TANZANIA COMMISSION FOR AIDS - Global HIV M&E Information

TANZANIA COMMISSION FOR AIDS
[TACAIDS]
MONITORING AND EVALUATING HIV/AIDS
PROGRAMMES AND ACTIVITIES
A GUIDE FOR FACILITATORS AND PRACTITIONERS

Acknowledgements
The production of this guide is a contribution of many people. The University of Dar es
Salaam Consultancy Bureau team did the greater part of writing the guide and their
contribution is specially acknowledged. The TACAIDS M&E Technical Working
group’s and the M&E Department’s under the leadership of Joyce Peters Chonjo, the
Director, Sophia Luhindi, Aroldia Muliokozi, Charles Mashauri and Isabella Ndatu
with their inputs at various stages of perfecting the guide are greatly appreciated. We
acknowledge the contribution of all others who contributed in the development of the
guide and the appended tools.
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TABLE OF CONTENTS
Acknowledgements 2
Preface 5
List of Acronyms 4
Outline of Modules 7
Prologue 8
Module 1: M&E Concepts and Practices 18
Module 2: Developing M&E Plan for
HIV/AIDS Programmes
22
Module 3: Overview of National M&E
Framework for HIV/AIDS
37
Module 4: Programme Tracking Form 42
Appendix 1: Guide to Facilitators 56
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List of Acronyms
AIDS:
BCC:
CSO:
DHS:
FMS:
HIV:
IEC:
LGA:
M&E:
MDA:
MIS:
MOH:
NACP:
NMEF:
NMSF:
PLWHA:
STI:
TACAIDS:
UNAIDS:
UNGASS:
Acquired ImmunoDeficiency Syndrome
Behaviour Change Communication
Civil Society Organizations
Demographic and Health Surveys
Financial Management System
Human Immunodeficiency Virus
Information, Education, and Communication
Local Government Authority
Monitoring and Evaluation
Ministries, Department, and Agencies
Management Information System
Ministry of Health
National AIDS Control Programme
National Monitoring and Evaluation Framework
National Multi-sectoral Strategic Framework
People Living with HIV/AIDS
Sexually Transmitted Infections
Tanzania Commission for AIDS
United Nations Joint Programmes on AIDS
United Nations General Assemble Special Session
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Preface
Our country has declared the HIV/AIDS pandemic a national disaster. In response to
this declaration, all sectors, government and private, have been obliged to mainstream
HIV programmes in their policies and plans. The Tanzania Commission for AIDS
(TACAIDS) was established in 2001 with the overall objective of coordinating the
HIV/AIDS programmes in the country.
The coordination role that the TACAIDS has been entrusted with requires, interalia, to
have an effective and efficient monitoring and evaluation framework that will enable
tracking and proper documentation of HIV/AIDS programmes and activities throughout
the country and all sectors. It is in this spirit that the National Monitoring and
Evaluation Framework (NMEF) on HIV/AIDS was developed. However, this
framework, hitherto, has not been translated into usage. This is because the envisaged
users have not been oriented on the monitoring and evaluation tools enshrined in the
framework. In order to facilitate understanding of the NMEF and its effective use, the
TACAIDS has prepared the present guide to be used by facilitators and practitioners
involved in monitoring and evaluation (M&E) of HIV/AIDS programmes in the
country.
The guide is organized around four modules, which are preceded by a prologue on basic
facts about HIV/AIDS. This prologue is aimed at orienting users on fundamental issues
regarding HIV prevention and management of AIDS. The first module introduces users
to the concepts and practices in monitoring and evaluation of HIV/AIDS programmes.
The second module is devoted to explaining step -by -step, processes involved in
developing and managing M&E frameworks at various levels where the actual
implementation of HIV/AIDS programmes takes place. The last (third) module
highlights the NMEF for HIV/AIDS.
Each module begins with an introduction in which the goal and objectives are
highlighted. Throughout the modules an attempt is made to include learning activities
that are deemed facilitative in the process of understanding HIV/AIDS M&E
imperatives. Three appendices are included in this guide. The first appendix is a guide
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to facilitators. This appendix has been included to enable facilitator to effectively
prepare for and execute training programmes. Other appendices are instruments on
M&E for HIV/AIDS programmes.
TACAIDS will be very happy to receive comments from readers and users that may
improve future versions of this guide.
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Outline of Modules
Prologue: Basic Facts about HIV/AIDS
The meaning of and differences between HIV and AIDS
History of HIV/AIDS
Transmission routes
Prevention strategies
AIDS: symptoms and illness patterns
Impact of HIV/AIDS
Why Monitor and Evaluate HIV/AIDS Programmes?
Who Should Use this Guide?
Module One: Monitoring and Evaluation: Concepts and Practices
What are monitoring and evaluation?
Concepts: Goals, Outcomes, and Objectives
Types of evaluation
Levels of measuring monitoring and evaluation process
Module Two: Developing a Monitoring and Evaluation Plan for HIV/AIDS
Programmes
Identifying appropriate Programme Activities
Stages in Developing an M&E Plan
Determining the scope and objectives of an M&E plan
Selecting indicators
Choosing the methodology and collecting information on the selected
indicators
Developing an M&E implementation matrix and timeline
Developing a plan to disseminate and use evaluation findings
Module 3: Overview of the National Monitoring and Evaluation Framework
for HIV/AIDS
Importance of the NMEF
Components of HIV/AIDS NMEF
Illustration of Indicators Alignment
Module 4: National Response on HIV/AIDS TACAIDS Programme/Activity
Tracking Form
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PROLOGUE
BASIC FACTS ABOUT HIV/AIDS
Before going into the mechanics of monitoring and evaluating HIV/AIDS programmes
it is important that basic facts about HIV/AIDS are internalized and appreciated by all
readers. Facilitators and practitioners need to learn the basic facts and issues that are
involved in the monitoring and evaluation of HIV/AIDS programmes and activities so
as to be able to develop relevant M&E frameworks for their areas of operation. This
prologue presents some basic facts about HIV/AIDS that are deemed important for all
persons involved in planning and implementing HIV/AIDS programmes.
