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1. I am cutting rocks http://img359.imageshack.us/img359/7104/picture420bt2.jpg

2. I am building a temple http://img359.imageshack.us/img359/7104/picture420bt2.jpg

3. Some principles of monitoring and evaluating health programmes

4. Questions What is monitoring? How is this different from evaluation? As DCSTs, what monitoring are you involved in? What evaluation activities are you involved in?

5. Learning Objectives • Understand basic concepts of M&E • Be able to critique M&E systems more rigorously (especially your own role in this) • Think critically about how you are monitoring and evaluating your own work

6. Monitoring • Monitoring is an on-going systematic review of the implementation of a program/project What, when, how many, where, at what cost, how well? • Where is the project at any given time – relative to objectives? • Is implementation is taking place as planned? • Does implementation vary from site to site? • How well has the project been implemented?

7. Why do we monitor? • Measures whether programme is on track • Ensures the most effective and efficient use of resources • Assist in making informed decisions about what to change • Provides the opportunity to spot difficulties in implementation early enough to take remedial action • Help distinguish between theory and implementation failure

8. What are you monitoring? Theimplementationof your work plans Are you performing activities as planned? Are you reaching the intended target population? Are you reaching the intended number of participants? Is it leading to the products (outputs) you expected? How do the participants perceive these services and activities?

9. Problem statement Goals Outcomes Objective Inputs Activities Outputs Rationales and assumptions

10. Goals To increase the quality of intrapartum care in order to reduce the number of stillbirths and asphyxiations Objective To increase the knowledge, skills and confidence of midwives and doctors in labour ward to use and interpret the partogram effectively and manage obstetric emergencies appropriately Problem statement The district has high stillbirth and perinatal asphyxia rates

11. Activities • Trainers – O&G, ADM, FP • Printed training aids • Projector • Transport • Regular partogram audits • Train managers in partogram use and assessment • ESMOE training and EOST and on-site mentorship • Set up/strengthen MMR processes • Master trainers • Fire drill dummy • Printed training aids • Projector • Transport • Excel and data presentation skills Inputs

12. Activities # facilities with quarterly partogram spot checks by DCSTs % partograms filled in correctly • Regular partogram audits • Train managers in partogram use and assessment • ESMOE training and EOST and on-site mentorship • Set up/strengthen MMR processes # managers/staff trained in partogram use and assessment # doctors, midwives, EMS personnel who received ESMOE training Outputs Outcomes

13. What is evaluation? • Evaluation is the systematic collection of information about a program that enables stakeholders to better understand the program, improve its effectiveness, and/or make decisions about future programming. • Focuses on the impact of the activities Did the activities achieve the planned objectives and targets?

14. Evaluation is about outcomes Outcomes are the changes that occur or the difference that is made for individuals, groups, families, organizations, systems, or communities during or after the program. Outcomes fall along a continuum from immediate (initial; short-term) to intermediate (medium-term) to final outcomes (long-term), often synonymous with impact.

15. Activities # facilities with quarterly partogram spot checks by DCSTs % partograms filled in correctly Relevant managers skilled in assessment of partogram and able to address weaknesses with feedback and training Midwives and doctors knowledgeable and skilled in use and interpretation of partogram Partogram used effectively to identify problems timeously and take effective, appropriate action Fresh stillbirth rate in facilities decreases • Regular partogram audits • Train managers in partogram use and assessment • ESMOE training and EOST and on-site mentorship • Set up/strengthen MMR processes # managers/staff trained in partogram use and assessment # doctors, midwives, EMS personnel who received ESMOE training Outputs Outcomes ST ST MT LT

16. ESMOE training of midwives Long term Short term Medium term LEARNING: The knowledge the midwives gain from training. Midwives knowledgeable and skilled in the use and interpretation of partograms BEHAVIOUR: The actions midwives take as a result of that knowledge. Improved management of labour through correct use and interpretation of partograms CONDITION: The conditions that change as a result of those actions. Reduction in stillbirths and early neonatal deaths

17. Evaluation of DCST work What difference did you make? What will you evaluate? Changes in knowledge, skill, attitudes, behaviour, motivation, decisions, policies and conditions How will you know these changes have happened? How will you know these changes happened as a result of your activities?

18. WBOT – household visits to pregnant women to educate family about danger signs in pregnancy Long term Short term Medium term LEARNING: The knowledge families gain from the health messages. Families are equipped with appropriate health care messages on danger signs during pregnancy. BEHAVIOR: The actions families take as a result of that knowledge. An increase in families of pregnant women recognising danger signs of pregnancy and seeking timely health care. CONDITION: The conditions that change as a result of those actions. Decrease in Maternal Mortality Ratio

19. Setting up a Kangaroo Mother Care Unit Long term Short term Medium term Change that occurred: Increase in the number of prem babies and mother pairs admitted to the KMC unit Difference that was made: Impact caused by difference:

21. Homework • Develop a monitoring and evaluation plan for one of your flagship projects/activities • Carry this through – document your monitoring indicators and your outcomes (short term, medium term and long term) • Write this up

22. Guidelines • Choose your project/activity • What do you want to monitor about the: • Inputs • Outputs • What are the short term, medium term and long term outcomes you wish to see? • How will you measure these? What will your indicators be?