1. MONITORING AND EVALUATION
FOR HIV/AIDS PROGRAMS
PDMES SEPTEMBER 2014

2. Monitoring AND Evaluation
Monitoring: What are we doing?
Tracking inputs and outputs to assess whether
program are performing according to plans
(e.g. people trained, condoms distributed)
Evaluation: What have we achieved?
Assessment of impact of the programme on
behaviour or health outcome
(e.g. condom use at last risky sex, HIV incidence)
Surveillance: monitoring disease
Spread of HIV/STD
(e.g. HIV prevalence among pregnant women)

3. Program Components
• Program inputs refer to the set of resources (i.e.,
financial, policies, personnel, facilities, space, equipment
and supplies) that are the basic materials of the
program.
• Program processes refer to the set of activities in which
program inputs are utilized to achieve the results
expected from the program.
• Program outputs are the results obtained at the program
level through the execution of program activities using
program resources.
• These may be divided into the following three
components: functional outputs, service outputs and
service utilization.

4. Program outputs
• Functional outputs are the direct result of program activities
in six key functional areas: policy, training, management,
commodities and logistics, research and evaluation, and
information, education, and communication (IEC).
Examples of
• Functional outputs include the number of people trained in
the last year, number of IEC messages aired on the radio over
the last quarter, and existence of a management information
system.
• Service outputs are the results of program activities aimed at
improving the service delivery system. These are measured in
terms of quality, accessibility of services, and program image
and acceptability.
• Service utilization is the result of making services more
accessible and satisfactory to potential clients. This result is
generally measured at the program level.

5. Program outcomes and impacts
• Program outcomes and impacts are the set of
intermediate and longer term results expected to
occur at the population level due to program
activities and the generation of program outputs.
• Program outcomes are the intermediate results at
the population level that are closely linked to
program activities and program-level results. These
intermediate results, or outcomes, are generally
achieved in two to five years.
• Program impacts are the results at the population
level that are long term in nature and are produced
only through the action of intermediate

6. Levels of Measurement
• Inputs, process, and outputs relate to
activities and results at the program level and
are usually measured with program-based or
facility-based data.
• Program-based data come from routine data
collection (e.g., service statistics, client and
other clinic records, administrative records,
commodities shipments, sales) as well as
information that is collected on site whether
services are delivered (e.g., provider surveys,
observation of provider-client interaction,
retail audits, mystery clients) or from a follow-

7. Program Outcomes
• Outcomes are usually measured with population-
based biological and behavioral data.
• Population-based data refer to information obtained
from a probability sample of the target population in
the catchment area for the program.
• This may be a country, a region, or a particular
subgroup of the population.
• The data are generally collected from surveys, such
as the Demographic and Health Survey, Behavioral
Surveillance Survey or the Young Adult Reproductive
Health Survey.
• Biological-based data are generally collected through
sentinel surveillance systems.

8. SELECTING AND USING INDICATORS
• Good indicators for the monitoring and evaluation of
HIV/AIDS/STI programs should be clear about the
purpose they are to serve. Once this is established,
efforts should be made to ensure that the indicator
is well defined, feasible to collect, easy to interpret,
and able to track changes over time.
Selecting Indicators
Features of a good indicator, more specifically,
• should actually measure the phenomenon it is
intended to measure (valid),
• produce the same results when used more than once
to measure precisely the same phenomenon
(reliable)

9. Cont’
• measure only the phenomenon it is intended to
measure (specific),
• reflect changes in the state of the phenomenon
under study (sensitive), and
• be measurable or quantifiable with developed and
tested definitions and reference standards
(operational).
• Most importantly, an indicator should be relevant. If
one cannot make decisions based on an indicator or
group of indicators, there is no point in collecting the
information.

10. Using Indicators
Criteria to consider in choosing among performance
indicators at the program level:
•Is the indicator oriented toward the targeted results
(objective) and is it at the appropriate level?
•It is important to include at least one indicator relating
to the desired results, appropriate to the scale of the
intervention.
• How easy is it to obtain the information, how often is
the information updated, and what are the sources of
the information?

11. • What is the quality of the data?
Effort should be given to design or select
indicators of high priority which involve
minimal difficulty in measurement.
Naturally, priority should be given to indicators
based on measures of known quality (i.e.,
strong reliability and validity).