A glimpse at the prologue:
• The meaning of and differences between HIV and AIDS
• History of HIV/AIDS
• Transmission routes
• Prevention strategies
• AIDS: symptoms and illness patterns
• Impact of HIV/AIDS
• Why should M&E planners know about HIV/AIDS?
What is HIV?
HIV stands for Human Immunodeficiency Virus. It is a virus known as retrovirus that
infects lymph glands and destroys lymphocytes through gene alteration; spreading the
disease between individuals mostly through semen, blood, uterine secretions, and to a
lesser extent, through the placenta and infected mother’s milk. This virus (HIV) is
called retrovirus because it lacks DNA and, therefore, it depends on the DNA in other
bodily cells (in this case, lymphocytes) to reproduce.
There are at least two viruses that can cause AIDS, AIDS related conditions, and
cancers in human beings. These are:
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• HIV-1: the most common cause of AIDS worldwide, except in West Africa where
HIV-2 is relatively common
• HIV-2 appears to be less virulent than HIV-1.
What is AIDS?
AIDS stands for Acquired ImmunoDeficiency Syndrome. The meaning of these words
can be explained as follows:
• Acquired: means the conditions are not inherited but are acquired from
environmental factors such as virus infections.
• Immune Deficiency: means that the viruses gradually cause deficient immunity,
which reflects poor nutrition and low resistance to infections and cancers
• Syndrome: means the viruses cause several kinds of diseases, each with
characteristic signs and symptoms. Because the infectious diseases caused by HIV
have so many variable manifestations before AIDS appears, HIV disease is a good
descriptive term to use.
Brief History of HIV/AIDS
The history of HIV/AIDS can be traced back to 1976-1979 when unrecognized cases of
AIDS in human parts appeared in the United States. It was not known exactly how the
AIDS virus initially entered the human population. Theories range from transmission
via monkey bites in Central Africa to contaminated vaccines. We continue to hear and
read about many such theories, but none have yet been proven
From the United States., the virus spread to Europe, Africa, and across the globe. In
Tanzania, the HIV was identified in 1983 when three persons were diagnosed to have
HIV infection. Since then the spread of HIV has not been halted such that by the year
2002, it was approximated two million people had been infected (United Republic of
Tanzania, National HIV/AIDS Policy, 2002). The infection rate is highest among 25-49
year olds (70%).
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HIV Transmission
There still are many stories about how people contract HIV/AIDS. Some of the stories
are true, but many are false. It is vital to know the actual ways by which HIV is
transmitted, as well as the ways by which it is not transmitted. Primarily, HIV is spread
through the sharing of virus-infected lymphocytes in semen (the thick, whitish fluid
secreted by the male during ejaculation) and in blood. Specifically, HIV is transmitted
through engaging in sexual behaviour or injectable intravenous drug sharing with
different partners. Generally and crudely speaking, HIV remains, essentially, but not
exclusively, a disease of sharing sex, sharing drug-laden needles, and sharing blood.
In Africa, AIDS is primarily a sexually transmitted disease (STD) and therefore, the
prevention of HIV infection greatly is greatly lies on changing sexual behaviour. It is
important to realize that certain sexual practices are very likely to transmit HIV. For
example, evidence shows that receptive anal-rectal intercourse-most dangerous. This is
because the rectum is thin, single cell layer, HIV infected lymphocytes in semen can
easily migrate into the body through breaks in the tissue. This area of the body is
highly supplied with blood vessels, and insertion of the penis or other objects may result
in tearing and bleeding. Anal- rectal intercourse must therefore be avoided.
Other HIV transmission routes include sharing of syringes and needles mainly by drug
users and abusers, and blood supply and transfusion. These routes are important ways of
transmitting HIV, but their proportion is low.
Risk of HIV Infection
Due to the fact that HIV infection is mainly through heterosexual intercourse,
HIV/AIDS has become a social, cultural and economic problem that touches on the
individual’s private lifestyles. This has had implications in terms of control, as in most
cases it is difficult culturally to discuss sex and sexuality openly.
The risk of HIV infection has been observed to be highest amongst young people and
especially girls. Girls and women, within our social and cultural environments are the
most vulnerable to HIV infection, as they do not, in many cases, have control over their
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sexuality. Poverty is yet another factor that increases the vulnerability of HIV infection
among women as some are forced to engage in high-risk business such as commercial
sexual workers for their survival, particularly in urban areas.
The dynamics of HIV/AIDS transmission are influenced by a number of factors. The
key ones include:
• Age: the infection prevalence is higher among 15-49 in the general population
because this age focus is more sexually active. Within the women population,
infections are higher in the age group of 25-34 than in other age group.
• Sex: Women are more vulnerable to the infections than men.
• Location: Urban population is at greater risk than the rural population.
• Occupation: there are some occupation categories that put people at greater
risks than others. Real examples can be sited.
• Cultural factors: here are certain values and customs that put sections of the
population at greater risk than others, (e.g. circumcision, female genital mutilation)
• Socio-economic factors: Socio-economic status of an individual is a key factor that
determines how one can better under take safer practices. Poverty is therefore,
another factor responsible for transmission
How HIV infects the body?
