Monitoring and Evaluation (M&E) Strategy. April 2013

Transcription

1 Monitoring and Evaluation (M&E) Strategy April 2013

2 Disclaimer The document is an internal document aimed to cover all consortium members, County partners as well as linkages with DFID where appropriate. The document has been made in a participatory approach representing the approach of all HPF consortium members; Crown Agents, Montrose, Health Partners International, Skills for South Sudan and Health Information Systems Programme. The document will be reviewed annually or when substantial changes are made. Next review: 15 th 2013 i

3 Table of Contents Page 1. Introduction and rationale for the M&E plan 2 2. Results framework 3 3. M&E strategy 4 4. Data management 6 Baseline data collection 6 Data sources 7 Data collection 7 Data flow 7 Data analysis 10 Periodic Surveys 11 Information and Communication Technology for Development 11 Role of the oversight Committees 11 Gender and social inclusion 12 Risk Monitoring 12 Conflict Sensitivity Strategy (CSS) Reporting Timelines 13 Annex A: Indicators table 15 Outcome Indicators 16 Output 1: (Service Delivery) 18 Output 2: (Community Ownership and Governance) 26 Outputs 3: (HSS) 30 Output 4: (Fund Management) 32 Value for Money Indicators 35 Annex B: DHIS data available per County in Annex C: MoH approval for HPF to access the DHIS data 48 Annex D: MoH Routine monthly report for health facilities 49 Annex E: MoH Quantified Supervisory Checklist 51 Annex F: The Health Systems Appraisal Tool for Counties 56 Annex G: The Health Systems Appraisal Tool for States 62 Annex H: Risk and Mitigation Strategies 68 Annex I: Health Pooled Fund logframe 73 ii

4 List of Abbreviations ACTs ANC ARI AusAID BCG BEmONC BPHS BSF CEmONC CHD CHF CHW CIDA C-LQAS CM CSS DFID DHIS DPT DQA ECHO EmONC EPI EU FM FRA/s FTEs GBP GIS GOSS/GoS S GRSS GSI HF HIV/AIDS HMIS Artemisinin-based Combination Therapies Ante-Natal Care Acute Respiratory Infection Australian Agency for International Development Bacillus Calmette Guerin (TB vaccine) Basic Emergency Obstetrics and Neonatal Care Basic Package of Health Services Basic Services Fund Comprehensive Emergency Obstetric and Neonatal Care County Health Department Common Humanitarian Fund Community Health Worker Canadian International Development Agency Community-Lot Quantity Assurance Sampling Community Midwife Conflict Sensitivity Strategy Department for International Development District Health Information System Diphtheria, Pertussis, and Tetanus Data Quality Assessment European Commission Humanitarian Office Emergency Obstetric and Neonatal Care Expanded Programme on Immunisation European Union Fund Manager Fiduciary Risk Assessment/s Full-Time Equivalents Pounds Sterling Geographic Information Systems Government of South Sudan Government of the Republic of South Sudan Gender and Social Inclusion Health Facility Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Health Management Information HPF HR/HRH HRIS HSD HSDP HSS ICT4D IDP IDSR IMF IPT/IPTp ITN LQAS LSSAI m-health M&E MCHW MDTF MOFEP MOH MUAC NGO OFDA OPD OPV ORS PFM PHC PHCC PHCU PMTCT PSI QSC RPIL RSS RTH SAIC SHTP SIDA SMOH SS Systems Health Pooled Fund Human Resources/ Human Resources for Health Human Resource Information Systems Health Service Delivery Health Sector Development Plan Health Systems Strengthening ICT for Development Internally displaced person Integrated Disease Surveillance and Reporting International Monetary Fund Intermittent Preventive Treatment of malaria in pregnancy Insecticide Treated Net Lot Quantity Assurance Sampling Local Support Services Aid Instrument Mobile Health Monitoring and Evaluation Maternal and Child Health Care Worker Multi-Donor Trust Fund Ministry of Finance and Economic Planning Ministry of Health Mid Upper Arm Circumference Non-Governmental Organisation Office of Foreign Disaster Assistance Out Patient Department Oral Polio Vaccine Oral Rehydration Salts Public Finance Management Primary Health Care Primary Health Care Centre Primary Health Care Unit Prevention of Mother to Child Transmission Population Services International Quantified Supervisory Checklist Revised Priority Indicator List Republic of South Sudan Road to Health Sudan Health Transformation Project Swedish International Development Cooperation Agency State Ministry of Health South Sudan iii

5 SSDP South Sudan Development Plan STIs Sexually Transmitted Infections TA Technical Assistance TB Tuberculosis TBA Traditional Birth Attendant TT Tetanus Toxoid U1/U5 Under 1/Under 5 UNFPA UNICEF VCT VFM VSO WASH WHO United Nations Population Fund United Nations Children s Fund Voluntary Counselling and Testing Value for Money Volunteer Services Overseas Water, Sanitation and Hygiene World Health Organisation ii

6 1. Introduction and rationale for the M&E plan The South Sudan Health Pooled Fund (HPF) is a three and a half year multi donor initiative, which commenced on 15 th October 2012; funded by the UK Department for International Development (DFID), the Australian Agency for International Development (AusAID), the European Union (EU), the Canadian International Development Agency (CIDA), and the Swedish International Development and Cooperation Agency (SIDA). The HPF will support delivery of essential primary health care and referral health services up to county hospital level as well as health system strengthening at the national, state, county and facility/community levels. The HPF will support services in Eastern Equatoria, Northern Bahr el Ghazal, Western Bahr el Ghazal, Warrap, Unity and Lakes states. This document is the Draft Monitoring and Evaluation (M&E) Plan for the Health Pooled Fund. It covers the first three work streams of the project; management of the HPF mechanism, support to health service delivery and health systems strengthening. DFID will contract an external HPF evaluation manager to provide on-going evaluation services for the fund. Figure 1 below denotes the document composition: What we will monitor How we will monitor? Information Sharing Methods Humanitarian Situation External Monitoring and Links Fund Management Gender & Social Inclusion Review (and feedback) of information Figure 1: Document composition The what is described through indicators related to the impact, outcome and outputs of the HPF. The how is specified through the information flow, sources of information, reporting timelines and periodic surveys. The review of information is described through sections on data analysis. Triggers for Humanitarian response will also be monitored throughout activities as a cross-cutting activity. 2

7 Information Sharing Methods will cover dissemination of information throughout the project. Finally the project acknowledges links to external monitoring, which exist and are crucial for the HPF M&E process. 2. Results framework The overarching objectives of the Health Pooled Fund are: To improve access, use, and quality of Primary Health Care (PHC) services and Emergency Obstetric and Neonatal Care (EmONC) services To increase accountability and effectiveness by working with community mechanisms for improving health and health education To support and strengthen key stewardship functions of the Ministry of Health (MOH) including: planning, management, coordination, supervision and monitoring at all levels, in accordance with MOH guidelines and tools; using the six pillars in the Health Sector Development Plan. While aligning with the South Sudan Development Plan (SSDP) and international targets, the HPF has the overarching targets of: Ensuring high quality and relevant primary health care service delivery is provided, and accessed Strengthening the health system at all levels: county, state and central, to deliver effective services that benefit the South Sudanese people Working to improve public financial management and towards implementation of the Local Services Support Aid Instrument as a precursor for a Government driven health service Figure 2 below shows the different phases and work streams of the project: Figure 2: HPF Logical Chain Bridging and long-term contracts 3

