1. NATIONAL EMERGENCY RESPONSE COUNCIL ON HIV & AIDS
(NERCHA)
NATIONAL HIV MONITORING AND EVALUATION SYSTEM
A paper prepared for presentation on the Southern African Monitoring & Evaluation
Association (SAMEA) at Birchwood Executive Hotel, Johannesburg, 28th -30th March
2007.
TITLE:
Development and Implementation of a National Multisectoral
Output Monitoring System (SHAPMoS) for HIV responses in
Swaziland: Challenges and lessons learned
Prepared by:
1. Patrick Mduduzi Dlamini – (B.A. Social Science, MBA –in progress) ,Swaziland
HIV/AIDS Program Monitoring System (SHAPMoS) Manager, National
Emergency Response Council on HIV and AIDS (NERCHA)
2. Mduduzi Ndlovu (B.A Social Science) Monitoring &Evaluation Officer, NERCHA
3. Mavis Vilane (B.A Social Science) Monitoring & Evaluation Officer, NERCHA
Swaziland’s paper presented during the SAMEA conference (28 – 30th
March 2007)

2. ACKNOWLEDGEMENTS
Swaziland’s paper presented during the SAMEA conference (28 – 30th
March 2007)
Special thanks go to Marelize Gorgens ( World Bank’s Global AIDS Monitoring and Evaluation
Team) for her continued technical support and guidance in the implementing of SHAPMoS
and the preparation of this report; Kevin Kelly (Centre for AIDS Development , Research &
Evaluation) for encouraging the NERCHA M&E team to participate at the conference; the US
Government (through the Center for Disease Control and Prevention (CDC) and the MEASURE
Evaluation project) for financial and technical support in M&E capacity building and the
operationalisation of SHAPMoS; UNAIDS Regional Support Team For Eastern and Southern
Africa and the UNAIDS Swaziland M&E advisor for their M&E technical guidance; to the
Regional HIV M&E Officers who are pioneering SHAPMoS operationalisation at the regional
level; to all HIV implementers who have submitted data; and to NERCHA management for
believing in the NERCHA M&E team and supporting SHAPMoS wholeheartedly.

3. TITLE:
Development and implementation of a national Multisectoral
output monitoring system (SHAPMoS) for HIV responses in
Swaziland: Challenges and lessons learned
1. Context
In 2004, an agreement was reached at international level that to manage the HIV
response at country level, three aspects needed to be in place: one national HIV
strategic and action plan, one national AIDS coordinating authority, and one national HIV
monitoring and evaluation system. These HIV response principles – commonly known as
the ‘Three Ones’ - were already at least partly in place in a number of countries before
this agreement was reached; the Three Ones agreement cemented these concepts and
focused attention on achieving them.
In Swaziland, a number of plans and strategic frameworks were developed since the
1990s to manage the HIV response (1st
of the Three Ones): the first national
Multisectoral HIV strategic plan (NSP) covered the period 2000 to 2005, and the second
NSP was launched in July 2006. The National Emergency Response Council on HIV and
AIDS (NERCHA) was established in 2003 to coordinate the HIV response (2nd
of the
Three Ones), and the National Multisectoral HIV monitoring and evaluation (M&E)
system was launched in October 2005. Therefore, by October 2005, Swaziland had
adhered, at least on paper, to the principles of the Three Ones.
2. Introduction to the National Multisectoral HIV M&E system (‘M&E system’) in
Swaziland
Swaziland’s paper presented during the SAMEA conference (28 – 30th
March 2007)
The goals of the M&E system is to track the spread of the epidemic, to track the
effectiveness and efficiency of the response to HIV in Swaziland, and to track the
inputs provided to enable the HIV response to be implemented. The M&E system is
therefore wholeheartedly linked to the NSP: the indicators in the M&E system have
been designed to measure the level of achievement of the objectives of the NSP (i.e. the
3rd
of the Three Ones measures the extent to which the 1st
of the Three Ones are being
achieved)