AIDS is associated with varying symptoms. The reason for this is that HIV impairs the
body’s ability to fight infection. It does this by destroying lymphocytes. Lymphocytes
are crucial cells in the body. They feed other cells, control cell growth, and guard
infection. They are the most common kind of cell in our biological defence system, the
immune system. Lymphocytes prevent cancers by controlling cell growth, and they help
protect against infections by producing antibodies (proteins that fight infection). As the
infected lymphocytes produce antibodies, HIV is also reproducing making a person
with AIDS appear undernourished and wasted, often has cancer, and is not protected
from infections. People do not develop effective acquired immunity to HIV because it
grows in the very cells that produce antibodies. Thus, people do not die directly of the
causative virus infection, but rather from one of the many diseases, infections, or
cancers that develop because of a weakened immune system.
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General Symptoms of AIDS
A number of symptoms are associated with AIDS. Some of these include the following:
• Loss of appetite with weight loss of ten or more percent in two months or less
• Swollen glands (lymph glands) in the neck, armpits, or groin that persist for three
months or more
• Severe fatigue (not related to exercise or drug use)
• Unexplained persistent or recurrent fevers often with night swears
• Persistent unexplained cough (not from smoking, cold, or flu) often associated with
a shortness of breath
• Unexplained persistent diarrhoea
• Persistent white coating or spots inside the mouth or throat that may be
accompanied by soreness and difficulty in swallowing
• Newly appearing persistent purple or brown lumps or spots on the skin.
• Nervous system impairment including general dementia, loss of memory, inability
to think clearly, loss of judgement, and/or depression. Other problems such as
headaches, stiff neck, and muscle weakness may occur
It is important to note that any of these symptoms may be caused by disease other than
AIDS, and this makes self-diagnosis difficult. However, if such symptoms persist or
several appear at the same time, you should suspect exposure to HIV and should
immediately see a physician familiar with the disease. The following points about HIV
and AIDS also need to be considered carefully.
• Having the HIV in one’s blood is not the same as having AIDS; most people
carrying HIV in their blood stream remain symptom-free for several years (during
which they can infect others, however)
• Although most HIV+ people will sooner or later develop AIDS, it is unclear at this
time whether all such carriers will go on to develop the disease. To date,
approximately 5 percent of HIV+ people have remained free from progressive
disease and maintain normal cell counts for a decade or more.
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• There have been a few AIDS cases reported in which the person is not HIV+. This
has led a few scientists to believe that HIV may not be the only cause of AIDS,
although this view is not widely held.
Common Illness Patterns Associated with AIDS
Like the symptoms, AIDS is associated with a number of illnesses some of which may
include the following:
• Wasting or Slim Disease: Severe weight loss, body wasting, and weakness often
associated with chronic diarrhoea and persistent coughing
• Kaposi’s sarcoma (KS): An unusual cancer of blood vessels that occurs in the skin,
mouth, lungs, liver, lymph glands, etc., giving rise to purplish spots or tumours.
• Lymphomas: Cancers of the lymphocytes.
• Aids-Related Dementia (ARD): a degeneration of the brain of the brain and spinal
cord leading to the nervous system impairments
• Vaginal fungus infections, abnormal growth of the cervix (uterine cervical
dysplasia) and endocervical cancer
HIV Prevention
There are presently no safe preventive vaccines or totally effective treatments. The only
preventive way is to assume responsibility for our own behaviour-sexual and drugrelated
behaviour. Whether or not HIV/AIDS becomes increasingly widespread is really
up to all of us! The key to prevention lies in understanding that HIV/AIDS is primarily
spread by the intimate sharing of bodily secretions through sexual intercourse. As noted
earlier, Sharing of HIV-infected cells (lymphocytes) in semen is responsible for more
than 90% of all AIDS cases in Tanzania. The remaining percent is contributed by:
• The sharing of blood by intravenous drug users
• Mother to child during pregnancy or birth through the placenta or through the
mother’s milk during nursing
• Blood transfusion
Specific preventive strategies and precautions include the following:
• Abstinence-Avoiding both sex and drugs
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• Avoidance of sharing semen through the proper and consistent use of a condom is
critical. It is important however, to note that the condom is not perfect and must be
used properly if it is to be effective. Both you and your partner must realize the
shortcomings of condoms.
• Fidelity-this requires commitment, establishing and maintaining caring and loving
relationships between partners, good communication patterns, and establishing a
strong value system.
Some important points about using a condom
• It must be in place before sexual intercourse begins
• There must be good lubrication so that it does not break
• Sexual intercourse must cease once there is ejaculation, so that there is no danger of
semen leakage
• You must be careful not to puncture the condom
• Be sure that the condom covers the entire penis and that it is carefully removed
immediately after ejaculation
• Leaving a condom in a wallet or warm place for a long time will cause
deterioration. If a condom sticks to itself, or is gummy or brittle, do not use it
• Condoms are generally not designed for and are prone to break during anal
intercourse
• Condoms occasionally fail (approximately less than 10 percent failure rate) due to
manufacturing defects but more often failure is due to improper use. Thus condoms
are not a foolproof guarantee of avoiding HIV/AIDS infection
• Despite all of the efforts to promote condom use for protection against HIV/AIDS
and other STDs, studies indicate that few people use condoms on a consistent and
regular basis.
• When one partner is HIV+ or has AIDS but the couple use a condom correctly and
consistently the transfer of HIV to the uninfected partner appears unlikely
Of the three strategies underscored above, the safest method of AIDS prevention
remains abstinence.
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Impact of HIV/AIDS
The impact of HIV infection and AIDS has been felt across all major sectors and at
household and individual levels. HIV/AIDS have caused significant increase in the
adult and child morbidity and it is now believed that AIDS is the leading cause of death.
Increased mortality rate has reduced life expectancy of Tanzanians from 56 years to 47
years by the year 2004.
Increased adult mortality rate has resulted in rapidly increasing the proportion of
children under 15 years of age who are orphans. By 2000, it was estimated that about
1.1% of the children had no both parents, 6.4% had no father and about 3.5 % had no
mother.