12. • How comparable are the results from the
indicator?
Because of the need to monitor the
performance of health interventions across a
number of programs simultaneously
and given the new evaluation methods for
HIV/AIDS/STI programs, priority should be
given to those indicators that offer
comparable results

13. • How responsive to change is the indicator?
An indicator should change in response to program
interventions. Indicators that are responsive to
underlying intervention efforts in a short period of
time (3-5 years) are to be preferred over, but should
not displace, those requiring a longer lag time (e.g.,
HIV prevalence).

14. Responsiveness also depends on sample size,
confidence intervals, and normal variation over
time.
This last factor, together with the expected
change due to the intervention, should
determine the frequency of data collection.
For example, if an indicator is only expected to
change over a five-year period, it does not make
sense to measure it every year.
It is necessary to first obtain a baseline value on
the indicator so that subsequent values can be
compared to determine if change or
improvement has occurred.

15. Input Process Output Outcome Impact
A FRAMEWORK for Monitoring and Evaluation
People
money
equipment
policies
etc. Training
Logistics
Management
IEC/BCC
etc.
Services
Service use
Knowledge
Behaviour;
Safer
practices
(population
level)
HIV/STI
transmission
Reduced
HIV impact

16. Input Process Output Outcome Impact
DATA COLLECTION for Monitoring and Evaluation
HIV/STI
surveillance
Household
Surveys
Facility
surveys
Programme Monitoring

17. Input Process Output Outcome Impact
Did the National Response Make the Difference?
1
HIV
prevalence
changing!2
Can the changes
in HIV prevalence
be attributed
to changes in
behaviour??
3
Can the changes in
behaviour be attributed to
interventions / programs?

18. Input Process Output Outcome Impact
The components of AIDS programmes
Voluntary counselling and testing
Reduction of mother-to-child transmission
IEC programs: knowledge, attitudes
Condom promotion and distribution
School programs: adolescent KAP
Targeted interventions
Control of STDs
Blood safety, prevention nosocomial transmission
Care & support programs (including ARV)

19. Lesson Learned: 5 Elements of a Good
Monitoring and Evaluation System
1 Presence Monitoring and Evaluation unit
2 Clear goals and objectives of the program
3 A core set of indicators and targets
4 A plan for data collection and analysis
5 A plan for data dissemination

20. Clear goals and objectives
• National strategic plan has
no specific goals and
objectives
• No system of ongoing
assessment with programs
reviews and built-in
evaluation
• Limited coordination with
districts and regions
• Limited coordination
between sectors
• Donor-driven M&E system
• Well-defined national
programme goals and
targets - M&E plan
• Regular reviews/evaluations
of the progress of the
implementation of the
national programme plans
• Guidelines and guidance to
districts and regions or
provinces for M&E
• Guidelines for linking M&E to
multiple sectors
• Co-ordination of national and
donor M&E needs
Not so
good
GOOD

21. A set of indicators (and targets)
• No indicators or indicators
that cannot be measured
• Indicators that cannot be
compared with past
indicators or with other
countries
• Indicators are only used for
donors and each donor has
its own set of indicators
• Indicators are irrelevant to
those who collect the data
• Each district or sector uses
its own indicator
• A set of priority indicators and
additional indicators that cover
programme monitoring,
programme outcomes and
impact - M&E plan
• Selection of indicators through
process of involving multiple
stakeholders and maintaining
relevance and comparability
• Utilization of past and existing
data collection efforts to assess
national trends (e.g. DHS)
Not so
good
GOOD

22. Data collection and analysis plan
• M&E is an ad hoc activity
without a plan, mostly driven
by donors
• Data are collected but not
analysed sufficiently / utilized
• There is no systematic
monitoring of programme
inputs and outputs
• An overall national level data
collection and analysis plan,
linked to the national
strategic plan
•
• A plan to collect data and
analyse indicators at
different levels of M&E
(programme monitoring)
• Second generation
surveillance, where
behavioural data are linked
to HIV/STI surveillance data
Not so
good
GOOD

23. Data dissemination plan
• Dissemination is ad hoc and
not planned or coordinated
• Annual surveillance report is
much delayed not user
friendly and not well
disseminated
• Dissemination to the districts
and regions is not done
• Dissemination activities are
donor driven
• Overall national level data
dissemination plan
• Well-disseminated
informative annual report of
the M&E unit
• Annual meetings to
disseminate and discuss
M&E and research findings
with policy-makers and
planners
• Clearinghouse / Resource
centre at national level
Not so
good
GOOD

