plan.
There are no clear mechanisms for monitoring M&E workplan implementation – the
M&E Operational Manual should vest oversight responsibilities upon the M&E TWG.
Gaps and weaknesses identified

in-depth analysis of progress towards M&E system strengthening milestones has
not occurred since the 2008 self-assessment

development of results and benchmarks for M&E Plan implementation needs to
proceed workplan development; activities in the WP need to be related to M&E
Plan results and milestones, not Agency-specific plans.

generic timeframes in the workplan curtail timely implementation

The costs of the M&E work plan were not included in the Medium Term
Expenditure Framework for the reporting period. The M & E system is funded
almost exclusively from international sources (GFATM preponderantly, as well as
bilateral and mutlitateral development organizations), hence sustainability is
severely curtailed

entity-specific costed M&E work plans do not exist in all entities
Recommendations for further action
Other Ministries need to be involved early on and consistently in the M&E
workplanning process, securing their buy-in for further lobbying for inclusion of
M&E related costs under their respective portions of the MTEF.
• The Workplan needs to be developed through a participatory process based on
results it is supposed to be contributing to; a simple mapping is not an
operational tool
• Entity/sectoral levels workplans are important to operationalize the National
costed M&E Workplan
• In order to become operation, the M&E workplan needs to be reported on
regularly. The M&E Operational Manual should vest oversight responsibilities
upon the M&E TWG.
•
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M & E system assessment report 2011, Republic of Moldova
Component 6. Communication, Advocacy and Culture for HIV M&E. Strengths and
weaknesses, steps to be done,
Rating: Mostly
Component description
The component on communication and advocacy for M & E has received overall more
positive ratings as there are efforts in the field of communicating the results of M & E
activities and disseminating data, as well as efforts to ensure transparency and
communication regarding various aspects of the national response, including M & E
system performance and outcomes. However, the sub-national and service providers
level are less included in the reporting mechanisms and hence the data related to their
efforts as part of the M & E system are less available. National M&E system information
products are described in the national M&E Plan, based on feedback from stakeholders
that have deemed them useful. However, at this assessment it has been recommended
to produce information products more timely, and to broaden dissemination channels
to include a broad array of partners at sub-national level. Also, targeted distribution to
partners less active in the national response to HIV has been recommended as advocacy
tool to enhance their buy-in.
While data produced by the M & E system are available on the web in the public domain
(for example on www.aids.md, www.ccm.md; www.cnms.md; www.cnsp.md;), their use
in policy development, particularly by other entities than those in the health sector, is
limited.
The performance of the M&E system is communicated/reported frequently though NCC
and TWG meetings, as well as national strategic planning processes and thematic
workshops.
While commitment for M & E for HIV exists, it is more formal and declarative than true
buy-in leading to actions. M&E policy and strategies are included in the NAP and other
relevant HIV policy and programmes, there seldom being invested efforts in a concerted
manner to ensure their effective, coherent and systematic implementation. There are
people who strongly advocate for and support M&E in some of the entities – members
of the NCC, while others, as the FBO and private sector, need further capacity building
and efforts should be invested to enhance their involvement in national M&E processes.
Within most of the line Ministries, there are promoters of HIV M&E – as in the case of
MoH, MoLSPF, MoE – but concerted technical support is needed to identify best ways to
mainstream HIV M&E in existing sectoral M&E mechanisms and reporting flows. The
commitment of decision-makers and managers for M & E within some organizations is
declaratory – while data is requested for reporting purposes, there is little engagement
for allotting human or financial resources or for capacity building and motivation of
staff. While HIV related information is requested before and/or during HIV review,
27
M & E system assessment report 2011, Republic of Moldova
planning and costing processes, data requested by managers is more related to process
indicators than impact indicators.
M&E personnel are part of the management and planning team, particularly in the case
of international organizations and NGO. In Ministries, the Analysis and M&E of Polices
Divisions report directly to Ministers and are part of the management teams. However,
at level of central level public institutions as well as most public sector service providers,
M&E personnel is segregated to managing data with limited impact on institutionalizing
proper mechanisms. M&E personnel do not have any particular opportunities for lateral
and vertical career moves within the entity.