8 In late 2012, the HPF awarded short term bridging contracts to County partners that were previously funded by the Basic Services Fund (BSF), Sudan Health Transformation Project (SHTP), Office for Disaster Assistance (OFDA), European Commission Humanitarian Office (ECHO) and the Common Humanitarian Fund (CHF). These short term bridging contracts will expire at the end of June 2013 and August 2013, depending on the state. In 2013, the HPF will award long term contracts to County partners, on a countywide service provision basis. 3. M&E strategy The general approach to HPF M&E is wherever possible, to integrate the different aspects of the programme into one single plan, in order to carry out M&E and learning most effectively. Priority will be given to the use of data elements routinely collected by MoH. Both MoH and DFID expressed a desire for the Health Pooled Fund to strengthen the SS HMIS rather than establishing parallel reporting systems. This is in line with the stated principles of the HMIS: One monitoring system based on the already approved M&E framework, One database in the District Health Information System software. Management and leadership of the Ministry of Health. 1 The HMIS tools in use are the weekly IDSR reports, monthly health facility reporting forms and the Quantified Supervisory Checklists. Supporting the roll out of the DHIS will lead to the provision of relevant, timely and quality information to all levels of the health care system to guide evidence based policies, strategies and services provision to ultimately improve the health of the population of South Sudan, which is the goal of the HMIS. The Ministry of Health at Central, State and County level will be highly involved in the monitoring and evaluation of the project. Review meetings, field visits, County and health facility supervision visits and assessments of the health system will be conducted jointly in the beginning of the project with the aim to empower the Ministry of Health to take more responsibility and ownership over the course of the project. Supervision visits to the States, Counties, health facilities and communities will be conducted regularly to verify the reports submitted by the County partners and provide technical support around challenges identified. In the first phase of the project, a HPF staff member will visit the County at least every 6 months to be part of the quarterly review meetings and collect the necessary information at County, health facility and community level. The purpose of the County visits are expected to change over time when systems at County level are in place and responsibilities and tasks are shifted from the County partner to the County Health Department. The HPF Health Systems Strengthening strategy is to build capacity especially at State MoH and County Health Department levels to ensure that supervision for monitoring quality service delivery takes place regularly. The HPF State Coordinators would be key in ensuring that continuous on-thejob training on supervisory skills occurs at SMOH and CHD levels with the support of other HPF technical staff. An assessment of the health system is an important part of project M&E. The health system assessment at the State and County level will identify gaps in the health system that need to be strengthened. This is done through a health system assessment tool, developed in consultation with the Ministry of Health at both the national level and State level. The assessments are 1 Republic of South Sudan, Health Management Information System Manual, July

9 conducted by SMoH and CHD staff who are also trained in analysis of the findings and writing of the report with technical support from HPF. The initial results from the health system assessment conducted in the six states between March and May 2013, will act as the baseline in subsequent years. The health system assessments will indicate the trends and relevance of the intervention to improve the strengthening of the health system in the six states. This assessment will be carried annually to monitor trends in the six HSS pillars in the Counties. The tool is included in Annex F. The project has access to different data sources that are listed in table 1 below: Routine Data Frequency Responsibility Integrated Disease Surveillance and Response (IDSR) Health Facility data through HMIS Quantified Supervisory Checklist Quarterly technical progress report Weekly Monthly Quarterly Quarterly CHD, with support from County partner where needed CHD, with support from County partner where needed CHD, with support from County partner where needed CHD, with support from County partner where needed Survey Data Frequency Responsibility Emergency Obstetric and Neonatal Care Survey 2013 MoH Maternal Mortality Survey 2013 MoH Community LQAS survey Every two years, next survey planned for 2014 MoH Health System Assessment Annually HPF, with support from MoH Health Facility Assessment Perception surveys e.g. on user satisfaction, government provision of services, accountability. County/State Gender and Social Exclusion Mapping Table 1: Available data sources Every 2-3 years, next survey planned at the end of 2013 Annually Annually MoH, with support from LATH HPF, with support from MoH and County partners SMoH and CHD, in partnership with the County partners 5

10 4. Data management Baseline data collection Collection of baseline data started in November 2012 and is expected to be completed in May Several methodologies have been used to collect baseline data to ensure a comprehensive package of information is gathered. Support to health service delivery NGO Mapping Data has been collected from different sources, including MoH, NGOs and donors, to map the NGOs supporting health services in the six HPF supported States. GIS mapping will be a core part of the NGO mapping exercise. County Mapping County specific information will be collected from different sources such as the MoH Community-LQAS survey, EPI and cold chain assessments as well as information available from BSF, PSI, UNICEF and MDTF. HMIS Data Reconciliation Health facility data from the NGOs and MoH will be reconciled into one system, the MoH District Health Information System (DHIS), to create a baseline and targets for HPF service delivery activities. Annex A gives an overview of the DHIS data available per County in Gender and social inclusion A gender and social inclusion (GSI) mapping exercise at County level will provide the baseline data for GSI. The outcome of the mapping exercise will inform the elucidation of relevant indicators and the development of specific activities to promote inclusion and monitor any improvements/increases in access to health care. Health Systems Strengthening A participatory approach will be used to quantifiably assess the health system pillars, both at state and county levels. The health system assessment tool that is used covers all health systems areas; Health service delivery, Human Resources for Health, Health Management Information Systems, Medical products, supplies and technologies, Health financing and Governance and Leadership. The County model, which will be adopted for the six states, means that there will be a shift from health facility based support by County partners to general support in health service strengthening of the County health departments to a level where the CHDs will be in charge of all the health services in the county. This will imply that capacity development in service delivery in issues of ensuring policies, manuals and guidelines are being implemented, clinical audits are carried out to ensure quality of care is regularly monitored by local managers, among other issues. In human resources development monitoring of performance of staff, in-service training plans based on training needs assessments, general improvement in managing of human eesources for Health including human resources information system and coordination of staffing of facilities with other County partners for proper staff-mix will be monitored. In health management information system the main area, apart from the areas to do with quality of data improvement, will be building the capacity of CHD managers to analyse, present and utilize data for decision making, health planning and management of the health service. In the Pharmaceuticals and Medical Products pillar emphasis will be supply chain management to ensure that service points through capacity building have the ability to quantify, forecast, make proper procurement requests, store, control stock and distribute medicines and other medical 6

