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IMPROVING PERFORMANCE REPORTING AT OGUR YOUTH INFORMATION AND CARE CENTRE (OYICC), ERUTE NORTH HEALTH SUB DISTRICT, LIRA
DISTRICT
BY
RONALD APUNYO, PGD PPM (UMI), PGD M&E (UMI), BSC ENV. HEALTH SCIENCE (MUK)
JOEL OKELLO, PGD PPM (UMI), DIP. LEADERSHIP IN COMMUNITY DEVELOPMENT (ESAMI, TANZANIA), B. DEVT STUDIES (MUK)
MEDIUMTERM FELLOWS
OCTOBER 2012
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Table of Contents DECLARATION ........................................................................................................................3 Fellow’s role in project implementation ......................................................................................4 Acknowledgements.....................................................................................................................5 Acronyms ...................................................................................................................................6 Executive Summary ....................................................................................................................7 1.0 Introduction and Background ................................................................................................9 1.1 Statement of the problem.................................................................................................10 1.2 Justification/Rationale .....................................................................................................10 1.3 Conceptual framework.....................................................................................................11 1.4 Objectives of the Study....................................................................................................12
2.0 Methodology.......................................................................................................................13 3.0 Project Results.....................................................................................................................14 3.1 Logic model/results framework and Log frame developed ...............................................14 3.2 Enhanced capacity of OYICC staffs on M&E data management and reporting.................14 3.3 OYICC information system linked to MOH HMIS ..........................................................16
4.0 Lessons learnt and challenges..............................................................................................17 4.1 Lessons learnt..................................................................................................................17 4.2 Challenges experienced and how they were overcome .....................................................17
5.0 Summary and Conclusion and Recommendations................................................................18 5.1 Summary.........................................................................................................................18 5.2 Conclusions.....................................................................................................................18 5.3 Recommendations ...........................................................................................................18
6.0 Appendices..........................................................................................................................19 6.1 OYICC HMIS 105 Report to District Health Office.........................................................19 6.2 OYICC data flow chart ...................................................................................................21
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DECLARATION I, Ronald Apunyo and Joel Okello do hereby declare that this endofproject report entitled,
‘Improving Performance Reporting at Ogur Youth Information and Care Centre (OYICC), Erute
North Health Sub District, Lira District’, has been prepared and submitted in fulfillment of the
requirements of the Mediumterm Fellowship Program at Makerere University School of Public
Health and has not been submitted for any academic or nonacademic qualifications.
Signed ………………………………………. Date…………………………………..
Ronald Apunyo, Mediumterm Fellow
Signed ……………………………………….. Date…………………………………….
Apunyo Ronald, Mediumterm Fellow
Signed ………………………………… Date…………………………………..
(full names of Institution Supervisor)
Institution Mentor
Signed ………………………………… Date…………………………………..
(full names of Academic Supervisor)
Academic Mentor
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Fellow’s role in project implementation
The two fellows were instrumental at all stages of project development. The fellows jointly
conducted problem and objectives analysis with Ogur Youth Information and Care Centre
(OYICC) staff that led to the development of the proposal. During implementation, the two
fellows led training of OYICC and Ogur Health Centre IV staff on monitoring and evaluation
fundamentals, reporting requirements, data flow structure among other key topics. The fellows
also monitored and evaluated the project to ensure compliance throughout the period of
implementation by way of regular visiting of the project site, including holding meetings with
project team members.
.
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Acknowledgements
We would like to thank the country management team of Medical Teams International under the
leadership of the Country Director, Felix Omodi, who was supportive of our cause to participate
in the prestigious fellowship programme. Special thanks go out to the staff of OYICC and Ogur
Health Centre IV who made this project a success. Our sincere gratification also goes out to our
academic mentor (Ibrahim Lutalo) and institutional supervisors (Dr. Isaac Milton Odongo and
Dr. Okello Patrick) who provided very useful comment and guidance throughout the duration of
the project. We are also indebted to the School of Public Health and would like to thank Joseph
Matovu and all the leadership of the fellowship programme for the encouragement and guidance
offered.
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Acronyms
AIDS Acquired Immune Deficiency Syndrome
ANC Antenatal Care
DHO District Health Office
HC IV Health Centre IV
HCT HIV Counseling and Testing
HIV Human Immunodeficiency Virus
HMIS Health Management Information System
HQ Headquarters
MAKSPH Makerere University School of Public Health
M&E Monitoring and Evaluation
MOH Ministry of Health
MTI Medical Teams International
PMTCT Prevention of Mother to Child Transmission
OIs Opportunistic Infections
OYICC Ogur Youth Information and Care Centre
STIS Sexually Transmitted Infections
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Executive Summary
Ogur Youth Information Counseling and Care Centre (OYICC), an affiliate of Ogur Health
Centre IV, located in Erute North Health Sub District – Lira, is one of the HIV/AIDs projects
being implemented by Medical Teams International (MTI) – Uganda. The centre targets youth
aged 1024 years old, HIV exposed children, HIVpositive children as direct beneficiaries and is
funded by MTI – Headquarters. The main objective of the project is to improve the quality of life
of youth and children infected and at risk of HIV/AIDS in Ogur and nearby Sub Counties in Lira
district. The centre provides appropriate treatment and care to 100% of HIV positive youth and
children who present with STIs and OIs.
