M&e system in Nigeria - Problem analysis hiv conference 2010 may 4


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  • Outer Ring: This links 6 components related to people, partnerships and planning that support data production and data use – i.e. the enabling environment for HIV M&E to function Middle ring: This links 5 components related to data management processes – collection, capture, and verification of all types of HIV M&E data, according to all levels of the HIV M&E staircase Inner ring: This involves analyzing data to create information, which is then disseminated to inform and empower decision-making at all levels Performance Goal for Component 1: Establish and maintain a network of organizations responsible for HIV M&E at national, sub-national and service delivery levels
  • Strategic documents include: National M&E plan, NSF, National AIDS policy and sector specific strategies.
  • Strategic documents include: National M&E plan, NSF, National AIDS policy and sector specific strategies.
  • TWG acts: and acts as a consultative group. Its terms of reference are included in the National HIV M&E plan. Weaknesses: Federal ministries, civil society organization and other implementers do not feel that M&E partnerships are truly multi-sectoral and that decisions are made through consensus.
  • The national M&E plan is not linked to sectoral and state level M&E plans. No mention of a capacity building plan, linkages to sectoral plans, does not provide guidelines for data auditing and supervision.
  • Lower level fail to critically analyze data, develop data into information and use data for strategic decision making.
  • A national Health & Research Ethics Committee (NHREC) established by FMOH approves all new research including HIV related research. There also exist a couple of registered IRBs that clear protocols on general research including HIV.
  • M&e system in Nigeria - Problem analysis hiv conference 2010 may 4

    1. 1. National HIV Monitoring and Evaluation System in Nigeria: Problem Analysis Kola Oyediran MEASURE Evaluation/JSI
    2. 2. Organizing Framework for a Functional National HIV M&E System – Twelve Components
    3. 3. Results: Strengths and Weaknesses
    4. 4. Organizational Structures with HIV M&E functions <ul><li>Strengths </li></ul><ul><ul><li>Clear M&E mandate for NACA articulated in most strategic documents </li></ul></ul><ul><ul><li>Roles and responsibilities for the other sectors stated in the M&E plan, albeit in a summarized version. </li></ul></ul><ul><ul><li>NACA, FMOH-NASCP and some federal ministries have human resource structure for M&E; </li></ul></ul><ul><li>Weaknesses </li></ul><ul><li>HIV M&E mandate not clear for most federal ministries and umbrella organizations. </li></ul><ul><li>Gaps in staffing and capacity for HIV M&E at all levels </li></ul><ul><li>Critical M&E skills e.g. epidemiology, IT and database management lacking at NACA, and FMOH-NASCP. </li></ul><ul><li>Remuneration for M&E is generally low and unsatisfactory across all entities. </li></ul>
    5. 5. Human Capacity for HIV M&E <ul><li>Strengths </li></ul><ul><li>M&E training curriculum for NNRIMS developed in 2007 to build capacity on HIV M&E. </li></ul><ul><li>Sub-committee on capacity building formed by national TWG to develop a new training curriculum for M&E. </li></ul><ul><li>NACA is in the process of developing a human capacity building plan. </li></ul><ul><li>Weaknesses </li></ul><ul><ul><li>A human capacity assessment for HIV M&E has not been carried out for all the sectors except for NACA and FMOH. </li></ul></ul><ul><ul><li>No national database for M&E trainers or trainees. </li></ul></ul><ul><ul><li>On job training, supervision and mentoring is not planned for and is neither well coordinated nor documented. </li></ul></ul>
    6. 6. Partnerships to Plan, Coordinate and Manage the Multi-sector HIV M&E System <ul><li>Strengths </li></ul><ul><li>Nigeria has a multi-sectoral M&E TWG - coordinates HIV M&E activities </li></ul><ul><li>Majority of GoN agencies, CSOs and international development partners are active participants of the TWG </li></ul><ul><li>Partnerships are being maintained through joint planning and other joint activities that involve multi-sectoral teams e.g. the RDQA exercise </li></ul><ul><li>Weaknesses </li></ul><ul><ul><li>There is failure to have functional technical working groups at state level. </li></ul></ul><ul><ul><li>Poor partnerships between and within sectors. </li></ul></ul><ul><ul><li>Membership of and TORs of the TWG have not been revised since its inception. </li></ul></ul><ul><ul><li>Communication about HIV M&E developments and outputs of the M&E system is poor between NACA and other sectors. </li></ul></ul>