11 products efficiently and effectively. In Health Care Financing capacity building in budgeting, financial management, and production of financial reports based on sound accounting procedures by the CHDs and SMOH will receive priority. In the Governance, Leadership and Management pillar HPF will assist the MOH to more clearly define the roles of the MoH National, State and County level in the health system in order to encourage meaningful decentralization of health services in the context of South Sudan. Joint planning, budgeting and review of health services of all the players in the county will be the aim. There will also be capacity building in improving general management at CHD and State Level. Data sources The project will have access to different sources of information to monitor project progress. Some of the data collection tools to be used have been tried and tested for some time, others may have to be designed, piloted and then refined. Participatory community-based consultations will be carried out regularly by the CHD and co-facilitated by the County partners to collect qualitative data and measure perceptions of improved/increased access to healthcare. Data collection The MoH has given approval to HPF to use DHIS data for monitoring purposes, and is allowing HPF direct access to the data by allowing HPF to receive the export file from County partners at the same time the file is sent from the CHD to SMoH, see annex B. Different surveys will be conducted by MoH over the next few years and HPF will use the survey results to monitor and evaluate the project. The HPF team will develop reporting forms and tools that will be used to collect data not routinely collected by MoH (e.g. health system assessment, quality of care assessment and gender and social inclusion mapping). These tools include the quarterly reporting form for the County partner and CHD, HPF field visit form and quality of care assessment. MOH patient registers will be the only tools used for data collection at the health facility level. The primary data collected (see annex C) is fed into the HMIS database. Data management at this level is currently paper based, but the County partner per County will support the CHD to capture the data into the Ministry of Health District Health Information System software (DHIS). The County is expected to send the data to the State MoH, and then the State MoH to forward information up to the national level. The Quantified Supervisory Checklist (see annex D) will be completed by the CHD for each health facility in the County; data is entered into the computer and submitted to the SMoH for inclusion in the DHIS database. State & County M&E officers are responsible for collating data within their catchment areas. These officers will be responsible for data receiving, collection, validation, analysis and dissemination. In addition, they will be responsible for providing robust support to the health facilities within their catchment areas. The HPF will provide on-going support to the County partners, State & County M&E officers. Data flow During the bridging period, it has become evident that the flow of data from health facilities needs to be standardized to be in line with MoH requirements. At the moment, the different County partners are not all using the MoH reporting forms. The flow of data is therefore not quite in line with MoH requirements, where data is expected to flow from health facility to County, State and finally the MoH RSS. While training is provided to County partners, health facility staff, CHD and 7

12 SMoH, copies of the DHIS monthly data and QSC reports is to be sent by the County partner directly to HPF to provide the HPF team with timely access to the data. The graph below shows the flow of data during the bridging period until approximately January 2014 when HPF will access the data from the CHDs and not from the County partners: MoH RSS Some computerised systems SMoH HPF Some feedback and support Different paper based tools used CHD Health facilities NGOs Some feedback and support Expected data flow next phases Each County will start at different stages when the implementation phase contracts are awarded to the County Partners. The changes that will be observed in the data flow will depend on the capacity at County level and the success of the capacity building efforts at CHD and health facility level by the County Partner. Initially limited change will be observed in the data flow. Routine data will follow the data flow policy of the MoH, with a copy of the export file going to the County Partner who will be sending this file to HPF. Other sources of information required for assessing project management will be sent directly to HPF. Regular review meetings will be held to analyse the data and feedback given to the CHD and health facilities. This is a complex issue and requires much more skill and knowledge. Therefore this is not expected to be completed in all the HPS supported States before January This phase will focus on health system strengthening and will contain a stronger component of government capacity building. 8

13 MoH RSS Computerised system SMoH HPF Regular review meetings, feedback and support CHD County Partner MoH paper based tools used only Health facilities Regular review meetings, feedback and support Community (Boma Health Committees, Community consultations) 9

14 The next phase will focus on building financial and management capacity at health facility and CHD level. The data flows in this phase will take place under one system, monitored by MoH RSS. Technical support will continue to be given at the different levels by HPF and County partners, but the data will flow according to the MoH data flow policy. MoH RSS Computerised system SMoH Regular review meetings, regular reports, feedback and support MoH paper based tools used only CHD Health facilities Regular review meetings, regular reports, feedback and support Community (Boma Health Committees, Community consultations) Data analysis Monthly information collected will be used for programmatic monitoring, including monitoring of targets. State and County analysis will be conducted every month by the CHD and the supporting County partner. This includes a review of the timeliness, completeness, precision, reliability, accuracy and validity of the health facility reports as well as the Quantified Supervisory Checklist (QSC) scores and trends. A feedback mechanism will be established at State and County levels to discuss the performance of the health facilities with health facility staff and relevant local authorities. Regular data quality assurance will be conducted by the M&E and programme team on indicators sourced from routine data collection. Monthly reports will be collated at state level and DQA conducted at facility levels with County and state officials. The state level monthly M&E meetings will also be used to verify data and clarify issues as appropriate. MoH HMIS will be used to manage the data within the programme. The software contains a variety of in-built data validation checks such as outlier and missing data checks. The HPF (alongside State & County MoH) will undertake at least one Routine Data Quality Assurance visit to each County partner (SP) every six months. At this point the SP will be able to verify source data against that which is reported in the monthly report. The frequency of monitoring visits is expected to be adapted, depending on the context and seasonality e.g. during the dry season there may need to be more intensive monitoring and reporting as the health facilities will be more accessible than in rainy season. 10

15 Periodic Surveys To assess the capacity of the health system, a baseline HSS assessment was carried out during the inception period. The team developed a health system assessment tool in collaboration with MoH. The adaptation involved limiting the assessment to SMoH and County Health Departments (CHD); health facilities in the selected states were not included in the initial assessment, but in the future the team will consider including some sampled health facilities. The implementation process was further adapted and implemented using the hand-holding-approach. The hand-holding approach involved identification of key change agents (focal persons) in each State with the SMoH, provision of a quick orientation on the process and tools application, and then working with the change agents in the SMOH and County Health Departments (CHDs). The same tool will be used annually at State and County level. The health system assessment tool consists of the following six blocks of the HSS Framework. Each of the 6 blocks receives a score between one and ten: 1. Service Delivery 2. HRH 3. HMIS 4. Pharmaceuticals & Medical Products 5. Financial Management 6. Governance, Leadership & Management A copy of the Health Systems Strengthening Assessment tool is included at Annexes E and F (County and State levels respectively). Information and Communication Technology for Development The Government of the Republic of South Sudan has identified the use of information and communication technology for development as a critical strategy for national development, and wishes to use it as a tool for socio-economic development, governance, and the general welfare of the people of South Sudan. HPF will take a leadership role in the establishment of the M&E sub-technical working group for mobile health solutions. As a member of the ICT4D task force and the South Sudan m-health working group, the HFP team will be pro-actively involved in the design and use of appropriate and new technology solutions for the health sector in South Sudan, averting solutions that are not appropriate for the context. HPF will support pilot testing of new technology solutions and tools in the six States supported by HPF. Role of the oversight Committees The HPF Steering Committee at national level consists of the Ministry of Health (MoH) as Chair, DFID as Co-Chair, the HPF Secretariat and committee Members (Ministry of Labour, Ministry of Finance and Economic Planning, donor co-chair of the sector working group, World Bank and USAID). The NGO health coordinator and national NGO representative will attend as observers. The Steering Committee reviews quarterly reports prepared by the Fund Manager that summarise allocations, expenditure, outputs and outcomes, as well as results against agreed performance indicators. State HPF Oversight Committees consist of the Ministry of Health (MoH) as Chair, the HPF Secretariat as Co Chair and Members (Ministry of Labour, Ministry of Finance, Ministry of Local Government, County partner and County counterparts). The Committee will meet quarterly and the discussion and outcome of each meeting will be recorded in HPF oversight Committee Minutes. The State Oversight Committee will provide oversight to the implementation of programmes approved for HPF funds, including approving major changes as necessary, and with the support of the Fund 11