Documentary analysis and discussions with the staff of OYICC revealed a weak monitoring and
evaluation system unable to support evidence based planning and decision making. The absence
of an effective monitoring and evaluation system constrained the ability of Ogur Youth
Information Counseling and Care Centre to: 1) effectively monitor and evaluate the project in
order to track progress to facilitate learning and sharing of best practices 2) mobilize resources
beyond its current USA based MTIHQ funders.
The general objective of the project was to strengthen evidence based decision making at OYICC
with specific objectives of: 1) developing a logic model/results framework and Logical
framework including revising project performance indicators for OYICC; 2) enhancing the
capacity of OYICC staffs on M&E data management and reporting and; 3) linking OYICC
information system to HMIS.
The project results included: 1) development of a logic model/results framework and Log frame
including revision of performance indicators to enhance monitoring, evaluation and reporting; 2)
enhanced capacity of OYICC staffs on M&E data management and reporting through training on
basic M&E and reporting; 3) The OYICC information system was linked to MOH HMIS by
developing a data flow plan jointly with the staff. The OYICC continues to submit HMIS 105
reports to the district health office.
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Key lessons learnt from the project is that good communication, Team work, Commitment and
support from both institutional and academic supervisors is critical in the overall success of the
projects and fellowship. This mitigates resistance to change.
Disbursement of funds through institutional account and difficulty in regularly accessing
academic supervisor were the main challenges. These were mitigated by having funds channeled
through the fellow’s account upon approval from the training coordinator and using multiple
approaches to communication with supervisor through emails, teleconferencing as well as
physical appointments during his private time respectively.
Much as the project was successfully implemented and key results achieved, sustainability of the
project interventions needs to be addressed in the long term by both OYICC as a project and
Medical Teams International.
Continuation of supportive supervision, replication of the OYICC project by MTI in sister
projects and follow up by MAKSPH will be crucial in promoting evidence based decision
making.
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1.0 Introduction and Background
Ogur Youth Information Counseling and Care Centre (OYICC), an affiliate of Ogur Health
Centre IV, located in Erute North Health Sub District – Lira, is one of the HIV/AIDs projects
being implemented by Medical Teams International (MTI) – Uganda. The centre targets youth
aged 1024 years old, HIV exposed children, HIV positive children as direct beneficiaries and is
funded by MTI – Headquarters. The main objective of the project is to improve the quality of life
of Youth and children infected and at risk of HIV/AIDS in Ogur and nearby Sub Counties in Lira
district. The centre provides appropriate treatment and care to 100% of HIV positive youth and
children who present with STIs and OIs.
Discussions with the Ogur Youth Centre and Ogur HC IV staff culminated into the development
of a problem and objectives tree. A scan through the project data base and review of HMIS 105
completed forms revealed: 1) there was no basis for monitoring and evaluating the project. The
project had a poorly developed log frame and or logic model with multiple objectives making it
inappropriate for monitoring and evaluating the project. Besides, most of the indicators stated in
the logical frame work were at output and activity level with no sound indicators to measure
outcomes of the project; 2) incompleteness of data collected from the youth centre and no
reporting on key HCT indicators to the HMIS. This grim picture held true for other indicators of
prevention of mother to child transmission (PMTCT), antenatal care (ANC) projects hitherto
implemented by the youth centre. (Source: Gregor funded Project database, September 2011).
OYICC is currently implementing a HCT including curative services. Discussions with facility
staff indicated that from the inception of the Centre, there had been little done to improve the
monitoring and evaluation system or setting up a results based monitoring and evaluation
system.
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1.1 Statement of the problem Documentary analysis and discussions with the staff of OYICC revealed a weak monitoring and
evaluation system unable to support evidence based planning and decision making.
The HIV/AIDS prevention and care project did not have a coherent M&E strategy including: a)
an updated logical framework and results framework to serve as a basis for monitoring and
evaluation of the project; b) M&E plan for data collection, analysis and dissemination covering
baseline, ongoing monitoring and evaluation; c) the M&E staff capacity was also weak with the
bulk of M&E activities being carried out by a front desk officer; d) Incompleteness and
untimeliness of reporting of results also characterized the M&E system; e) the absence of data
sharing and reporting mechanism between the youth centre and the Health Centre IV that
stemmed from the fact that: i) there was inadequate M&E data management capacity at OYICC;
ii) OYICC data capture tools were not comprehensive enough to capture data on HMIS
indicators making the final data on clients that is recorded into the HMIS for reporting to the
district less than the actual number being served by OYICC.
