1. Health Monitoring and Evaluation MSc Students
Assessment of M&E system for Malaria Prevention and Control Program in Jimma Zone
Health Monitoring and Evaluation MSc Students
2008/2009 Class

2. Outline Background Problem statement Rationale of the study Objectives
Methodology
Findings
Discussion
Conclusion
Recommendations
Intervention

4. Background
In (DTTP) different professionals are practicing the theoretical to translate the knowledge into practice in the community.
This contribute to development of the community when identified gaps are implemented.
M&E students worked on malaria prevention and control M&E system

5. Background….
Malaria prevention and control program has the following strategies:
Case management
Vector Control
Epidemic prevention and control
Supportive
Education
Human resource development
Monitoring and evaluation.

6. Background cont… The scaling up of these strategies requires:
Robust surveillance system
Monitoring and Evaluation
Health-information systems (HIS) at all levels from local to national level
Therefore, M&E is fundamental for decision-making and Program improvement

7. Problem Statement
Malaria is the major Public Health problem in Ethiopia
Among the top ten leading cause of morbidity and mortality report:
20% admissions
48% of out patient consultation
24.9% inpatient death
Affects school attendance by 20%
Contributes to 47% of the child death

8. Problem Statement
In 2006, report showed that despite much progress in the fight against Malaria, still the M & E system for the program has several problems:
Non-centralized malaria Data base system & lack of network
Impaired data capturing and storage
The Roll back Malaria follow-up survey was not conducted as intended
Untimely and incompleteness of the reports

9. Problem Statement
This has several impacts to the implementation of Malaria prevention & control:
planning done using obsolete /no data at all,
choice of the treatment options done without information collected from the same settings.
The above situations also applies similar to Jimma Zone, Mana district.

10. Rationale of the study
Managers at various levels need quality information to make programmatic decisions.
Accurate and timely reporting to national authorities and donors is vital in order to secure continued funding
The study aimed at assessing the factors which can be easily acted upon by local authorities.

11. Scope of the study M&E system- 12 components by WORLD BANK:
Partnership, People and Planning
Collection, Capturing and Verification of data
Data for Decision
Due to factors:- time for the DTTP, resource available and areas of M&E system which can be simply recuperated by means of the resources at the local level: components selected include

12. Scope of the study … routine program monitoring,
supervision and data auditing,
survey and surveillance
M&E data base
Using identical rationale, research, evaluation and learning practices was discarded form the survey

13. Objectives: General objective
To asses the process of data collection, capturing and verification of Malaria prevention and control M&E system at Jimma Zone
Specific objectives
To asses timeliness and completeness of Malaria prevention and control monitoring reports
To describe the frequency and coverage of surveys and surveillance.

14. Specific objectives …
To assess how Malaria prevention and control data base operates to generate data
To asses whether the supervision and data auditing system of malaria prevention and control is in accordance to the guideline

15. METHODOLOGY Study Design Cross sectional study.
Period 13th April to 15th May .
Quantitative and Qualitative methods
Study population:
Staffs involved in M&E system from Zonal Health Department, district health office, health center and health posts

16. Methodology… Study Sites Included: Jimma Zonal health Department,
Jimma Town Health Office
Manna district health office,
Jimma Health Center
Yebu Health Center,
Biturie health post
Gudeta bula Health post
Jimma Higher2 Health Center
Kito/sato Health Post
Jiren Health Post

17. Methodology … Sampling technique
Convenience: study sites including health facilities
Purposive : health care workers (respondents)
Sample size:
A total of 22 health workers responded to the
prepared tools for data collection

18. Methodology … Data collection The data collection process included:
Reviews of documents and reports received from April 2008 to March 2009.
Observation
Semi-structured interviews

19. Methodology … Data analysis:
Quantitave data entered into SPSS Version 16
Qualitative data analyzed using thematic approach

20. Methodology … Ethical consideration:
Officially introduction letters to study sites
Verbal consented pre requisite.
Interviewee free to withdraw at any time .

21. Findings Demographic characteristics 22 interviews were conducted
Respondents included
11 Jimma Town Health office
8 Manna District Health Offices respectively.
3 zonal health department
Their working experience varies from 1 to 4 years.

22. Malaria Program Monitoring Supervision & Data Auditing
Table 3: Provision of Training on M&E and presence of Plan for the M&E components
District/Zone
Malaria Program Monitoring
Survey & Surveillance
Supervision & Data Auditing
M&E Database
Jimma Zone HO
Training
Yes
M&E Plan No
Jimma Town HO
Mana district HO

24. Routine data collection & reporting
Expected – number of reports expected
Submitted -number of reports received
Completeness- proportions of the reports expected that were submitted

28. Timeliness
Though no reliable data to establish the report timeliness rate, qualitatively it was identified that there was chronic problems of incompleteness, and untimely (timeliness) of the reports at the district level from the health facilities

29. Table 4: Number of Supervision planned and conducted in each for each strategic components by districts in the last 12 months (xpt Manna)
Intervention strategies
Jimma zone
Jimma town
Planed
Conducted %
Case mgt 4
100
ITN 1 25
IRS
Env’tal mgt 2 50
Epidemic control

31. Table 5: Data auditing practice by District/Zone
Data Auditing Plan
Focal Person
Trained
Frequency
Jimma town
Yes No
Not regular
Jimma zone
Quarterly
Manna district

33. Table 8: Information on malaria survey by district/zone office
Ever involved in survey
Has fund for survey
Feedback from conducting
Survey
Jimma zone
Yes no No
Manna district
Jimma town

35. Data base All districts and zone have database in place.
The JZHD and JTHO have both paper based and electronic database systems
Manna district uses paper based database system.
However, all health facilities commonly apply paper based database system

36. Discussions
All the districts surveyed implements five strategic elements of MPC and is in line with the national guideline and Dr. Yemane’s 2009 Presentation.
presence of M & E system for each of the elements as also studied by Chilundo et al 2004.
monthly reports as the common reporting frequency in both districts, while Manna have reports that are submitted on a weekly basis.