HIV/AIDS has had significant impact on health care provision. Hospital staff and
services capacity is overwhelmed. It is now estimated that about 50% of the hospital
bed in the country are occupied by HIV/AIDS exerting pressure on the meagre
resources allocated for health case. The demand for medicines has increased
tremendously. The successes of the National TB campaign have been challenged by
increased TB patients. The economic impact of HIV/AIDS is difficult to assess because
it involves multiple variables. However, fatigue and frequent illnesses are associated
with absenteeism from studies and work-places (be it self employment or wage
employment). The impact of this is an increased burden for health care outlays and
reduced productivity.
The World Bank had estimated that the average real GDP growth rate for the period
between years 1985-2010 would drop from 3.9% without AIDS to between 2.8% -
3.3% with AIDS. These are serious economic implications of the pandemic to our
nation.
More specifically, the impact is manifested in the following areas:
• Reduced productivity:
• Loss of skilled workforce:
• Socio-economic impact:
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o At household and individual levels, illness and death of the economically
active household members due to HIV/AIDS not only seriously drains the
meagre income but also affects survivors’ welfare in all it dimensions. For
example, the education of children, the health of children, the income
earning capacity and productivity, all are interfered. The issue of orphaned
children left without parents and adequate care is yet another impact on the
society.
o At National levels, budgetary allocations to other developments activities are
interfered. For example, huge amounts of money is spent on hospital bills
when the workers become sick and admitted, and high funeral cost once the
worker dies, sometimes involving transport cost to one’s place of domicile.
Why Monitor and Evaluate HIV/AIDS Programmes?
The reasons to monitor and evaluate HIV/AIDS are many. Following are some of these
reasons:
• Monitoring and evaluation show if and how HIV/AIDS intervention programmes
are working. People who are supporting HIV/AIDS intervention programmes
would like to know which activities are working using demonstrable results. They
also want to know how their programmes are working and assess how the
programmes are benefiting the intended communities. All these are achievable by
using M&E.
• M&E can be used to strengthen HIV/AIDS programmes. With adequate data
obtained through M&E, we can easily set priorities for strategic planning and assess
the implementation of activities as well as expenditure.
• M&E shapes the decisions of funding agencies and policy makers. M&E enable
funding agencies and decision makers to make strategic choices about how to spend
resources and prove that the expenditure produces measurable results.
• M&E results contribute to the understanding of workable programmes in the area of
HIV/AIDS interventions.
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• M&E helps in the mobilization of community involvement in the HIV/AIDS
intervention programmes. Community involvement is essential in developing the
sense of ownership of programmes.
Who should use this Guide?
This guide is a useful resource for all people involved in planning and executing
HIV/AIDS programmes. It is particularly meant for TACAIDS implementing
partners including HIV/AIDS focal persons in Local Government Authorities
(LGAs), Government Ministries, Departments, and Agencies (MDAs), and civil
society organizations.
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MODULE ONE
MONOTORING AND EVALUATION: CONCEPTS AND PRACTICES
Monitoring and evaluation are two concepts that are closely related. They are so closely
related that they are always placed together. Generally, when people talk of monitoring
they also implicitly talk about evaluation. However, the two concepts are only similar
and they are never the same.
Objectives
• After studying this module, you should be able to:
• Define monitoring and evaluation
• Describe the various types of evaluation
• Define and explain indicators
• Provide examples of how to select indicators to match your programme objectives
and activities
What are monitoring and evaluation?
Monitoring is the routine tracking of a programme’s activities by measuring on a
regular, ongoing basis whether planned activities are being carried out. Results of
monitoring reveal whether programme activities are being implemented according to
plan, and assess the extent to which a programme’s intended services are being used.
Thus monitoring involves the following:
• The routine (daily, monthly, or quarterly) assessment of on going activities and
processes.
• Assessment of what is being done, where, when, and by whom.
Evaluation is a periodic assessment of overall achievements. Whereas monitoring
examines what is being done, evaluation looks at what has been achieved or what
impact has been made.
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Types of evaluation
There are three main types of evaluation. They include:
i) Formative evaluation – This is an evaluation that is conducted at the
beginning of a project or programme. It aims at providing baseline
information upon which future changes can be evaluated.
ii) Mid-term evaluation – Mid-term evaluation is conducted while the project is
going on in order check the trends and levels of the implementation of the
project.
iii) Summative evaluation – Summative evaluation is usually carried out at the
end of the project/programme. It aims at assessing the achievements of the
project against the set objectives through indicators identified to show the
extent to which the objectives have been realised.
Levels of measuring monitoring and evaluation (M&E) process
Evaluation is usually measured at four levels namely, inputs, output, outcome, and
income levels. These levels are briefly explained below. The explanations have been
adopted from UNAIDS, 2002.
Inputs:
Outputs:
Outcomes:
Impacts:
people, training, equipment, and resources, which go into a project or
programme, in order to achieve outputs.
involve activities or services delivered through the programme or
project. These include for instance, HIV/AIDS prevention programme
and care and support services. The outputs are critical requirements for
achieving outcomes.
These are changes in behaviour or skills. Examples include such changes
as adoption of safer sex practices and increased ability to cope with
AIDS.
These are measurable health results achieved by the outcomes of the
project. For example, adoption of safer sex practices are expected to lead
into reduced STI/HIV infection and ultimately reduced AIDS impact in a
community.
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Clearly, inputs and outputs fall under process indicator, and outcome and impacts fall
under outcome and impact evaluation respectively.
In practice, as you move from one level to the other, fewer practitioners are being
involved in the measurement process. For example, all TACAIDS implementing
partners will be required to collect inputs deemed necessary to undertake an
implementation process. Again, quite a good number of implementing partners may
collect some process data, that is, will be involved in undertaking the activities and
delivering services (outputs). But fewer implementing partners will assess outcomes of
the project; and even fewer implementing partners will be required to assess impact.