16 Manager ensure that milestones are achieved. The State Oversight Committees will be involved in the quarterly review of the reports from the Counties. County Committees consist of the CHD as Chair, and the County partner in the County as the secretary. The suggested members of the committee are the County Commissioner and County Executive Director. The HPF state coordinator and civil society organization representatives could be invited to observe the quarterly review meetings. The County partner will record the outcome of meetings and share with the State MoH/HPF State coordinator. The County Committees will be involved in the quarterly review of the program in the County, which includes a review of the supervisory checklists completed that quarter and the DHIS data from the health facilities. Gender and social inclusion A strong awareness of gender issues has been adopted in project design, with inputs and outputs to be disaggregated by gender, and specific targets set for women s representation in committees. During the HMIS reviews with MoH, HPF will advocate for better inclusion of gender disaggregated data in the health facility reports as this will allow reporting on indicators by gender. It is also recognised that the involvement of men is of critical importance if issues such as access to health care and family planning are to be addressed effectively. Asides from gender of the patients, there are other social identities relevant to determining access to health care in South Sudan. These include, age, ethnic identity, education, place of residence, migrant/displacement status, and others. These groups will emerge during the gender and social exclusion mapping that will take place at county level. Initially, this process will be driven by County partners in partnership with CHDs due to a lack of capacity at county level to undertake relevant mapping exercises. From county level the mapping process will be built up to State level. Relevant mapping will commence early in project implementation, and will be updated on an annual basis. Risk Monitoring HPF has been described as medium to high risk, attributable to factors outside of project control such as security, pharmaceutical supply, human resources for health and government support. The list of risks and mitigation strategies will likely change as the project matures, and new risks develop, or anticipated risks recede. Risks so far identified are included at Annex G. Project risk reviews will be repeated every 6 months with the aim to review the risks identified, identify new risks and assess their potential impact on the project s deliverables, and review appropriate mitigation strategies. Conflict Sensitivity Strategy (CSS) Conflict Sensitivity is included in the M&E plan to ensure progress against it can be measured throughout the lifetime of the programme. The following indicators are included in the indicator table: 1. Increased skills as measured by pre and post training evaluations. It will be necessary to measure the increased in the skills and abilities of County partners and CHDs before and after training. Skill measurement will be undertaken by an external organisation contracted to undertake training, and indeed the method by which they intend to measure increases in the skills of participants will be taken into account in the evaluation of their proposals. 2. Increased conflict sensitivity of programmes as measures by pre and post intervention evaluations. The extent to which CSS activities lead to increased conflict sensitivity in programmes must be measured. This will be evaluated both pre and post CSS activities, through questionnaires and 12

17 evaluations conducted prior to training of SPs and CHDs, as well as within the second year of their implementation. 3. Quality consultation reports produced, reflective of community consultations. The HPF s conflict sensitive approach rests largely on an accurate understanding of the local context within each county. Following training, this will be ascertained in most part through consultations undertaken by County partners and CHDs. It will therefore be crucial to ensure consultations are conducted and reported in a manner which allows for the opinion of communities to emerge as faithfully as possible. Quality assurance of consultations will be carried out by HPF team members on a random sample basis, with team members attending consultations on an ad-hoc basis and verifying the accuracy of subsequent reports and analysis. HPF evaluation manager 5. Reporting Timelines Reports are submitted on a monthly, quarterly and annual basis. The HPF will involve the County partners, steering committees and DFID on the dates when the reports are required for submission. The programme is subject to Annual Reviews and a project completion report in line with standard DFID monitoring and evaluation procedures, to determine overall progress towards meeting log frame objectives, and to identify any work streams where issues may be arising and potential solutions for resolution. Table 2 below gives an overview of the type of reports that will be produced. Type of Report From To Frequency DHIS report QSC Finance report Progress report HPF progress report County partner County partner County partner County partner HPF HPF HPF HPF Monthly before the 5 th of the following month Quarterly QSC report from each health facility in the County Quarterly before 15 th of the following month Quarterly - before 15 th of the following month, after review meeting at County level, countersigned by the CHD HPF DFID, SC Monthly and quarterly (July, October, January, April) Annual Review HPF DFID, SC Annual (April) 13

18 Appendices 14

19 Annex A: Indicators table Objective: Government led health systems that save lives Indicator Indicator Definition and Unit of Measurement Baseline March 2016 Data Source Frequency Responsibility for data collection HPF team member responsible for database entry and analysis Requirement Under 5 mortality rate (per 1000 live births) (reporting to be disaggregated by gender and poverty quintile) Definition: The under-five mortality rate is the probability of a child dying before its fifth birthday 106 per 1000 live births N/A N/A 95 per 1000 live births South Sudan Household Survey Estimated frequency is every 5 years MoH 2 Health M&E officer Project Logframe (see annex H) Maternal mortality ratio (per 100,000 live births) (reporting to be disaggregated by gender and poverty quintile) Definition: Number of maternal deaths per 100,000 live births 2054 per 100,000 live births N/A N/A 1643 per 100,000 live births South Sudan Household Survey Estimated frequency is every 5 years MoH, supported by CIDA/USAID 3 Health M&E officer Project Logframe 2 It is not confirmed when the next Household Survey is planned 3 CIDA/USAID are planning another survey in the next two years (2015) either as a stand-alone maternal mortality survey or as wider DHS survey (Source: DFID-HPF Logframe) 15

20 Outcome Indicators Objective: Increased access to quality health services, in particular by children, pregnant women and other vulnerable groups. Indicator Indicator Definition and Unit of Measurement Baseline March 2016 Data Source Frequency Responsibility for data collection HPF team member responsible for database entry and analysis Requirement Percentage of 1-year olds vaccinated with the third dose of DPT vaccine Definition: % of children under 1 who received their third dose of DPT or DPT containing vaccine 18,000 (11%) 48,106 (20%) 125,000 (50%) 200,000 (82%) EPI register HMIS Monthly CHD supported by County partner Health M&E officer Project Logframe Unit of measurement: % Numerator: DPT 3 in children under 1 Denominator: Population under 1 year (5% of the population) Proportion of children under 5 with fever in the last two weeks who were taken to a health facility (by gender) Definition: Proportion of children with fever in the two weeks prior to the survey whose mothers sought advice or care in a health facility within 24 hours of onset of fever. 15.3% N/A N/A 52% C-LQAS Every two years MoH, with support from LATH Health M&E officer Project Logframe Unit of measurement: % Numerator: Number of mothers interviewed with an appropriate response Contraceptive Prevalence Rate Denominator: Number of mothers interviewed with appropriate responses and numbers with inappropriate response Definition: Proportion of women using any modern FP method at 6.5% N/A N/A 14% C-LQAS Every two years MoH Health M&E officer Project Logframe 16

21 Objective: Increased access to quality health services, in particular by children, pregnant women and other vulnerable groups. Indicator Indicator Definition and Unit of Measurement the time of the survey. Baseline March 2016 Data Source Frequency Responsibility for data collection HPF team member responsible for database entry and analysis Requirement Unit of measurement: % Numerator: Number of women using any modern FP method Percentage of births attended by skilled health personnel Denominator: All women interviewed Definition: Proportion of mothers who delivered in the presence of a skilled birth attendant (doctors, registered midwives, nurse-midwife, Medical Assistant or Clinical Officer) Unit of measurement: % 7,311 (2,8%) 18,800 (7%) 27,500 (10%) 52,000 (19%) HMIS Monthly CHD supported by County partner Health M&E officer Project Logframe Numerator: Deliveries attended by doctors, registered midwives, nurse-midwife, Medical Assistant or Clinical Officer Denominator: Estimated pregnant women (5.6% of population) 17