•
•
•
•
Gaps and weaknesses identified
commitment for HIV M & E if frequently formal and declaratory
communication of M & E data is incomplete – the contribution of other sectors
and the sub-national and service provision level is less reflected
communication of M & E data is not always timely- the 2010 KAP report and 20092010 BSS report are yet to be finalized and made fully available
gaps in communication may lead to overlap of activities planned and carried out
Recommendations for further action
M&E information products ought to be designed based on the needs of different
target audiences, and ought to be distributed systematically via channels relevant
for the specific target audience – for example, excessive technicalities should be
avoided in messages disseminated via mass media and targeting general
population
For enhancing commitment and action, further capacity building of M&E
promoters within various entities is needed, as well as concerted technical support
to identify best ways to mainstream HIV M&E in existing sectoral M&E
mechanisms and reporting flows
Regular intersectorial M&E capacity building and consultative processes form a
culture of working together as part of one M&E system
Relevant representatives within LPA should be receivers of M&E information
products disseminated, and should be greater involved in national M&E
consultative processes
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M & E system assessment report 2011, Republic of Moldova
Component 7. Routine HIV Programme Monitoring. Strengths and weaknesses, steps
to be done
Rating: Partial
Component description
Each of the groups have been asked to identify main programme areas, both for services
implemented based on public sector medical institutions as well as based on civil society
entities. The following areas have been identified and examined by all most and some fo
the groups:
– based on public sector medical institutions
• VCT – 100%
• ARV treatment– 75%
• Lab testing and diagnosis – 50%
• Prevention and nosocomial transmission control – 50%
• PMTCT – 25%
• OI treatment – 25%
• STI treatment – 25%
• Methadone substitution treatment – 25%
• M&E and reporting – 25%
– based on civil society entities
• Social assistance and protection services – 100%
• Harm Reduction – 100%
While such diversity in key areas implemented based on public sector medical
institutions reduces comparativeness of analysis, such prioritization on behalf of groups
is indicative of the pool of expertise represented, and assists in determining key
challenges in many more areas than if facilitators of the workshop would have
prescribed a pre-established set of areas.
The assessment indicated that systems for routine monitoring of VCT and treatment and
care are quite well designed; M&E processes and reporting has clearly prescribed data
flows and reporting to central level: prevention among key populations in at risk,
including OST, also have systems in place. However, the prevention interventions in the
general population and among young people and social assistance and protection
services are severely lacking proper routine monitoring mechanisms. In the case of
social assistance, such systems are in process of institutionalization under the leadership
of MoLSPF, while in the broader area of prevention such leadership has been only
recently assumed by the National AIDS Center and standardized approaches are
sporadic (in the case of prevention of nosocomial infections and prevention by medical
institutions there are some protocols in place and some reporting formats; in the case of
other prevention interventions, these are notably lacking). There are national guides
and standard forms available: the National Epidemiological Surveillance Guide and
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M & E system assessment report 2011, Republic of Moldova
Operational Manual (currently under development to replace ongoing Standard), the
HIV case reporting forms, treatment case management forms (including reporting on OI
and STI treatment), VCT Information System, PMTCT reporting forms, instructions for
statistics reports produced by the Ministry of Health (for HIV and STI cases). Other
programme areas lack guides or instructions. The national standards and instructions
available reflect data collection mechanisms from public service providers; mechanisms
for data provision by the civil society are largely centered around GFATM grants
implementation and require substantive efforts for broadening the scope to include all
services provided, included those funded by other donors, and for institutionalization.
National guidelines need to be developed fully to document the procedures for
recording, collecting, collating and reporting programme monitoring data.
The same operational definitions of routine monitoring output indicators, as specified in
the national M&E system, are systematically used by all groups delivering services.
Indicators reported on have definitions consistent with international guides and
recommendations. Reporting from NGOs is largely conditioned by reporting of subrecipients based on GFATM indicators set. Entities from the health sector delivering the
same services use standardized data collection forms; specialized social assistance
services and standardized approaches to reporting on social assistance and protection
are currently under development with MoLSPF as coordinator, hence standardized
reporting forms are yet to be fully designed and used. Use of standardized forms by
NGOs outside of interventions funded from GFATM grants is inconsistent and needs to
be further strengthened.
Most of the reporting is still paper based. Information Systems used for routine
monitoring include SIME-HIV/STI Component, SIME-TB, Unique Identifier IS for IDUs; the
methadone register IS to be used both in the civilian and penitentiary system is
currently under development. The SIME-HIV/HIV Component is yet to be fully
operationalized; currently the module for epidemiologists is being used prospectively,
and some retrospective data have been introduced up to 2007, while the treatment
case management module is yet to be fully launched. Barriers to full operationalization
are related to lack of high-quality internet connection and domain within the NAC, as
well as lack of database administrators. The NAC is encouraged to be proactive in
seeking support for redressing both the human resources and technical capacity issues
and the PRs have pledged to locate such support from economies within the HIV
consolidated grant. The SIME-HIV/STI component is not fully operational in Transnsitria
as well, internet connection being identified as a problem. The Social Assistance
Information System which is expected to be the system-wide routine monitoring IS is
still under development; the module of assistance to people living with/affected by HIV
is expected to be integrated in the respective IS. While software is in process of being
developed, hardware is secured from GFATM Round 8 funds. There are some sectorspecific IS within the larger social assistance and protection sector (as the data related
to indemnities and other financial support, as well as indemnities for disabilities data)
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M & E system assessment report 2011, Republic of Moldova
that could provide data related to services accessed by PLHIV, however, confidentiality
issues need to be proper addressed in order to identify best means of using them.
