NATIONAL HIV/AIDS/STI/TB COUNCIL NAC ZA MBIA NATIONAL HIV/AIDS/STI/TB MONITORING & EVALUATION PLAN 2006 - 2010 Sept 2006 National HIV/AIDS/STI/TB Council NATIONAL HIV/AIDS/STI/TB MONITORING AND EVALUATION PLAN 2006 - 2010 September 2006 This Publication is made possible by Support from Cooperating Partners ii National HIV/AIDS/STI/TB Monitoring & Evaluation Plan TABLE OF CONTENTS PREFACE ....................................................................IV ACKNOWLEDGEMENT..........................................................V LIST OF ABBREVIATIONS........................................................VI 1. INTRODUCTION.............................................................1 1.1 BACKGROUND.............................................................1 1.2 GLOBAL PERSPECTIVES ON M&E..............................................3 1.3 A THEORETICAL FRAMEWORK FOR M&E........................................4 2. NATIONAL M&E PLAN ........................................................6 2.1 OVERVIEW ................................................................6 2.2 DATA SOURCES ............................................................9 2.2.1 ACTIVITY REPORT FORM...................................................10 2.2.2 COHORT STUDY .........................................................12 2.2.3 EDUCATION MANAGEMENT INFORMATION SYSTEM............................12 2.2.4 SPECIAL EDUCATION SURVEY..............................................13 2.2.5 HEALTH MANAGEMENT INFORMATION SYSTEM................................13 2.2.6 NATIONAL COMPOSITE POLICY INDEX (NCPI) SURVEY ..........................14 2.2.7 SENTINEL SURVEILLANCE SURVEY .........................................15 2.2.8 UNAIDS FINANCIAL RESOURCE FLOWS SURVEY...............................16 2.2.9 WORKPLACE SURVEY.....................................................16 2.2.10 ZAMBIA DEMOGRAPHIC AND HEALTH SURVEY (ZDHS) .........................17 2.2.11 ZAMBIA HEALTH FACILITY SURVEY..........................................18 2.2.12. ZAMBIA SEXUAL BEHAVIOUR SURVEY (ZSBS).................................19 2.2.13 SPECIAL STUDIES.......................................................19 2.3 TIMEFRAME FOR IMPLEMENTATION OF DATA SOURCES ..........................20 2.4 INFORMATION PRODUCTS ..................................................20 2.4.1 OVERVIEW ..............................................................20 2.4.2 QUARTERLY SERVICE COVERAGE REPORT....................................21 2.4.3 ANNUAL HIV/AIDS M&E REPORT ............................................22 2.4.4 BIENNIAL UNGASS REPORT................................................23 3. CAPACITY BUILDING IN M&E ..................................................26 REFERENCES................................................................29 APPENDIX 1: FEATURES OF A GOOD M&E SYSTEM ..................................30 APPENDIX 2: NAC DATA FLOW WHEEL.............................................31 APPENDIX 3: LOGICAL FRAMEWORK, INDICATORS, BASELINES, TARGETS, DATA SOURCES......32 APPENDIX 4: UNGASS INDICATORS ..............................................38 APPENDIX 5: GFATM INDICATORS ................................................41 APPENDIX 6: ADDITIONAL INDICATORS ...........................................44 APPENDIX 7: NAC ACTIVITY REPORTING FORMS (FOR NGOS/FBOS/CBOS/LMS)..........50 APPENDIX 8: SIX-MONTHLY SERVICE COVERAGE REPORTING FORMAT......................60 ANNUAL HIV/AIDS M&E REPORT FORMAT ...................................63 APPENDIX 9: UNGASS REPORT FORMAT ..........................................70 APPENDIX 10: STAKEHOLDER RESPONSIBILITIES ...................................77 APPENDIX 11: TERMS OF REFERENCE OF M&E TECHNICAL WORKING GROUP ...........80 APPENDIX 12: LIST OF TWG MEMBERS WHO CONTRIBUTED TO THE M&E PLAN...........81 APPENDIX 13: INDICATOR DEFINITIONS ...........................................82 National HIV/AIDS/STI/TB Monitoring & Evaluation Plan iii PREFACE The HIV/AIDS epidemic is the most serious challenge faced by Zambia since independence. Zambia is one of the worst-affected countries in the entire world. About 15.6 percent of the population ages 15- 49 is currently infected and the prevalence has been near this level for the past decade. The consequence has been widespread death and massive suffering among the Zambian people. Consequently, the HIV/AIDS epidemic also brought