STRENGTHENING COUNTRY M&E SYSTEM FOR AMREF UGANDA PROJECT REPORT AUGUST 2012

Transcription

1 STRENGTHENING COUNTRY M&E SYSTEM FOR AMREF UGANDA PROJECT REPORT AUGUST 2012 BY Asiimwe Elizabeth Margret Ojok Humphrey Morrish Medium term fellow 2012

2 STRENGTHENING COUNTRY M&E SYSTEM FOR AMREF UGANDA PROJECT REPORT AUGUST 2012 BY Asiimwe Elizabeth Margret: MPhil. Comparative and International Education; B.A Education Ojok Humphrey Morrish: Bachelor of Business administration; PGD Project Planning & management. OCTOBER ii

3 Table of Contents Table of Contents... iii Acronyms... iv List of Figures... v Declaration... vi 1. Introduction and Background Literature review Statement of the problem Justification/Rationale: Figure 1:Conceptual Framework AMREF M&E SYSTEM The project Project Outcomes Lessons learnt Challenges Summary, conclusions and recommendations Appendix iii

4 Acronyms AMREF African Medical and Research Foundation CDC HIV/AIDS HMIS META M&E NGO SDs SMT TB VHTs Centre for Disease Control Human Immune Deficiency Syndrome Health Management Information Systems Monitoring and Evaluation Technical Assistance Monitoring and Evaluation Non governmental organization Strategic Direction Senior Management Team Tuberculosis Village Health Teams iv

5 List of Figures Figure 1:Conceptual Framework AMREF M&E SYSTEM Figure 2: Number of projects with M&E tools. Figure 3: Fellow lead M&E technical working group HIV, TB and Malaria to review and refine projects M&E plans and generate country level indicators. Figure 4: Pictures of AMREF M&E teams Figure 5: The director of AMREF M&E presenting the database to AMREF Uganda M&E team in Uganda in Gulu v

6 Declaration vi

7 1. Introduction and Background The African Medical and Research Foundation (AMREF) is a health development organization founded in 1957 by three surgeons as the Flying Doctors Service of East Africa, laying the foundation for what is now one of the continent s leading health development and research organizations. AMREF's vision is for lasting health change in Africa: communities with the knowledge, skills and means to maintain their good health and break the cycle of poor health and poverty Headquartered in Nairobi Kenya, today, AMREF implements its projects through country programmes in Kenya, Ethiopia, Uganda, Tanzania, Senegal, South Sudan and South Africa. Training and consulting support are provided to an additional 30 African countries In Uganda, AMREF has been working since the mid 1980s, registered as a Ugandan NGO in AMREF programmes focus on the health of women and children. AMREF is concerned with increasing skills for caretakers of mothers so that they have professional care before, during and after childbirth; prevention and treatment of cervical cancer, and proper management of childhood illnesses. AMREF s main areas of intervention are maternal and child health; HIV/AIDS and Tuberculosis; safe water and sanitation; malaria; and essential clinical care. Monitoring and evaluation was not significant on AMREFs agenda for years. Many programmes were implemented in various parts of Africa without a strong emphasis on M&E. In Uganda the need for M&E has recently grown to be recognized. Before the award of the CDC Grant on scaling up of comprehensive HIV/AIDS prevention program in 2010, the META project of Makerere University school of public health CDC conducted AMREFs M&E capacity assessment that highlighted the strengths and weaknesses of AMREF M&E system, upon which the fellows, based to seek and strengthen the M&E system for the organization. 1