All source documents are available at the sub-national (raion/service-providers) level for
audit purposes. During oversight field visits undertaken by the National AIDS Center and
the data validation missions carried out by the NCHM, the quality of data is checked and
feedback offered. Mechanisms for ensuring confidentiality of data need to be further
strengthened. Technically, double reporting on the use of services is possible – the
unique identifier system needs to be scaled up for use in services targeting CSW and
MSM, for a clear overview of the true demand for services while maintaining
confidentiality.
National guidelines on how data quality should be maintained are underdeveloped.
Currently, data validation at the source occurs for indicators reported to GFATM. These
systems ought to be institutionalized to ensure a sustainable data quality management
approach. Internal data quality audits need to be performed by the coordinator of NAP
implementation – the National AIDS Center. National level validation of data for
international reporting – like the UNGASS progress report or the UA Joint Reporting Tool
– occurs regularly through intersectorial consultations and consensus building
procedures.
Financial resources/investments for HIV are reported on via NASA. National health
Accounts are expected to be operationalized by the end of 2010 and shall be used for
proper financial monitoring of expenditures in HIV.
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Gaps and weaknesses identified
inconsistent use of standardized forms by NGOs outside of interventions funded
from GFATM grants
prevention interventions in the general population and among young people are
severely lacking proper routine monitoring mechanisms
national standards and guidelines are not available in all programme areas
the national guides and systems in place do not account properly the contribution
of the civil society; data provision from civil society is associated to GFATM
reporting and contributions outside GFATM are onloy sporadically monitored to
the national M&E system
information systems for reporting are underdeveloped; those existing are yet to be
fully operationalized
confidentiality and data quality assurance mechanisms are underdeveloped
Recommendations for further action
Under the leadership of NAC, a mapping of all existing standards and guides, and
their revision/development for all programme areas needs to be undertaken
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M & E system assessment report 2011, Republic of Moldova
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Concerted development of standardized data collection forms for all service
providers – public and NGO alike – to enhance comparativeness of data
Instituting mechanisms for internal and external data quality audits
Social protection and assistance services being in process of institutionalization,
this represents a window of opportunity for instituting clear M&E processes based
on explicit national guidelines and quality standards
Developing the social services to PLHIV/affected by HIV Information System either
as a separate IS or as a module of the SIAS (Social Assistance Integrated
Information System)
Laboratory data information system needs to be developed
Scale up the Unique Identifier system to cover CSW and MSM; identify possibilities
to cross-check databases of beneficiaries to identify share of CSW who also use
drugs or share of MSM who also sell sex
NAC to be proactive in seeking support for redressing both the human resources
and technical capacity issues hampering the operationalization of SIME-HIV/HIV
component
Developing the Guide on HIV diagnosis quality management
Capacity building foe laboratory staff in molecular-genetic investigations
(internship abroad for 4-6 months, for 4 laboratory staff )
Equipping labs with necessary equipment
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M & E system assessment report 2011, Republic of Moldova
Component 8. Surveys and Surveillance. Strengths and weaknesses, steps to be done,
Rating: Mostly
Component description
An inventory of surveys has been carried out at the 2010 Response Analysis/ desk
review of M&E system performance. A proper description of surveys carried out,
including population group parameters and sampling methodologies, needs to be
reflected in the M&E Operational Manual in order to ensure planning of comparative
surveys in the future for proper trends analysis. The M&E workplan for 2011-2012 and
the M&E calendar list major data collection activities planned. Surveys and surveillance
conducted to date have contributed to measuring indicators in the national M&E plan.
All surveys are planned through participatory process, the research protocols and
questionnaires being discussed at relevant TWG meetings (mostly, M&E and
Surveillance TWGs), in order to ensure inclusion of all relevant data needs.
All data collection efforts have been planned to include many components to make best
use of resources in the resource-constrained setting of Moldova. For example, separate
surveys on condom availability and use are not conducted, but questions to that regard
are incorporated in KAP surveys carried out regularly among youth (15-24 age group)
and general population. The surveys results are disseminated widely through the
websites form the public domain and the NCC TWG.
