M&E-The Ethiopian Experience

MERG MeetingGeneva,Switzerland

Oct. 25-26,2004

Dr. Wuleta Lemma, CDC/Tulane/WB

M&E and Surveillance Advisor, HAPCO/MoH

Outline

• Background

• M&E---Case Study

• After Bangkok

• New Development

Status of HIV/AIDS

Background-Ethiopia

• People living with HIV/AIDS ……..…………….….. 1.5 million

• Estimated percent of adults (15–49) infected with HIV ….. 4.4%

• Rural = 2.6%; Urban = 12.6%

• Cumulative deaths due to AIDS ………………..…... > 1 million

• Children infected and living with HIV ………………... 96,000

• Cumulative number of children orphaned by AIDS …... 540, 000

• Number of pregnant women living with HIV …………. 130,000

• Number of PLWHA needing ART ……………………. 245,000

Estimated and Projected Adult HIV Prevalence, Urban Ethiopia and Regions, 1982-2008

0

2

4

6

8

10

12

14

16

18

20

82 84 86 88 90 92 94 96 98 00 02 04 06 08

Year

Ethiopia

Tigray

Somali

Addis Ababa

SNNPR

Oromia

Harari

Gambella

Dire Dawa

Benishangul G.

Amhara

Afar

HIV

Pre

vale

nce

(%)

Weighted urban HIV prevalence: 12.5%

Estimated and Projected Adult HIV Prevalence, Rural Ethiopia and Regions, 1982-2008

0

1

2

3

4

5

6

7

82 84 86 88 90 92 94 96 98 00 02 04 06 08Year

Ethiopia

Tigray

Somali

SNNPR

Oromia

Harari

Gambella

Dire Dawa

Benishangul G.

Amhara

Afar

HIV

Pre

vale

nce

(%

)

: 2.8% (2004)

2004 prevalence range: 1.0% - 5.2%

Assumed start of rural HIV epidemic: 1984

Estimated and Projected HIV Incidence by Age Group, Ethiopia, 1982-2008

0.0

0.2

0.4

0.6

0.8

1.0

1.2

82 84 86 88 90 92 94 96 98 00 02 04 06 08Year

15-19 yrs

20-24 yrs

25-29 yrs

HIV

Inci

denc

e (%

)

Estimated HIV Population Size by Sex and Age, Ethiopia, 2003

0

20

40

60

80

100

120

140

160

180

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65 +

Age Group (years)

Male

Female

No

. HIV

-po

sitiv

e (t

ho

usa

nd

s) No. HIV-pos, 2003:

Female: 810,000

Male: 650,000

Total: 1.5 million

M&E-The Ethiopia experience

Challenges to “One M&E System” Challenges to “One M&E System” No M&E unit at the national level Indicators not harmonized- Everybody have their own –

Ministries, Donors, CSO etc No unified data collection formats- Organizations have

their own different formats for similar indicators- “Same person ” at lower fills it all !!!!

Different report-Information Flow Limited not unified capacity building plan -- including

training and human capacity at all levels to role out a national M&E system

Non existence of an integrated data base (including HMIS)

Surveillance more developed than Program Monitoring Limited Budget for M&E Non-existent and disjointed Evaluation plan Infrastructure (road, telecommunication, networking, etc) varies from region to region

M&E-2003-present

• M&E Department at national ( 5 Staff ), Regional HAPCOs and district focal persons. M&E team includes MoH

• Secured budget (MAP,GF, PEPFAR and Others)

• Comprehensive training plan for all regions developed – ToT manual to follow

• Equipment (Computers & accessories) for all regional M&E Departments and all new ART sites- Take advantage of Woreda net

• National M&E Framework (with indicators, methods of data collection, Information flow, who collects what etc) after extensive consultation published in December 2003 and distributed to all Regions, NGOs, FBOs & Donors

M&E 2003-presentM&E 2003-present

National M&E Operational Plan with detail M&E Formats for all program activities

Assessment of National Financial Monitoring System of NHAPCO

Harmonization of GF requirement with national Indicators

Consolidated Surveillance and M&E resource mapping for MoH completed

Expanded Surveillance : 66 sites for 2003, almost twice the number sampled in 2001 (34 sentinel surveillance sites in 2001) first BSS done/report distributed nationwide (>27,000

sample) BBS-2 starting

After Bangkok

University Students

• 2003/4 (1996 ET) M&E data collected

• 2 University Students/ Region plus

• ~2 per District (606 district)

• Most regions completed

• Information includes at Federal level --Sector Ministries, Bilateral, Multilateral and NGOs

Example-FormsDonors and others support, currently active HIV/AIDS projects/programs (Information source: bilateral and multilateral organizations, NGOs etc)

Project budget HIV/AIDS Project title Project duration

Project area Allocated utilized Balance

Name of implementing agency/agencies

Infrastructure information Road to Zone town All weather asphalt All weather gravel Winter road Telephone Digital Manual (menubela) Telegram Electric Power From main source/hydraulic Generator

Module 01 Education

Module 02 Drug Administration and Control Authority (DACA)

Module 03 Ethiopian Red Cross Society (ERCS)

Module 04 FMoH, RHBS, WHOs and Facilities (Health)

Module 05 Other Government Offices

Module 06 Bilateral and Multilateral Organizations

Module 07 Civil Societies (NGOs, FBOs, CBOs, POs, etc.)

Module 08 Kebele HIV/AIDS Committee??

Module 09 Woreda HIV/AIDS Committee??

Module 10 Zonal HIV/AIDS Committee??

Module 11 Regional HAPCO

Module 12 National HAPCO

M&E Operational ManualM&E Operational Manual-12 -12 modules-meeting in Nov, 2004modules-meeting in Nov, 2004

(>150 people)(>150 people)

Other-Opportunity/Challenge

• Ethiopia approved for the largest GF (GF2+GF4 > $600M, PEPFAR around 50M/year)

• ~10-12% for M&E(inc. HMIS) and Surveillance/year• FMoH- HMIS (HMIS and M&E Advisory Committee

formed-Work stared)• LMIS• Lab Information system• Patient monitoring system• M&E National/Regional ToT training• Training on Medical Record

Home based Care

Health Posts

Tertiary Referral Hospitals ( 5)

HEP: basic general health care

Basic care, including pain and symptom relief

Regional / Zonal Hospital

District Hospital

District Hospital District Hospital

Health Center

ARTSpecialty care

Acute Illness CareHIV Counseling and Testing

Pain Management

Formal Health System Levels Service Components

Health CenterHealth Center

Health Center HIV counseling and testing, PMTCT, OI treatment and prophylaxis, TB dx , ART follow up, nutrition counseling and support, psychosocial support

[ pain management]

COMMUNITY

Uniformed Services

CS

W

Transporters

CHWs

The Network Model

New Development/Strategies

• HAPCO to Report to MoH• Implication on M&E not clear (assumed not much

as the National M&E Framework was accepted in SPM)

• Implication on structure not clear• Health Extension Workers (23,000 to be deployed

in 5 years). 2005 M&E training planned• Performance based District Block grants

Thanks!!!