8 2 Literature review Monitoring and evaluation as a management strategy has been widely tried by governments and civil society organizations to guarantee quality of service (Wholey, et al, 2004). M&E adds value to effectiveness of processes and regulatory frameworks particularly with regard to achieving results. (The World Bank Group, 2009). Despite attempts and resources governments and partners have invested in M&E, performance levels have remained low in regard to quality assurance and achievement of set targets. (Hovland, 2007). The World Bank analysis of sector wide approaches in 6 developing countries identified neglect of M&E systems, designs and capacity building as a major challenge. The analysis revealed that there was neglect of M&E capacity building and use as compared to the strong emphasis on procurement, disbursement and financial management. The report said that it has resulted in an insufficient results focus. Although AMREF recognized the need for M&E, support for this function was still limited to the projects whose donors emphasized the need for M&E. this limited the capacity within the organization and the accrued benefits. 3. Statement of the problem Organizational structure for M&E: Until the end of 2010, the existing monitoring and evaluation system in AMREF Uganda was largely project specific based on donor demand. The institutional structure for M&E was weak and M&E was in project whose donor placed emphasis on having an M&E staff. The mandates and authority to carry out the full function of M&E was not clearly defined and scattered across projects with project managers fully responsible for M&E in their projects. M&E in projects was mainly carried out to meet donor needs for statistical information, reports and accountability for funds. M&E capacity: only 04 out of 20 projects then had technical monitoring and evaluation staff. Only 13 out of 128 project technical staff ever had training of 2

9 some sort on M&E, majority of these staffs were at management level. Other project staff did not have any training on M&E. M&E Planning: M&E across projects was seen as statistical task and an external obligation to meet donor needs. As a result monitoring and evaluation was mainly considered baseline assessment, midterm evaluation and end of project evaluations conducted by external consultants. There was no clear plan to manage and carry out regular M&E activities. Only 4 out of 20 projects had existing M&E plans with inadequate resources allocated/ planned to carry out the planned M&E activities. Costed work plan and budget: All projects had budgets and result based work plan detailing activities and cost. However, activities and cost were not adequately linked with outputs, outcomes and impact. Executions of work plans were difficult as project activities were not logically scheduled. At times activities that provide input for another activity were implemented at the same time thus providing difficulty in terms of accountability and documentation of process, outcomes or results in reports. Data management: All the 20 AMREF projects implementing in the country program had some sort of a database but in various formats. However, some of the databases contained data that were not relevant for the project planning let alone reporting of outcomes/ results. Information in the databases ranged from number of training conducted, boreholes drilled etc but left out people using the borehole, people trained etc. this was because there was no clear planning for data needs which led to inadequate tools for data collection. On outcome reporting, 80% of the projects relied on government data from health facilities and VHTs which has wider coverage sometimes than the projects. This made it difficult to collect data required by the projects for M&E purposes that did not exist on the HMIS forms. 3

10 4. Justification/Rationale: Although AMREF Uganda had a functional program department at a country level, there was no central M&E unit. M&E was conducted in an ad hock manner incapable of providing the organization with the system required to ably measure, track and report progress towards set targets, plans or achievements of its strategic actions defined in its country strategic plan and Business Plan Establishing a coordination mechanism for M&E activities; developing a unified guiding framework, harmonizing the different project M&E systems, developing and implementing a central M&E data management system will serve to increase AMREFs ability to answer to the increasing demand for accurate timely and reliable information within the country programme in order to meet the demand for accountability for resources advanced to AMREF for its work and enhance programme management, learning and evaluation. 4

11 5. Figure 1:Conceptual Framework AMREF M&E SYSTEM 5

12 6. The project Overall objective: The overall goal of the project was to strengthen the country monitoring and evaluation system for AMREF Uganda. Specific objectives; I. To conduct a situational analysis to establish and document current M&E system II. III. To develop country M&E framework/plan To develop and implement an electronic web based M&E database 1. Methodology: A participatory approach was adopted in the entire project implementation involving AMREF global M&E head, senior management team (SMT) AMREF Uganda, middle management staff and project teams to own and enforce roll out. AMREF global M&E head provided technical support to ensure strategic alignment of the country M&E system to the one AMREF Business Plan M&E system. AMREF Uganda s SMT was involved in order to own the system and approve rollout process, whereas the involvement of the project team was to ensure participation, ownership and clear understanding to be able to directly use the system. To aid this process, a multilevel stakeholders project teams with representation of all the above categories was instituted. The activities and processes are further described below. Activities are presented in a chronological order specifying the methods employed for each activity. The project was planned and implemented through three phases as bulleted below; Phase One: Situation Analysis 6