22 Output 1: (Service Delivery) Objective: Strengthened delivery of health services, particularly responsive to the needs of women and children Indicator Indicator Definition and Unit of Measurement Baseline March 2016 Data Source 4 Frequency Responsibility for data collection HPF team member responsible for database entry and analysis Requirement Under 5 OPD consultations curative, under 5 OPD consultations preventive/promoti ve services and total under 5 consultations Definition: Children under 5 years attending the health facility for curative consultations and/or preventive/promotive services Unit of measurement: Number Numerator: Number of curative consultations by children 5 years and younger, Number of children under 5 receiving preventive/promotive services, which is total of o MUAC <125mm under 5 years + o MUAC<115mm under 5 years + OPD consultati ons curative under 5 male = OPD consultati ons curative female = Consultati ons preventiv e = Total consultati ons under 5 = 534,000 OPD consultations curative under 5 male = OPD consultations curative female = Consultations preventive = Total consultations under 5 = 1,200,000 OPD consultations curative under 5 male = OPD consultations curative female = Consultations preventive = Total consultations under 5 = 2,000,000 OPD consultation s curative under 5 male = OPD consultation s curative female = Consultation s preventive = Total consultation s under 5 = 3,125,000 HMIS Monthly CHD supported by County partner Health M&E officer Project Logframe o DPT1 fixed and outreach under 1 year+ o DPT2 fixed and outreach under 1 year + o DPT3 fixed and outreach 4 Sources will only be the QSC and HMIS forms for PHCCs and PHCUs to comply with the Business Case statement Any additional data collection must not be burdensome and detract from the health system strengthening aspects of the HPF 18

23 Objective: Strengthened delivery of health services, particularly responsive to the needs of women and children Indicator Indicator Definition and Unit of Measurement under 1 year + Baseline March 2016 Data Source 4 Frequency Responsibility for data collection HPF team member responsible for database entry and analysis Requirement o Measles fixed and outreach under 1 year. Total number of curative consultations by children 5 years and younger and number of children under 5 receiving preventive/promotive services Denominator: None Number and percentage of children aged 6-59 months given Vitamin A supplements in the last 6 months (by sex) Definition:Number and % of vitamin A supplements provided to children aged 6-59 months Unit of measurement: number and % Numerator: Vitamin A supplements provided to children aged 6-59 months 53,000 (3,5%) 200,000 (12,5%) 480,000 (30%) 975,000 (60%) HMIS Monthly CHD supported by County partner Health M&E officer Project Logframe Denominator: Estimated number of children 6-59 months eligible for vitamin A supplements. This is calculated as follows: Take the population of children under 5 years (19% of the population) minus under 1 year (5% of the population), this gives the months population; this is multiplied by 2 (for the 2 doses a year). Then add the under 1 population. Percentage of women who Definition: Proportion of pregnant women attending the 20,500 34,000 57, ,750 ( HMIS Monthly CHD supported by County partner Health M&E Project Logframe 19

24 Objective: Strengthened delivery of health services, particularly responsive to the needs of women and children Indicator attended at least four times for antenatal care during pregnancy Indicator Definition and Unit of Measurement antenatal clinic for the fourth time or more Unit of measurement: % Baseline March 2016 Data Source 4 Frequency Responsibility for data collection (8%) (12%) (20%) (37%) officer HPF team member responsible for database entry and analysis Requirement Numerator: Antenatal client 4th or more visit Denominator: Estimated pregnant women (5.6% of population) Definition: Number of women years of age who start any modern contraceptive method 3,500 8,000 12,000 22,500 HMIS Monthly CHD supported by County partner Health M&E officer Project Logframe Unit of measurement: Number Numerator: Family Planning acceptor (new) Denominator: None Number of facilities with capacity to offer Emergency Obstetric care (disaggregate BEmONC and CEmONC) Definition: Number of HPF supported health facilities offering Basic Emergency Obstetric and Neonatal Care (BEmONC) or Comprehensive Emergency Obstetric and Neonatal Care (CEMONC) services 15 CEmONC Quarterly report from County partner Quarterly CHD supported by County partner Health M&E officer Project Logframe Unit of measurement: Number Numerator: Number of health facilities offering all BEmONC services (IV antibiotics, IV oxytocin, IV anti-convulsants, manual removal of placenta, assisted delivery by vacuum extraction, manual vacuum 20

25 Objective: Strengthened delivery of health services, particularly responsive to the needs of women and children Indicator Indicator Definition and Unit of Measurement aspiration of retained products of conception, neonatal resuscitation) and number of health facilities offering CEmONC services (caesarean section and emergency hysterectomy in addition to the BEmONC services) Baseline March 2016 Data Source 4 Frequency Responsibility for data collection HPF team member responsible for database entry and analysis Requirement Denominator: None % of pregnant women who received at least two doses of IPTp during ANC visits during their last pregnancy Definition: Percentage of pregnant women who receive IPT2 as part of the ANC visits Unit of measurement:% Numerator: Antenatal client IPT 2nd dose HMIS Monthly CHD supported by County partner Health M&E officer DFID M&E malaria in South Sudan Denominator: Antenatal client 1st visit Number of pregnant women receiving a measure of prevention for malaria in accordance with WHO guidelines (ITN) Definition: Antenatal client receives insecticide treated net Unit of measurement: Number Numerator: Number of insecticide treated net to antenatal client HMIS Monthly CHD supported by County partner Health M&E officer DFID M&E malaria in South Sudan Denominator: None Number of pregnant women receiving a measure of prevention for malaria in accordance with WHO guidelines Definition: Antenatal client IPT 2nd dose Unit of measurement: Number Numerator: Antenatal client IPT 2nd dose HMIS Monthly CHD supported by County partner Health M&E officer DFID M&E malaria in South Sudan 21

26 Objective: Strengthened delivery of health services, particularly responsive to the needs of women and children Indicator (IPTp) Indicator Definition and Unit of Measurement Denominator: None Baseline March 2016 Data Source 4 Frequency Responsibility for data collection HPF team member responsible for database entry and analysis Requirement Delivery in Health Facility with skilled health personnel Definition: Number of women who deliver in health facilities with skilled birth attendants (doctors, registered midwives, nurse-midwife, Medical Assistant or Clinical Officer) HMIS Monthly CHD supported by County partner Health M&E officer DFID M&E malaria in South Sudan Unit of measurement: Number Numerator: Number of women who deliver in health facilities with skilled birth attendants (doctors, registered midwives, nurse-midwife, Medical Assistant or Clinical Officer) Denominator: None Insecticide treated net to child under 5 years or ANC Definition: Insecticide treated net given by health facility staff to child under 5 years or antenatal client HMIS Monthly CHD supported by County partner Health M&E officer DFID M&E malaria in South Sudan Unit of measurement: Number Numerator: Insecticide treated net to child under 5 years Plus Insecticide treated net to antenatal client Denominator: None ANC IPT 2 nd dose Definition: Antenatal client IPT 2nd dose HMIS Monthly CHD supported by County partner Health M&E officer DFID M&E malaria in South Sudan Unit of measurement: Number Numerator: Antenatal client IPT 22