National surveys or surveillance with behavioral component in the general population
are conducted every 2-3 years; however financing is exclusively from international
sources. The national level Workplace survey has been carried out for the first time in
2008 with ILO financial and technical support; there are yet no plans as to the
periodicity of such surveys. Surveys on HIV prevention in a nationally-representative
(right bank only) sample of schools have been conducted regularly in order to be able to
report on the relevant UNGASS indicator; such surveys have been largely dependant on
the push of donors to counteract inconsistencies in political will, and on UNGASS
reporting as an advocacy tool.
Biological surveillance targeting IDUs, CSW, MSM and prisoners is conducted every 2-3
years, being exclusively dependant on international resources. Inconsistent sampling
methodologies affect comparativeness of results in time. Currently, surveillance os not
properly institutionalized within any institution, and there are no allocations from the
public budget. The draft Surveillance Guidelines and Operational Manual which are
expected to substitute the National Epidemiological Surveillance Standard, has been
developed according to international guidelines; however, it lacks a proper
implementation framework with allocations of responsibilities for each of the steps.
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M & E system assessment report 2011, Republic of Moldova
The ethical clearance procedure is underdeveloped. There is an Association of Bioethics, sued to clear the surveys prior to their implementation. Ethical controls are built
in all survey documents – the informed consent for participation in the survey, and the
anonymity of respondents being just some examples. However, a proper Ethical
Commission is not functioning in Moldova.
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•
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Gaps and weaknesses identified
Financing exclusively from international resources curtails sustainability of the
surveillance system
Surveys are implemented based on availability of resources, and do not always
cover all M&E Plan needs
Operational research is underdeveloped; capacities to plan and conduct such
research are underdeveloped
Inconsistent survey methodologies affect comparativeness of data overtime
Recommendations for further action
Gradual financing form the public budget for all studies and surveillance
Clear responsibilities should be agreed upon in planning and conducting surveys,
to ensure coherence and replication of experience, as well as survey
methodologies consistent over time
Mechanisms to ensure use of survey data in strategic planning and programme
design need to be improved
All survey reports needs to be concentrated in one single national data depository
– currently www.aids.md serving as proxy
Intersectorial in-depth consultations are needed at the survey planning stage to
ensure maximum use of the opportunity presented by the survey, and full
collection of all relevant data
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M & E system assessment report 2011, Republic of Moldova
Component 9. National and Sub-national HIV databases. Strengths and weaknesses,
steps to be done
Rating: partial
Component description
The concept of the comprehensive national data depository has been developed in a
participatory manner, structured around data needs at different levels and in different
sectors of the national response to HIV. The national data depository is developed based
on the CRIS3 platform and is expected to integrate pre-existing data to constitute a
single data presentation platform, avoiding double reporting and enhancing data
accessibility, transparency and dissemination. The data depository shall be available
online and shall provide full access to visualization of data by monitoring plans and
indicator sets. Physically, the data depository shall be placed on a server located on the
premises of the National AIDS Center, the latter being the institution tasked with its
maintenance. SIDATA is currently configured and ready for piloting based on the GFATM
monitoring plan (indicator set). However, due to lack of specialized human resources
within NAC (database administrator), and due to internet connectivity problems, the
piloting is yet to be scheduled. There are plans to fully operationalize the database by
the end of 2011, but these are contingent on the NAC undertaking its SIDATA
coordinator and maintaining role.
Other databases for electronically capturing and storing data generated for/by the
national HIV M&E system include the National Bureau of Statistics databank that
captures demographic, economic, health determinants and morbidity data, as well as
data on MDG-related indicators. There are also Information Systems of the National HIV
M&E response, used for routine programme monitoring, which are expected to feed
into SIDATA – SIME-HIV (HIV and STI components, VCT IS, Unique Identifier, Methadone
Register. Information Systems for sectoral reporting by MoLSPF is underway. Feasibility
for other sectoral IS needs to be examined; potentially, separate monitoring plans
within SIDATA could be created. Once SIDATA is operational, automated import
mechanisms ought to be designed to avoid double jeopardy on reporting institutions.
Operationalization of SIDATA would enhance transparency and availability of data,
which are currently provided only as part of ordinary M&E system information products
(requiring additional efforts to be compiled) or based on ad hoc requests.
Structures, mechanisms procedures and time frame for transmitting, entering,
extracting, merging and transferring data exist for all sector databases that support the
national HIV M&E system exist. The National M&E Plan outlines responsibilities, and the
Operational Manual to be developed ought to detail structures, mechanisms,
procedures and time frame for transmitting, entering, extracting, merging and
transferring data into the national HIV M & E database, as well as clear roles and
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M & E system assessment report 2011, Republic of Moldova
information flows to and from public and NGO service providers at local level, actors at
sub-national level and central level institutions.
