Secure Health Programme Monitoring and Evaluation December 12, 2013 Violet Murunga

1. Secure Health Programme Monitoring and Evaluation December 12, 2013 Violet Murunga African Institute for Development Policy (AFIDEP) 1

2. Overview • What M&E is • Why M&E is important • Unpacking M&E • Frameworks • Indicators • Data sources • Progress reporting mechanism

3. Defining M&E M&E is the process by which data are collected and analyzed in order to provide information to policy makers and others with a better means for learning from past experience, improving service delivery, planning and allocating resources, and demonstrating results as part of accountability to key stakeholders..

4. M&E is an integral part of programme management

5. Results based Programming Within the development community there is a strong focus on results— hence the growing interest in M&E DFID is expecting robust information from the Secure Health Programme and other BCURE programmes to facilitate learning of effective capacity building models

6. Underlying principles for M&E Efficiency Effectiveness Relevance and appropriateness Combined, all these criteria enable judgment about whether the outputs and outcomes of the project are worth the costs of the inputs

7. Monitoring • Sometimes referred to as process evaluation as it focuses on the implementation process: • How well has the program been implemented? • How much does implementation vary from site to site? • Did the program benefit the intended people? At what cost?

8. Monitoring programme interventions • An ongoing, continuous process • Collection of data at multiple points throughout the program cycle, including at the beginning to provide a baseline • Track progress of activities against time, resources and targets set in order to ensure timely completion of the project

9. Evaluation Assessing how well the program activities have met expected objectives Assessing the extent to which changes in outcomes can be attributed to the program or intervention Impact evaluation is measuring the difference in the outcome of interest between having or not having the program or intervention

10. Evaluating a programme interventions data collection at the start of a programme (to provide a baseline) and again at the end, rather than at repeated intervals during program implementation a control or comparison group in order to measure whether the changes in outcomes can be attributed to the program a well-planned study design.

11. When should M&E Take Place M&E is a continuous process that occurs throughout the life of a program. It should be planned at the design stage of a program, with the time, money and personnel that will be required calculated and allocated in advance.

12. When should M&E Take Place • Monitoring should be conducted at every stage of the program, with data collected, analyzed and used on a continuous basis. • Evaluations are usually conducted at the end of programs. However, they should be planned for at the start because they rely on data collected throughout the program • baseline data is especially important.

13. M&E for Capacity Building interventions Capacity building (or capacity development) is a process that improves the ability of a person, group, organization, or system to meet objectives or to perform better. Performance is a result or set of results that represent productivity and competence related to an established objective, goal or standard. Capacity Building is Behavior Change and depends on the context

14. M&E for Capacity building interventions Unlike other aspects of health-related monitoring and evaluation (M&E), capacity measurement is not supported by a comprehensive history of theory and practice. Thus, capacity measurement in the health sector is both new and experimental.

15. M&E for Capacity building interventions There are intrinsic challenges to measuring capacity that are reflected in the concept and role of capacity itself. For example, capacity derives its relevance from the contribution it makes to performance. There are endless areas where performance is required in the health sector, and an equally wide range of possible capacity variables that influence performance.

16. M&E for Capacity building interventions In addition, contextual factors (or factors outside the control of most health sector actors ) can have a strong influence on capacity or the desired outcome of capacity- building intervention. These and other characteristics of capacity and capacity building explain why there are no gold standards for capacity-building M&E.

17. Conceptual framework for capacity in the health sector Understanding capacity and performance of individuals and organizations demands careful consideration of their role in larger systems, and their relationships within those systems” (Morgan, 1997).

18. What is different about M&E for Capacity building interventions Traditionally, monitoring and evaluation focuses more on measuring performance and less on the way performance is achieved or sustained. capacity-building M&E focuses fundamentally on processes (e.g., building alliances, mobilizing communities, decentralized planning, learning) and other qualitative aspects of individual or organizational change (e.g., motivation to perform) that contribute to better performance. Consequently, M&E of capacity building often seeks to capture actions or results that often are not easily measured.

19. What is different about M&E for Capacity building interventions In capacity-building intervention, the process and result of capacity building becomes the “intermediate outcome” that is expected to lead eventually to improved and sustained performance. Exploring the links between changes in capacity and changes in performance is therefore key. However, it often involves considerable speculation about the capacity needed to achieve those goals.

20. What is different about M&E for Capacity building interventions One of the main gaps in the knowledge base that informs capacity measurement is the lack of common understanding of the relationship between capacity and performance. Little is known about what elements or combinations of elements of capacity are critical to performance. Moreover, there is considerable variation in what constitutes “adequate” performance.

21. Implications for M&E in capacity building interventions Broadening the concept of capacity building beyond technical skills and resources and thinking about capacity building in terms of multiple levels and influences helps planners and evaluators to hypothesize about what aspects of capacity are critical to performance and to define entry points for targeting capacity-building interventions.

22. Implications for M&E in capacity building interventions Need for a clear understanding of the interaction among different aspects of capacity and how they work (or fail to) work together, particularly with respect to individual and organizational behavior. These types of variables may require additional interpretation to ensure a complete grasp of capacity and its role in improving performance.

23. Implications for M&E in capacity building interventions The extent of experience is so limited that, at this stage, capacity measurement is considered to be an art rather than a science. Evaluators must therefore approach M&E of capacity building interventions with a willingness to test strategies and share what they have learned in order to build a body of theory and practice.

