46278 HIV/AIDS M&E - Getting Results These reports describe activities, challenges and lessons learned during the World Bank Global Global AIDS Monitoring and Evaluation Team's (GAMET) work with countries and other partners. HIV/AIDS Program Zanzibar's National HIV M&E System bears fruit soon after launch The Global AIDS Monitoring and Evaluation Team (GAMET) & Zanzibar National AIDS Commission "Setting up a functioning HIV Monitoring and Evaluation AIDS Program, the "MAP"). In 2004, under the UK DFID- System in Zanzibar wasn't easy or fast. But persistent and funded Support to International Partnership Against carefully planned efforts have borne fruit. Even skeptics AIDS in Africa (SIPAA) program, an M&E assessment now see how generating good M&E data enable good was undertaken. This assessment led stakeholders to decisions that achieve better results." Asha Abdulla, critically review and update the M&E system plan and Executive Director, Zanzibar AIDS Commission. tools. In late 2005, the World Bank Global AIDS Monitoring and Evaluation Team (GAMET) and UNAIDS Zanzibar's AIDS response ­ national plans reassessed the M&E system, and made suggestions for strengthening it. Building on the two assessments, ZAC The first three AIDS cases in Zanzibar were officially then led stakeholders to redesign the Zanzibar National reported in 1986. By the end of 2002, HIV prevalence was Multisectoral HIV M&E System. GAMET provided still relatively low in the general population (0.6%)1, but technical leadership, working in close collaboration with high in most-at-risk populations such as needle-sharing the ZAC M&E unit, the SIPAA program and UNAIDS. injecting drug users (29% in 2006). In May 2006, the re-developed M&E system was Between 1987 and 1988, the Revolutionary Government of launched in a colorful ceremony by the Chief Minister of Zanzibar (RGoZ) designed and carried out an Emergency Zanzibar. Its goal is `to enable ZAC and its partners to Short Term Plan. This was followed by Medium Term monitor the spread and impact of the epidemic in Plans I and II which lasted from 1989 to 1996. The first two Zanzibar, to monitor the efficiency of the national medium term plans were health-oriented with a focus on: response to HIV, and to evaluate the effectiveness of the Motivating behavior change; Ensuring blood safety; national response to HIV, using relevant and accurate Counseling and caring for people living with HIV (PLHIV) HIV data in planning effective interventions.' After the and Community involvement. From 1998 to 2000 the launch, ZAC trained a team of national accredited M&E RGoZ Medium Term Plan III provided a framework for a trainers, who then rolled out M&E training for all key multisectoral response to fight HIV&AIDS, recognizing that stakeholders in Zanzibar in 2006 and 2007. At the HIV is not only a health problem but also a potential social beginning of 2007, ZAC increased the number of staff in and economic crisis. its M&E unit from one to four in order to cope with the scaled up HIV M&E activities. In 2002, the RGoZ established the Zanzibar AIDS Commission (ZAC) with the mandate of leading, managing The investments in the HIV M&E system paid off; by and coordinating the national multisectoral response to December 2006 the HIV M&E system had obtained and HIV in Zanzibar. In developing and implementing the five processed the first round of data from HIV implementers. year Zanzibar National HIV&AIDS Strategic Plan 2004/5- 2008/9 (ZNSP), Zanzibar has tried to mobilize all Government and non Governmental sectors to design and implement various HIV interventions in Zanzibar. How the Zanzibar M&E system was developed from 2003 to 2007 ZAC worked with stakeholders to start developing the National Multisectoral HIV&AIDS system in late 2003. The first M&E plan developed in 2003 was pre-condition for accessing World Bank funds (through the Multi-country All key stakeholders ­ more than 300 organizations - were 1 trained on M&E and using the HIV M&E system Source: Zanzibar MOHSW population survey 2002 These data were used to create an HIV quarterly service (e) It was hard to plan, manage, coordinate and support coverage report and brochure on the Oct-Dec 2007 equitable and non-duplicated work; quarter, which were both disseminated to all stakeholders. (f) People questioned the commitment levels of AIDS Generating, compiling, and disseminating M&E data to HIV organizations and questioned the outcomes of their stakeholders in Zanzibar is now routine, with quarterly HIV work; and service coverage reports being generated every quarter. (d) Implementers did not like M&E activities. A slow start to HIV M&E Great progress in HIV M&E by the end of 2007 HIV Stakeholders were reluctant to participate in M&E Dramatic improvements were achieved in 2006 and and did not appreciate its value 2007 in M&E staffing and expertise, recognition of the At the early stages of the national multisectoral HIV value of reliable data, enthusiasm and commitment to response in Zanzibar, most implementing agencies had M&E that started data flowing. Now, the components of not yet developed a close and trusting working relationship a functioning M&E system are in place, and recent with Government. Nor did these agencies recognize the relevant data from stakeholders across the islands are importance of undertaking M&E: widely available in easy-to-use formats. Some of the civil society agencies misperceived M&E The national M&E system has staff at national and as a way for Government to play an unfriendly decentralized sub-national levels. ZAC has four HIV `watchdog' function towards civil society, and so they M&E staff at the national level. The Zanzibar AIDS were reluctant to provide reports on the activities they Control Programme, the Health Management were implementing to the Government. Information System, and the Office of the Chief