IT equipment and supplies are available at the level of central institutions from the
health and social protection sectors, while the sub-national and service provision level
are less equipped. A mapping of the existing infrastructure and availability of computers
and connectivity for all key levels involved in data collection, entering, collation and
transfer needs to be undertaken. Human resources currently existing are not sufficient
to develop, maintain and update the database; capacity building of existing and new
human resources is needed. Database administrators ought to be integrated in the
organigram of the NAC, the entity to coordinate SIDATA; while initially funding can be
secured from the GFATM HIV consolidated grant, plans ought to be made for gradual
financing from the budget of the institutions and/or other public financial sources.
Continuous in-training on database use is needed for service providers, accompanied by
periodic evaluations of knowledge and skills. Supportive supervision and mentoring are
key for entering quality data and using IS to their full capacity.
Quality control mechanisms are in place for reporting on GFATM indicators, to ensure
that data are accurately captured. Data validation mechanisms need to be fully
institutionalized, with internal and external audits of quality of data at the service
providers level as well as at levels of aggregation.
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Gaps and weaknesses identified
SIDATA not yet operational due to human resources shortages and technical
connectivity problems
Certain sectors are missing any IS; reporting is paper-based. The SIME-HIV/HIV
component needs to become fully operational to provide routine case
management data
Capacity of existing human resources needs to be further strengthened to ensure
quality of data entry and use of IS
Quality control mechanisms are underdeveloped and exist only for reporting on
GFATM indicators and international reportings
Recommendations for further action
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A team needs to be established within the National AIDS Center to administer
SIDATA. Agreements need to be signed with all institutions that have data entry or
data validation roles according to the National M&E Plan. Data flows for SIDATA
and SIME-HIV, and the NAC central role in administration and maintenance, need
to be endorsed by Decree of the Ministry of Health
Underdeveloped IS need to be fully operationalized. Feasibility for other sectoral IS
needs to be examined; potentially, separate monitoring plans within SIDATA could
be created.
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M & E system assessment report 2011, Republic of Moldova
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Database configuration needs to be fully completed and import mechanisms
designed to ensure complementarity of sectoral IS and SIDATA
Continuous in-training in IT and database use is needed for service providers;
trainings should be followed-up by period evaluations of knowledge and skills, and
on-the-job supervision and refresher trainings
Database administrators ought to be integrated in the organigrams of entities
administering databases; gradual allocations from the inbstitutions’ budgets
should be made to ensure sustainability of the positions and of the database
administration role
Internet connectivity problems need to be urgently addressed by both the
National AIDS center and the Tiraspol AIDS Center
37
M & E system assessment report 2011, Republic of Moldova
Component 10. Supportive Supervision and Data Auditing. Strengths and weaknesses,
steps to be done,
Rating: Not at all
Component description
As indicated by the M & E system assessment effective mechanisms for data quality
assurance are underdeveloped in Moldova. Data originating form different sources may
vary, such inconsistencies affecting planning for better programme delivery. Data errors
may begin at the entry level of service providers, both caused by technical
inconsistencies, interpretation errors and lack of capacities, and affect further collation
and aggregation. Some data validation controls are implemented as part of monitoring
on GFATM grants implementation. Implementation of SIME-HIV/HIV component by
epidemiologists shall further reduce collation errors. National comprehensive
reconciliation and validation in-country processes exist for international reporting like
UNGASS and UA. However, these elements are sporadic, data quality assurance lacking
comprehensiveness and permanence.
The National Center for Health Management has been tasked to develop Data Quality
Assurance Guidelines for the health sector and to undertake the role of external data
quality audits. The National AIDS Center has been tasked with internal data quality
management and audits by the National M&E Plan provisions. A clear framework and
correlation among internal and external data quality assurance mechanisms needs to be
specified in the M&E Operational Manual that is to be developed.
The National AIDS Center and NCHM ought to develop, with technical assistance from
development partners, the first draft of the protocol for auditing routine HIV service
data, from health, social protection public service delivery points and NGO service
delivery points. This protocol would be part of the Data Quality Assurance Guidelines for
the health sector. The draft shall than be discussed at various intersectoral meetings to
ensure a holistic approach and complementarity with mechanisms existing/developing
in other sectors. NGO ought to be supported in developing own internal data quality
assurance controls.
National guidelines and tools for supportive supervision on M&E are lacking. These
ought to be general for all M&E in public health Programmes to avoid excessive
fragmentation. In Moldova, the Government system for planning, management and
implementation is still based on a hierarchical system of oversight and reporting.
Despite significant improvements in Government requirements for the development
and implementation of results-based programs, in practice accountability on results is
weak. Particularly in the health sector, reports to the supervising institutions tend to
represent lists of inputs and activities, providing little information on achievements and
results.
