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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. Outline. Background M&E---Case Study After Bangkok New Development. Status of HIV/AIDS . Background-Ethiopia.

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m e the ethiopian experience

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

outline
Outline
  • Background
  • M&E---Case Study
  • After Bangkok
  • New Development
background ethiopia
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
slide6

: 2.8% (2004)

2004 prevalence range: 1.0% - 5.2%

Assumed start of rural HIV epidemic: 1984

slide8

No. HIV-pos, 2003:

Female: 810,000

Male: 650,000

Total: 1.5 million

slide10

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-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
slide12

M&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 resourcemapping 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
university students
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
other opportunity challenge
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
slide18

The Network Model

Formal Health System Levels Service Components

ART

Specialty care

Acute Illness Care

HIV Counseling and Testing

Pain Management

Tertiary Referral Hospitals ( 5)

C

O

M

M

U

N

I

T

Y

Regional / Zonal Hospital

Uniformed Services

District Hospital

District Hospital

District Hospital

Health Center

HIV counseling and testing, PMTCT, OI treatment and prophylaxis, TB dx , ART follow up, nutrition counseling and support, psychosocial support [ pain management]

Health Center

Health Center

Health Center

Transporters

CSW

Health Posts

HEP: basic general health care

CHWs

Basic care, including pain and symptom relief

Home based Care

new development strategies
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
ad