Government Statistician also have M&E staff. The Most civil society organizations had raised their District HIV Focal Persons and the Ministerial HIV focal funding from private donors, and had received little or persons also conduct M&E functions within their no funding for their HIV activities from Government activities. Over 300 agencies have Zanzibar National funding mechanisms. Therefore civil society HIV&AIDS Programme Monitoring System (ZHAPMoS) mistakenly felt no obligation to report to the focal persons who conduct M&E. Health clinics have Government in addition to reporting to the donors who fund their activities. Data Officers responsible for M&E. The key HIV M&E staff have been trained on M&E under the ZAC rollout Many civil society agencies also were struggling to of M&E capacity building in Zanzibar. provide services for HIV interventions with limited financial and human resources. Their staff was very The M&E Task Team for HIV&AIDS in Zanzibar busy, and tied up with HIV operations, which made (METTHAZ) is functional and vibrant. METTHAZ has them even more reluctant to spend time and money regular meetings and members take part in overseeing generating data for M&E. They viewed M&E as a time and coordinating various M&E functions. consuming and administrative function that would not add much value to their HIV service delivery goals and ZAC and the district HIV&AIDS teams (DHAPs) targets. advocated with implementers to provide data and reports for HIV M&E, which increased the number of Negative attitudes to HIV M&E affected program implementers reporting. Over 80% of those who were planning and implementation trained (more than 300 organizations) submitted data to Because of stakeholder reluctance to collect and provide ZAC using ZHAPMoS forms. data for HIV M&E, the HIV M&E system in Zanzibar was Zanzibar has developed a full set of "how to" not yet functional when the assessments were done in documents: 2004 and in 2005. Without a function M&E system, a couple of things went wrong in planning, implementing and · the M&E Operational Framework Volume 1 and achieving the desired goals of HIV interventions: Volume 2 to guide M&E processes at all levels; (a) Critical decisions were made without readily available, · The Zanzibar National HIV&AIDS Programme reliable & accurate data; Monitoring System (ZHAPMoS) Guidelines; (b) M&E staff in a number of agencies were · Data auditing and supervision guidelines; underemployed and de-motivated; · a costed National HIV M&E Road Map; (c) There was limited structured learning and research · Packages for training stakeholders in M&E. and it was hard to really know which interventions were making a difference or how they might be A national HIV Road Map (costed work plan) is improved; developed every year with inputs from METTHAZ and 2 forms the basis of resource mobilisation and decisions Different technical support partners ­ The World about HIV M&E investments that need to be made. Bank, SIPAA, UNAIDS, USG and other consultants ­ all worked together in a spirit of partnership A national HIV database was designed, developed, and without concern about `turf' issues: they shared installed onto the ZAC computer. Guidelines for data lessons, strategies and experiences. auditing and supervision were developed and District and ZAC staff were trained on how to use the guidelines. Useful lessons for other countries Steps have been taken to coordinate HIV research and learning in the future. By the end of 2007, ZAC had A functional M&E system is the backbone of developed Terms of Reference for a consultant to support good governance, favorable publicity and a the development of a joint learning, research and positive corporate image for a national AIDS evaluation agenda. response. Since the M&E system in Zanzibar became functional, reports of HIV activities being Data have been generated and reports developed using implemented have been produced and disseminated the ZHAPMoS system and the health clinic data collection broadly. People who read these reports get an systems. Using the data submitted by implementers, ZAC insight into stakeholders' HIV achievements, which has generated quarterly service coverage reports, the increases respect for the HIV organizations. The annual HIV report, and the biennial UNGASS report. The M&E system has been used to monitor reports have been disseminated to key stakeholders to implementation and improve the quality of programs use for decision-making in HIV programs. being implemented. The secret to success in M&E work is to join Critical success factors for stakeholder hands in concerted efforts by all stakeholders in participation in the M&E system all sectors, from national to decentralized levels.' Capacity building, communication and advocacy ZAC undertook a number of activities which were a are key to empowering all stakeholders to catalyst to making the HIV M&E system operational. These meaningfully participate in a national M&E system. are the main factors that caused stakeholders to provide To ensure stakeholders use M&E data for data and use information generated from the M&E system: decision making, National AIDS Commissions should generate and disseminate user friendly and ZAC led intensified and continued advocacy, targeting interesting information products, and heads of agencies and encouraging them to continuously advocate for stakeholders to implement HIV M&E activities and provide reports to deliberately and consciously use M&E data for ZAC decision making. Many HIV reports are seen by ZAC mobilized sufficient domestic and international stakeholders as complicated, long and difficult to HIV M&E funding and technical resources and understand. Therefore ZAC published user friendly, supported implementers to undertake their M&E roles easy to read, and well illustrated brochure and M&E guidelines. Stakeholders