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M & E system assessment report 2011, Republic of Moldova
Oversight and data validation field visits have been carried out by the National AIDS
Center (for laboratories, raion public health centers, VCT, ARV treatment centers), the
National Health Management Center (data validation for the semi-annual reporting to
GFATM), the RDVD, the NBTC. A recommendation put forth at the assessment has been
to plan supportive supervision visits by a multidisciplinary team (for example NAC,
MoLSPF, LPLHIV jointly), to make most use of resources while providing multilateral
feedback and mentorship.
Feedback mechanisms and monitoring implementation of recommendations are lacking.
A suggestion has been made at the workshop to review standardized feedback forms
that are completed during monitoring visits related to National TB Programme
implementation, and potentially to adapt those for the needs of the National
Programme on HIV/AIDS/STIs. Mechanisms to follow-up on how feedback has been
addressed are also lacking.
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Gaps and weaknesses identified
Effective mechanisms for data quality assurance are underdeveloped. Existing data
quality assurance lacks comprehensiveness and permanence.
National Data Quality Assurance Guidelines for the health sector are yet to be
developed; mechanisms for internal data quality management and audits ought to
be developed by NAC based on such National Guidelines
National guidelines and tools for supportive supervision in M&E are lacking
Feedback mechanisms and monitoring implementation of recommendations are
lacking missing
Recommendations for further action
The National AIDS Center and NCHM ought to develop, with technical assistance
from development partners, the first draft of the protocol for auditing routine HIV
service data, as part of the National Data Quality Assurance Guidelines.
Multisectoral consultations on the draft are needed to ensure a holistic approach
and complementarity with mechanisms existing/developing in other sectors.
The NCHM is to develop through a participatory process the draft the National Data
Quality Assurance Guidelines and external data audit protocol. All implementers
under NAP, including NGO, should be tasked with developing own internal data
quality assurance mechanisms based on a standard framework protocol.
National guidelines and tools to be developed for supportive supervision on M&E in
public health Programmes
Supportive supervision visits need to be undertaken by a multidisciplinary team to
make most use of resources while providing multilateral feedback and mentorship.
Capacity building in use of data quality assurance mechanisms needs to be organized
after the guidelines and protocols are developed, to ensure their consistent use.
Feedback mechanisms and mechanisms to follow-up on how feedback has been
addressed need to be developed and applied to enhance supportive supervision
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M & E system assessment report 2011, Republic of Moldova
Component 11. HIV Evaluation and Research Agenda. Strengths and weaknesses,
steps to be done
Rating: Partial
Component description
While some evaluations occur in the framework of the National programme on
HIV/AIDS/STIs, including joint multi-stakeholder mid term and end programme reviews,
and some research is being carried out under the auspices of the Academy of Sciences,
an inventory of the research institutions and research and evaluation initiatives is
missing, and a concerted approach to periodic identification of evaluation and research
priorities and investigation problems is imperative for value added.
The priority research topics have been prioritized based on input from key HIV and
research stakeholders. However academics have been consulted only sporadically.
Efficient and permanent communication channels need to be established between
decision makers and technical operational level of NAP implementers, and academia, to
institute an applied and practical scientific approach. The priority research topics
include:
elucidation of the role of injection drug use in HIV infection among pregnant
women, female sex workers and MSM
determining the share of heterosexually or homosexually acquired HIV infection
among men, not associated with IDU
gender-associated vulnerabilities to HIV and STIs on the left bank of Dniestr river,
and comparisons with the right bank
studying the factors driving adolescents to adopt risky behaviors
description of linkages to care, the care/treatment experience, and survival after
HIV diagnosis
a descriptive study of HIV-infected pregnant women to define the PMTCT program
experience and transmission outcome; and care for women
Such priorities need to be reviewed periodically, at the stage of the MTR and final
review of the NAP. In practice, planning of evaluations and research is usually
contingent of financial coverage availability and the mandate of the funding agency, and
less so determined by the national research priorities. Operational research is
underdeveloped in Moldova. While planned in the NAP and M&E workplan, extensive
capacity building is needed for proper research design and implementation of such
operational research.
Joint reviews of the HIV response take place during mid-term and end-of term NSP
reviews (i.e. MTR 2008-2009, RA 2010). Annual reports of NSP implementation have
been developed by the National AIDS Center; the report development process should
become more participatory. International partners actively participate in joint HIV
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M & E system assessment report 2011, Republic of Moldova
Program Reviews, frequently assuming a facilitator’s role in addition to technical
support. Country-level stakeholders also actively participate in joint HIV Program
Reviews; such participation varies depending on capacities of partners. Local public
administration authorities ought to be consistently involved at all stages of planning and
implementation of evaluations and research, this also representing a capacity building
avenue.