13 Phase Two: Develop Country M&E Framework and Plan Phase Three: Develop Country M&E Database Phase One: Situation Analysis [3 months]. This phase focused on identifying the issue to be addressed by the project; formation of the project team and review of current state of M&E system in AMREF Uganda. Formation of the project teams As already stated, a 25 member team with representation from AMREF strategic/senior management team (SMT), programme management team, field staff from seven project offices was formed Gulu, Luwero, Kitgum, Pader, Apac, Nakasongola, and Kampala central including country office. SMT included AMREF country director, deputy country director, human resource manager with a co opted member, the AMREF global M&E head; programme management team included all programme and project managers; field staff included M&E technical staff project M&E managers, Officers and selected project technical officers. In a one day orientation workshop with the project teams, the fellowship project was communicated and each member was asked to list what they thought was the state of M&E in AMREF. A list of views was generated and analyzed. 75% of participants thought that AMREF Uganda M&E system was very weak especially in data collection, reporting and use, 10% equated AMREF Uganda M&E as non functional and 15% thought that AMREF Uganda M&E system is mixed and difficult to understand so they do not know what to say about it. Based on this findings the team was asked to suggest what they think should be the focus of the fellowship project if it is to help improve M&E in AMREF. 95% of participants suggested training, development of tools and harmonization of different projects systems. 5% wanted development of project databases. These findings reflected the dire need to strengthen the national M&E system for 7

14 AMREF by setting up the organizations framework and structure for M&E, data management system followed by capacity building. Through brainstorming session, it was decided that the medium term fellows would carry out the project of strengthening the entire AMREF Uganda M&E system. The deputy country director pledged full support of the country programme in ensuring that the project improves the M&E system of AMREF Uganda. A detailed plan was then developed. Four M&E technical working groups were formed with a focus on 4 of AMREF s strategic directions. Terms of reference developed and approved for each technical working group, activities identified and action plan with budget develop and approved. The technical working groups include: 1. Maternal and child health; 2. HIV/AIDS, TB and Malaria; 3. Water, sanitation and hygiene and, 4. Clinical and diagnostic. Review of existing Project M&E systems: Following the formation of the M&E technical working group, a two day workshop was held in Kampala in May 2012 at AMREF boardroom with the project teams to identify key areas of focus for each of the 17 projects. Each project manager presented their project M&E strategy highlighting key components of the strategy. Using a checklist, each project was assessed for the following strategy components; 1) result framework; 2) a log frame; 3) an M&E plan for data collection and analysis, covering baseline, ongoing monitoring and evaluation; 4) reporting charts and formats; 5) feedback and review plan; 6) capacity building plan; 7) implementation work plan and 8) the budget. The outcome of the assessment is indicated in the chat below in figure 2: 8

15 Figure 2. In a breakout session, the M&E technical working groups reviewed project M&E tools, identified weaknesses and made recommendations for improvements for each project under their technical direction/ working groups. HIV, TB and Malaria (n=7); Maternal and Child Health (n=); Water, Sanitation and Hygiene (n=4) and Clinical & Diagnostic (n=3). Within a period of two months, each technical working group supported the projects to harmonize M&E structures, functions and processes in all 23 projects currently implementing in the country programme. A draft individual project tools were prepared for review and a draft list of country level indicators developed for review in the meeting that followed in May 2012 in Gulu. Development of country M&E plan/harmonization of project M&E systems: A three day workshop to develop country M&E framework and plan was held in May 2012 in Gulu. The AMREF M&E director at AMREF headquarters on behalf of the institutional supervisor attended the workshop and guided the team 9