about the mushrooming of street kids, a social problem which is threatening future generations and future national development prospects Government therefore put in place legislation through an Act (Act No. 10 of 2002, The National HIV/AIDS/STI/TB Council) of Parliament on how the country could wage successfully a “war” against the scourge. Under this act of parliament, the National Aids Council (NAC) was established, whose mandate is to coordinate, monitor and evaluate inputs, activities, outputs and impacts of HIV/AIDS programmes. Therefore, for NAC to effectively carry out its mandate and to realise the third one i.e. having one national M&E system, it needed a very robust M&E Plan that would provide necessary information for the effective coordination, monitoring and evaluation of the country's National response to HIV/AIDS. The first edition of the M&E Plan, 2002 2005 National HIV/AIDS/STI/TB M&E Plan worked towards developing a very robust M&E system as well as the harmonisation of various stakeholder M&E systems so as to feed into the national M&E system; a process set the set the third one in motion. National and global indicators from the national surveys were aligned with the national M&E system allowing easy reporting to international commitments such as UNGASS. This second edition of the National HIV/AIDS/STI/TB M&E Plan is therefore aimed at providing and further improving the means for NAC to monitor the national response and provide effective leadership in the fight against the pandemic. This M&E plan is also aimed at strengthening the third one in general as well as strengthening the sub-structure level M&E capacity to coordinated and monitor the activities under the various HIV/AIDS interventions. Seventy-eight (78) indicators have initially been identified as core set of measures to monitor the response. There are 4 indicators at impact level, 38 indicators under intensifying prevention (theme 1), 17 indicators under expanding treatment (theme 2), care and support, 5 indicators under mitigating socio-economic impact (theme 3), 8 indicators under strengthening the decentralised response and mainstreaming HIV and AIDS (theme 4), 3 indicators under improving the capacity for monitoring and evaluation by all partners (theme 5) and 3 indicators under Integrating Advocacy, Coordination and Leadership of the Multisectoral Response(theme 6) Hon. A. Cifire (MP) Minister of Health and Chairperson of the Cabinet Committee on HIV and AIDS. iv National HIV/AIDS/STI/TB Monitoring & Evaluation Plan ACKNOWLEDGEMENTS The success of developing the first edition of the National M&E Plan would not have been possible without the dedicated commitment of the following individuals: Dr. Buleti Nsemukila, Central Statistics Office, Dr. James Guwani, UNAIDS, Dr. Dean Phiri, Ministry of Health, Mr. Chibwe Lwamba, USAID/Zambia, Mr. Paul Chitengi, NAC, Mr. John Grove, CDC, and Ms. Chola Nakazwe Daka,Central Statistic Office. Other members of the NAC Technical Working Group who contributed significantly and whose tireless efforts are highly appreciated are listed in Appendix 12 NAC would also like to acknowledge the contributions of the members of the National Alliance of State and Territorial AIDS Directors (NASTAD) Zambia Team, listed in Appendix 12 in further reviewing and editing the national M&E Plan. We are indebted to the cooperating partners that have continued to provide support to NAC in the finalization of this first edition. We are equally indebted to the AIDS Task Forces and all Stakeholders in the fight against HIV/AIDS/STI/TB for their continued support for NAC, especially as we prepare to start implementing the second edition of the National HIV/AIDS/STI/TB M&E Plan. Without your tireless cooperation, all the effort that has gone into the development of this plan will be futile. We therefore also look forward to your continued support during the implementation of this plan. Dr. Mushaukwa Mukunyandela Chairperson National AIDS Council National HIV/AIDS/STI/TB Monitoring & Evaluation Plan v LIST OF ABBREVIATIONS AIDS Acquired Immune Deficiency Syndrome ARV Anti-retroviral treatment BCI Behavioural Change Intervention BSS Behavioural Surveillance Survey CBOH Central Board of Health CBO Community Based Organization CDC United States Centers for Disease Control and Prevention DFID Department for International Development DPO Disabled Persons