Ghana Case Study

1. Ghana Case Study Malaria-specific Slides

2. Data for Decision Making

3. Class Activity: Is it Monitoring or Is it Evaluation? 1 • The Director of Health wants to know if interventions being implemented in Region A are increasing ITN use in pregnant women and children under five in that region • Minister of Health requires information on quantities of RDTs used in health facilities in 2009 • A country director is interested in finding out if the population knows about and is using the voucher scheme for ITNs

4. Class Activity: Is it Monitoring or Is it Evaluation? 2 • The Director of MCH wants info on # of pregnant women receiving two or three doses of SP (IPT1 and IPT2) • Current under-five mortality rate needs to be determined NOTE: DATA ARE KEY TO MONITORING AND EVALUATION

5. Component 1a: Decision Maker • Decision maker is a person responsible for acting at any level: • Lower levels: Community Leader • Middle level: DDHS • Top level: Program Manager, D-G • Global level: RBM Executive Director/ WHO DIR-GEN

6. Stakeholder Analysis (Tool on pen drive, useful for M&E plan to identify stakeholders and their needs)

7. Examples of Decisions (could be Deductive, Inductive, or Logical) • Policymaking: e.g., ITN Policy • Strategic Planning: RDTs/ IRS Targeted • Program Management: e.g., Zoning with staff to enhance monitoring • Resource Allocation: e.g., GBF Budget • Drugs and Commodities, Human Resources, Infrastructure and Equipment

8. “Making Data Speak” • Results: • Stakeholders took informed decision to change from chloroquine to ACTs • Implementation Framework drawn with timelines, persons responsible, resources needed • Task Teams formed to address various aspects • Development of Anti-Malaria Drug Policy/Procurement of ACTs • Incorporation into Country Drug Policy and Standard Treatment guidelines

9. “Making Data Speak” (cont.) • Results: • Updating of training manuals, guidelines • Communication and behavior change communication • Launching/adoption of new policy • Training/capacity strengthening • Monitoring: drug quality, pharmacovigilance, use, prescriber habits

10. Anti-malaria drug policy change is an on-going process Development of Policy Updating of Policy Implementation of Policy** Re-evaluation of Policy Monitoring of Policy

11. Data Analysis

12. Mean Average number of confirmed malaria cases per month Sum of the values, divided by the number of cases – also called average Total number of cases Number of observations Mean number of cases Very sensitive to variation

13. Median • Represents the middle of the ordered sample data • For odd sample size, the median is the middle value • For even, the median is the midpoint/mean of the two middle values Median number of confirmed malaria cases Median for 2008 Median for 2009 Not sensitive to variation

14. Mode • Value that occurs most frequently • It is the least useful (and least used) of the three measures of central tendency Mode number of confirmed malaria cases Mode for 2008 Mode for 2009

15. Annual Parasite Incidence (API) Number of microscopically confirmed malaria cases detected during one year per unit population Confirmed malaria cases during 1 year API X 1,000 Population under surveillance

16. Has the Program Met its Goal?

17. Interpreting Data • Does the indicator meet the target? • What is the programmatic relevance of the finding? • What are the potential reasons for the finding? • What other data should be reviewed to understand the finding (triangulation)? • How does it compare (trends, group differences)? • Conduct further analysis.

18. Practical • Question: • Are ANC clinics in country X reaching their coverage targets for IPTp? • Data Source: • Routine health information

19. Data Source General ANC Registers • Which of these variables are relevant for answering your question? • Have you defined the use of each relevant variable? • Answers: • 1) New ANC clients, IPTp-1 • 2) New ANC clients = Denominator, • IPTp-1 and IPTp-2 = Numerator

20. IPTp Coverage – Facility Performance Number of ANC clients receiving IPTp • Question: • Among the five facilities, which one performed better? • Answer: • Cannot tell because we don’t know the denominators

21. IPTp Coverage – Facility Performance Number of ANC clients receiving IPTp Question: Now that you have the denominators, which facility performed better? Response: Facility 5

22. Are facilities reaching coverage targets? Target-80%

23. Data dissemination and presentation

24. Tables Percentage contribution of reported malaria cases, by year (2000–2007), Kenya Source: WHO, World Malaria Report 2009

25. Bar chart

26. Bar chart Source: Quarterly Country Summaries, 2008

27. Stacked bar chart

28. Stacked bar chart % Children <5 with Fever who Took Specific Anti-Malarial, 2007–2008

29. Histogram

30. Line graph Number of Clinicians* Working in Each Clinic During Years 1-4, Country Y *Includes doctors and nurses.

31. Caution: Line graph Number of Clinicians* Working in Each Clinic During Years 1-4, Country Y *Includes doctors and nurses.

32. Pie chart

33. Pie chart N=257

34. How should you present… • Prevalence of malaria in Ghana over a 30-year period? • Data comparing prevalence of malaria in 10 different countries? • Data on reasons why individuals are not using ITNs (out of all individuals surveyed who own an ITN and are not using it)? • Distribution of patients tested for malaria by parasite density?

35. MEASURE Evaluation is a MEASURE project funded by the U.S. Agency for International Development and implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill in partnership with Futures Group International, ICF Macro, John Snow, Inc., Management Sciences for Health, and Tulane University. Views expressed in this presentation do not necessarily reflect the views of USAID or the U.S. Government. MEASURE Evaluation is the USAID Global Health Bureau's primary vehicle for supporting improvements in monitoring and evaluation in population, health and nutrition worldwide.