4. At the heart of the M&E system is the concept that a national set of impact, outcome
and output indicators are informed by a set of episodic data sources (for outcome and
impact indicators) and routine data sources (for output indicators). These data sources
are then analyzed to prepare information products (standard reports that the NERCHA
prepares on a routine basis), which are disseminated on a regular basis for stakeholders
to use it as they make decisions.
There are seven episodic data sources in the national HIV M&E system and three routine
data sources. The routine data sources are: financial data from NERCHA, routine data
about HIV services delivered at health facilities (medical HIV services), and routine
data about HIV services taking place in communities (non-medical HIV services).
As a central element of the decentralized and sectoral approach to coordinating HIV
services in Swaziland, NERCHA has developed a National Minimum Package of HIV
services (NMP). The NMP is the basic service delivery package for the HIV and AIDS
response in the country - it was derived from the priority strategies in the NSP, and
provides every region with a ‘checklist’ of which HIV services need to be included in its
annual district HIV action plan. It will be measured by the Swaziland HIV and AIDS
Programme Monitoring System (SHAPMoS). The NMP serves as the foundation for
implementation planning, resource mobilization and distribution as well as monitoring and
evaluation. The NMP is more fully defined in the body of this Strategic Management Plan.
3. What is SHAPMoS?
SHAPMoS – Swaziland’s HIV and AIDS Programme Monitoring System – is a national
routine data collection system that collects routine data about HIV services taking place
in communities and disaggregated by regions (non-medical HIV services) – it is one of the
10 data sources of the national HIV M&E system.
It only provides data about the outputs (immediate, short-term results) of HIV services
being delivered in the community (e.g. number of persons trained, number of peer
educators, number of OVC supported, etc.)
Swaziland’s paper presented during the SAMEA conference (28 – 30th
March 2007)

5. 4. How was SHAPMoS developed and implemented?
4.1 Development of SHAPMoS
A National M&E Capacity Assessment was conducted in 2004. This capacity
assessment showed that there is lack of M&E capacity in the country in general, and
that there were few practitioners in the country. Results showed that only 52% of
NGOs (which form the majority of HIV implementers) had received training that
involved the monitoring and evaluation of programmes. A recommendation was to
develop a nation-wide M&E system. After that, wide consultative meetings with
stakeholders in the response to HIV and AIDS (public, private, civil society sector)
were held in a bid to engage them in the development of a national M&E system.
NERCHA facilitated the establishment of M&E Technical Working Group (July 2003)
that was composed of key members from all different stakeholders (NGO, civil
society, faith based, CBO’s, private sector, and government). The committee was
responsible for the development of a national M&E Framework, which consisted of
Development of national core indicators (input, output, outcome & impact). On an
operational, level the committee had a mandate of advising on the implementation of
the National HIV and AIDS M&E System and review progress made with the
implementation of the NERCHA integrated annual work plan for monitoring and
evaluation. In addition, the committee had a responsibility of reviewing progress on
integrated work plan for M&E; provide input in content of M&E information products.
Other duties include review dissemination strategies; advise on progress of
SHAPMoS; provide guidance on M&E training needs; drive development of UNGASS
report; advice on information system for NERCHA databases; and guide research.
NERCHA, through the technical working group, facilitated the development of
SHAPMoS guidelines. The guidelines describe what data should be collected, how
data are to be collected; the responsibility of different stakeholders, as well as
benefits of the system to implementers and NERCHA (Swaziland as a whole).
Along with the guidelines was the development of a SHAPMoS training plan that
detailed the curriculum, duration of training, as well as target group within
organizations. These documents were piloted with stakeholders to determine if they
were realistic or not, and comments were incorporated into the final versions.
Swaziland’s paper presented during the SAMEA conference (28 – 30th
March 2007)

6. Since SHAPMoS is a paper-based system, a form was designed and piloted , and
approved by the technical working group, that is filled by implementing partners when
reporting on specific indicators on activities that they have implemented within a
quarter. The form was printed into a SHAPBooks to cover at least two years. The
SHAPBook designed had a self-carbonated form in triplicate: white, blue and green.
The main purpose is that an implementing partner would fill the form and send a copy
(white form) to the regional office, the blue form to a coordinating body and the
green form remaining. It also allows the sectors to get a feedback on activities
undertaken by their affiliates and compile sector reports that will inform sectoral
planning. The form submitted to regions is captured into an information system; and
transferred to NERCHA (national level) for report writing. The form that remains
the book is for the implementer to check what was submitted and track progress in
comparison with next quarters.
DATA FLOW FOR QUARTERLY SHAPMoS REPORTING
Swaziland’s paper presented during the SAMEA conference (28 – 30th
March 2007)
SHAPMoS Focal PERSON
(HIV IMPLEMENTERS)
NERCHA M&E Unit
Send the SHAPM oS form to
HIV Coordinating Body and to
ReM AC
Conduct data audits to 20% of
organisations that submitted
SHAPM oS Forms
Record the names of HIV
implementers that have submitted
SHAPM oS Forms
Prepare QSCR
Regional HIV/AIDS M&E
Coordinator (ReMAC)
Appoint / nominate the
SHAPM oS Focal Person
HIV COORDINATING BODY
Capture SHAPM oS data on
SHAPData
Verify completeness of
SHAPM oS Forms
Capture results of SHAPM oS data
audits on SHAPData
Send QSCR back to regions
for dissemination
Attend quarterly HIV and AIDS
feedback workshops
Record the names of HIV
implementers that submitted
SHAPM oS Forms
Record SHAPM oS data
Assist ReM AC with organising
quarterly HIV/AIDS workshops
Identify organisations that have
not reported on SHAPM oS or
that are struggling with
SHAPM oS reporting
Send SHAPData to NERCHA
M &E Unit
Disseminate QSC Report
Organise quarterly HIV and AIDS
feedback workshop in the region
Conduct HIV and AIDS feedback
workshop in the region
Send SHAPM oS data audit report
to NERCHA M &E Unit
Prepare SHAPM oS data audit
report
Prepare SHAPM oS Form
Attend quarterly HIV and AIDS
feedback workshops
Capture indicator scores in
CRIS database
Send an electronic copy of
indicator scores to CSO
Review data audit results
Provide names of these
organisations to Regional
HIV/AIDS M &E Coordinators
Conduct participatory supervision
visits