Organizations FHI Family Health International ZDHS Zambia Demographic and Health Survey ZSBS Zambia Sexual Behaviour Survey GFATM Global Fund for AIDS, Tuberculosis, and Malaria HIV Human Immunodeficiency Virus HMIS Health Management Information System M&E Monitoring and Evaluation MAP Multi-Country AIDS Program MOH Ministry of Health NAC National AIDS Council NASTAD National Alliance of State and Territorial AIDS Directors NGO Non-governmental Organization NORAD Norwegian Agency for Development PLWHA Persons Living With HIV/AIDS PMTCT Prevention of Mother-to-Child Transmission SIDA Swedish International Development Agency STI Sexually Transmitted Infection UNAIDS Joint United Nations Programme on HIV/AIDS USAID United States Agency for International Development VCT Voluntary Testing and Counselling WHO World Health Organization ZNBTS Zambia National Blood Transfusion Services vi National HIV/AIDS/STI/TB Monitoring & Evaluation Plan 1. INTRODUCTION 1.1. BACKGROUND The first case of HIV/AIDS in Zambia was diagnosed in 1984. In 1986, the GRZ established the National AIDS Prevention and Control Program (NACP) with assistance from the WHO Global Program on HIV/AIDS. Several national plans were developed to face the challenge of curbing the emerging epidemic, with the first, the emergency short-term plan developed in 1987 to ensure safe blood and blood product supplies. Two Medium Term Plans, MTP 1 and MTP 2 covered the years 1988-1992 and 1994-1998 respectively. The National HIV/AIDS Intervention Strategic Plan and the National Monitoring and Evaluation Plan were developed for 2002 to 2005. These comprehensive plans focused on national level decision making and coordination. This plan and its counterpart, the Zambia HIV and AIDS Strategic framework, were updated and built upon the 2002 to 2005 plans. To coordinate and support the development, monitoring and evaluation of the multi-sectoral national response for the prevention and mitigation of HIV/AIDS, STI and TB, the National HIV/AIDS/STI/TB Council (NAC) was established by an act of Parliament in December 2002. NAC is composed of a Council and a Secretariat. The Council's 15 members are drawn from civil society (including religious organisations) and the public and private sectors. Furthermore, the National HIV/AIDS Policy was published in 2005 to provide the directive and mandate for the national response. For the current period, 2006 to 2010, the National HIV/AIDS Strategic Framework (NSF) was developed to prevent, halt and begin to reverse the spread of HIV and AIDS by 2010. The NSF defines six (6) themes which describe priority action areas: 1) Intensifying Prevention; 2) Expanding Treatment, Care and Support; 3) Mitigating the Socio-Economic Impact; 4) Strengthening Decentralized Response and Mainstreaming HIV and AIDS; 5) Improving the Monitoring of the Response; and 6) Integrating Advocacy and Coordination of the Multisectoral Response. Strategic objectives for each theme are outlined and described in Figure 1. Monitoring and evaluation (M&E) is increasingly becoming a key component of programme design and management. Governments, donor organizations and programme managers are making conscientious efforts to ensure active and iterative monitoring processes are in place at every stage of the project life cycle. Most countries implementing HIV/AIDS programmes have national monitoring frameworks and a set of indicators linked to the UNGASS Declaration of Commitment on HIV/AIDS, selected in consultation with a broad range of stakeholders. The absence of a common operational M&E framework in most countries has crippled efforts to increase capacity for quality assurance, national oversight and adequate use of M&E for policy adaptation. To facilitate effective coordination, the government, through NAC, developed a National HIV/AIDS M&E System to allow the country to track its progress towards the goals and objectives as stated in the National HIV/AIDS Strategic Framework (NSF). This document outlines the monitoring and evaluation framework, strategies and indicators to monitor the multisectoral response to HIV and AIDS in Zambia. National HIV/AIDS/STI/TB Monitoring & Evaluation Plan 1 This monitoring and evaluation plan recognizes that the fulfilment of NAC's coordination can only be as effective as the information it has on the implementation status for the various interventions as well as