The TWG on M & E is in charge for coordination and implementation of research and
evaluations; however the TOR currently underway need to explicitly mandate the TWG
to act as such. Performance reviews and evaluations are ordinarily complex
multisectoral processes with the involvement of all key national stakeholders. However,
participation of certain entities – more often NGO of PLHIV is limited by capacity gaps.
Sustained capacity building needs to be hence an important element of all performance
reviews and evaluations planned.
Establishment of a review committee to assess the compliance with ethical standards of
studies conducted on human subjects would be necessary. The current procedure
consulting the Association of Bio-ethics is superficial, as it has unclear membership and
procedures of review. These endorsements do not have any legal force. A
recommendation made has been to institute a research and studies approval
mechanism, based on the National Center for Public Health that would also request as
prerequisite prior endorsements from line institutions.
The buy-in and commitment of different stakeholders, including NCC members, to the
feasibility of research differs. Research and evaluation findings are regularly
disseminated and discussed through national consensus building events. The HIV
research and evaluations findings are being used in policy formulation, planning and
implementation, however, such use would need to be further enhanced. For example,
studies indicate risky sexual behaviours as a major HIV risk for sexual partners of IDUs;
however, harm reduction programmes, hampered by limited budgets and lack of
additional resources, find it difficult to adjust their services and focus more on condom
promotion. Capacity building on evidence-informed strategic planning, service delivery
and resource allocations needs to be undertaken regularly. The State Chancellery is the
entity within the Government controlling the format and process for developing public
policies; technical support should be provided to them to make up clear requirements
for explicit reference to strategic information available in draft public policy documents.
Relevant international and regional HIV research and evaluations findings, as well as the
experience of comparable countries and epidemics, are also being used in policy
formulation, planning and implementation.
Financial resources earmarked for conducting planned research and evaluations are
almost exclusively international. For enhanced sustainability, gradual takeover of costs
of evaluations and research from the public budget is imperative.
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M & E system assessment report 2011, Republic of Moldova
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Gaps and weaknesses identified
an inventory of the research institutions and research and evaluation initiatives, as
well as a concerted approach to periodic identification of evaluation and research
priorities, are missing
planning of evaluations and research is usually contingent of financial coverage
availability and the mandate of the funding agency, and less so determined by the
national research priorities.
Certain members of the NCC display reservations regarding the feasibility of
investment of financial resources for research, considering regional research a
proxy for our epidemic
operational research as underdeveloped
Recommendations for further action
Undertake a mapping of the evaluation and research capacity and of studies and
evaluations planned or implemented by various entities, in order to develop a
register of technical support capacity and to update M&E workplan and Calendar
with planned events. Such inventory and register need to be dynamic and
periodically complemented with information provided by various partners, and
needs to be available online, including links to organizations’ sites and/or
uploaded CV of experts
Institute a research and studies approval mechanism, based on the National
Center for Public Health
review national research priorities periodically, at the stage of the MTR and final
review of the NAP
Efficient and permanent communication channels need to be established between
decision makers and technical operational level of NAP implementers, and
academia, to institute an applied and practical scientific approach.
Capacity building on evidence-informed strategic planning, service delivery, and
resource allocations needs to be undertaken regularly, targeting the National AIDS
center, decision makers from sectoral level institutions, other NAP implementers
(including NGO), and representatives of funding organizations
Technical support should be provided to the State Chancellery to make up clear
requirements for explicit reference to strategic information available in draft
public policy documents.
Capacity building for proper operational research design and implementation
For enhanced sustainability, advocacy needs to be undertaken for gradual
takeover of costs of evaluations and research from the public budget
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M & E system assessment report 2011, Republic of Moldova
Component 12. Data Dissemination and Use. Strengths and weaknesses, steps to be
done.
Rating: Mostly
Component description
While the M & E system assessment has commended the transparency and availability
of data, it has pointed out the somewhat sporadic nature of data provision, has
identified certain actors missing form the information flows, and has identified the need
for a clear data dissemination and use plan, that would institutionalize information and
data flows and would enhance data use for policy making.
The data needs of various stakeholders have not been properly assessed. The data
collection is guided by the NAP M&E Plan indicators data needs and international
reporting commitments. Needs of different actors are not dully taken into account when
drafting information products. Some data is disseminated without the proper
interpretation on in a complicated and overly technical manner, making it virtually
unusable by some of the actors, particularly decision-makers that seldom have the
scientific expertise. Operationalization of SIDATA nation depository shall constitute a
definite improvement in the enhancing of data transparency, however data analysis and
interpretation need to be additionally disseminated to enhance data use for strategic
planning, design of interventions and financial allocations for the national HIV response.
