Monitoring and Evaluation of HIV and AIDS programs is very critical in the fight against this disease that has devastating impact across the globe and especially in Sub-Saharan Africa. The is an adage that says, “a problem identified is a problem half-solved”. HIV and AIDS has been recognized as a major problem afflicting the world; thus, every effort is being made to understand the disease and provide information to guide the planning and implementation of services that would be of great benefit not only to those infected and affected by HIV, but to the general public.
In an effort to foster the One Health policy, Liberia has operated an integrated monitoring and evaluation system for health. Over 700 health facilities (Public and Private) report aggregated data on a monthly basis using a booklet (HMIS Form) that contains indicators and data elements for all health programs provided. These reports are submitted to District Health Teams where they are entered electronically into the DHIS2 platform. This system is backed by a joint integrated supportive supervision conducted at all levels as well as a rigorous on-site data verification (OSDV) to ensure good quality data is reported.
Conforming to MOH‘s decentralization policy, the national M&E institutional framework is divided into four levels. These levels include the following: national, county, district and community levels. Over 238 sites have been trained to provide HIV treatment care and support and more than 500 sites provide treatment for pregnant women to prevent mother-to-child transmission of HIV.
Routine Monitoring and Supervision at all levels
Monitoring is the process of observing whether an activity or service is occurring as planned. It involves the continuous oversight of the implementation of an activity, seeking to ensure that input deliveries, work plans, targeted outputs, and other required actions are proceeding according to plan. Monitoring aims to identify evidence of any diversion from a planned course of action; thus identifying the need for a more formal evaluation of activities and allowing timely solutions to problems to be sought.
MOH standard monitoring and reporting tools will be used to collect and keep raw data, and produce quarterly reports. Monitoring will be done at all levels including the service delivery point and the County Health Teams that have oversight management responsibilities to the service point.
To facilitate effective monitoring, all SRs will be required to submit to the PR (PCU) at the beginning of every quarter, detailed quarter activities plan with clear time work plans, responsible staff and expected results.
Monthly Monitoring at all Service Delivery Points
All health facilities will be monitoring their outputs on a monthly basis. Such monthly monitoring will help service providers detect the problems at an early stage and take corrective measures so that the annual targets of the program are met. CHTs are to also conduct monthly supervisory visits to health facilities.
Quarterly monitoring at all Management Levels
County and Central MOH will carry out quarterly monitoring at their respective levels to ensure that program results are produced as planned. Such monitoring will include On-site data verification (OSDV) and verification of implementation (VOI) and supportive supervision and follow-up visits to the next lower level of the health system.
Annual Reviews at all Service Delivery and Management Levels
Annual Reviews will primarily focus on the yearly progress of the program. Therefore it serves as annual interim evaluations. At the same time, an Annual Review will analyze the performance towards the achievement of long-term goals and targets.
Integrated supportive Supervision
Supervision visits will be conducted throughout the project cycle in view of understanding the status of implementation of project objectives. This will offer the opportunity to give an account or recording of work that has been done; reflect on it; receive feedback, and where appropriate, provide guidance to improve implementation.
The PCU shall organize a Quarterly Joint Review to involve the various MOH departments, NLTCP, NACPand the SRs to discuss on the status of grant implementation.
Further review of the implementation of programs will be done at the National County Health Review and the national health conference conducted annually. These reviews provide the opportunity for the implementers of clinical response to TB/HIV and the program manager to discuss challenges and faction common action points for progress. The objective of this review is to share experiences among the stakeholders on what has worked and what has not (achievements, issues, constraints and lessons learnt) in view of improving performance.
Data Quality Audit
Data quality audit by the MOH (PR) will be done through reviewing of activities carried at all level of the program implementation. The MOH will also conduct field visit to randomly selected service delivery points to verify data quality. Standard data auditing guidelines will be developed and used for this purpose. These visits are intended to also provide technical advice where this is needed, troubleshooting and problem solving to improve recording and reporting. This is done through examining the raw data that has been used to compile reports by comparing the quarterly programmatic and financial reports against raw data (daily registers, activity reports, training reports, workshop evaluation forms, clinical registers or any other source document used to compile the quarterly reports). Reports on DQA will be shared with the facilities, national program(s) and implementing partners.