16 Figure 3: Fellow lead M&E technical working group HIV, TB and Malaria to review and refine projects M&E plans and generate country level indicators. in refining and harmonizing project M&E plans. Project M&E plans were reviewed and the draft country M&E plan generated. 19 participants attended the workshop. In breakout sessions, workshop participants worked in teams to identify Indicators across projects addressing same AMREF Strategic Directions (SDs). The identified indicators were classified from Impact, Intermediate Outcomes, Short term Outcomes and Outputs levels. Data sources and data collection tools were identified for each indicator to ensure that all projects use harmonized data collection tools. The AMREF M&E director then provided technical inputs on the framework developed, supporting the team to define results and link to different levels of AMREF results framework (in appendix) based on AMREF s intervention strategies outlined in the business plan M&E Plan. A draft M&E plan was then compiled for review by the team and subsequent rollout in a meeting held in August 2012 in Luwero. Refining and building consensus for Country M&E framework and plan: The workshop to refine and build consensus on AMREF Uganda country M&E plan was held in Luwero and Kampala in August The participants included all AMREF Uganda M&E staff, the project managers and M&E managers from AMREF Kenya, Tanzania, South Africa, South Sudan, Ethiopia and Senegal. The then AMREF acting country director, acting deputy country director, Finance Manager and Administration Manager also participated. The meeting was chaired by AMREF M&E director who sits in Nairobi Kenya and the AMREFM&E medium term fellows. During this period, the team visited project implementation sites in Nakasongola and Luwero and in Kampala, the Kampala urban projects in Kawempe division to understand the project contexts properly, ascertain that the developed tools would adequately capture the data 10

17 needed as well as inform the other project teams on the rollout of the M&E system. The AMREF (Africa) M&E managers participated in the roll out to learn from Uganda the roll out of the country M&E system but also to give external support and oversight. To many of them it was a great learning and sharing experience as explained in the mails that followed the workshop. Figure 4: Pictures of AMREF M&E teams M&E system rollout meeting in AMREF Luwero workshop M&E fellows review group work Tanzania, Ethiopia M&E managers and & AMREF Database Officer Review Uganda s M&E Plan Luwero M&E team in a field visit to Kawempe Project 11 AMREF Uganda hosts all AMREF M&E Managers to share the roll out of AMREF M&E system led by AMREF M&E fellows

18 Phase Three: Develop Country M&E Database Phase Three: Develop and Implement AMREF Country Information Management System (ACIMS a web based Database). This phase was planned to be implemented after the fellowship project. However, the plan was overtaken by the AMREF HQ proposing to develop a global database for all AMREF programmes. An AMREF global M&E database was developed and follows the full specification of the AMREF central M&E system. Therefore, there was no need of developing additional database. The database is already functional and all AMREF projects are already using the database which takes care of all AMREF programs. Figure 5: The director of AMREF M&E presenting the database to AMREF Uganda M&E team in Uganda in Gulu During the development of the AMREF database, the AMREF fellows were consulted and contributed significantly to the database development process. Considering that this is a comprehensive database, reviews and updates are continuous and the meetings held in Uganda to develop the country M&E system contributed significantly in providing feedback and in some cases having the 12

19 database designer who also attended the Luwero meeting update and incorporate the suggested amendments immediately. 7. Project Outcomes Strengthening the country M&E system for AMREF Uganda project was expected to have five planned outcomes; Documented Country and projects M&E Plans. Improved tracking and reporting, data quality and information use within AMREF Uganda. Increased use of data from routine data sources and surveys for program and policy decision making. Increased donor/ stakeholders satisfaction and confidence. Improved M&E skills of project staff Documented Country and projects M&E Plans: A documented AMREF country M&E plan is in place, with project M&E plans well aligned and fitting into it. The AMREF M&E plan was designed is in line with the National development plan, the AMREF strategic and business plans. AMREF Uganda has already realized improved reporting. There is a report tracking system inbuilt into the AMREF database. An analysis made by the AMREF database administrator showed that AMREF Uganda had been excellent in reporting and use of the established AMREF database. Report in appendix 2. Increasing the use of data is a process, but there are indicators that the data is being used for purposes beyond reporting as was previously the case. AMREF Uganda was able to write 8 abstracts that were accepted and presented in the first Bieannual AMREF conference in April Two of the abstracts written by one of the fellows were selected for two other conferences; the integration conference held in Nairobi in September 2012 and for the 13