7. 4.2 Implementation of SHAPMoS
In 2006, NERCHA engaged in training of 15 cadres of local trainers and selected the
best 10 trainers. These were contracted to undertake nation-wide training of HIV
implementers in SHAPMoS. The remaining five trainers were reserved for future
trainings in order to meet demand. This was necessary to build capacity of local
trainers in the country as well as to have a pool of dedicated local trainers that could
be contracted /engaged as the need arose.
After training of trainers was completed, the NERCHA M&E department had to print
M&E documents (M&E operational plan, SHAPMoS guidelines, SHAPMoS training
curricula and SHAPMoS Books) to be used as part of training and reference
materials.
Even though it was outdated (some implementers have change address or they have
ceased to operate), NERCHA used a 2004 directory of HIV implementers to invite
organizations to attend training. NERCHA also used information provided by the
sectoral umbrella organizations, and information collected by MEASURE Evaluation,
to compile a list of who should be trained.
During the training, it emerged that most implementing partners did not have M&E
capacity. However, the training strategy was such that after the 3 days-training, a 1-
day mentorship visit to every trained implementer would be conducted. During the
visit, the trainer would formally introduce the system to the organization, assist in
appointment of the SHAPMoS focal person, and assist in developing daily record
keeping tools for the implementing partner. This exercise help in improving the image
of NERCHA, as implementing partners began to understand how national coordination
is undertaken, as well as importance thereof.
Swaziland’s paper presented during the SAMEA conference (28 – 30th
March 2007)
It is worth noting that when training commenced we had not fully conducted advocacy
sessions, and there were concerns raised by implementing partners that their head
of organizations were aware of SHAPMoS or the need to nominate a SHAPMOS focal
person in the organization, who would then be sent for training. This resulted in
NERCHA having to suspend all pending trainings to concentrate on advocacy sessions
through workshops with heads of agencies (private and public sector);
sectors/umbrella /coordinating organizations. Where possible, we also obtained
assistance to be included in agenda of other national forums (HIV stakeholders’

8. meetings) where SHAPMoS would be presented and this increasing advocacy reached.
In other words, SHAPMoS was integrated into the main organization.
NERCHA had to design communication materials that to enhance understanding
during, and after training. These include printing of posters and brochures with
short, specific messages such as role of SHAPMoS focal person, data flow in
SHAPMoS, and benefits of SHAPMoS to implementers.
– In view that some implementers were not trained and that reporting time
was due for those trained , communication through the mass media was
undertaken (more training & radio jingles to remind implementers to submit
reports) to reach as many implementers as possible.
– On the first reporting quarter (April – June 2007), the reporting rate was
35 %, and a total of 45 reports were received from organizations reporting
on SHAPMoS.
– On the second reporting quarter (July – September 2007) , reporting rate
of was at 62 % , and we received 113 forms from 60 (out of 97)
implementing partners
5. What were the major challenges with developing and implementing SHAPMoS?
5.1 Challenges during the development of SHAPMoS
Piloting was only done in a workshop format, resulting in challenges with the data element
definitions and changes to the SHAPMoS forms required.
Swaziland’s paper presented during the SAMEA conference (28 – 30th
March 2007)
Making sure that those NERCHA departments understood the relevance of SHAPMoS
for THEIR work the department had to present to all staff in the organization. In
addition, the department had to engage all heads of sections in programs to be involved
because previously there has been lack of mainstreaming of M&E within the functions of
NERCHA.

