This document summarizes a presentation on monitoring and evaluation given at an end-of-phase event on May 22, 2014. It discusses responsive M&E systems for program success and the importance of building national M&E capacity. It provides examples of tools and approaches used by MEASURE Evaluation to support countries, including developing M&E guidelines, training curricula, and providing technical assistance. Challenges in M&E like implementation, coordination and measuring achievements are also noted. The presentation emphasizes adapting local M&E systems as contexts change from malaria control to elimination.
12. “ For time and the
world do not stand still.
Change is the law of
life. And those who
look only to the past or
the present are certain
to miss the future.”
-John F. Kennedy
15. Malaria M&E
Looking for Impact, Finding a System
Dr. Leopoldo Villegas, MD, DTM&H, MSc,
DrPH, AdvDPHM
MEASURE Evaluation
End-of-Phase-III Event, May 22, 2014
25. Global Contribution
World Malaria Report (2010, 2011)
Global plan for artemisinin resistance
containment (GPARC)
Reports Presentations Articles
Secretarial and technical support
to RBM MERG
26. M&E Tools
MIS
2013
Updated MIS toolkit
Supported Regional Malaria Framework
for South East Asia
Finalized Released Household Survey Indicators
for malaria control
Framework for evaluating the impact of malaria
control programs – June 2014
Malaria M&E training curriculum
27. Technical Leadership
Publication in peer-reviewed journals
Symposium/presentations at international conferences
Multi-Agency Malaria Impact Evaluation PMI
15
28. Building Capacities
Malaria M&E courses
2010-2013 2011-2014 2011 2013
Malaria M&E short course
Extensive mentoring/capacity building
Curriculum development – M&E cascading training
32. Adaptive Local Systems
Understand your system
Multisectoral approaches – tailored to
local conditions
Combination optimal “mix” interventions
Knowledge of your malaria epidemiology,
actors & roles
Common goal > Elimination
Monitoring and evaluation knowledge
management
34. Session X:
Advances in Monitoring and Evaluation
of Programs for Key Populations
Sharon S. Weir
MEASURE Evaluation
End-of-Phase-III Event, May 22,
2014
36. ANSWER SHEET
1 COMMON THEME: _________________________________
2 CIRCLE ONE ANSWER:
3 CIRCLE ALL THAT APPLY:
4 CIRCLE BEST ANSWER:
5 How many questions did you answer correctly? 0 1 2 3 4
WINNERS GET A PRIZE!
Your Name:____________________________________________
0 1 2 3 4 5 6 7 8 9
A B C D
0 1 2 3
37. 1. 3 STATEMENTS. WHAT IS THE COMMON THEME?
Welcome to Lake
Wobegon, where all
the women are
strong, all the men
are good-looking,
and all the children
are above average.
A Garrison Keillor
38. 1. THEME?
For the first time ever,
overweight people outnumber
average people in America.
Doesn't that make overweight
the average then? Last month
you were fat, now you're average
- hey, let's get a pizza!
B
Jay Leno
42. -- AND BY EXTENSION
WHAT IS NOT AVERAGE,
WHAT LIVES IN THE TAILS.
ANSWER:
43. 2. HOW MANY OF THESE 3 STATEMENTS
COMMUNICATE THAT KEY POPULATIONS
LIVE IN THE TAILS?
1. Key populations (also referred to as most-at-risk
populations) are
people who inject drugs,
gay men and other men who have sex
with men,
transgender persons and
sex workers.
2. They are disproportionately infected with HIV compared to the general
population.
3. There is no way toward an AIDS-free future without targeting approaches
toward these highly marginalized and often hard to reach populations.
Source:
FROM USAID WEBSITE APRIL 22 http://www.usaid.gov/what-we-do/global-health/hiv-
and-aids/technical-areas/key-populations-targeted-approaches
44. 2. ANSWER: ALL 3
1. Key populations (also referred to as most-at-risk populations)
are
people who inject drugs,
gay men and other men who have sex with men (MSM),
transgender persons and
sex workers.
2. They are disproportionately infected with HIV compared to
the general population.
3. There is no way toward an AIDS-free future without targeting
approaches toward these highly marginalized and often hard to
reach populations.
45. Figure 2 Forest plot showing meta-analysis of risk of HIV infection among female sex workers
compared with women aged 15–49 years in low-income and middle-income countries, 2007–11,
Stefan Baral , Chris Beyrer , Kathryn Muessig , Tonia Poteat , Andrea L Wirtz , Michele R Decker,
Susan G Sherma, The Lancet Infectious Diseases, Volume 12, Issue 7, 2012, 538 - 549
It’s true. Meta-analysis shows
HIV infection among Sex
Workers is much higher than
among women 15-49.
But….
IS SOMETHING
MISSING?
46. DIGGING DEEPER
1. Who are key
populations?
2. Why are they
more likely to
be infected?
3. What
programmatic
response is
needed?
4. Where?
49. 3. WHO Are Key Populations Per
Global Definitions?
KEY
POP?
A) Alli A 29 year old female who
exchanges sex for cash?
Yes or No
B) Bob A 24 year old man with 5 female
partners in the past 4 weeks who
pays women for sex?