20 American Society for Tropical Medicine and Hygiene to be held in Georgia Atlanta in November In all the field offices, there are boards and talking walls displaying of data and other information that shows performance by the different projects for staff use and other stakeholders can easily access this information. Increased donor/ stakeholders satisfaction and confidence. With improved data collection reporting and other forms of sharing, there is bound to be satisfaction for the different stakeholders. The chief executive officer for AMREF Netherlands expressed her excitement on the improvement of AMREF Uganda s M&E system. In her debrief on the 1 st October 2012 in Luwero after a field visit, she said that she was impressed by the fact that AMREF Uganda had come up with harmonized and focused indicators as well as an M&E system that will generate more reliable information for the organization. Donor and stakeholder satisfaction is also a process outcome and therefore, it will be tracked overtime, even after the fellowship. Improved M&E skills of project staff; as already mentioned above, about 25 staff were fully involved in designing the M&E system for AMREF Uganda. This was an important experience for the team. It was a step in building the capacity of staff in development of M&E plans, data collection tools, indicators and the general system. There is increased knowledge about M&E across AMREF Uganda. All 23 projects currently implementing in Uganda have developed and are using key elements of an M&E system to guide project operations design and M&E. These include result framework, log frame, M&E plan, reporting chart and formats, data collection templates, feedback plan, result work plan and budget. An example of a performance monitoring plan for the Scaling up of comprehensive HIV prevention project is attached in the appendix 1. This has increased projects ability to collect and report outcomes or results being achieved by the projects. There is also a plan for training a number of other project officers in M&E in order to create a strong base and M&E culture in the organization. 14

21 The Unplanned and unintended outcome. Strengthening the country M&E system for AMREF Uganda project was expected to yield five planned outcomes as mentioned above. However, the project realized more outcomes not initially planned as described below; An M&E unit was established with clear structure, mandate and authority. One of the M&E fellows was recruited to become the country M&E manager to coordinate all country M&E activities. The M&E unit organgram is presented in appendix 3 8. Lessons learnt In the process of implementing the Strengthening of the country M&E system for AMREF Uganda project some lessons were learnt. Team work made the process of development faster. All the project team members involved were able to identify the M&E weaknesses in the country program as well as projects and also propose measures of improvement. The same team members were involved throughout the development of the M&E system which strengthened ownership and implementation. The implementation process of any project may not necessarily follow the plan laid down at the planning stage. Whereas the fellows had planned to implement two phases of their plan during the fellowship time, AMREF headquarter was influenced and developed a database for all AMREF. This therefore meant that AMREF Uganda could no longer develop a parallel database but get integrated into the one AMREF database. It takes a serious team to follow up identified issues and have them worked on. A team from META, identified and communicated the M&E gap in AMREF Uganda. Although an M&E manager for the CDC project for whose analysis was made was recruited, still there was no country 15

22 M&E department and system. The courage of the two M&E fellows to follow up the META recommendations has influenced the organization to establish and operationalize an M&E unit. Even the youngest systems would provide lessons to be shared. In August 2012, all M&E managers from Africa came to Uganda to share and learn from the rollout of AMREF Uganda s M&E system. They also provided technical support and oversight which made the country M&E system improved further. Indicator harmonization is key where you have several projects that are funded by different donors with different interests, but it is also a long, intensive process. It has to ensure that all the donor, project, country and national needs are catered for thus the need involve multiple stakeholders at country level to come up with standard indicators with full consideration of data collection implication and cost. 9. Challenges Busy schedules of project teams making it difficult to arrange meetings and workshops. Although several workshops were held, it was not easy to find dates when all the teams would be completely free to dedicate the required time to meet and work. Some of the work was therefore drafted prior to the meetings and then harmonized and consensus built during the meetings. Delayed release of funds; funds from the school of public health were released later than anticipated. This delayed the commencement of some activities. However, AMREF Uganda provided some financial support which helped in the start up of the project. M&E is often last in, first out when budgets are tight. Although the m&e unit has been established, its funding is still limited. At project level, M&E activities still receive the least budgets and when projects are constrained with funds, it s the M&E activities that are encroached on to bridge the gaps. 16

