M&E-The Ethiopian Experience MERG Meeting Geneva,Switzerland Oct. 25-26,2004 Dr. Wuleta Lemma, CDC/Tulane/WB M&E and Surveillance Advisor, HAPCO/MoH
Mar 27, 2015
M&E-The Ethiopian Experience
MERG MeetingGeneva,Switzerland
Oct. 25-26,2004
Dr. Wuleta Lemma, CDC/Tulane/WB
M&E and Surveillance Advisor, HAPCO/MoH
Outline
• Background
• M&E---Case Study
• After Bangkok
• New Development
Status of HIV/AIDS
Background-Ethiopia
• People living with HIV/AIDS ……..…………….….. 1.5 million
• Estimated percent of adults (15–49) infected with HIV ….. 4.4%
• Rural = 2.6%; Urban = 12.6%
• Cumulative deaths due to AIDS ………………..…... > 1 million
• Children infected and living with HIV ………………... 96,000
• Cumulative number of children orphaned by AIDS …... 540, 000
• Number of pregnant women living with HIV …………. 130,000
• Number of PLWHA needing ART ……………………. 245,000
Estimated and Projected Adult HIV Prevalence, Urban Ethiopia and Regions, 1982-2008
0
2
4
6
8
10
12
14
16
18
20
82 84 86 88 90 92 94 96 98 00 02 04 06 08
Year
Ethiopia
Tigray
Somali
Addis Ababa
SNNPR
Oromia
Harari
Gambella
Dire Dawa
Benishangul G.
Amhara
Afar
HIV
Pre
vale
nce
(%)
Weighted urban HIV prevalence: 12.5%
Estimated and Projected Adult HIV Prevalence, Rural Ethiopia and Regions, 1982-2008
0
1
2
3
4
5
6
7
82 84 86 88 90 92 94 96 98 00 02 04 06 08Year
Ethiopia
Tigray
Somali
SNNPR
Oromia
Harari
Gambella
Dire Dawa
Benishangul G.
Amhara
Afar
HIV
Pre
vale
nce
(%
)
: 2.8% (2004)
2004 prevalence range: 1.0% - 5.2%
Assumed start of rural HIV epidemic: 1984
Estimated and Projected HIV Incidence by Age Group, Ethiopia, 1982-2008
0.0
0.2
0.4
0.6
0.8
1.0
1.2
82 84 86 88 90 92 94 96 98 00 02 04 06 08Year
15-19 yrs
20-24 yrs
25-29 yrs
HIV
Inci
denc
e (%
)
Estimated HIV Population Size by Sex and Age, Ethiopia, 2003
0
20
40
60
80
100
120
140
160
180
0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65 +
Age Group (years)
Male
Female
No
. HIV
-po
sitiv
e (t
ho
usa
nd
s) No. HIV-pos, 2003:
Female: 810,000
Male: 650,000
Total: 1.5 million
M&E-The Ethiopia experience
Challenges to “One M&E System” Challenges to “One M&E System” No M&E unit at the national level Indicators not harmonized- Everybody have their own –
Ministries, Donors, CSO etc No unified data collection formats- Organizations have
their own different formats for similar indicators- “Same person ” at lower fills it all !!!!
Different report-Information Flow Limited not unified capacity building plan -- including
training and human capacity at all levels to role out a national M&E system
Non existence of an integrated data base (including HMIS)
Surveillance more developed than Program Monitoring Limited Budget for M&E Non-existent and disjointed Evaluation plan Infrastructure (road, telecommunication, networking, etc) varies from region to region
M&E-2003-present
• M&E Department at national ( 5 Staff ), Regional HAPCOs and district focal persons. M&E team includes MoH
• Secured budget (MAP,GF, PEPFAR and Others)
• Comprehensive training plan for all regions developed – ToT manual to follow
• Equipment (Computers & accessories) for all regional M&E Departments and all new ART sites- Take advantage of Woreda net
• National M&E Framework (with indicators, methods of data collection, Information flow, who collects what etc) after extensive consultation published in December 2003 and distributed to all Regions, NGOs, FBOs & Donors
M&E 2003-presentM&E 2003-present
National M&E Operational Plan with detail M&E Formats for all program activities
Assessment of National Financial Monitoring System of NHAPCO
Harmonization of GF requirement with national Indicators
Consolidated Surveillance and M&E resource mapping for MoH completed
Expanded Surveillance : 66 sites for 2003, almost twice the number sampled in 2001 (34 sentinel surveillance sites in 2001) first BSS done/report distributed nationwide (>27,000
sample) BBS-2 starting
After Bangkok
University Students
• 2003/4 (1996 ET) M&E data collected
• 2 University Students/ Region plus
• ~2 per District (606 district)
• Most regions completed
• Information includes at Federal level --Sector Ministries, Bilateral, Multilateral and NGOs
Example-FormsDonors and others support, currently active HIV/AIDS projects/programs (Information source: bilateral and multilateral organizations, NGOs etc)
Project budget HIV/AIDS Project title Project duration
Project area Allocated utilized Balance
Name of implementing agency/agencies
Infrastructure information Road to Zone town All weather asphalt All weather gravel Winter road Telephone Digital Manual (menubela) Telegram Electric Power From main source/hydraulic Generator
Module 01 Education
Module 02 Drug Administration and Control Authority (DACA)
Module 03 Ethiopian Red Cross Society (ERCS)
Module 04 FMoH, RHBS, WHOs and Facilities (Health)
Module 05 Other Government Offices
Module 06 Bilateral and Multilateral Organizations
Module 07 Civil Societies (NGOs, FBOs, CBOs, POs, etc.)
Module 08 Kebele HIV/AIDS Committee??
Module 09 Woreda HIV/AIDS Committee??
Module 10 Zonal HIV/AIDS Committee??
Module 11 Regional HAPCO
Module 12 National HAPCO
M&E Operational ManualM&E Operational Manual-12 -12 modules-meeting in Nov, 2004modules-meeting in Nov, 2004
(>150 people)(>150 people)
Other-Opportunity/Challenge
• Ethiopia approved for the largest GF (GF2+GF4 > $600M, PEPFAR around 50M/year)
• ~10-12% for M&E(inc. HMIS) and Surveillance/year• FMoH- HMIS (HMIS and M&E Advisory Committee
formed-Work stared)• LMIS• Lab Information system• Patient monitoring system• M&E National/Regional ToT training• Training on Medical Record
Home based Care
Health Posts
Tertiary Referral Hospitals ( 5)
HEP: basic general health care
Basic care, including pain and symptom relief
Regional / Zonal Hospital
District Hospital
District Hospital District Hospital
Health Center
ARTSpecialty care
Acute Illness CareHIV Counseling and Testing
Pain Management
Formal Health System Levels Service Components
Health CenterHealth Center
Health Center HIV counseling and testing, PMTCT, OI treatment and prophylaxis, TB dx , ART follow up, nutrition counseling and support, psychosocial support
[ pain management]
COMMUNITY
Uniformed Services
CS
W
Transporters
CHWs
The Network Model
New Development/Strategies
• HAPCO to Report to MoH• Implication on M&E not clear (assumed not much
as the National M&E Framework was accepted in SPM)
• Implication on structure not clear• Health Extension Workers (23,000 to be deployed
in 5 years). 2005 M&E training planned• Performance based District Block grants
Thanks!!!