37. Discussion …
At manna, the weekly reports with (87%) incompleteness rate
Qualitatively it was also identified that there were problems of incompleteness, untimely and underreporting of the reports at the district level from the health facilities.

38. Discussion …
According to the Ethiopian HIMS 2008, the cut off point for the incompleteness of the reports is when 80% or greater of the expected reports to be submitted are submitted.
Similar findings by MCP report 2006, untimely and incompleteness to be rampant problems across the country.

39. Conclusion
Indeed, it is clear from this study that monitoring and evaluation system in Jimma zone is severely crippled in the area of data collection, capturing and verification.
Challenges seem to vary with districts and also within different level of health services delivery system.
The monthly reports is the frequent used mode of reporting,

40. Conclusion …
The supervision of the health facilities is conducted in all districts; however the frequency varies between the districts and mostly is less than quarterly visits to the health facilities.
Surveillance of Malaria cases which is done in majority (71%) of the surveyed facilities has at least one trained focal person in each of the facilities undertaking the activities.

41. Recommendations Case management reporting needs to be sustained
The Weekly reports need to be improved in completeness as per the standard
The supervision should be as per guidelines

42. Recommendations …
The survey being conducted with in the district should involve the staff
Efficient information management system is highly required for surveillance of disease and control program
Process evaluation of the M&E system to involve all stakeholders and come up with explanations of the observed deficit in the system

43. Intervention Purpose of intervention
Aimed on improving the capacity of health professional involved in data collection, capturing and verification.
Monday, April 17, 2017 43

44. Intervention………
The group selected to intervene only with knowledge gap due to time and resource constraints.
Manual for training were prepared, they included the following topics:
Malaria prevention and control monitoring and evaluation process,
Supportive supervision and data auditing/verification,
Surveillance and survey, monitoring and evaluation
Database management, and recording and reporting.
Monday, April 17, 2017 44

45. Intervention…… Training methodology Power point presentation using LCD
Training manual power point presentation materials were distributed to the participants
Explanation using flip chart
Group Discussion
Monday, April 17, 2017

46. Intervention………. Training contents Objective of the study
General findings of the study
Monitoring and Evaluation
Concepts
Purpose
Importance
Basic Terminologies
Monday, April 17, 2017

47. Training……. Process components of Monitoring and Evaluation
Routine program monitoring
Performance monitoring
Methodologies of performance monitoring
Tools of routine monitoring
Surveillance and survey
Concepts & Differences and similarities
Purpose and uses, types of surveillance
Key sources of malaria surveillance data
Features of good surveillance system
Monday, April 17, 2017

48. Training……… Supportive supervision and data auditing
Concepts & components of supportive supervision
Steps in conducting supervision
Methodology of data auditing/verification
Monitoring and Evaluation Database
Data entry, Data collection and interpretation
Relevance of database
Importance of proper filing and keeping of database
Monday, April 17, 2017

49. Results of Pre and post test.
Pre and post test result of Jimma town training participants
Code
Pre-test result
Post-test result
Difference
% change 1 53 75 22
29% 2 89 14
16% 3 38 65 27
42% 4 5 30 25
83% 60
37% 6 69 87 18
21% 7 50 NA 8 71 90 19 9 10 85 20
24%
Average % change
34%
Monday, April 17, 2017

50. Results.……
Pre and post test result of Manna district training participants
Code
Pre-test result
Post-test result
Difference
% change 4 40 60 20
33%
H2001 52 64 12
19% 1 24 28
54% 8 32
13% M9 80 56
70% 84
76% 7 16 0%
GB1
50%
GB2 88
73%
Monday, April 17, 2017

51. Conclusion
The result from Paired T-Test show that the differences in mean scores between the Pre-Test and Post Test are Statistically Significant t(8) = -3.541, p = .008. The test show that the chance of the mean occurring by chance alone is about (or 0.8%).

52. Intervention……. Discussion during training
Major problems which were discussed by participants included.
Untimely reports
Incomplete reports
Inadequate skill on monitoring and evaluation
Shortage of logistic supplies
In appropriate format
Lack of regular supervision and feedback
Lack of graphical presentation of data
Monday, April 17, 2017

53. intervention……….. Proposed solutions Timely submission of Reports
Provision of the necessary logistics
Managing the database properly
Preparing checklist for supportive supervision
Monday, April 17, 2017

54. Solution…….. Conduct regular supervision and feedback
Appropriate and standardized report formats
Monthly performance assessment of the work done at all level
Utilization of tools of monitoring (e.g preparation of graphical data)
Monday, April 17, 2017

55. Dissemination of final findings
While discussing with the heads on final dissemination of findings, an agreed up on plan of action has been developed to be consumed by the offices for implementation.
Monday, April 17, 2017

56. THE END