23 The country M&E manager is overloaded with work. Being the only person in the country office unit he has to balance immediate reporting responsibilities, proposal development with longer term M&E system strengthening activities like technical backstopping to the different projects. 10. Summary, conclusions and recommendations The Makerere university college of health sciences school of public health in collaboration with CDC offered a great opportunity to the AMREF fellows to take part in the fellowship program. This has in effect brought about a tremendous change in the organizational programs. All projects currently have M&E plans that guide their M&E activities. These programs directly link into the national M&E system that was developed in line with the one AMREF M&E system and the national development plan. Recommendations: AMREF should provide the M&E unit necessary support to follow up of AMREF project teams to ensure that the rolled out M&E system is continually operationalised. The AMREF M&E unit needs to continually follow up and operationalize the community of practice constituted during the M&E system development process, for it to keep sharing M&E information and providing the M&E teams support. Significant shift in awareness and culture around M&E. All the AMREF program staff should be offered M&E trainings so that they are all able to implement the M&E system without difficulty and ensure continued ownership of the system. The Makerere university college of health sciences school of public health fellowship program should plan to carry out a monitoring visit in the future to 17

24 the organization and possibly the fellows to establish the sustainability to the project after the fellowship program. 18

25 Appendix Appendix: 1 Scaling up of comprehensive HIV prevention project. Objective Objective 1: Strengthen the capacity of district and community structures to promote sexual and other behavioral risk reduction interventions in individual and small group settings 1 Program indicators Annual target (IPYr) 1.1 Number of individuals reached with individual/small group interventions primarily focused on Abstinence, Being faithful and Condom use ABC 1.2 Number of the high risk individuals in the general population reached with individual/small group level preventive interventions that are evidence based and meet minimum standards focused on AB 1.3 Number of CSWs reached with individual and/or small group level interventions that are evidence based and meet minimum standards. 1.4 Number of persons from fishing communities reached with individual and/or small group level interventions that are evidence based/meet minimum standards. 1.5 Number of persons from uniformed services reached with individual and/or small group level interventions that are Performance Narrative on performance Curr Qtr Cumm for the IPYr 33, ,902 Cumulative performance indicates 105% reached with ABC+ against annual target. 5, Cumulative 122% reached with preventive interventions that are evidence based and meet minimum standards AB. 1, CSWs were reached with small group level interventions that are evidence based and meet minimum standards. Representing 57% performance against annual target , fishing community members were reached with small group level intervention s that are evidence based/ meet minimum standards. 8, % performance against target. 1 These are based on PMMP submitted at award, during continuation application or as per last quarter depending on the most up-to-date 19

26 evidence based/meet minimum standards. Objective 2: Strengthen the capacity of district health facilities and health service providers to scale up safe medical circumcision (SMC) services. 1.6 Number of PLHIV reached with individual/small group interventions that are evidence based/meet minimum standards. 1.7 Number of discordant couples followed up with support services (Routine testing and counseling, provided 1, Representing 55% performance against target Up to 65 discordant couples have been followed up. Representing 21.6% performance against target. with condoms). 1.8 Number of targeted condom outlets Condom distribution was done through 45 established sites at health facilities during the reporting period. Most of these were existent outlets. 1.9 Number of condoms distributed to individuals. 2.1 Number of males circumcised as part of the minimum package of MC for HIV prevention. 2.2 Increase SMC coverage in the targeted districts 2.3 Proportion of HIV negative men referred from HCT sites & discordant couple clubs who are provided with SMC 350, ,146 1,148,446 1,148,446 male condoms were distributed during the reporting period. 30,000 15,859 37,623 SMC services were provided to 37,623 clients against the annual target of 30,000. Representing 125% performance against target. From 37 health facilities 15% 27% 27% A cumulative 27% SMC service coverage has been attained. The denominator is the total number HC in the 8 districts, that is 162 and currently 47 HCs are performing SMC. 12% 90% 90% 50% HIV negative males referred for SMC. 20