27 Objective: Strengthened delivery of health services, particularly responsive to the needs of women and children Indicator Indicator Definition and Unit of Measurement 2nd dose Baseline March 2016 Data Source 4 Frequency Responsibility for data collection HPF team member responsible for database entry and analysis Requirement Denominator: None Malaria treated at health facility Definition: All patients treated for malaria in the health facility HMIS Monthly CHD supported by County partner Health M&E officer DFID M&E malaria in South Sudan Unit of measurement: Number Numerator: Malaria clinically diagnosed uncomplicated U5 Plus Malaria severe U5 Plus Malaria uncomplicated 5 years and older Plus Malaria severe 5 years and older Denominator: None Curative consultation under 5 male Definition: Curative consultations under 5 years male Unit of measurement: Number HMIS Monthly CHD supported by County partner Health M&E officer 2011 MoH and donors agreed data elements to be measured Numerator: Curative care under 5 years (male) Denominator: None Curative consultation under 5 female Definition: Curative consultations under 5 years female Unit of measurement: Number HMIS Monthly CHD supported by County partner Health M&E officer 2011 MoH and donors agreed data elements to be measured Numerator: Curative care under 5 years (female) Denominator: None 23

28 Objective: Strengthened delivery of health services, particularly responsive to the needs of women and children Indicator Indicator Definition and Unit of Measurement Baseline March 2016 Data Source 4 Frequency Responsibility for data collection HPF team member responsible for database entry and analysis Requirement Number of antenatal client 4 th or more visit Definition: Antenatal client 4th or more visit Unit of measurement: Number Numerator: Antenatal client 4th or more visit HMIS Monthly CHD supported by County partner Health M&E officer 2011 MoH and donors agreed data elements to be measured Denominator: None Number of antenatal client tested for HIV Definition: ANC client tested for HIV Unit of measurement: Number Numerator: ANC client tested for HIV HMIS Monthly CHD supported by County partner Health M&E officer 2011 MoH and donors agreed data elements to be measured Denominator: None Number of antenatal clients who collect test results Definition: ANC client collecting results Unit of measurement: Number Numerator: ANC client collecting results HMIS Monthly CHD supported by County partner Health M&E officer 2011 MoH and donors agreed data elements to be measured Denominator: None DPT 3 dose under 1 year Definition: DPT3 dose in child under 1 year Unit of measurement: Number Numerator: DPT3 dose in child under 1 year HMIS Monthly CHD supported by County partner Health M&E officer 2011 MoH and donors agreed data elements to be measured Denominator: None Facilities with stockouts of any ACTs at Definition: Facilities who have stock out of either ACTs Adult, HMIS Monthly CHD supported by County partner Health M&E HPF 24

29 Objective: Strengthened delivery of health services, particularly responsive to the needs of women and children Indicator the end of the month Indicator Definition and Unit of Measurement Child, Infant, Toddler at the end of each month, reported through the MOH routine monthly report part 2 Baseline March 2016 Data Source 4 Frequency Responsibility for data collection HPF team member responsible for database entry and analysis officer Requirement Numerator: Facilities in a month reports closing balance of 0 of any ACT, as per the breakdown of the MOH routine monthly report part 2 Denominator: None Health Facilities scoring 80% for infrastructure Definition: PHCCs and PHCUs scoring 80% or more for infrastructure on the Quantified Supervisory Checklist HMIS (QSC) Quarterly CHD supported by County partner Health M&E officer HPF Numerator: Sum of all the scores for infrastructure Denominator: None Health Facilities scoring 80% for equipment Definition: PHCCs and PHCUs scoring 80% or more for equipment on the Quantified Supervisory Checklist HMIS (QSC) Quarterly CHD supported by County partner Health M&E officer HPF Numerator: Sum of all the scores for equipment Denominator: None 25

30 Output 2: (Community Ownership and Governance) Objective: Communities have increased ownership, governance and demand for health services Indicator Indicator Definition and Unit of Measurement Baseline March 2016 Data Source Frequency Responsibility for data collection HPF team member responsible for database entry and analysis Requirement Number of health facilities with systems in place for communities to feedback regarding health services Definition: Number of health facilities with any of the following systems in place for communities to feedback regarding health services: 1. Regular meetings between health committee and health facility incharge Quarterly report from County partner Quarterly CHD supported by County partner Project logframe 2. Feedback system in place in the health facility Unit of measurement: Number Numerator: Number of health facilities Denominator: None Number of established health committees at facility level with the ability in providing feedback to County partner Definition: Number of established health committees with any of the following 4 systems in place for communities to feedback regarding health services: 1. Health committee established contact person for community members to give feedback and informed the community how this person can be Quarterly report from County partner Quarterly CHD supported by County partner Project logframe 26

31 Objective: Communities have increased ownership, governance and demand for health services Indicator Indicator Definition and Unit of Measurement reached Baseline March 2016 Data Source Frequency Responsibility for data collection HPF team member responsible for database entry and analysis Requirement 2. Health committee documents the feedback received from the community members 3. Health committee reviews the feedback received during the VHC meetings 4. Health committee has regular meeting with the health facility in-charge about the feedback received. 5. Health committee reports major issues to health facility incharge, County partner or CHD Unit of measurement: Number Numerator: Number of health committees Denominator: None Number of training sessions attended by health facility committees on related issues of governance and community participation, using Definition: Number of health committees trained on issues related to governance and community participation, using the standard training package. Unit of measurement: Number Numerator: Number of health Training report Quarterly Skills for South Sudan Project logframe 27

32 Objective: Communities have increased ownership, governance and demand for health services Indicator the standard training package Indicator Definition and Unit of Measurement committees trained Denominator: None Baseline March 2016 Data Source Frequency Responsibility for data collection HPF team member responsible for database entry and analysis Requirement Number of Community Health Mobilisers trained and active in mobilising community participation and ensuring good governance of health services, using the standard training package (by gender) Definition: Number of male and female Community Health Mobilisers (CHMs) trained using the standard training package and number of CHMs that are actively involved in mobilising the community and ensuring good governance or health services. Unit of measurement: Number Numerator: Number of male CHMs trained, number of female CHMs trained and number of monthly progress reports submitted by the CHMs after the training. Training report Monthly activity report from CHMs Annually Quarterly Skills for South Sudan Skills for South Sudan Project logframe Denominator: None Number and percentage of community board/health facility committee representatives at county level that are women Definition: Number and percentage of community board/health facility committee representatives at county level that are women Unit of measurement: Number and % Numerator: Number of female health facility committee representatives in the county Quarterly report from lead County partner Quarterly CHD supported by County partner Project logframe Denominator: Number of male and female community board members in the county 28

33 Objective: Communities have increased ownership, governance and demand for health services Indicator Indicator Definition and Unit of Measurement Baseline March 2016 Data Source Frequency Responsibility for data collection HPF team member responsible for database entry and analysis Requirement Number of health facilities with participatory and GSI-sensitive systems in place for communities to feedback regarding health services Definition: Unit of measurement: Numerator: Denominator: GSI M&E Number of established and representative (e.g. gender, youth, other vulnerable groups) health committees at facility level with enhanced ability in providing feedback to County partner Definition: Unit of measurement: Numerator: Denominator: GSI M&E Increased conflict sensitivity skills as measured by pre and post training evaluations Definition: County partners and CHDs conflict sensitivity skill levels increase Unit of measurement: % Numerator: Self- assessment baseline and self-assessment end-line, pre and post training Questionn aire prior to CS training Pre and post training questionnaire s Once Third-party training providers CSS Denominator: None Increased conflict sensitivity of programmes as measures by pre and post intervention evaluations. Definition: Conflict sensitivity of programmes increase as a result of training, analysis and ongoing consultations Unit of measurement: Quarterly report from County partner Quarterly CHD supported by County partner Health Officer M&E CSS 29