    7. 7. National, Multi-sectoral HIV M&E Plan <ul><li>Strengths </li></ul><ul><ul><li>The process of developing the national M&E plan was broad-based multi-sectoral and participatory. </li></ul></ul><ul><ul><li>The national HIV M&E plan is explicitly linked to the National Strategic Framework. </li></ul></ul><ul><ul><li>Ownership of the plan was displayed, as all sectors had good knowledge of its contents and sections that relate to their sectors. </li></ul></ul><ul><li>Weaknesses </li></ul><ul><ul><li>Current plan does not fully describe the implementation of all 12 components </li></ul></ul><ul><ul><li>National M&E system assessment was not conducted before developing the national M&E plan. </li></ul></ul><ul><ul><li>Some of the indicators do not have baseline values. </li></ul></ul>
    8. 8. Costed, National, multi-sector HIV M&E Work Plan <ul><li>Strengths </li></ul><ul><ul><li>The SKM unit at NACA, the HMIS, NASCP and other sectors have annual operational plans within their organizations. These plans include institution or sector-specific activities related to HIV M&E. </li></ul></ul><ul><li>Weaknesses </li></ul><ul><ul><li>No national multi-partner, multi-level M&E workplan that is costed and supported, thus activities are not well coordinated and often lead to duplication and failure to leverage resources. </li></ul></ul><ul><ul><li>Most activities are not guided by the national needs but tend to be donor driven. </li></ul></ul><ul><ul><li>Difficult to assess how well the M&E plan has been strengthened in the absence of the workplan. </li></ul></ul>
    9. 9. Communication, Advocacy and Culture for HIV M&E <ul><li>Strengths </li></ul><ul><ul><li>HIV and AIDS M&E are viewed as important and given due attention by management </li></ul></ul><ul><ul><li>HIV M&E is a key priority in the National HIV and AIDS policy and NSF 2. </li></ul></ul><ul><ul><li>NACA uses its website and newsletters as a routine mechanism to communicate HIV M&E information to all stakeholders. </li></ul></ul><ul><li>Weaknesses </li></ul><ul><ul><li>No HIV M&E communication and advocacy plan </li></ul></ul><ul><ul><li>No high-level officials identified as ‘M&E champions’ who actively endorse M&E actions. </li></ul></ul><ul><ul><li>Limited use HIV M&E information to guide programme implementation, decision-making, resource mobilization and strategic planning beyond NACA. </li></ul></ul><ul><ul><li>View M&E as routine data collection for their funding partners. </li></ul></ul>
    10. 10. Routine HIV Program Monitoring <ul><li>Strengths </li></ul><ul><ul><li>Availability of national data collection guidelines for the health related programs </li></ul></ul><ul><ul><li>Availability of national guidelines for the private sector health facilities though little has been done to enforce adherence to these guidelines. </li></ul></ul><ul><ul><li>National HIV and AIDS M&E plan contains definitions of indicators, reporting forms and data flow chart for both non-health and health implementers </li></ul></ul><ul><li>Weaknesses </li></ul><ul><ul><li>Implementers collects indicators not aligned to the national M&E plan </li></ul></ul><ul><ul><li>Reporting is still very poor among the private sector health facilities. </li></ul></ul><ul><ul><li>Poor national referral systems for patients/clients. </li></ul></ul><ul><ul><li>Critical program monitoring tools are not available at sites. </li></ul></ul><ul><ul><li>Data quality guidelines are not available for program monitoring. </li></ul></ul>
    11. 11. Surveys and Surveillance <ul><li>Strengths </li></ul><ul><ul><li>National HIV M&E plan clearly stipulates importance of surveys and surveillance </li></ul></ul><ul><ul><li>Important surveys and surveillance conducted e.g. NARHS+, IBBSS, Workplace Survey, Epidemiology and Response Policy Analysis, MOT, National Triangulation exercise. </li></ul></ul><ul><ul><li>FMOH has started compiling an inventory of all surveys that were conducted in 2009 </li></ul></ul><ul><li>Weaknesses </li></ul><ul><ul><li>Scope of the surveys and surveillance is limited to provide national estimates, </li></ul></ul><ul><ul><li>Second generation surveillance has never been conducted. </li></ul></ul><ul><ul><li>Facility based surveys designed to assess quality of care, health system supports for quality care; and facility utilization by PLWH are still weak in Nigeria. </li></ul></ul><ul><ul><li>Human capacity to use survey and surveillance data is limited e.g at state, facility and implementers levels. </li></ul></ul>
    12. 12. National and Sub-national HIV Databases <ul><li>Strengths </li></ul><ul><ul><li>Nigeria has a number of robust databases that capture HIV and AIDS information e.g the DHIS, LHPMIP. </li></ul></ul><ul><ul><li>NACA has good IT infrastructure that is used for M&E. </li></ul></ul><ul><li>Weaknesses </li></ul><ul><ul><li>Various partners encourage different databases at national level that are not linked to each other </li></ul></ul><ul><ul><li>The databases are not linked leading to duplication of effort </li></ul></ul><ul><ul><li>IT equipment and infrastructure is very poor at the state level </li></ul></ul><ul><ul><li>Protection of data and data backup systems are poor </li></ul></ul><ul><ul><li>Human capacity to manage the databases is poor at lower level - particularly State and LGA </li></ul></ul>