The project addressed the gaps identified above through: 1) capacity building on M&E data
management to improve reporting: 2) participatory learning and action to facilitate development
of an M&E plan, results framework and tools; 3) hands on coaching and mentoring on M&E.
1.2 Justification/Rationale
The absence of an effective monitoring and evaluation constrained the ability of Ogur Youth
Information Counseling and Care Centre to: 1) effectively monitor and evaluate the project in
order to track progress of the project, facilitate learning and sharing of best practices; 2)
mobilize resources beyond its current USA based MTIHQ funders. Good donorship requires
that there is value for money. Due to inadequacies in the existing monitoring and evaluation
system, teasing out the results at outcome and impact levels the project was impossible. The
project addressed this gap by developing a comprehensive monitoring and evaluation system to
facilitate evidence based decision making.
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1.3 Conceptual framework
•
Figure 1 above illustrates conceptual framework for strengthening M&E system of OYICC. With
a developed results framework, updated logical framework, enhanced capacity of the staffs on
M&E data management and reporting, and OYICC information system linked to the MOH
HMIS, OYICC M&E system will be strengthened.
Results framework and Logical framework including updated project
Capacity of OYICC staffs on M&E data management and reporting.
Linkage of OYICC information system to HMIS
Strengthened OYICC M&E Reporting system
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1.4 Objectives of the Study The general objective of the project was to strengthen evidence based decision making at
OYICC. The purpose of the project was to strengthen M&E system at OYICC
Specific Objectives of the study included:
1. Develop a logic model/results framework and Logical framework including project
performance indicators for OYICC
2. To enhance the capacity of OYICC staffs on M&E data management and reporting.
3. To link OYICC information system to HMIS
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2.0 Methodology
The fellows used a three thronged strategy to implement the project: 1) Participatory Learning
and Action to facilitate revision and development of a more robust monitoring and evaluation
system including revision of the project log frame and development a project logic model/results
framework; 2) Capacity building; and 3) hands on coaching and mentoring especially on the
tools. The capacity building strategy entailed enhancing the capacity of OYICC staff on: a)
HMIS and OYICC tools; b) basic monitoring and evaluation including data management and; c)
orientation on reporting. A technical team comprising of the fellows and the district
biostatistician facilitated the training workshop sessions. Onthejob coaching and mentoring of
OYICC staff by the fellows on the HMIS tools. Orientation on HMIS included focus on accurate
and complete reporting within the existing DHO monitoring system (HMIS) and review during
monthly review meetings and monitoring visits to the project by the fellows. The monitoring
visits and meetings were used as avenues to discuss and address pertinent issues arising from the
implementation of the intervention.
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3.0 Project Results 3.1 Logic model/results framework and Log frame developed
Through a participatory learning and action process, the participants made up of staff from
OYICC and Ogur Health Centre IV developed a results framework and revised the project
performance indicators with facilitation from the fellows and the Lira District HMIS focal
person. (Please refer to Annex 1 and 2). The log frame and Results framework will remain living
documents to be updated on a semiannual basis.
3.2 Enhanced capacity of OYICC staffs on M&E data management and reporting.
Both staff of OYICC and Ogur HC IV received training on basic M&E and reporting. Two sets
of trainings were undertaken each focusing on different topical M&E issues. Prior to the
commencement of trainings, participant’s knowledge on M&E was assessed by administration of
a pre test, and a post test administered at the end of the second training. Below is a presentation
of the results. (Annex 3 Training programme attached)
Fellow facilitating logframe development Participant making presentation
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§ Generally majority of participants scored higher in the post test, indicating improvement
in the knowledge levels.
§ Participant 10 scored higher in the pretest and dropped in the post test, participant fell
sick and dropped out of training for 1 day.
Fellow making presentation Presentation by Lira district HMIS focal person
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3.3 OYICC information system linked to MOH HMIS Prior to the implementation of the project, OYICC information system was tailored to meet only
donor reporting requirements with no reporting through the MOH HMIS system. A data flow
plan was developed jointly with the staff of OYICC to harmonise reporting to the donor and
MOH (See Annex 6.2). Ogur Youth Information and Care Centre continues to submit HMIS 105
reports to the district health office as a result. See Annex 6.1
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4.0 Lessons learnt and challenges 4.1 Lessons learnt
The following were the key lessons learnt from inception to execution of the project.
