1. Donald T. Simeon Caribbean Health Research Council
Monitoring and Evaluation Healthy caribbean conference barbados, 0ctober 16-18, 2008

2. What is Monitoring
Monitoring is the routine process of collecting data to measure progress toward program objectives
Monitoring involves routinely looking at the way we implement programs, conduct services etc.
Examines efficiency

3. What is Evaluation
Evaluation is the use of research methods to systematically investigate a program’s effectiveness
Evaluation involves measurements over time
Need for baseline
Sometimes requires a control or comparison group
Evaluation involves special research studies

4. Why Monitor and Evaluate Programmes?
To ensure that programs are being implemented as designed (fidelity of programme implementation)
To ensure the delivery of quality services (continuous quality control - CQI)
To ensure that the programmes are making a difference (outcomes)
To ensure that programmes and funds are used appropriately and efficiently (accountability)

5. Fidelity of Programme Implementation
Are projects and components of projects (i.e., specific activities) being conducted as planned and on schedule?
Done primarily through programme monitoring
Examine the implementation of activities relative to a planned schedule
Programme monitoring ensures that programs are administered and services are delivered in the way they were designed

6. Continuous Quality Improvement
Use information to modify/improve the configuration and implementation of programmes
What was learned from implementing the programme that can be improved upon?
What went wrong and how can it be corrected next time?
What worked especially well and how can those lessons be incorporated into future activities?
Did the intervention work? Were the outcomes as expected?

7. Programme Outcomes
Are the projects/interventions having the desired effect on the target populations?
For example, are health care providers using clinical guidelines as recommended?
Done primarily through programme evaluation
Determine whether programme/project made a difference (e.g., does the use of guidelines result in decreased rates of complications in diabetic patients)

8. Programme Outcomes
Usually examined through studies designed to collect data on logical outcomes from the project/intervention (e.g., periodic surveys of target groups)
Did the programs have the expected/desired outcomes? If no, why? Was it a function of implementation challenges or poor project design or a study design that failed to capture outcomes?
What are the implications for future interventions? Should they be the same or can they be improved in some way?

9. Accountability
Taxpayers, donor agencies and lenders need to know:
funds were used as intended
programmes made a difference
Evaluation findings document achievements as well as what remains to be done
Findings can be used to demonstrate unmet needs and facilitate requests for additional funds.

10. Best Practices for M&E Systems
funding should be proportional to programme resources
ideally about 7% of the program budget
needed at all levels
most useful if performed in a logical sequence
first assessing input/process/output data (monitoring/process evaluation),
then examining behavioural or immediate outcomes
and finally assessing disease and social level impacts.
minimize data collection burden and maximize limited resources
activities should be well coordinated
utilize ongoing data collection and analysis as much as possible
M&E activities should be proportional to programme resources (ideally about 10% of the programmatic budget)
M&E is needed at all levels and is most useful if performed in a logical sequence; first assessing input/process/output data, then examining behavioral or immediate outcomes and finally assessing disease and social level impacts.
Indicators and instruments for data collection and analysis build upon wide experience and recent developments, but can be adapted locally.
M&E indicators should measure population-based biological, behavioral, and social data to determine the "collective effectiveness" of consolidated programs. These survey efforts should be supplemented with good qualitative data.
To minimize data collection burden and maximize limited resources, M&E activities need to be well coordinated and utilize ongoing data collection and analysis, where appropriate, in preference to designing new instruments or stand-alone systems.
To increase the utilization of evaluation results, M&E design planning, analysis, and reporting should actively involve key stakeholders, such as district and national programme managers, policy makers, community members, and programme participants.

11. Best Practices for M&E Systems
To increase the utilization of evaluation results, M&E design planning, analysis, and reporting should actively involve key stakeholders
programme managers, policy makers, community members, and programme participants
M&E indicators should be comprehensive
should also measure population-based biological, behavioural, and social data to determine "collective effectiveness"
M&E activities should be proportional to programme resources (ideally about 10% of the programmatic budget)
M&E is needed at all levels and is most useful if performed in a logical sequence; first assessing input/process/output data, then examining behavioral or immediate outcomes and finally assessing disease and social level impacts.
Indicators and instruments for data collection and analysis build upon wide experience and recent developments, but can be adapted locally.
M&E indicators should measure population-based biological, behavioral, and social data to determine the "collective effectiveness" of consolidated programs. These survey efforts should be supplemented with good qualitative data.
To minimize data collection burden and maximize limited resources, M&E activities need to be well coordinated and utilize ongoing data collection and analysis, where appropriate, in preference to designing new instruments or stand-alone systems.
To increase the utilization of evaluation results, M&E design planning, analysis, and reporting should actively involve key stakeholders, such as district and national programme managers, policy makers, community members, and programme participants.