are interested in reading A functional METTHAZ steered HIV M&E activities, these materials and in using them. and mobilized and encouraged HIV stakeholders to undertake M&E activities A national costed HIV M&E work plan is important for ensuring that enough resources are generated ZAC developed training materials, trained accredited for HIV M&E. trainers who then rolled out the M&E training to all implementers from national to community levels Early results from the M&E work ZAC developed and disseminated communication and advocacy materials on HIV M&E which increased stakeholders' understanding, appreciation and support Data obtained from the M&E system have been used in for HIV M&E activities information products which cover: ZAC delegated M&E system roles to various · Key highlights and trends in the national AIDS stakeholders among the implementers, Ministries and response Districts at national and decentralized levels. With ZAC · Main achievements and quantity of HIV services staff sharing the responsibilities for implementing M&E provided activities with others, it was possible to implement · Challenges and shortcomings in implementing HIV activities efficiently and on time work in Zanzibar ZAC involved all stakeholders in developing and · Recommended actions to strengthen the HIV implementing the HIV M&E system response in Zanzibar. 3 With the achievements that have got the M&E system technical assistances, and training needs. So, for functioning, the following changes have been noted: example, in discussing the M&E data, people realized that technical assistance was needed for · Misconceptions and reluctance were replaced by undertaking workplace surveys, and to harmonize understanding and support the data collection tools used for poverty monitoring, · Instead of resistance, now there is eagerness to the Zanzibar AIDS Control Program and ZAC. participate without prompting M&E data have been used to develop a Zanzibar · Stakeholders own the M&E system and implementers Advocacy & Communication Strategy: The have become M&E advocates quarterly service coverage reports have shown that HIV & AIDS awareness among the population in · Public confidence in HIV service organizations is Zanzibar has reached very high levels, but gradually increasing behavioral changes lag. In response, ZAC decided to develop an advocacy and communication strategy Most important of all, M&E data have been used to make for HIV that would use a Behavioral Change decisions: Communication (BCC) approach instead of an Information, Education and Communication (IEC) M&E data have been used for budget reallocation: approach. The first two M&E quarterly service coverage reports analyzed and presented data that indicated that media In implementing the new advocacy and had been underutilized in HIV communication, communication strategy -- which is in place and advocacy and campaign work. This issue was operational -- ZAC management and the M&E and discussed by the ZAC management and Ministry of Advocacy & Communication staff will continue to information during the National HIV Advocacy and take the lead in advocating for technical and Communication Committee meeting. Subsequently, financial resources, for strong implementation of ZAC increased the budget for HIV media activities and M&E activities, and for wide dissemination of also increased the budgets allocations to stakeholders HIV&AIDS information among all HIV-related to undertake HIV work with media. agencies. M&E data have been used to develop and scale up interventions for most-at-risk populations What bottlenecks and challenges remain for the (MARPs): The M&E quarterly service coverage M&E system? reports of 2007 indicated that most-at-risk populations (MARPs) have not been targeted enough by the AIDS There are bottlenecks that still challenge implementation response in Zanzibar, given that Zanzibar's epidemic of various HIV&AIDS activities in Zanzibar. Some appears to be concentrated among MARPs. The HIV stakeholders are reporting after the deadline for implementers undertaking MARP programs and ZAC quarterly reporting has passed. Data analysis was a long management discussed this data, and decided how to and tedious process before the database was act on it. (a) ZAC identified available funding that could developed; March 2008 will be the first time that the be used to reach these underserved populations, as a database is being used, and there may be "teething priority for the Zanzibar response. The ZAC planning problems" to resolve. Districts need a lot of supportive team worked with organizations serving MARPs to supervision to fully embrace their M&E roles. More plan activities that could be funded through the World publicity and dissemination of M&E information products Bank TMAP project component for the Community AIDS Response Fund. (b) NGOs scaled up their is needed. A deliberate and conscious culture of using interventions targeting MARPs using resources from M&E data needs to be nurtured. Global Fund round 6 and other sources. M&E data have been used to catalyze private Prepared by: sector AIDS activities: A ZAC meeting with AIDS Julie Tumbo, M&E Advisor to the Zanzibar AIDS Business Coalition in Zanzibar reviewed a quarterly service coverage report which highlighted the need for Commission, and GAMET team member informal businesses to be involved in HIV activities. Kimwaga Muhiddin Ali, M&E Coordinator, Zanzibar AIDS The AIDS Business coalition of Zanzibar then started Commission discussing and developing strategies to involve informal private sector in HIV activities. More topics in the "Getting Results" series are at: M&E data have been used to decide and identify www.worldbank.org/aids > Getting Results M&E technical assistance and training needs: The quarterly service coverage reports help HIV July 2008 stakeholders identify strategic areas that need 4 5