24. Overview of Indicators
Bi-annualBi-annualProgrammeProgramme
reportsreports
/modelling/modelling
CS3CS3 The number and percent of persons with advanced HIVThe number and percent of persons with advanced HIV
infection receiving ART (UNGASS)infection receiving ART (UNGASS)
AnnualAnnualProgrammeProgramme
reportsreports
CS2CS2 The percent of districts with at least one health facilityThe percent of districts with at least one health facility
providing ARTproviding ART
AnnualAnnualProgrammeProgramme
reportsreports
CS1CS1 The number of individuals receiving HIV testing andThe number of individuals receiving HIV testing and
counselling in the last 12 monthscounselling in the last 12 months
a)a) The number of individuals who received HIV testingThe number of individuals who received HIV testing
b)b) Percent of those tested who received pre-test counsellingPercent of those tested who received pre-test counselling
c)c) Percent of those tested who were positivePercent of those tested who were positive
d)d) Percent of those tested who received their resultsPercent of those tested who received their results
through post-test counselling servicesthrough post-test counselling services
FrequencyFrequencyMethodsMethodsCore IndicatorsCore Indicators

25. Overview of Indicators, con’t...
Every otherEvery other
yearyear
Interviews /Interviews /
recordrecord
reviewreview
CS4CS4 The existence of comprehensive HIV/AIDS care andThe existence of comprehensive HIV/AIDS care and
support policies, strategies and guidelinessupport policies, strategies and guidelines
Every 2-4 yearsEvery 2-4 yearsHealthHealth
facilityfacility
surveysurvey
CS7CS7 Percent of health facilities that have the capacity andPercent of health facilities that have the capacity and
conditions to provide advanced level HIV care andconditions to provide advanced level HIV care and
support services, including provision and monitoring ofsupport services, including provision and monitoring of
ARTART
Every 2-4 yearsEvery 2-4 yearsHealthHealth
facilityfacility
surveysurvey
CS6CS6 Percent of health facilities that have the capacity andPercent of health facilities that have the capacity and
conditions to provide basic level HIV testing and HIV/AIDSconditions to provide basic level HIV testing and HIV/AIDS
clinical managementclinical management
Every 2-4 yearsEvery 2-4 yearsHealthHealth
facilityfacility
surveysurvey
CS5CS5 The percent of facilities that either provideThe percent of facilities that either provide
comprehensive care and support services onsite forcomprehensive care and support services onsite for
people living with HIV or through an effective referralpeople living with HIV or through an effective referral
systemsystem
FrequencyFrequencyMethodsMethodsCore IndicatorsCore Indicators

26. Overview of Indicators, con’t...
To beTo be
determineddetermined
HealthHealth
facilityfacility
survey /survey /
special labspecial lab
studystudy
CS8CS8 The percent of designated laboratories with theThe percent of designated laboratories with the
capacity to monitor ART according tocapacity to monitor ART according to
national/international guidelinesnational/international guidelines
Every 2-4 yearsEvery 2-4 yearsHouseholdHousehold
surveysurvey
CS10CS10 The percent of orphans and vulnerable children lessThe percent of orphans and vulnerable children less
than 18 years whose households received free basicthan 18 years whose households received free basic
external support in caring for the childexternal support in caring for the child
Every 2-4 yearsEvery 2-4 yearsHouseholdHousehold
surveysurvey
CS9CS9 The percent of persons aged 15-59 who have beenThe percent of persons aged 15-59 who have been
chronically ill for 3 or more months in the last 12 monthschronically ill for 3 or more months in the last 12 months
whose households received free basic external support inwhose households received free basic external support in
caring for the chronically ill personcaring for the chronically ill person
FrequencyFrequencyMethodsMethodsCore IndicatorsCore Indicators

27. Overview of Indicators, con’t...
Every otherEvery other
yearyear
Interview /Interview /
recordrecord
reviewsreviews
CS-A1CS-A1 The existence of national monitoring andThe existence of national monitoring and
evaluation capacity for HIV/AIDS care and supportevaluation capacity for HIV/AIDS care and support
programmesprogrammes
Every 2-4 yearsEvery 2-4 yearsHealthHealth
facilityfacility
surveysurvey
CS-A2CS-A2 The percent of health facilities with record keepingThe percent of health facilities with record keeping
systems for monitoring of HIV/AIDS care and supportsystems for monitoring of HIV/AIDS care and support
FrequencyFrequencyMethodsMethodsAdditional IndicatorsAdditional Indicators