34 Objective: Communities have increased ownership, governance and demand for health services Indicator Indicator Definition and Unit of Measurement Reporting criteria Baseline March 2016 Data Source Frequency Responsibility for data collection HPF team member responsible for database entry and analysis Requirement Numerator: Reporting requirement: As a result of monitoring the context, have you made changes to programme implementation Denominator: Reporting requirement: Number of changes to programme implementation made as a result of your understanding of the context? Quality consultation reports produced, reflective of community consultations Definition: Community consultations are undertaken effectively, with community views accurately represented in analysis Unit of measurement: Qualitative Random sample attendance of consultations Ad-hoc Conflict Adviser/HPF Team members Health officer M&E CSS Numerator: Ad-hoc observation against a consultation checklist to check quality of intervention Denominator: None Outputs 3: (HSS) Objective: Strengthened health systems at State and County level with detailed focusing on Policy, Human Resources for Health, Health Financing including strengthening of payroll and LSSAI, Health Information, Leadership and governance 30

35 Indicator Indicator Definition and Unit of Measurement Baseline Mileston e 3 March 2016 Data Source Frequency Responsibility Requirement Number of HPF Steering Committee meetings chaired by the Government of the Republic of South Sudan Number of State Oversight Committee meetings held Definition: HPF Steering committee meetings chaired by the Government of the Republic of South Sudan Unit of measurement: Number Numerator: Number of meetings held Denominator: None Definition: HPF State Oversight committee meetings held Unit of measurement: Number Numerator: Number of meetings held Denominator: None Meeting minutes Quarterly HPF Project logframe Meeting minutes Quarterly HPF Project logframe Number of facilities with quarterly integrated supportive supervision visits conducted by county health department using the QSC tool Definition: Number of facilities with quarterly integrated supportive supervision visits conducted by county health department using the QSC Unit of measurement: Number Numerator: Number of HF supervised Denominator: None Quantified supervisory checklist (QSC) Quarterly CHD supported by County partner Project logframe Number of States and Counties with a Health System Performance Score of over 65% using the HSS assessment Definition: Number of States with health system performance score over 65% using HSS assessment tool Number of Counties with health system performance score over 65% using HSS assessment tool Unit of measurement: Number Numerator: Number of States and number of Counties with % over 65 performance score Health Systems Appraisal Tool Annually HPF Project logframe Denominator: None Number of health facilities submitting HMIS reports Definition: Facilities submitting HMIS Part 1&2 reports to CHD Unit of measurement: Number HMIS reports Monthly Project logframe 31

36 Objective: Strengthened health systems at State and County level with detailed focusing on Policy, Human Resources for Health, Health Financing including strengthening of payroll and LSSAI, Health Information, Leadership and governance Indicator Indicator Definition and Unit of Measurement Baseline through the DHIS (according to the data flow policy) by the end of the milestone period Numerator: Facilities submitting HMIS data Denominator: Functioning health facilities in the Counties supported by HPF Mileston e 3 March 2016 Data Source Frequency Responsibility Requirement Number of counties achieving PFM milestones and benchmarks to target schedule as outlined in the framework Definition: The number of the counties that achieved PFM milestones and benchmarks to target schedule Unit of measurement: Number Numerator: Number of the counties that achieve the milestone and benchmarks target Denominator: HPF supported number of counties Assessment report Annually HPF Project logframe % of health facilities where 80% or more of health workers are on government payroll in 6 HPF States Definition: Unit of measurement: % Numerator: Denominator: Assessment report Annually HPF Project logframe Facility Manager has received performance written feedback from CHDs Definition: QSC score for Facility manager has received performance written feedback from CHD Unit of measurement: Number Numerator: Answer to question Facility manager has received written performance feedback from CHD is yes Quantified supervisory checklist (QSC) Quarterly CHD supported by County partner 2011 MoH and donors agreed data elements to be measured Denominator: None Output 4: (Fund Management) Objective: An Effectively and efficiently managed health pooled fund 32

37 Indicator Indicator Definition and Unit of Measurement Baseline March 2016 Data Source Frequency Responsibility Requirement % of completed monthly financial reports received in time from County partner % of completed monthly financial reports approved in time by HPF Definition: % of monthly financial reports received from the County partner by the 15 th of the following month Unit of measurement: % Numerator: Number of reports received by the 15 th of the following month Denominator: Total number of reports received Definition: % of monthly financial reports reviewed and approved by HPF within 15 days after receiving the report from the County partner Unit of measurement: % Numerator: Number of reports approved within 15 days after receiving the report from the County partner Denominator: Total number of reports approved Financial reports Monthly County partner HPF Financial reports Monthly FM HPF % of completed quarterly technical reports received in time from County partner Definition: % of quarterly technical reports received from the County partner by the 15th of the following month Unit of measurement: % Numerator: No of reports received by the 15 th of the following month Quarterly technical report Quarterly SP to FM HPF Denominator: Total number of reports received % of completed quarterly technical reports approved in time by HPF Definition: % of quarterly technical reports reviewed and approved by HPF within 30 days after receiving the report from the County partner Unit of measurement: % Quarterly technical report Quarterly SP to FM HPF Numerator: Number of reports approved within 30 days after receiving the report from the County partner Denominator: Total number of reports approved Timely payment Definition: % of County partners paid within 14 days Budget report Monthly FM HPF 33

38 Objective: An Effectively and efficiently managed health pooled fund Indicator Indicator Definition and Unit of Measurement Baseline to County partners of clearance of monthly report Unit of measurement: % March 2016 Data Source Frequency Responsibility Requirement Numerator: Number of County partners paid within 14 days Denominator: Total number of County partners paid 34

39 Value for Money Indicators Indicator Indicator Definition and Unit of Measurement Baseline March 2016 Data Source Frequency Responsibility Requirement Disbursement ratio of (county) contracts Definition: Relate total budgets contracted by HPF to SPs, to the actual expenditure by SPs County partners budgets Quarterly Finance Manager HPF VFM Strategy Unit of measurement: % Numerator: Value of approved and reimbursed expenditures Approved invoices Denominator: Value of SPs approved budgets Direct cost per beneficiary Definition: Direct costs (directly attributed to specific health services/ HSS results) per County population benefiting Unit of measurement: cost in GBP Approved invoices DHIS database Annually Finance Manager HPF VFM Strategy Numerator: Direct costs expenses (reimbursed) Denominator: County population (from MoH District Health Information System database) Indirect cost per beneficiary Definition: Indirect costs (not directly attributed to specific health services/ HSS results) per County population benefiting Unit of measurement: cost in GBP Approved invoices DHIS database Annually Finance Manager HPF VFM Strategy Numerator: Indirect costs expenses (reimbursed) Denominator: County population (from MoH District Health Information System database) Cost per consultation per client (beneficiary) Definition: Relate total SP County budget, to no. of clients accessing / using health facilities and services supported. This is aggregated at County level. Approved SP budgets DHIS database Annually Health M&E officer HPF VFM Strategy Unit of measurement: cost in GBP Numerator: Curave consultaon under 5, 35