This process results into a pyramid as represented in the diagram below:
Impact
Outcome
Outputs
Inputs
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Goals, Outcomes, and Objectives
In order to clearly understand monitoring and evaluation, one needs to understand
well the concepts such as goals, outcomes and objectives.
Goals
A goal states the impact a programme intends to have on a target population. The
target population is the specific group of individuals the programme is trying to
affect. Goals are stated in a general way.
Outcomes
These are specific results a programme is intended to achieve. Outcomes are
related to and translated from programme goals. Outcomes can be short, medium,
or long term.
Objectives
An objective is the specific measurable outcome of a programme. Strictly stated,
an objective is an explicit, measurable statement of a programme outcome.
Objectives are of two types: population level and programme level objectives.
Population level objectives: state intended results in terms of the target population
and are directly related to the outcomes identified by a programme. Objectives
describe what impact the programme is intended to have in the target population.
Population objectives are determined on the basis of baseline information that is
collected prior to the commencement of the programme implementation.
Programme level objectives: state intended results in terms of the structure,
management or operations of a programme. They describe the activities intended
to be undertaken to achieve the expected impact of the programme.
In order to internalize the meanings of these concepts let us illustrate by using an
example.
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Suppose our programme is aimed at improving the reproductive health of young
people aged 10-19 years in Kinondoni district. The goals, outcomes, and
objectives may be stated as follows:
Goal: To improve the reproductive health of young people aged 10-19 years in
Kinondoni district
Outcome: In order to translate this goal to outcomes, we have to describe the
specific results the programme intends to achieve. There are two possible ways to
do this. First, we can improve their reproductive health by increasing the use of
condom among the targeted youth. Secondly, we can also improve the young
people’s health status by increasing in the number of young people who delay
onset of sexual activity. Thus the outcomes are stated hereunder:
Outcomes
• To increase condom use among sexually active youth ages 10-19
• To increase the number of sexually active young people aged 10-19
years who freely discuss condom use
Population objective
In order to translate the outcomes into population objective we have to refer to
baseline data. Suppose our baseline data was that five percent of youth aged 10-
19 use condoms and that we need to increase the number of youth in this age
group. Our population objective will be to set an objective that we anticipate to
reach in terms of percentage. We can, therefore, set our objective at 15 per cent
where the increase will be 10 per cent from the baseline information.
What is an indicator?
An indicator is a measurable statement of programme objectives and activities.
Indicators are developed after defining a programme’s objectives and activities.
Some programmes have single indicators; others have multiple indicators. In HIV/AIDS
programmes, multiple indicators are preferred to single indicators so as to be able to
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capture various dimensions of a programme. However, indicators should be selected
careful so that they reflect programme objectives and activities and evaluation
priorities.
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MODULE TWO
DEVELOPING A MONITORING AND EVALUATION PLAN FOR HIV/AIDS
PROGRAMMES
A HIV/AIDS monitoring and evaluation system can be described as a set of procedures
through which planned information flows within an organization and to different
internal and external stakeholders in order to support decision making. The overall
purpose of the previous module was to enable you grasp the basic concepts and
processes regarding monitoring and evaluation as important instruments for developing
an M&E plan befitting your HIV/AIDS intervention programme. In this module, we
take you- step by step- through the process of developing an M&E plan. The module
starts with explaining concepts of programme goals, outcomes, and objectives, which
form the basis of an M&E plan
Objectives
After studying this module, you should be able to:
• Understand the rationale, key elements, and steps required to develop a Monitoring
and Evaluation (M&E) Plan
• Identify and apply program goals, outcomes and objectives in developing a
Monitoring and Evaluation Plan
• Develop and select program monitoring and evaluation indicators
• Select appropriate data collection methods for M&E
• Identify M&E internal and external resources
• Develop and review an M&E implementation plan matrix for own intervention
programme.
Identifying appropriate programme activities
After having defined the goals, outcomes, and objectives, the next step is to identify the
strategy and activities appropriate to the programme.
Activities can be identified by:
• Clearly defining desired healthy outcomes
• Identifying the protective and risk enhancing antecedents that influence the
outcomes
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Strategies are vehicles or means of implementing the identified activities. The can be
designed by:
• Defining programme’s goals and desired behavioural outcomes in relation to
preventing HIV transmission and/or coping with AIDS
• Identifying the factors that according to research or your experience, influence both
positively and negatively the behavioural outcomes the programme desires.
• Identifying one or more programme activities that can influence the factors
mentioned above
Example of defining goal, outcomes, factors, and strategies/activities: Suppose our goal
is to decrease rates of HIV and STIs among youth aged 10-19 years in Kinondoni
district.
Programme
goal
Decrease rates of
HIV and STIs
among youth
ages 10-19 in
Kindondoni
district
Programme
desired
behavioural
outcomes
• Decrease
premarital sex
• Increase use of
condoms
among sexually
active youth
• Increase age of
sexual initiation
• Increase age of
marriage
Factors
(antecedents of
behavioural
outcomes
• Community
norms about
premarital sex
and appropriate
age of sexual
initiation
• Opportunities
for education
• Individual’s
ability to say
‘no’ to sex (life
skills)
• Youth access to
condoms and
confidential
clinical services
Programme activities
that can influence the
antecedents
Develop education
programme to
encourage adults to
discuss norms around
premarital sex with
youth
Initiate community
sensitization campaign
to change norms that do
not value girls’
education
Lobby for expansion of
opportunities for
secondary education
Provide life skills
education emphasizing
how to say ‘no’ to sex
Encourage development
of national policies that
encourage provision of
services to youth (e.g.,
condoms)
Influence community
norms to support later
age marriage
Programme
strategies
Community
sensitization
workshops
Life skills
training
workshops in
schools
Inclusion of
life skills in
school
curriculum
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Stages in developing an M&E plan
Five main stages are involved in developing an M&E plan. These stages are:
1. Determining the scope and objectives of an M&E plan
2. Selecting indicators
3. Choosing the methodology and collecting information on the selected indicators
4. Developing an M&E implementation matrix and timeline
5. Developing a plan to disseminate and use evaluation findings
Stage 1: Determining the scope and objectives of the M&E plan
A scope is the extent of the activity you will undertake in a monitoring and evaluation
process. In determining the scope of our M&E system, we ask ourselves six key
questions:
• What should be monitored and evaluated?