• Good communication right from startup of the project mitigates resistance to
change due to the project paving way for successful implementation
• Even with meager resources, one can still implement successful projects as long as
there is commitment
• Team work is key to successful project implementation (Case of where there are
two fellow involved)
• Commitment and support from both institutional and academic supervisors is
critical in the overall success of the projects and fellowship
4.2 Challenges experienced and how they were overcome
• Accessing funds through institutional account: Wrote to the fellowship training
coordinator who offered guidance. We had funds posted on our account as a result
• Pushing organization to move the same pace with the fellowship programme:
Effective communication with line managers, support from the institutional
supervisor, prioritization of own work and working longer hours based on need by
fellows
• Difficulty in regularly accessing academic supervisor. (Lira) : Multiple approach
to communication with supervisor through emails, teleconferencing as well as
physical appointments during his private time
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5.0 Summary and Conclusion and Recommendations 5.1 Summary
This project set out to improve performance reporting at ogur youth information and care centre
(OYICC), Erute North Health Sub District, Lira District by strengthening the monitoring and
evaluation system at OYICC. Part 1.0 presented the introduction and background to the project.
Part 2.0 presented the statement of the problem detailing how the project addressed the gaps and
justification for the intervention. Part 3.0 presented the objectives of the project.
Part 4.0 presented the methodology for the implementation of the project. Implementation
strategies included: 1) participatory learning and action to facilitate revision and development
of a more robust monitoring and evaluation system; 2) capacity building; 3) hands on coaching
and mentoring especially on the tools.
Part 5.0 presented the key results of the project. Key results includes: 1) development of Logic
model/results framework and Log frame including project performance indicators; 2) Enhanced
capacity of OYICC staffs on M&E data management and reporting. Both staff of OYICC and
Ogur HC IV received training on basic M&E and reporting; 3) linkage of OYICC reporting
system to the District HMIS system and Ministry of Health – Resource Centre.
5.2 Conclusions
Much as the project was successfully implemented and key results achieved, sustainability of the
project interventions needs to be addressed in the long term by both OYICC as a project and
Medical Teams International.
5.3 Recommendations • Continuation of supportive supervision to OYICC
• Replication of the OYICC project in a sister project in Paderto be facilitated by
the Organisation and then to all other MTI projects.
• Follow up by MAKSPH
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6.0 Appendices 6.1 OYICC HMIS 105 Report to District Health Office
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6.2 OYICC data flow chart
Laboratory Counseling Youth Dept Pharmacy
Program Manager
HIV/AIDS (MTI Country Office)
Youth Dept Counseling Laboratory Pharmacy
HIV/AIDS Coordinator (OYICC)
MTI Headquarters (Donor)
Ogur Health Centre IV (HSD)
Lira District Health
Department
MOHRC
Before Project Implementation After Project Implementation
MTI Headquarters (Donor)
MOHRC
Program Manager HIV/AIDS (MTI Country Office)
Lira District Health
Department
HIV/AIDS Coordinator (OYICC)
Ogur Health Centre IV (HSD)
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Provide appropriate treatment and care to 90% of HIV + children and youth who present with STIs, OIs and other medical conditions at OYICC by the end of 1
year. Increase access and use of youth friendly counseling and testing services for 90% youth and children Provide PMTCT services to 80% of pregnant youth and 20% of their partners attending ANC services
within 1 year Provide psychosocial support to youth & children infected and
affected with HIV/AIDS
Funds
Project Management
Technical Expertise
Transport
Equipment/ Supplies
Treatment of STI & Opportunistic infections
Strengthening the referrals for HAART/Pediatric
HIV/AIDS care
Procure and avail drugs and laboratory test kits to provide a comprehensive diagnosis procedures
related to HIV
Follow up of HIV+ children and youth for
adherence
Carry out HCT services within the centre and outside the centre (Outreach sessions)
Procure the current recommended ARVs for PMTCT prophylaxis
Psychosocial Support
Youth and children who present with STI & Opportunistic infections treated
Children and Youth friendly counseling and
testing services provided
Pregnant women attending centre
provided with PMTCT services
Psychosocial support for youth and children
provided
Improved management capacity at OYICC
Increased number of youth and children
presenting with OIs, STIs treated. Increased
number of youth and children
accessing HCT services Increased
percentage of pregnant youth attending the
center accessing PMTCT services
Increased percentage of youth who
identify at least three modes of
HIV transmission and
prevention
Objectives
Improved the quality of life of youth and children
infected and at risk for HIV/AIDS in Erute North
Health Sub District
Inputs Major Activities Outcomes Impact Outputs
MEDICAL TEAMS INTERNATIONAL OGUR YOUTH INFORMATION AND CARE CENTRE PROJECT RESULTS
FRAMEWORK