Dissemination of data ought to be done in a more systematic manner. Currently it is
done in an ad-hoc manner, and some data may be disseminated through a variety of
means (websites, e—newsletters, NCC Bulletin), while other may fall through the cracks.
There are also delays in producing and dissemination of information products.
Standardization of dissemination channels is needed – currently, most of the
dissemination is done through e-mail or by making data available online, which may not
be convenient for local level service providers with limited internet connectivity. There
should be special efforts made to include local public administration in dissemination
channels they find convenient, to enhance their involvement in the national response.
HIV stakeholder information needs need to be regularly assessed and distinct
dissemination channels and messages for different target groups need to be developed
in partnership with the Communication TWG.
There is some evidence of use of M & E data for strategic planning. Data from the
second generation surveillance researches/studies are used for the strategic planning
especially in the process of scaling up HIV/AIDS control and prevention activities and
services. All prevention campaigns are based on Knowledge, Attitudes, practices and
behaviors studies, as well as impact studies realized post campaigns. However, data
should be used in a more systematic manner to guide policy development and sharpen
the focus of programme implementation.
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M & E system assessment report 2011, Republic of Moldova
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•
•
•
•
•
Gaps and weaknesses identified
Stakeholder information needs have not been assessed in depth
Data interpretation and analysis capacities are underdeveloped
Dissemination of data performed in an ad-hoc manner; there are delays in
producing and disseminating information products
Some data is disseminated in a complicated and overly technical manner, while
decision-makers seldom have the scientific expertise
Data disseminated primarily via electronic communication channels, while local
level service providers have limited internet connectivity
Recommendations for further action
HIV stakeholder information needs need to be regularly assessed and distinct
dissemination channels and messages for different target groups need to be
developed
Involving communication specialists on board to draft know-your-epidemic
messages targeting different stakeholder groups (Government, LPA, mass media)
Study findings and other feedback needs to flow back to implementers from the
local/raion area, to enhance partnerships and capacities
List of links to the most recent information products in the news section or in a
permanent menu, on www.aids.md and NCC Bulletin
Dissemination endeavors need to be included in the M&E workplan with formal
responsibilities allocation and clear deadlines
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M & E system assessment report 2011, Republic of Moldova
CHALLENGES AND PRIORITIES FOR ACTION
In conclusion, the 2011 self-assessment of the M&E system performance has indicated
that some important progress has been registered since the 2008 review, particularly in
regard to development of a National M&E Plan as part of the NSP and of a M&E
workplan, more integrative approaches to M&E capacity building, clearer scope of
responsibilities for the M&E TWG, and more priorities-based approach to studies,
surveillance, evaluations and research. The coordination of M&E system and its
effectiveness has been enhanced by the NAC newly-established Coordination Unit that
acts as an additional layer ensuring implementation oversight, hence permitting the
more independent data audit and evaluation roles of the M&E Unit that serve as data
validation mechanisms.
Challenges
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Lack of clear TORs for the M&E staff at all levels
Need to institutionalize capacity building in M&E and to keep an inventory of
trainings and persons trained
Lack of comprehensive TOR for the M&E TWG
Lack of sectorial, territorial and institutional-level M&E plans
The M&E WP has been developed based on activities planned, not on results to
be achieved /or on key areas where system strengthening endeavours are
needed
M&E related costs preponderantly covered by donors; sustainability still
questionable
Gaps in protocols, including in data quality assurance, for certain NAP
programme areas; need to standardize all routine data collection forms
Difficulties in operationalizing the national database SIDATA and some
informational systems (IS) for the routine NAP monitoring
Lack of protocols and guidelines for supportive supervision and data quality
assurance
Lack of an evaluation and research agenda
Operational research not carried out in a consistent and comprehensive manner;
Limited allocations to the M&E system from the state budget and over-reliance
on international financial support, which curtails sustainability;
Gaps in national technical expertise;
Underdeveloped sub-national M&E system in Transnistria, and limited data
sources, affecting the completeness of the strategic information base
Key Priorities for Actions


Develop the M&E Operational Manual as an implementation framework for the
National M&E Plan
Strengthen capacities of the National AIDS Center to coordinate NSP monitoring,
and to institute internal data quality assurance mechanisms
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M & E system assessment report 2011, Republic of Moldova



Institute operational sub-committee within the M&E TWG, to fulfill the technical
coordination functions and responsibilities vested upon the TWG
Support development of national guidelines and tools for data quality assurance,
and instruments for supportive supervision, for the broader health sector
Advocate for allocations for M&E from the state budget to enhance
sustainability
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