12. Developing/Selecting Indicators

13. Indicators
Specific measures that reflect a larger set of circumstances
Greater emphasis on transparency globally, people want instant summary information, instant feedback
Indicators respond to this need

14. Indicators – things to know
only indicate – will never capture the richness and complexity of a system Designed to give ‘slices’ of reality
encourage explicitness: they force us to be clear and explicit
usually rely on numbers & numerical techniques (rates, ratios, comparisons)
have specific measurement protocols which must be respected

15. Sources of Data Primary Data Sources: Secondary Data Sources:
Quantitative program data e.g. from coverage of services
Surveys: demographic health surveys, epidemiological, behavioral and other studies
Research and impact evaluations.
Qualitative data from program staff, key informants and direct observation
Secondary Data Sources:
National response documentation, expenditures reports and program review reports.
Surveillance reports
Routine statistics e.g. mortality, hospital admissions

16. Relating Program Objectives to Indicators
Program goals and objectives may be vague or overly broad, making indicator selection difficult
Indicators should be clearly related to program goals and objectives
Program objectives may have multiple indicators
Indicators are used at all levels of the programme implementation process
Process indicators
Outcome indicators
Impact indicators

17. Types of Indicators Impact
Indicators are used for national and global reporting e.g. mortality rates
Outcomes
Program indicators are used for reporting to national authorities and donors. Changes at end of intervention/program period e.g. rate of HBP control among targeted patients, hospital admissions et.
Outputs
Selected Interventions Indicators (such as approval of a policy, health care professionals trained) are used for programmatic decision making
Inputs
Resource allocation indicators may be included
Financial, human, material, and technical resources
Performance Indicators
What are they?
Performance indicators are measures of inputs, processes, outputs, outcomes, and
impacts for development projects, programs, or strategies. When supported with sound
data collection—perhaps involving formal surveys—analysis and reporting, indicators
enable managers to track progress, demonstrate results, and take corrective action to
improve service delivery. Participation of key stakeholders in defining indicators is
important because they are then more likely to understand and use indicators for
management decision-making.
Independent Evaluation Group, The World Bank, 2xxx
Note: Handout of indicators
Indicators form the basis for
Gathering baseline information before beginning implementation
Selecting desired level of improvement
Setting targets for assessing performance during implementation and adjusting as needed
Evaluating and reporting results to stakeholders and constituents
Note: Project indicators contribute to strategic programs can be programmatic or intervention related as per the goals of specific projects and should contirbute implicit in the be

18. Some considerations
How can the main focus of the objective best be measured?
What practical constraints are there to measuring the indicator?
Are there alternative or complementary measures that should be considered?
What resources (human and financial) does the indicator require?
Do standard (validated, internationally recognized) indicators exist?
How will the results not captured by the selected indicator be measured? (Indicators are imperfect)

19. General Criteria of Good Indicators
Indicators should be expressed in terms of:
Quantity
Quality
Population
Time
For example, an indicator written for the program objective of “Improving glycemic control in diabetic patients” might specify:
“Increase from 30% to 50% (quantity) of gylcaemic control rates (quality) among diabetic patients (population) by October 2009 (time).”

20. Examples of Indicators
# care providers trained to use clinical guidelines in the past year
% patients with controlled diabetes in health centres
% A&E admissions for diabetes related complications

21. General Criteria of Good Indicators
Simple, clear and understandable
Valid – does it measure what it is intended to measure
Specific – Should measure only the conditions or event under observation and nothing else
Reliable – should produce the same result when used more than once to measure the same event
Simple, clear and understandable. The indicator should be immediately understood as a measure of project effectiveness.
• Useful. The indicator should be functional and practical.
• Valid. The indicator should actually measure the phenomenon it is intended to measure.
• Specific. The indicator should measure only the phenomenon it is intended to measure. There should be one indicator related explicitly to each activity.
• Reliable. Conclusions based on any given indicator should be the same regardless of whom, when, and under what conditions the assessments were completed.
• Replicable. The indicator is not unique to one project or time frame.
• Relevant. Decisions will be made based on the data collected. The proposed indicators and the data associated with them must be appropriate to the project rationale.

22. General Criteria of Good Indicators
Relevant – related to your work
Sensitive – will it measure changes over time
Operational –should be measurable or quantifiable using definitions and standards
Affordable – should impose reasonable measurement costs
Feasible – should be able to be carried out using the existing data collection system
Other criteria include:
Sensitive They should reflect changes in the state of the condition
or event under observation.
Operational They should be measurable or quantifiable using tested
definitions and reference standards.
Affordable They should represent reasonable measurement costs.
Feasible They should be possible to carry out in the proposed data
collection.

23. Summary
To ensure that programs are being implemented as designed and funds are used appropriately and efficiently
To ensure that the programmes are making a difference
The selection of appropriate indicators (relative to program objectives) is critical to the success

24. Thank you