Monitoring and Evaluation (M&E)
The rapid scale up of the response has been accompanied by an increasing emphasis on measurable indicators and results. These include programme monitoring data, behavioural and biological trends data and evaluation of programmes. The increasing demands on country monitoring and evaluation systems can only be met if better systems are built and supported.
WHO’s work is strengthening of M&E systems in countries is conducted in a close collaboration with UNAIDS, World Bank, UNICEF; CDC, USAID and many other partners. This partnership aims to support countries in the development of better M&E systems. This includes the development of a national M&E plan based upon a simple framework, selected indicators and a plan for data collection, reporting, analysis and dissemination strategy for the next three to five years; training and capacity building of M&E staff; development of regional networks of consultants and institutions for technical assistance; development of locally appropriate tools and methods for M&E; development of a data management system (CRIS). It is also important to link the national M&E plans to international goals such as the goals set at the UNGASS Declaration on HIV/AIDS and the Millenium Development Goals.
WHO’s efforts in M&E focus on the health sector. A major part of the interventions and programmes against AIDS take place in the health sector. Therefore, much of WHO’s work in M&E concentrates on development of guidelines and tools for monitoring health interventions, such as anti-retroviral treatment programmes, counselling and testing, and prevention of mother to child transmission. In addition, WHO is facilitating the collection of data on specific indicators of the health sector response at the country level.
Guidelines and Tools
One of WHO’s main activities is the development of guidelines and tools for monitoring and evaluation of health sector programmes. The guidelines have been developed in close collaboration with other international agencies and organizations, and major donors with strong country inputs. The focus is on national level monitoring.
In 2000, a guide for national programmes was developed with a set of core and additional indicators for 14 programme areas. In the subsequent years work has been ongoing on the development of M&E guides for specific interventions areas, such as young people and HIV prevention, prevention of mother to child transmission, care and support and anti-retroviral therapy programmes. Since 2003 several guidelines have been published to describe a coherent approach to the M&E of scaling up to reach the goal of "3 by 5".
- M&E toolkit, HIV/AIDS, tuberculosis and malaria (2004)
- Guide to M&E national HIV/AIDS prevention programmes for young people (10 to 24 years old) (DRAFT, 2004)
- National guide to monitoring and evaluating programmes for the prevention of HIV in infants and young children (2004)
- National AIDS Programmes: A guide to monitoring and evaluating HIV/AIDS care and support (2004)
- Monitoring and evaluating of national ART programmes in the rapid scale-up to 3 by 5 (2003)
- Technical brief: The M&E of the 3 by 5 Initiative (2003)
- National AIDS programmes: a guide to monitoring and evaluation
- National AIDS Programmes: A guide to indicators for monitoring and evaluating national antiretroviral programmes
One measure of progress towards achieving the UNGASS goals is the percentage of people living in low and middle income countries who have access to key prevention and care services. WHO coordinated an assessment of the coverage of several key health services in 70 countries. The results serve as a baseline against which future progress can be measured. Using service statistics and expert assessment, the coverage was found to be low in most countries for voluntary counselling and testing, the prevention of mother to child transmission, antiretroviral therapy and prophylaxis for opportunistic infections. The situation was much better for blood screening and application of the directly observed short course (DOTS) strategy for tuberculosis control, as these services are widely available in many countries. The coverage survey will be repeated in 2003.
- Coverage of selected services for HIV/AIDS prevention, care and support in low and middle income countries in 2003
The UNGASS goals include a number of indicators that measure the performance of the health sector. WHO’s activities focus on three programme indicators and three impact indicators.
- Percentage of HIV-infected women receiving a complete course of antiretroviral prophylaxis to reduce the risk of MTCT
- Percentage of people with advanced HIV infection receiving antiretroviral combination therapy
- Percentage of patients with STIs at health-care facilities who are appropriately diagnosed, treated, and counseled
- Percentage of young people aged 15 – 24 who are HIV-infected
- Percentage of HIV prevalence among sex workers and their clients, injecting drug users, and men having sex with men
- Percentage of HIV-infected infants born to HIV-infected mothers
Details on M&E of the UNGASS declaration can be found in the Guidelines on Construction of Core Indicators.