9. 5.2 Challenges during the implementation of SHAPMoS
5.2.1 Lack of funding and awareness of M&E
There has been lack of focus on and funding for development of HIV programme
monitoring systems (at national and implementer level. E.g. 7-10 % of budget devoted to
M&E). Most implementers do not have a budget for M&E.
It has emerged that lack of funding in organisations is due to low awareness of the need
for and importance of M&E. Some implementers think that M&E will reveal their
weaknesses.
5.2.2 Lack of M&E Capacity & staff
In 2004, CADRE (Centre for AIDS Development Research and Evaluation) conducted an
M&E capacity assessment in the country among HIV implementers, which found that
there were few practitioners in the country. Results showed that only 52% of NGOs
(which form the majority of HIV implementers) had received training that involved the
monitoring and evaluation of programmes. Some of the recommendations made were that
some training on basic M&E (including development of M&E plans) should be conducted.
Although NERCHA conducted such trainings, they were not enough for the whole country
and therefore as SHAPMoS was introduced it was necessary that a series of training
workshops were conducted. The trainings covered basic M&E concepts and zeroed on the
SHAPMoS concept.
During the training and mentorship, it was discovered that most implementing partners
have reporting requirements of donor-funded programmes and this created confusion as
to how it links with the routine national system. e.g. Global Fund requirements (funded
through NERCHA) and SHAPMoS reporting (SHAPMoS is supposed to replace all other
reporting requirements).
In addition, some organisations did not have an M&E reporting system, and when call for
training was made they ended up sending the wrong person for training.
5.2.3 Unrealistic expectations
Swaziland’s paper presented during the SAMEA conference (28 – 30th
March 2007)
As stated that SHAPMoS was introduced against a backdrop of limited M&E skills, which
therefore led to unrealistic expectations on what the systems could produce. People
expected the systems to come with finances under the pretext that it will enable them

10. to access further funding. In addition, they expected that this was going to be extra
job for reporting and as such, organisations expected NERCHA to fund employment of an
M&E person.
5.2.4 Lack of enthusiasm to report
The Swaziland National HIV and AIDS Policy and the National Strategic Plan provide a
mandate for NERCHA to request implementation to take place: it requires that all HIV
implementers report to NERCHA on activities that they carry out. It is difficult for
NERCHA to enforce this requirement without a legal instrument. In the absence of such
an instrument, NERCHA is engaging all the relevant sectors/umbrella organisations to
ensure that their affiliates take part in the operationalisation of SHAPMoS.
In addition, there have been negative Perceptions from implementers about the
NERCHA affecting the willingness to report. Implementing partners have viewed
NERCHA as a funder due to the dual role of being a principal recipient of Global Fund and
as a Coordination Authority. As such, an implementing partner who applied for funding
and was unsuccessful will tend to be unwilling to participate in reporting.
5.2.5 Lack of a best practice in M&E
This has poised a great challenge in terms of strategising as well as convincing people on
importance of M&E and information sharing. It has been evident that there is lack of
culture of data use for planning and decision-making.
Lastly, there was misunderstanding that SHAPMoS ‘will be expensive to implement’.
However, the truth is that if an organization has its own system, SHAPMoS reporting is
neither time consuming nor expensive
5.2.6 Lack of a list of HIV implementers –
There was no comprehensive list of implementers, and NERCHA had to put an
advertisement in the newspaper to collect additional names for training.
Swaziland’s paper presented during the SAMEA conference (28 – 30th
March 2007)

11. 6. What are the lessons learnt in terms of developing and implementing SHAPMoS-
type systems?
6.1 Lessons relating to the Development of SHAPMoS
Develop 2 separate training curricula – one for SHAPMoS reporting, one for
SHAPMoS management
1. Importance of advocacy and stakeholder participation-
Stakeholder involvement is an important factor in the implementation of such a
process. As stated in the development of the system we had to engage the
stakeholders from as early as the definition of the indicators up to the piloting of
the tools. This has led to buy in among the implementers and is recommended
should one decided on implementing such a programme.
Swaziland’s paper presented during the SAMEA conference (28 – 30th
March 2007)
2. Decentralization:
As we set out to operationalize the system, the government of Swaziland had just
developed a Decentralization Policy that was aimed at taking services to the
grassroots level and ensuring that the people at that level are able to make
decisions about the services. NERCHA employed Regional HIV Coordinators &
regional M&E officers to be responsible for working with implementers at regional
level. The routine data system was, therefore, aligned with the decentralization of
government services. Their duties include identifying of implementers advocate
for reporting, conducting mentorship receiving the forms from implementers and
analysis as well as the drafting of the regional report.
3. Paper-based approach-
The system is mainly paper based meaning all implementers are required to submit
their reports in hardcopy. This was to ensure that even grass-root level
organizations feel they are important enough to be covered and they contribute to
the system. This has favorable to most organizations because they lack computer
facilities. It is envisaged that as time goes on we would then proceed to computer
based reporting.