27 2.4 Proportion of district hospitals that have health service staff (doctors, clinical officers, nurses, counselors & surgical assistants) trained in SMC according to WHO/national standards 2. 5 Proportion of sub district hospitals (HCIV) that have health service staff (doctors, clinical officers, nurses, counselors & surgical assistants) trained in SMC according to WHO/national standards Proportion of HCIIIs that have health service staff (clinical officers, nurses, counselors & surgical assistants) trained in safe SMC according to WHO/national standards Proportion of district hospitals that have adequate facilities and surgical kits to provide SMC according to WHO/national standards. 2.8.Proportion of sub district hospitals (HCIV) that have adequate facilities and surgical kits to provide SMC according to WHO/national standards 2.9.Proportion of HCIIIs that have adequate facilities and surgical kits to provide SMC according to WHO/national standards 21 80% 87% 87% 7 of 8 district hospital have had health teams trained in SMC. 90% 0 100% There are 20 health centre IVs in the 8 supported districts. Cumulatively health workers from 20 HCIVs were trained. 7% 0 6% The 8 districts have a total of 132 HCIIIs; In total staff from 8 HCIIIs (No extra trained this quarter) have been trained. This represents a cumulative performance of 6 % achievement. 80% 70% 70% Health facilities with adequate facilities and surgical kits to provide SMC were selected for SMC service provision. All 7 supported district hospitals received surgical kits. 90% 100% 1005 There are 20 health centre IVs in the 8 supported districts. Cumulatively 20 HCIVs received surgical kits. 7% 0 5.3% The 8 districts have a total of 132 HCIIIs; In total 7 HCIIIs have adequate facilities and surgical kits to provide SMC. This represents a cumulative performance of 5.3 %

28 Objective 3: Strengthen the capacity of district health facilities to improve the diagnosis and treatment of STIs. Objective 4: Strengthen the district health referral systems in collaboration with implementing partners Number of individuals who receive HCT services & receive their test result from IPs and are advised for SMC Number of couples who receive CHCT services & receive their test results from IPs and are advised on SMC Number of couples among whom disclosure is facilitated through couple s groups/chct and advised on SMC. 3.1 Number of persons diagnosed and treated. 4.1 Number of clients served at the referral points. NAdependant on IPs NAdependant on IPs NAdependant on IPs achievement. 15,496 37,260 This indicator is dependent on IP activities. However, 1.6 % clients had HCT done in a period of 3 months. 0 0 This indicator is dependent on IP activities. 0 0 This indicator is dependent on IP activities ,173 12, ,309 1,576 22

29 Appendix 2 Office Logins Profile updates Activity HQ 39 0 Kenya Uganda Tanzania 4 0 Other

30 Appendix 3: AMREF Uganda s M&E organ gram COUNTRY DIRECTOR Abenet Berhanu M & E Manager Morrish Ojok One of the fellows was recruited to become country M&E manager PROJECT/ PROGRAME MANAGERS Lawrence Kaggwa SCHAP Magaret Mugisa CIDA Nakasongola Moses Olwenyi SRHR Kitgum Project M & E Manager SCHAP Florence Anobe M & E Officers Maureen Nankanja SCHAP Wakiso Maria Nambiro SCHAP Luwero Denis Kafoko SCHAP Apac Fred Kahwa SCHAP Kalangala M & E Officers Elizabeth Asiimwe MAT Luwero Scholastic Adong SRH Kitgum Abel Muzoora CIDA Nakasongola 24

31 Appendix: AMREF s Results Based Framework 25

32 AMREF Uganda CDC/MUKSPH fellows with AMREF Uganda M&E team, managers and Director of M&E in AMREF HQ 26

33 References: Group, T. W. (2009). Building Governmen M&E systems. Priority for Government M&E Systems. Independent Evaluation Group. Accessed on September /2/2012. Hovland, I. (2007). Making a Difference: M&E of Policy Research. Working paper 281. Westminster, London: Overseas Development Institute. Wholey S.J., H. P. (2004). Handbook of Practical Program Evaluation. (Vol. 2nd Edietion). New York: John Wiley and Sons Publichers Inc. 27