24. Despite the challenges • M&E for capacity building is important for answering the following questions • the process of capacity change (how capacity building takes place), • capacity as an intermediate step toward performance (what elements of capacity are needed to ensure adequate performance), • capacity as an outcome (whether capacity building has improved capacity)

25. Some tools, methods and approaches Performance indicators The logical framework approach Theory-based evaluation Formal surveys Rapid appraisal methods Participatory methods Public expenditure tracking surveys Cost-benefit and cost-effectiveness analysis Impact evaluation

26. Performance indicators measures of inputs, processes, outputs, outcomes, and impacts Should be supported with sound data collection— perhaps involving formal surveys—analysis and reporting, to enable managers to track progress, demonstrate results, and take corrective action to improve service delivery Defining indicators should be a participatory activity to generate buy in for use of results for decision making

27. Types of performance indicators • Indicators of program inputs measure the specific resources that go into carrying out a project or program • Indicators of outputs measure the immediate results obtained by the program • Indicators of outcomes measure whether the outcome changed in the desired direction and whether this change signifies program “success” (impact evaluation)

28. Types of performance indicators • Indicators can be either be quantitative or qualitative. • Quantitative indicators are numeric and are presented as numbers or percentages. • Qualitative indicators are descriptive observations: Used to supplement or complement the numbers and percentages by adding a richness of information about the context in which the program has been operating e.g. “availability of institutional guidelines for sourcing, appraising, analyzing and using research”

29. Use of performance indicators Setting performance targets and assessing progress toward achieving them. Identifying problems via an early warning system to allow corrective action to be taken. Indicating whether an in-depth evaluation or review is needed.

30. Advantages of performance indicators Effective means to measure progress toward objectives. Facilitates benchmarking comparisons between different organizational units, districts, and over time.

31. Disadvantages or performance indicators Poorly defined indicators are not good measures of success. Tendency to define too many indicators, or those without accessible data sources, making system costly, impractical, and likely to be underutilized. Often a trade-off between picking the optimal or desired indicators and having to accept the indicators which can be measured using existing data

32. Characteristics of a good indicator produce the same results when used repeatedly to measure the same condition or event; measure only the condition or event it is intended to measure; reflect changes in the state or condition over time; represent reasonable measurement costs; and be defined in clear and unambiguous terms. Be consistent with international standards and other reporting requirements.

33. Common challenges to selecting indicators • An indicator that • the program activities cannot affect • Too vague • Relies on unavailable data • Does not accurately represent the desired outcome

34. General guidelines for the selection of indicators • Indicators requiring data that can realistically be collected with the resources available. • At least one or two indicators (ideally, from different data sources) per key activity or result. • At least one indicator for each core activity (e.g., training event, social marketing message, etc.). • No more than 8-10 indicators per area of significant program focus. • Use a mix of data collection sources whenever possible.

35. Logical Framework Approach Helps to clarify objectives of any project, program, or policy. Aids in the identification of the expected causal links—the “program logic”—in the following results chain: inputs, processes, outputs (including coverage or “reach” across beneficiary groups), outcomes, and impact.

36. Logical Framework Approach Leads to the identification of performance indicators at each stage in this chain, as well as risks which might impede the attainment of the objectives. Also a vehicle for engaging partners in clarifying objectives and designing activities. During implementation the LogFrame serves as a useful tool to review progress and take corrective action.

37. Use of Logical Frameworks Improving quality of project and program designs—by requiring the specification of clear objectives, the use of performance indicators, and assessment of risks. Summarizing design of complex activities. Assisting the preparation of detailed operational plans. Providing objective basis for activity review, monitoring, and evaluation.

38. Advantages of Logical Frameworks Ensures that decision-makers ask fundamental questions and analyze assumptions and risks. Engages stakeholders in the planning and monitoring process. When used dynamically, it is an effective management tool to guide implementation, monitoring and evaluation.

39. Disadvantages of Logical Frameworks If managed rigidly, stifles creativity and innovation. If not updated during implementation, it can be a static tool that does not reflect changing conditions. Training and follow-up are often required.

40. Logframes

41. How comfortable are you in working with logical frameworks? What’s a logical framework? I’ve heard of them but they scare me a bit I have used them a bit but could do with some help I am pretty comfortable using logical frameworks I have a personal logframe which I use to plan out my entire life

42. How do Theories of Change and Logframes relate to each other? Theories of change are a bit like hippies – they are free and creative… Gaudiramone, flikr …and Logframes are their slightly nerdy cousin! RochelleHartman, flikr

43. Input Output Outcome Impact

44. Tips for better logframes • Keep the language SIMPLE and CONCISE • Make sure the indicators are measurable – and where possible objective • The indicator should tell you what you will measure – the milestone and target should flow from this • Impacts should be high level and there is no need to include targets and milestones

45. Ben’s birthday

47. Theory-based evaluation Has similarities to the LogFrame approach but allows a much more in-depth understanding of the workings of a program or activity—the “program theory” or “program logic.” Does not assume simple linear cause-and effect relationships

48. Theory-based evaluation By mapping out the determining or causal factors judged important for success, and how they might interact, it can then be decided which steps should be monitored as the program develops, to see how well they are in fact borne out. This allows the critical success factors to be identified. And where the data show these factors have not been achieved, a reasonable conclusion is that the program is less likely to be successful in achieving its objectives.

49. Use of Theory-based evaluation Mapping design of complex activities. Improving planning and management.

50. Advantages of theory-based evaluation • Provides early feedback about what is or is not working, and why. • Allows early correction of problems as soon as they emerge. • Assists identification of unintended side-effects of the program. • Helps in prioritizing which issues to investigate in greater depth, perhaps using more focused data collection or more sophisticated M&E techniques. • Provides basis to assess the likely impacts of programs.