• When should an HIV/AIDS programme be monitored and evaluated?
• What are the resources required?
• Who should be involved in M&E?
• Where should M&E take place?
1.1 What should be monitored and evaluated?
An M&E system measures three aspects of the programme development: programme
design, systems development and functioning, and implementation.
Programme design is measured by process evaluation. The programme design involves:
• Developing a strategy or systematic approach to address the needs of the target
group
• Identifying actions and activities required to implement the strategy
• Identifying the resources needed to carryout the activities
Systems development and functioning is measured through monitoring and process
evaluation.
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Systems development involves the creation of a management and support system to
carryout the programme. Support systems include:
• Management information system (MIS)
• Financial management systems (FMS)
• Personnel systems
• Commodities and logistics
Systems development involves conducting such preparatory activities as:
• Recruiting and training staff
• Developing curricula
• Drafting service guidelines
• Developing information education communication (IEC) or behaviour change
communication (BCC)
Systems functioning involve the ongoing performance of the systems used to operate
the programme and includes issues such as:
• How decisions are made within the programme
• Whether internal and external communication channels are functioning well
• How well coordination between various departments is conducted
• Whether training and supervision are ensuring quality performance
• Personnel job descriptions and job performance
Implementation is the process of carrying out programme activities with the target
population and providing services to them, that is, the actual performance of your
planned activities. For example, the activities of peer educators’ education centre may
include; conducting educational sessions, distributing condoms and IEC materials, and
providing counseling to fellow youth. Implementation is measured through monitoring,
process evaluation, and outcome/impact evaluation. Monitoring and process evaluation
reveal how programme implementation is occurring. Outcome and impact evaluation
help determine whether the programme being implemented is achieving its objectives
by measuring changes in outcomes in the target group. This information helps explain
Page 27

why the programme is or is not reaching its objectives and contributes to the
understanding of programme outcomes.
Summary of stage 1.1: using the example of peer education programme
Activities
Design stage
Determine whether peer
educators are an effective
way of reaching the target
population
Systems development and
functioning stage
• Develop curricula to
train peer educators
• Recruit, select, and
train peer educators
Implementation stage
Peer educators provide
education and counseling
services three times a week
in three centres
Monitoring and Process
evaluation
Did you consult youth in
the target population about
the effectiveness of peer
educators?
• How many peer
educators are recruited,
selected and trained?
• What is the quality by
of the training provided
to peer educators?
• How many youth are
counseled by peer
educators
• What is the quality of
counseling provided by
peer educators
Outcome and impact
evaluation
N/A
N/A
Do changes in knowledge,
attitudes, and behaviour
occur among youth who are
counseled by peer
educators?
1.2 When should an HIV/AIDS programme be monitored and evaluated?
Monitoring and evaluation are done at different stages. Monitoring and process
evaluation should be undertaken throughout the period of the programme. The
information collected during the programme implementation period can be used to
ensure that you are meeting the objectives, to improve programme performance, and
provide feedback to stakeholders.
Outcome and impact evaluations are done near the end of a programme using the
baseline information gathered at the beginning of the programme. Outcome and impact
evaluations should not be conducted prematurely. For some intended outcomes, such as
changes in risk behaviours, programme activities need to be carried out some years
before changes can be noticed in the target population.
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When exactly should outcome and impact evaluation be conducted depends on
programme objectives, the information needs of stakeholders, knowledge of the
programme, available resources, etc.
1.3 How much will M&E cost?
This involves determining the cost of monitoring and evaluation including time and
resources required for conducting M&E. It involves prioritizing on the areas to be
evaluated basing on available resources and time.
1.4 Who should be involved in M&E?
Ideally, M&E should involve as many stakeholders as resources permit. These may
include programme staff, beneficiaries (e.g., youth), school authorities, community
leaders, parents, local government officials, service providers, donors, etc. Stakeholders
may be involved at various phases of evaluation including: planning and design,
collecting and analyzing data, identifying the key findings, dissemination of results, etc.
1.5 Who should carry out the evaluation?
Evaluation can be done by programme staff, by hiring an outsider or a combination of
the two. Decision on who should conduct the evaluation depends on a number of factors
including cost, time, financial feasibility, etc. In some situations, using outside
evaluators may be more appropriate. Most funding agencies require an external
evaluation because these are perceived to be more objective as they have less stake in th
outcome of evaluation. However, programme managers need to ensure that the outside
evaluators are sensitive to programme goals and local context in which the programme
is being implemented. External evaluators should be seen as part of the support system
rather than threats.
Stage 2:
Selecting Indicators
An indicator has been defined as a measurable statement that targets the programme
objectives and activities. Other aspects of indicators to focus on are the forms and
characteristics of indicators.
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Forms of expressing indicators
Indicators can be stated qualitatively (using statements – referred to as non-numeric) or
quantitatively (as numeric indicators). Non-numeric indicators are expressed in words.
They are referred to as qualitative or categorical indicators. They denote the presence or
absence of an event or criteria. Examples of non-numerical indicator are given in the
statement below:
o Peer education recruitment completed? (Yes/No)
o Training curricula included topic on HIV/AIDS (Yes/No)
Numeric indicators can be expressed as counts, percentages, ratios, proportions, rates,
or averages. Counts give an idea of the number of events that took place, or the number
of people reached, without indicating the total possible number.
