Strategies for More Effective Monitoring and Evaluation Systems in HIV

Strategies for More Effective Monitoring and Evaluation Systems in HIV Programmatic Scale-Up in Resource-Limited Settings: Implications for Health Systems Strengthening.

Program monitoring and evaluation has the potential to be a cornerstone of health systems strengthening and of evidence-informed implementation and scale-up of HIV-related services in resource-limited settings. The authors discuss common challenges to monitoring and evaluation systems used in the rapid scale-up of HIV services as well as innovations that may have relevance to systems used to monitor, evaluate, and inform health systems strengthening. These include (1) Web-based applications with decentralized data entry and real-time access to summary reporting; (2) timely feedback of information to site and district staff; (3) site-level integration of traditionally siloed program area indicators; (4) longitudinal tracking of program and site characteristics; (5) geographic information systems; and (6) use of routinely collected aggregate data for epidemiologic analysis and operations research. Although conventionally used in the context of vertical programs, these approaches can form a foundation on which data relevant to other health services and systems can be layered, including prevention services, primary care, maternal-child health, and chronic disease management. Guiding principles for sustainable national monitoring and evaluation systems include country-led development and ownership, support for national programs and policies, interoperability, and employment of an open-source approach to software development.

This article starts with a diagnosis of the challenge of providing timely and useful feedback to key staff at individual health facilities when information is hand tallied from paper-based sources and reported up to district, regional, national, and international agencies on schedules that reflect the latter’s needs. When the objective is continuous improvement of quality, scale, equity, and impact of services, the benefits of web-based real-time systems using solar powered mobile phones for data entry (such as Rwanda is developing) are evident. Overcoming silos in HIV monitoring and evaluation systems, each one designed for its own programme (e.g. antiretroviral treatment, prevention of mother-to-child transmission, voluntary counselling and testing), is key to moving forward to systems that integrate disease- or programme-specific data within broader primary care.