Yes or No
C) Chip A 34 year man who has had sex
with men?
Yes or No
D) Daisy A 17 year old female student who
has had 4 partners in the past 4
weeks and exchanges sex for cash
Yes or No
50. 3. WHO Are Key Populations? A and C
ARE YOU SATISFIED WITH THE DEFINITIONS?
KEY
POP?
Vulnerability STI PLACE
A) Alli – A 29 year old
female who exchanges sex
for cash
Yes Jailed HIV Yes
B) Bob – A 24 year old man
with 5 female partners in
the past 4 weeks who pays
women for sex
No None None Yes
C) Chip – A 34 year man
who has had sex with men Yes Jailed
Gonorrhea,
Chlamydia
Yes
D) Daisy – A 17 year old
student who has had
4 partners in the past
4 weeks and exchanges
sex for cash
No
Youth
Sex age 13
Chlamydia Yes
51. Of 678 female
workers at a
sample of venues
where people meet
new sexual
partners in Liuzhou
China, how many
are sex workers?
678
•Ever
had sex 648 • 50+
231•Exchanged sex
for cash/gifts
148 • 26+
35+
• 148 Exchanged
sex for cash
past 4 weeks
• 50+
Number with a
a positive rapid
test for syphilis.
Illustrates limitation of a narrow
sex worker definition. PLACE
approach includes all 50 workers
at venues who had a positive rapid
syphilis test.
52. WHY?
? ? ? New HIV
Infections
Extra credit: Fill in the
blanks.
53. CAUSAL MODEL
Underlying Proximate Biological
New HIV
Infections
Determinants Transmission
Exposure to HIV
Susceptibility to HIV
Number of partners
Lack of condom use
Anal Sex
Lack of Circumcision
54. UNDERLYING DETERMINANTS
Based on Boerma, Weir JID 2004
and collaboration with JP Figueroa
General
• Age
• Sexual
Orientation
• Location
Vulnerability
• Unemployment
• Low Education
• Stress
• Inadequate
support
• Genetics
Adverse Life
Events
• Rape
• Jail
• Untreated
infections
• Homeless
• Violence
55. TAILORED RESPONSE
Combination Prevention Programme
Package of Individual Level High Quality Health
Services
Programme Enabler
Interventions
SiteOutreach
Improveavailability,acceptability
andaccessibilityofservices
Improvedqualityofservices
Social Enabler Interventions
Empowermentactivities
Improvelegalandpolicyenvironment
Programstoaddressstigma,violence
anddiscrimination
EnablingEnvironmentatthe
CommunityLevel
Biomedical Services
HIVtestingandcounselling
Linkagetocare,viralload
reduction
STIscreeningandtreatment
Psychosocialinterventions
Harmreduction includingneedle
andsyringeprogramsandopioid
substitutiontherapy
HBVImmunization
Behaviour Change
Services
Condompromotion&
distribution
Targetededucation
andriskreduction
counselling
Figure 1 Combination Prevention Programme (modified from Operational
Guidelines for Monitoring and Evaluation of HIV Programmes for Sex Workers,
Men who Have Sex with Men and Transgender People)
57. “Superstar lawyers and math whizzes and software
entrepreneurs appear at first blush to lie outside
ordinary experience. But they don't. They are
products of history and community, of opportunity
and legacy. Their success is not exceptional or
mysterious. It is grounded in a web of advantages
and inheritances, some deserved, some not, some
earned, some just plain lucky – but all critical to
making them who they are. The outlier, in the end, is
not an outlier at all.”
Malcolm Gladwell, Outliers: The Story of Success
58. “Sex workers, and gay men, transgender people, and people
who inject drugs appear at first blush to lie outside ordinary
experience. But they don't. They are products of history and
community, of opportunity and legacy. The higher prevalence
of HIV infection they share, their lack of access to services,
their vulnerability, is not exceptional or mysterious. It is
grounded in a web of disadvantages and disinheritances,
prejudices and prison sentences, mostly undeserved, some
just plain unlucky – but all critical to making them who they
are, how they live, and what they will die from. The outlier, in
the end, is not an outlier at all.”
― Sharon Weir, Edited text from Malcolm Gladwell,
Outliers: The Story of Success
59. ACKNOWLEDGEMENTS
AND LAST QUESTION
MEASURE PLACE Team
o Sarah Hileman, Zahra Reynolds, William Miller, Jess Edwards,
Grace Mulholland
Mentors , Colleagues, Supporters
o Peter Figueroa, Freddie Ssengooba, Ties Boerma, Keith Sabin,
Abu Abdul-Quader, Jamie Blanchard, Jinkou Zhao, Ludo Bok,
Jenny Butler, Lovette Byfield, Krista Stewart, Erin Balch,
Joseph Mwangi, MEASURE Evaluation team
4) How many Jamaica references (loosely defined) appear
in this presentation?
60. ANSWER: 8
Based on Boerma, Weir JID 2004 and
in collaboration with JP Figueroa
Malcolm Gladwell,
Outliers:
2 Mentors, Colleagues, Supporters
Peter Figueroa, Lovette Byfield
Jamaica Venue:
Alli, Bob, Chip,
Daisy