In evaluation terms, it is advisable to state indicators as percentages, ratios, and
proportions. These measures have advantage in allowing the operator to see what was
achieved in relation to the denominator (the total possible number).
Characteristics of indicators
Indicators should be specific. The more specific the indicator, the more likely that we
are able to measure the programme objectives and activities. Indicators should specify:
o Characteristics of the target population intended to be reached. This includes
specifying gender, age and residence, marital and schooling status
o Location of target population such as rural or urban youth, youth in a certain city or
district, etc.
o The time frame within which the objectives are intended to be achieved
Indicators should have the same scale as its corresponding programme objectives. For
example, if the objective is to increase the age at the first sexual activity among
adolescents aged 10-19 years who live in Kinondoni, then the indicator should measure
‘average age at first sexual activity among adolescents aged 10-19 years who live in
Page 30

Kinondoni district. If the indicator scale is different from objectives, the results will be
misleading.
Types of indicators
Indicators are categorized according to the type of evaluation. Process evaluation bears
indicators for design, systems development and functioning, and implementation.
Planning to conduct impact evaluation needs to develop indicators for programme
implementation and outcomes.
Design indicators are related to key elements of design such as:
o Existence of clearly defined goals and objectives
o Involvement of local stakeholders in programme planning and
o Assessment of needs and preferences of the target population for HIV/AIDS
activities and services
Systems development and functioning indicators are related to programmatic objectives
and activities
Programme objectives state results in terms of the organizational structure, management
or operations of a programme, and the corresponding activities involved in the
development and functioning of a system. Systems development and functioning
indicators measure whether an organization’s or programme’s systems are operating
and how effectively they have prepared programme personnel for implementation.
Examples include:
o Number of peer educators trained to provide youth education and counselling
o Existence of a clear organizational structure
o Number of collaborating partners, networks or coalitions established to support
HIV/AIDS programmes and activities in the area
Implementation indicators are related to both programmatic and population objectives
and activities. Programmatic and population objectives are met by the implementation
of programme activities. Implementation indicators measure whether and how many
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planned activities have been conducted, and the quality of the implementation of those
activities. Examples of implementation indicators include:
o Number of youth who seek peer counselling services
o Number and type of involvement by stakeholders in the HIV/AIDS programme
o Number and type of communication products developed for the target population
Outcome indicators are related to population objectives. Population objectives state
results in terms of the programme participant and are measurable statements of the
outcomes you hope to achieve in your target population. Outcome indicators measure
the changes in outcome that your programme’s activities are trying to produce in your
target population. Examples of outcome indicators include:
o Average age at first sexual activity
o Percentage of youth who say they would advocate safer sex among their peers and
friends
o Pregnancy rate among female youth during specific time period
o Incidence rate of HIV/STIs for the target population during a specified time period
Stating indicators
For meaningful results in the M&E framework, indicators need to be stated with great
precision and clarity. Some of the guidelines in stating indicators follow:
State indicators in clear and precise language as general indicators may be open to
many interpretations and may hinder the ability to interpret M&E results. An example
of a general and specific indicator is as follows:
General indicator:
Specific indicator:
number of youth who seek peer counselling services
number of female school youth aged 10-19 years who reside in
our district who seek counselling services from peer educators
during a four-month period.
Avoid changing the wording of indicators after an M&E framework has begun
implementation as this may hinder your ability to interpret M&E results. So in the
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example above, the age for instance, should not be changed in the middle of
implementation. Changes can only be made after the four-month period.
Indicators should be valid and reliable. That is they should accurately (validity)
measure the concept or event they are supposed to measure over a consistent period of
time (reliability).
Example of a matrix of preparing a list of indicators:
Steps:
i) Write the objectives in the table
ii) For each objective, write the activities you have planned to achieve the
objective. Include all activities in addressing the antecedent factors
iii) For each activity, specify the target population (e.g., youth, vulnerable
groups, etc.)
iv) For each activity (note whether it refers to: programme design, programme
systems development and functioning, programme implementation, and
programme outcome/impact) list all possible indicators
Table 1: Preparing a list of possible indicators
Objectives Activities Target
population
Objective 1 Activity 1
Activity 2
Activity 3
etc.
Objective 2 Activity 1
Activity 2
Activity 3
etc.
Objective 3 Activity 1
Activity 2
Activity 3
etc.
Location
Possible
indicators
Indicator 1
Indicator 2
Indicator 3
Indicator 1
Indicator 2
Indicator 3
Indicator 1
Indicator 2
Indicator 3
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Selection of indicators
As noted earlier, indicators need to be relevant to programme goals and objectives.
Ideally, indicators should possess three broad qualities:
• Feasible to collect
• Easy to interpret
• Able to track changes overtime
Most of the indicators on HIV/AIDS programmes are derived from international survey
programmes such Demographic and Health Surveys (DHS), or out of protocols
promoted by international bodies such the United Nations. Such indicators need to be
contexulized to country local environments. This will be explained further in module
four.
Stage 3: Choosing the methodology and collecting information on the selected
indicator
This step should include the monitoring and evaluation methods, data collection
methods and tools, analysis plan, and an overall timeline.
It is crucial to clearly spell out how data will be collected to answer the monitoring and
evaluation questions. The planning team determines the appropriate monitoring and
evaluation methods, outcome measures or indicators, information needs, and the
methods by which the data will be gathered and analyzed. A plan must be developed to
collect and process data and to maintain an accessible data system.
The plan should address the following issues:
• What information needs to be monitored?
• How will the information be collected?
• How will it be recorded?
• How will it be reported to the central office?
• What tools (forms) will be needed?
• For issues that require more sophisticated data collection, what study design will be
used?
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• Will the data be qualitative, quantitative, or a combination of the two?
• Which outcomes will be measured?