the impact and outcome of programmes. This has been factored into the monitoring framework which comprises outcome and impact indicators as well as programme performance output indicators with a strong linkage between the two levels of information reporting. DEVELOPMENT OF THE 2006-2010 M&E PLAN Participatory and qualitative methods were used in developing this M&E Plan. The use of the participatory approach was a critical feedback received from the development of the previous plan and as an important way of enhancing ownership and stakeholder buy-in, which are more likely to result in successful implementation of the 2006-2010 M&E Plan. 2 National HIV/AIDS/STI/TB Monitoring & Evaluation Plan The development involved in-depth consultation with all sectors and stakeholders from the national, provincial and district levels. Between May-November 2005, NAC held consultative meetings with the 72 DATFs and 9 PATFs to develop District and Provincial Monitoring and Evaluation Plans. The findings from the district and provincial consultations and themes and strategies from the district and provincial M &E plans informed the content of the National M&E framework. At the National Level, the NAC M&E TWG, with support from partners and stakeholders instituted the following processes: (cid:108)Desk reviews of various national and international M&E documents to ensure that the Zambia M&E Plan aligns to international M&E processes and plans (cid:108)Consultative meetings with key partners including the United Nations Agencies, US Government Agencies, International and Local NGOs, FBOs, Civil Society Organizations, PLWHAs, Private Sector, Academic Institutions and key government agencies (cid:108)Development of a draft 2006-2010 M&E Plan with list of core indicators (cid:108)Development of targets and baseline measurements for the indicators with a focus on Universal Access targets (cid:108)Presentation draft 2006-2010 M&E Plan with core indicators, targets and baseline data in a stakeholder forum for discussion and endorsement (cid:108)Finalization of the framework by incorporating the suggestions and recommendations that arise at the stakeholder forum This document therefore provides a summary of input from these processes and presents the second edition of Zambia's M&E operational plan. 1.2. GLOBAL PERSPECTIVES UNAIDS, World Bank and USAID among others have developed concepts and guidelines to facilitate and improve monitoring and evaluation practices in place in most countries. In Zambia the 2006-2010 HIV/AIDS Strategic Plan Framework clearly prioritizes effective M&E. The following principles have been identified as a basic requirement for forging stronger national M&E frameworks: Global-Level Alignment: Commitment should be made by partners at the global level to align their basic needs for M&E for the purpose of accountability for funds, and to agree on core elements of a country-level M&E system that can address these needs (minimally, timely completion of the NARFs and submission to DATFs in districts in which global partners are providing services). Core national system linked to the National HIV/AIDS Action Framework: Each National HIV/AIDS Action Framework should be accompanied by a core system for monitoring progress, including progress towards the realization of UNGASS and Millennium Development Goals (MDG), under the leadership of the national AIDS authority. Agreed Investment Strategies for Data Quality Control: National-level stakeholders within the National HIV/AIDS Action Framework should utilize the M&E system map completed in 2005 and continue to make assessments of existing M&E systems a priority. Stakeholders should agree on how systems can be improved and how a shared core system can be established to provide high-quality data for analyzing country performance. Investment in national capacity: National governments, AIDS authorities and the associated development partnerships must make the case for investing in essential capacity-building to meet national M&E needs. Production and dissemination of timely and useful reports can be powerful evidence to support system investment. 1.3. A THEORETICAL FRAMEWORK FOR M&E Confusion between Monitoring and Evaluation concepts is common. There is a simple distinction between these concepts in that Monitoring is the routine, regular assessment of National HIV/AIDS/STI/TB Monitoring & Evaluation Plan 3