40 Indicator Indicator Definition and Unit of Measurement Baseline curative consultation 5 years and older, Antenatal client 1st visit, Antenatal client 4th or more visit, Post natal client 1st visit, VCT client seen, DPT1, DPT2, DPT3, measles March 2016 Data Source Frequency Responsibility Requirement Denominator: SP County budget (total) (Voluntary) contribution by community to (external supported) investment in health services Definition: Valuation of community contribution, in relation to SP inputs (SP County budget), with trend analysis. Unit of measurement: % Numerator: Recording and reporting of community contribution (voluntary labour, local materials) by Boma Health Committees to CHD and valuation of community contribution by CHD + SP (based on opportunity cost principle) Approved budgets SP Quarterly progress reports from County partners /CHD Annually Health M&E officer HPF VFM Strategy Denominator: SP County budget (total) No. of supervision and support visits to health facilities, initiated by CHD or other govt. departments, against external support. Definition: Relate number of effective supervision and support visits initiated and carried out by CHD (and other government officers) against SP initiated and implemented support visits Quarterly progress reports from County partners /CHD Annually Health M&E officer HPF VFM Strategy Unit of measurement: number Numerator: Number of effective supervision and support visits initiated and carried out by CHD (and other government officers) Denominator Total number of effective supervision and support visits initiated and carried out by CHD (and other government officers) and those initiated and implemented by the SP Equitable access to health services for women/girls Definition: Male vs. Female clients numbers of out-patient consultation visits DHIS database Annually Health M&E officer HPF VFM Strategy 36

41 Indicator Indicator Definition and Unit of Measurement Baseline Unit of measurement: March 2016 Data Source Frequency Responsibility Requirement Numerator: Gender disaggregated HMIS at health facility level of all out-patient consultation visits for patients under 5 and 5 years and older. Denominator Equitable access to all training for women Definition: Access for women to all training (inservice and pre-service) training supported by SP Unit of measurement: % Numerator: Training/days/persons attended by female staff Quarterly progress reports from County partners /CHD Annually Health M&E officer HPF VFM Strategy Denominator: Training/days/person attended by male and female staff 37

42

43 Annex B: DHIS data available per County in 2012 Eastern Equatoria State Lakes State Budii Ikotos Kapoeta E Kapoeta N Kapoeta S Lopa/Lafon Magwi Torit Awerial Cueibet Rumbek C Rumbek E Rumbek N Wulu Yirol E Yirol W Consultation curative under 5 years male Consultation curative under 5 years female Consultation curative 5 years and older male Consultation curative 5 years and older female Antenatal client 1st visit Antenatal client 4th or more visit Antenatal client IPT 2nd dose Family planning new user Delivery in facility by skilled birth attendant Delivery in facility by TBA MCHW CHW CM or Village Midwife Delivery in community Delivery referred

44 Budii Ikotos Kapoeta E Kapoeta N Kapoeta S Lopa/Lafon Magwi Torit Awerial Cueibet Rumbek C Rumbek E Rumbek N Wulu Yirol E Yirol W Post natal client 1st visit Malaria uncomplicated clinically diagnosed under 5 years Malaria uncomplicated confirmed under 5 years Malaria severe under 5 years Malaria uncomplicated 5 years and older Malaria severe 5 years and older Vitamin A supplementation 6-59 months Vitamin A supplementation new mother MUAC less than 115 mm under 5 years MUAC less than 125 mm under 5 years VCT client tested for HIV - new VCT client tested HIV positive - new VCT client who collects test result

45 Budii Ikotos Kapoeta E Kapoeta N Kapoeta S Lopa/Lafon Magwi Torit Awerial Cueibet Rumbek C Rumbek E Rumbek N Wulu Yirol E Yirol W Antenatal client tested for HIV Antenatal client HIV positive given PMTCT Caesarean section Headcount estimated RPIL Consultation curative under 5 years calculated Consultation curative 5 years and older calculated Consultation curative all calculated Headcount under 5 years

46 Northern Bahr el Ghazal Unity State Aweil E Aweil N Aweil S Aweil W Aweil C Abiemnhom Guit Koch Leer Mayendit Mayom Pariang Payinjiar Rubkona Consultation curative under 5 years male Consultation curative under 5 years female Consultation curative 5 years and older male Consultation curative 5 years and older female Antenatal client 1st visit Antenatal client 4th or more visit Antenatal client IPT 2nd dose Family planning new user Delivery in facility by skilled birth attendant Delivery in facility by TBA MCHW CHW CM or Village Midwife Delivery in community Delivery referred Post natal client 1st visit

47 Aweil E Aweil N Aweil S Aweil W Aweil C Abiemnhom Guit Koch Leer Mayendit Mayom Pariang Payinjiar Rubkona Malaria complicated clinically diagnosed under 5 years Malaria complicated confirmed under 5 years Malaria severe under 5 years Malaria complicated 5 years and older Malaria severe 5 years and older Vitamin A supplementation 6-59 months Vitamin A supplementation new mother MUAC less than 115 mm under 5 years MUAC less than 125 mm under 5 years VCT client tested for HIV - new VCT client tested HIV positive - new 47 VCT client who collects test result Antenatal client tested for HIV

48 Aweil E Aweil N Aweil S Aweil W Aweil C Abiemnhom Guit Koch Leer Mayendit Mayom Pariang Payinjiar Rubkona Antenatal client HIV positive given PMTCT 16 Caesarean section 3 19 Headcount estimated RPIL Consultation curative under 5 years calculated Consultation curative 5 years and older calculated Consultation curative all calculated Headcount under 5 years

49 Warrap State Western Bahr El Ghazal Abyei Gogrial East Gogrial West Tonj East Tonj North Tonj South Twic Jur River Raja Wau Consultation curative 5 years and older female Consultation curative 5 years and older male Consultation curative under 5 years female Consultation curative under 5 years male Antenatal client 1st visit Antenatal client 4th or more visit Antenatal client IPT 2nd dose Family planning new user Delivery in facility by skilled birth attendant Delivery in facility by TBA MCHW CHW CM or Village Midwife Delivery in community Delivery referred Post natal client 1st visit

50 Abyei Gogrial East Gogrial West Tonj East Tonj North Tonj South Twic Jur River Raja Wau Malaria complicated clinically diagnosed under 5 years Malaria complicated confirmed under 5 years Malaria severe under 5 years Malaria complicated 5 years and older Malaria severe 5 years and older Vitamin A supplementation 6-59 months Vitamin A supplementation new mother MUAC less than 115 mm under 5 years MUAC less than 125 mm under 5 years VCT client tested for HIV - new VCT client tested HIV positive - new VCT client who collects test result Antenatal client tested for HIV Antenatal client HIV positive given PMTCT

51 Abyei Gogrial East Gogrial West Tonj East Tonj North Tonj South Twic Jur River Raja Wau Caesarean section Headcount estimated RPIL Consultation curative under 5 years calculated Consultation curative 5 years and older calculated Consultation curative all calculated Headcount under 5 years

52 Annex C: MoH approval for HPF to access the DHIS data 48

53 Annex D: MoH Routine monthly report for health facilities 49

54 50

55 Annex E: MoH Quantified Supervisory Checklist 51

56 52

57 53