12. 4. Organizational structure in NERCHA
The M&E unit was operating under the Technical Department, and that had to be
changed. M&E had to be moved to Coordination of programs to form part of
planning / coordination unit in NERCHA, not under finance.
6.2 Lessons learnt during the implementation of SHAPMoS
1. Advocacy proved to be a very important factor in the implementation of the
system. At the onset, it was difficult to get implementers on the same
understanding.
a. Importance of doing advocacy with head of implementers/
organizations to get buy-in first before training is undertaken.
2. Mentorship.
a. This helped in aligning data collections tools with the national system.
b. This allows for close liaison with the implementers and to understand
their, challenges and strengths. This also serves as public relations
function for the NERCHA
3. Supervision, mentorship and data auditing
a. To ensure data quality the regional M&E officers have to conduct
data audits of at least 10 % of implementing partners who submitted
reports. The purpose of these visits is to support and mentor the HIV
implementers in M&E, to improve the response rate of reporting, and
to correlate the summary data in SHAPMoS with the raw data (daily
record keeping forms). In addition, the national SHAPMoS officers at
NERCHA should also support and mentor the regional M&E officers
(ReMACs), so that ReMAC’s feel comfortable with all their SHAPMoS
responsibilities.
Swaziland’s paper presented during the SAMEA conference (28 – 30th
March 2007)
b. During partnership meetings, the US Government indicated it would
support SHAPMoS in a number of ways: one of the ways was through
conducting four rounds of support visits to the regions for the first 4
quarters of SHAPMoS reporting. This support would be provided by a
USG partner, MEASURE Evaluation. During all rounds of visits, a
person from NERCHA accompanied the MEASURE colleague, so that
the national NERCHA staff gain experience in how to conduct

13. mentorship visits to the regions. Whereas the first round of
MEASURE support visits focused on supporting the ReMACs only,
MEASURE accompanied the ReMACs and the NERCHA staff to
supervision and data auditing visits to some HIV implementers during
January 2007.
c. The results first round of MEASURE-supported supervision visits to
HIV implementers were startling and very insightful: it revealed that
some implementers do not have all the files where information is
stored, but end up filling the forms from their memories. NERCHA is
working on improving tools and data filling at implementer’s level. The
lesson learnt here is that supervision and mentorship visits to all
levels of stakeholders involved in SHAPMoS – at the decentralized
government level (i.e. regions for Swaziland) and to HIV implementers
– is essential. The lesson is that these type of support visits are
essential. These visits should not only kick start the supervision and
data quality process itself, but should also act as opportunities to give
the national staff experience in how to carry out such visits.
d. Focal persons have also indicated that time spent on SHAPMoS is
“too much”. MEASURE Evaluation’s support visit indicated that one
organization’s SHAPMoS focal person takes 50% of her time to work
on SHAPMoS. However, this is because the organization did not have
an M&E system before. Therefore, the lesson here is that if
organizations have their own M&E systems, SHAPMoS do not take
long. If organizations do not have their own M&E systems, SHAPMoS
will take long in the beginning because the organization has to set up
their own M&E system first.
Swaziland’s paper presented during the SAMEA conference (28 – 30th
March 2007)

14. References:
1. Gorgens-Albino M. (2006/7) “GAMET Monitoring and Evaluation Missions
Reports to Swaziland”.
2. Kemerer V. (2007) “USG/MEASURE Evaluation Quarterly Regional
Capacity Building Visit- second series”, January & February 2007
3. National Emergency Response Council on HIV/AIDS (NERCHA)-
“Quarterly HIV Service Coverage Report – July to September 2006”.
4. National Emergency Response Council on HIV and AIDS “SHAPMoS
Guidelines” ,(2005)
5. National Emergency Response Council on HIV and AIDS “National
Multisectoral HIV and AIDS Monitoring and Evaluation System
Operational Plan”, Vol 1. (October 2005).
Swaziland’s paper presented during the SAMEA conference (28 – 30th
March 2007)
6. UNAIDS (2004) “Three Ones” Key Principles: Coordination of National
Responses to HIV and AIDS. Guiding Principles for National Authorities
and their partners.