Transitioning M&E functions: The case of Rwanda

By Dr Veronicah MUGISHA, MBcHB, DPH, Mmed

M&E Director, ICAP-Rwanda

Outline

• Background and organization of M&E in Rwanda

• Planning the transition

• Implementing the transitioning of M&E functions

• M&E functions under the transition

• Progress to date

• Challenges and perspectives

Background

• Pre-condition for phase 2 of Track 1.0 funding

• Transfer of funding and program management responsibilities from international IPs to local institutions

• Transition plan included in Track 1.0 continuing application

Planning the transition

• Transition Task Force (TTF) chaired by MoH, CDC; composed of IPs

• TTF assessed sites (in Oct 2009) to determine order of transition

• Main TA functions identified for transition; each forming a TWG:

– Clinical mentorship and quality of services– M&E – Management

• UPDC identified by GoR and USG as the local institution to be transitioned to

• Political/policy agreement on the readiness to receive TA aimed at strengthening national capacities

Implementing the transitioning of M&E functions

• M&E TwG chaired by ICAP, co-chaired by TRACPlus. Members: CDC, AIDSRelief, UPDC, M&E/MoH, HMIS

• Meeting weekly to agree on tasks and propose plan for transitioning M&E; develop, pilot and adopt site assessment tools

• Detailed discussions and agreement on relevance of key M&E functions

• A collaborative and transparent assessment of site level capacities in M&E, Management, quality of care

Key M&E functions provided by IPs

• Training on M&E and data management• Mentorship and TA support• Data quality assurance and verification of reports• Database maintenance and support for computer

maintenance (preventive maintenance and repair)• Reporting:

– APR, SAPR and quarterly narrative reports– Track 1.0 quarterly, semi annual and annual data and

reports: narrative and data reports– Collection PEPFAR/Track 1 indicators not routinely

reported in MOH monthly reports.

Progress to date (April to July 2010)

• Technical meetings between TRACP+, UPDC and IPs– Orientation on tools– Reporting guidelines and indicators

• Joint field activities:– Readiness to transition assessment (Oct 2009)– Baseline assessment in April/May 2010– Mentorship, data collection, verification & preparation of

Track 1.0 data reports since April 2010

• TRAC clinic reporting handed over to TRACplus:– ICAP reviewed the Apr-Jun data report

• M&E framework and plan for the transition drafted and adopted by TTF

Roles & Responsibilities - consensus• UPDC will:

– Take over M&E, data management, and use at DH level– Prepare, compile and transmit PEPFAR and Track 1.0 reports– Monitor data quality– Conclude and oversee contract for maintenance of computers and other IT

equipment• TRACPlus will

– Ensure data base maintenance and support and migration from IQCHART to open EMR when it becomes ready

• DH will:– Supervise HC on M&E and data management– Eventually take over preparation and transition of Track 1.0 reporting to UPDC

• IPs will:– Transfer knowledge and skills on M&E tools and reporting to UPDC– Continue to provide TA to UPDC, TRACPlus and district hospitals until the end

of transition

Challenges

• Low HR capacity in M&E: staff instability, little interest in data management

• Gap between policy and implementation• Principle and approach of transition not clear

from the beginning:– Different expectations and interpretations– Different appreciation of issues at stake

• Transition was USG-driven and took long to be owned by GoR

• CDC not yet clear about Track 1 reporting

Perspectives

• Detailed discussion and analysis of M&E functions and IP approaches with TRACPlus and UPDC

• Transitioning M&E staggered behind subagreement transition (by end of March 2011 for AR and March 2012 for ICAP)– Certain M&E function to continue after 2012??– Mentorship and TA support on M&E: Filing systems,

data quality assurance, improvement, auditing (DQA) and use

– Quality assurance and verification of GoR reports (Tracnet, monthly PMTCT, VCT)

Conclusion

• Transitioning is a non optional condition

• Many challenges

• It is possible with full commitment of all parties

Thank you