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Implementing M&E for the Multisectoral AIDS
Programme in Gauteng
Using Behavioural Surveillance Surveys
Sue le Roux & Dr Francis Akpan, Multisectoral AIDS Unit
Outline
• Background to Gauteng AIDS Programme• Description of M&E system and M&E Plan• The role of surveillance surveys• Behavioural surveillance surveys: Youth in
school, youth out of school, taxi drivers• Comparability of findings (2003 and 2006)• Issues for M&E practitioners • Recommendations
Gauteng AIDS Programme
• Multisectoral, government + civil society + business
• Communication / education / mobilisation
• 4 Goals1. Prevent new HIV infections
2. Comprehensive care
3. Support for children and families
4. Coordinate the multisectoral response
M&E system and plan• Theoretical Basis: UNAIDS Guidelines and 3 Ones
• Routine Reporting: reporting tool, financial & narrative
• Surveillance System:– Repeat biological and behavioural surveys – Facility surveys
• Research:– Evaluations of existing interventions– Evaluations of new interventions– Other Research: to inform programme development & planning
• Overall System: Flowchart and database, M&E plan, Log frames with indicators
LEVEL
M&E PRODUCT
06 07
08 09
10 DATA SOURCE STRATEGIC GOAL
HSRC survey of HIV
prevalence and incidence
X
X
HSRC
Prevention
Antenatal Survey
X X
X X
X NDOH
Prevention
StatsSA or MRC Mortality
report
X
X
X StatsSA / MRC
Prevention
Care
TB Register
X X
X X
X NDOH
Care
Gauteng household survey /
Community psychosocial
survey
X
MSAU
Children / Poverty
DHS / Quality of life
X
Care
Children / Poverty
HIVISS (Sentinel
Surveillance)
X
X
GDH / MSAU
Care
Impact study of AIDS on
Gauteng
X
MSAU
Multisectoral
GPG Prevalence &
Behavioural Survey
X
MSAU
Prevention
IMPACT
Demographic profile of
Gauteng
X
X MSAU
Multisectoral
DHIS
X X
X X
X GDH
Care
HSRC
X
X
HSRC
Prevention
TB Register
X X
X X
X GDH
Care
ART / CCMT Reports
X X
X X
X GDH
Care
HBC evaluation
X
X MSAU
Care
CBC evaluation
X
X MSAU
Children / Poverty
BSS
X X
X X
X MSAU
Prevention
OUTCOME
Media evaluation
X
MSAU
Prevention, Multisectoral
Evaluation of training courses X X
X X
X MSAU
Prevention, Care, Children
/ Poverty, Multisectoral
Peer education evaluation /
Lifeskills evaluation
X
X
DOE / MSAU
Prevention
VCT evaluation
X
GDH, NDOH
Care
PMTCT evaluation
X
MSAU, GDH
Care, Children
DSD audits / visits
X X
X X
X DSD
Care, Children / Poverty
Mapping
X X
X X
X MSAU
Care
HBC review / evaluation
X
X
MSAU
Care
CBC evaluation
X
X
MSAU
Care
CCMT / ART evaluation
Care
Condoms
X X
X X
X NDOH
Prevention
ICAS / GSSC Reports
X X
X X
X ICAS / GSSC
Care
PROCESS
SABCOHA reports
X X
X X
X SABCOHA
Prevention, Care,
Multisectoral
TB register
X X
X X
X GDH
DHIS
X X
X X
X GDH
ICAS reports
X X
X X
X ICAS
DSD child care register
X X
X X
X DSD
Quarterly reports
X X
X X
X
Depts
NGOs
MSAU
Financial reports
X X
X X
X
Depts
NGOs
MSAU
HIVISS (Routine information
system)
X
X
MSAU
OUTPUT
Media monitoring (AMPS) X
X X
X X
MSAU
INPUT HR Records
X X
X X
X GPG
NGOs
Why surveillance surveys
• Repeat surveys of similar groups• Biological surveillance (information about biological end-
points) and behavioural surveys (risk-related behaviour)• Bi-annual behavioural surveillance, using established
methodologies, of priority populations – e.g. BSS of youth, taxi drivers, commercial sex workers, etc
• BSS can be a useful tool in informing responses to HIV and AIDS because they monitor behaviour, attitudes and knowledge over a period of time
• BSS can monitor trends which are vital to the effective creation of intervention plans and their implementation
• BSS can reach hard-to-reach population groups that a more standardised household survey is incapable of
BSS 2003 and 2006
2003• Youth in school• Youth out of school• Commercial sex workers• Hostel residents
2006• Youth in school• Youth out of school• Taxi drivers
BSS indicators
• Knowledge of HIV prevention methods• No incorrect beliefs about AIDS• Comprehensive knowledge of HIV • Multiple partners in the last 12 months• Risky sex in the last year• Condom use at last risky sex• Sex with a sex worker in the last 12 months• Condom use at last commercial sex• Accepting attitudes to those living with HIV
Areas of interest (Taxi drivers)
• Short distance, long distance, cross border• Number of nights spent away from home• ‘Sleep-over trips’ outside of Gauteng• Circumcision• Condom use at last sex with non-regular partner• Alcohol use• VCT• Sources of information / language of preference
YIS / YOS sample 2003/06Characteristics
of sample2003 2006
Geographical area
Soweto and southern suburbs (Eldorado Park, Lenasia, Lenasia South, Ennerdale, Mondeor)
Ekurhuleni West (Alberton, Boksburg, Edenvale, Germiston, Katlehong, Kempton Park, Tembisa, Vosloorus)
Race YOS71% African29% Coloured or Indian
YIS66% African31% Coloured or Indian4% White
YOS98% African1% Coloured
YIS84% African4% Coloured 11% White
Age YOS15-19: 39%20-24: 61%
YIS15-19: 95%20-24: 5%
YOS15-19: 25%20-24: 75%
YIS15-19: 96%20-24: 4%
Challenges of comparability
• The ‘exact group’ cannot be compared over time
• Similar populations could be fundamentally different in Gauteng
• Temporality
• Non-linear concept of causality / assumption of causality
• Different special risk groups included
Issues for M&E practitioners
• Challenge of identifying trends and changes• Comparability of samples• Ensuring methodological consistency
(documentation, staff turnover)• Attributing changes to programmes and
interventions (impossible)• Role of stakeholders / programme managers in
interpretation of findings• Consider how to optimise the data and
investment in research (e.g. advanced analysis)
Recommendations• M&E Plan and know how surveillance fits in• Allocate resources• Persist with BSS – established, comparable,
credibility, replicable• If possible link biological and behavioural
surveys• Utilisation of the product: interpret data in a way
managers can understand; use findings to influence plans and programme design and implementation
• Allocate resources for advanced analysis and ensure technical capacity (specs, project management, service provider)
