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2. 2 Why are Result & Impact Indicators Needed? To better understand the positive/negative results of EC aid. The main questions are: 1.What change is needed? 2.For whom? 3.How to measure this change?

3. 3 Why are Result & Impact Indicators Needed? 1. Assist EC country teams to develop a set of indicators for the programming level (e.g. to guide development and monitoring of a Country Strategy Paper) 2. To fill, as much as possible, the 'missing middle' between implementation indicators and global impact indicators

4. 4 The Missing Middle Outputs Results (Outcomes) Specific Impacts Intermediate Impacts Global Impacts Implementation Programming

5. 5 Health Intervention Logic Institutional Reform Regulation of Private Sector Health Care Worker Recruitment & Training Infrastructure Education Increased Affordability of Health Care Enhanced Service Availability & Quality Improved Health Awareness Optimal Employment Reduction in Mortality Economic Growth Social Development Poverty Reduction Output Clusters Results (Outcomes) Specific Impacts Intermediate Impacts Global Impacts Reduction in Morbidity & Disability Mitigation of External Risks Essential Medicines & Equipment Increased Service Utilization & Intervention Coverage Improved Health Behaviour Reduced Health Risks MDG 4 MDG 4 MDG 5 MDG 5 MDG 5 MDG 6 MDG 6 MDG 6 MDG 6 MDG 6 MDG 6 MDG 7 MDG 8 Stronger Labour Markets MDG 1

6. 6 Result (Outcome) Indicators Institutional Reform Regulation of Private Sector Health Care Worker Recruitment & Training Infrastructure Education Increased Affordability of Health Care Enhanced Service Availability & Quality Improved Health Awareness Optimal Employment Output Clusters Results (Outcomes) Indicators Mitigation of External Risks Essential Medicines & Equipment 1. Household expenditure (out-of-pocket) 2. Qualification of health care workers 3. Well equipped health facilities 4. Access to health facilities 5. Hospital beds 6. Availability to health care workers 7. Availability of drugs 8. Awareness of infant & maternal care 9. Awareness of HIV/AIDS 10. Awareness of water borne diseases 11. Employment in health sector

7. 7 Specific Impact Indicators Institutional Reform Regulation of Private Sector Health Care Worker Recruitment & Training Infrastructure Education Increased Affordability of Health Care Enhanced Service Availability & Quality Improved Health Awareness Optimal Employment Output Clusters Results (Outcomes) Specific Impacts Indicators Mitigation of External Risks Essential Medicines & Equipment Increased Service Utilization & Intervention Coverage Improved Health Behaviour Reduced Health Risks 12. Antenatal care coverage 13. Births attended by skilled personal 14. Child immunisation 15. Family planning 16. Malaria treatment 17. TB detection & treatment 18. Antiretroviral therapy coverage 19. Diarrhoea treatment 20 Child vitamin supplementation 21. Contraceptive use 22. Malaria prevention 23. Hand washing 24. Road safety 25. Safe drinking water & basic sanitation 26. Food safety 27. Air pollution

8. 8 Intermediate Impact Indicators Institutional Reform Regulation of Private Sector Health Care Worker Recruitment & Training Infrastructure Education Increased Affordability of Health Care Enhanced Service Availability & Quality Improved Health Awareness Optimal Employment Reduction in Mortality Output Clusters Results (Outcomes) Specific Impacts Intermediate Impacts Indicators Reduction in Morbidity & Disability Mitigation of External Risks Essential Medicines & Equipment Increased Service Utilization & Intervention Coverage Improved Health Behaviour Reduced Health Risks 28. Life expectancy 29. Maternal mortality 30. Child mortality 31. Adult mortality 32. Spread of HIV/AIDS 33. Spread of malaria 34. Spread of TB 35. Disability levels Stronger Labour Markets

9. 9 The Missing Middle Outputs Results (Outcomes) Specific Impacts Intermediate Impacts Global Impacts Implementation Programming

10. 10 Attention 1. This is a simplified tool, not a template. Intervention logic must be developed for each country based on its context and existing government strategies 2. Indictors are not fixed but provide ideas on how to set, monitor and evaluate CSP objectives 3. Crosscutting issues should be mainstreamed into relevant indicators (e.g. disaggregation of data by gender) 4. Outcomes/Impact are not fully attributable to the EC Outputs are 100% attributable to the EC but attribution falls as you move up the chain of results

11. 11 List of Key Indicators (with examples) Affordability Result (Outcome) Indicators 1. Household expenditure (out-of-pocket) Service Availability & Quality Result (Outcome) Indicators 2. Qualification of health care workers 3. Well equipped health facilities 4. Access to health facilities 5. Hospital beds 6. Availability to health care workers 7. Availability of drugs Health Awareness Result (Outcome) Indicators 8. Awareness of infant and maternal care 9. Awareness of HIV/AIDS 10. Awareness of water borne diseases Employment Result (Outcome) Indicators 11. Employment in health sector Service Utilization & Intervention Coverage Specific Impact Indicators 12. Antenatal care coverage 13. Births attended by skilled personal 14. Child immunisation 15. Family planning 16. Malaria treatment 17. TB detection and treatment 18. Antiretroviral therapy coverage 19. Diarrhoea treatment 20 Child vitamin supplementation Health Behaviour Specific Impact Indicators 21. Contraceptive use 22. Malaria prevention 23. Hand washing 24. Road safety Health Risks Specific Impact Indicators 25. Safe drinking water and basic sanitation 26. Food safety 27. Air pollution Mortality Intermediate Impact Indicators 28. Life expectancy 29. Maternal mortality 30. Child mortality 31. Adult mortality Morbidity & Disability Intermediate Impact Indicators 32. Spread of HIV/AIDS 33. Spread of malaria 34. Spread of TB 35. Disability levels