    13. 13. Supportive Supervision and Data Auditing <ul><li>Strengths </li></ul><ul><ul><li>Recipients of GF and MAP funds, NACA has been conducting supervision using guidelines from these funding partners. </li></ul></ul><ul><ul><li>Protocols for RDQA have been used to conduct a joint data audit exercises for select output level indicators. </li></ul></ul><ul><ul><li>Training on data collection for prevention activities to prevent double counting </li></ul></ul><ul><ul><ul><li>assess whether individuals are receiving the minimum level of services at the community level. </li></ul></ul></ul><ul><li>Weaknesses </li></ul><ul><ul><li>No supportive supervision or data auditing guidelines or reporting formats that are standardized. </li></ul></ul><ul><ul><li>Supportive supervision and data auditing is not scheduled thus conducted in an irregular basis </li></ul></ul><ul><ul><li>Feedback from supportive supervision is not documented and is often provided through verbal conversations. </li></ul></ul><ul><ul><li>Only national level organizations seem to be conducted supportive supervision and data auditing. </li></ul></ul><ul><ul><li>Capacity to conduct the supportive supervision and data auditing is low at state level since some states were not trained. </li></ul></ul>
    14. 14. HIV Evaluation and Research Agenda <ul><li>Strengths </li></ul><ul><ul><li>NACA has commenced the development of a National HIV research agenda. </li></ul></ul><ul><ul><li>A research sub-committee of the NTWG was set up to coordinate research and public health evaluation. </li></ul></ul><ul><ul><li>Various reviews of the national response have been conducted in a participatory manner e.g. MTR of NSF, WB MAP1 Review, and NSF end of term review. </li></ul></ul><ul><li>Weaknesses </li></ul><ul><ul><li>Poor coordination of the various research and evaluation that are happening in Nigeria </li></ul></ul><ul><ul><li>No inventory of research and evaluation studies therefore there is no clarity on how much investment is being put towards research and evaluation </li></ul></ul><ul><ul><li>No clear structure of disseminating and using information generated from research and evaluation studies carried out </li></ul></ul>
    15. 15. Data Dissemination and Use <ul><li>Strengths </li></ul><ul><ul><li>NNRIMS NOP states the various data dissemination forums and data use by various stakeholders. </li></ul></ul><ul><ul><li>Reports are produced by NACA are posted on the website to disseminate information to the various stakeholders and the public as well. </li></ul></ul><ul><ul><li>Clear evidence of M&E information use in the review and development of the national strategic framework </li></ul></ul><ul><li>Weaknesses </li></ul><ul><ul><li>There has been no stakeholder information needs assessment at national and sub-national level. </li></ul></ul><ul><ul><li>Stakeholders are clearly not aware of information products that have been produced by NACA. </li></ul></ul><ul><ul><li>Data use is very limited at the sub-national level </li></ul></ul><ul><ul><ul><li>Information is not clearly disseminated to various stakeholders at the sub-national level </li></ul></ul></ul>
    16. 16. Key Recommendations <ul><li>Development of a costed M&E workplan </li></ul><ul><li>No national M&E costed workplan though an M&E plan may provide guiding principles for the national M&E systems there is need to develop a roadmap that clearly define how the M&E plan will be implemented and operationalised </li></ul><ul><li>Strengthening State level M&E systems </li></ul><ul><li>While there are clear systems and structures at national level, state level system is poor and not harmonized </li></ul>
    17. 17. Key Recommendations <ul><li>SACA’s role </li></ul><ul><li>The federal system entails that states are autonomous. This creates difficulty in the development of uniform structures at State and LGA. Continued advocacy is needed for all SACAs to become agencies. </li></ul><ul><li>Human Capacity </li></ul><ul><li>Lack of human capacity across all sectors was noted. Need to build human capacity through conducting Human capacity assessments, development of capacity building plans, actual implementation of the capacity building and monitoring the implementation of the capacity building plan. </li></ul>
    18. 18. Key Action Points after Assessment <ul><li>Develop of a costed M&E workplan </li></ul><ul><li>Research and Evaluation agenda drafted </li></ul><ul><li>National M&E technical working group is under going review </li></ul><ul><li>Harmonization of indicators and tools commences </li></ul><ul><li>Strategy for strengthening sub-national levels </li></ul>
    19. 19. THANK YOU! Visit us online at http://www.cpc.unc.edu/measure MEASURE Evaluation is funded by the U.S. Agency for International Development (USAID) through Cooperative Agreement GHA-A-00-08-00003-00 and is implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill, in partnership With Futures Group International, John Snow, Inc., Macro International Inc., Management Sciences for Health, and Tulane University. The views expressed in this presentation do not necessarily reflect the views of USAID or the United States government.
    20. 20. <ul><ul><li>A dupe, Ndewo, Nago de </li></ul></ul>