• How will the data be analyzed and disseminated?
Stage 4: Developing an M&E implementation matrix and timeline
The matrix provides a format for presenting the inputs, outputs, outcomes, and
impacts—and their corresponding activities—for each program objective. It
summarizes the overall monitoring and evaluation plan by including a list of methods to
be used in collecting the data. The timeline shows when each activity in the M&E plan
will take place.
In developing an M&E implementation matrix (or M&E framework as commonly
known) we use the four levels of measuring indicators (inputs, outputs, outcome, and
impact. For HIV/AIDS intervention programmes, the M&E framework is divided into
two parts according to HIV/AIDS response dimensions, namely, prevention and care
and support. One part captures prevention indicators and the other captures the indicator
corresponding to care and support. What is developed is called M&E input-outputoutcome-impact
framework. These levels are briefly re-stated as follows:
Input indicators: these measure what goes into a programme. They include such
things as money, number of condoms, drugs for treating
opportunistic infections, ARVs, test kits, training, etc.
Output indicators: these measure what comes out of input indicators. They include
such things as trained personnel (nurses, peer educators, etc.),
number of youth educated about life skills, orphans supported
with school fees, number of condoms distributed, etc.
Outcome indicators: These describe the programme outcomes. They include measures
on increased knowledge, changed attitudes, adoption of healthy
promoting behavours (e.g., safer sexual behaviours, abstinence),
etc. These outcomes are expected to have impact on HIV/STI
transmission rates.
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Impact indicators: These measure the resultant effects of outcomes of a programme
implementation. They include the reduced incidences on
HIV/STI transmission.
The input-output-outcome-impact continuum can be summarized as follows alongside
the two dimensions of HIV/AIDS response:
Prevention
Inputs
Resources, sss
supplies, staff,
etc.
Outputs
Services, IEC,
knowledge, etc.
Outcome
Risk behaviour,
treatment
practices, etc.
Impact
Incidence
Care and
Support
Inputs
Resources,
supplies, staff,
etc.
Outputs
Services, IEC,
knowledge, etc.
Outcome
Discrimination,
stigma, support,
treatment
Impact
Survivors’
quality of life
Figure 1:
Framework for monitoring and evaluating HIV/AIDS programmes
(adopted from UNAIDS, 2000; pp. 15)
Step 5: Developing plan to disseminate and use evaluation findings
The last step is planning how monitoring and evaluation results will be used, translated
into program policy language, disseminated to relevant stakeholders and decisionmakers,
and used for ongoing program refinement. This step is not always performed,
but it should be. It is extremely useful in ensuring that monitoring and evaluation
findings inform program improvement and decision-making. A mechanism for
providing feedback to program and evaluation planners should be built-in so that
lessons learned can be applied to subsequent efforts.
Page 36

This step often surfaces only when a complication at the end of the program prompts
someone to ask, “How has monitoring and evaluation been implemented and how have
the results been used to improve HIV prevention and care programs and policies?” If no
plan was in place for disseminating monitoring and evaluation results, this question
often cannot be answered because monitoring and evaluation specialists have forgotten
the details or have moved on. The absence of a plan can undermine the usefulness of
current monitoring and evaluation efforts and future activities. Inadequate
dissemination might lead to duplicate monitoring and evaluation efforts because others
are not aware of the earlier effort. It also reinforces the negative stereotype that
monitoring and evaluation are not truly intended to improve programs. For these
reasons, programs should include a plan for disseminating and using monitoring and
evaluation results in their overall Monitoring and Evaluation Work Plan.
Illustration of M&E Matrix Plan
Strategic objective: _______________________________________________
Inputs
(activities
and
resources)
Indicators
Outputs Outcomes Impact
Data source
and collection
method
Responsible
person
Illustration of time line
Activities to
assess
Month
1
Month
2
Month
3
Time line
Month
4
Month
5
Month
6
Month
7
Page 37

MODULE THREE
OVERVIEW OF THE NATIONAL MONITORING AND EVALUATION
FRAMEWORK FOR HIV/AIDS PROGRAMMES
To fulfil its strategic leadership and co-ordination role, TACAIDS has developed a
National Monitoring and Evaluation Framework (NMEF) the application of which will
harmonise all monitoring and evaluation efforts for all sectors involved in the
prevention of HIV transmission and management of AIDS. These include the Local
Government Authorities (LGAs) and Government Ministries, Departments, and
Agencies (MDAs), and Civil Society Organizations. The framework is therefore, a tool
for measuring the effectiveness of the country’s efforts to combat HIV/AIDS.
For maximum advantage, it is recommended that this module be read in close reference
to the NMEF.
Objectives
After studying this module, you should be able to:
• Appreciate the importance of the National Framework for HIV/AIDS
• Understand the components of the National Framework for HIV/AIDS
• Understand the levels of measurement provided for in the National Framework for
HIV/AIDS
• Describe the thematic areas of HIV/AIDS intervention provided for in National
Framework for HIV/AIDS
Importance of the National M&E Framework for HIV/AIDS
The National Monitoring and Evaluation Framework is important for the following:
1. To monitor and to evaluate the use of resources, activities and achievements are
necessary management functions to ensure proper and appropriate resource utilization
while navigating to the planned goals.
2. To ensure consistency in use of indicators and linkage between the different
initiatives supported by the Government;
Page 38

3. Ensure linkage between data collection efforts by different stakeholders and to
promote appropriate upward and downward reporting and sharing of
information;
4. Serve as guide in training of LGAs, MDAs, CSOs so that they develop their
own M&E frameworks that suit their local conditions.
5. To tailor and fit the information needs of different stakeholders to the M&E
process.
Components of HIV/AIDS M&E
The National Framework for HIV/AIDS is a logical structure for managing HIV/AIDS
program comprising five major components as hereunder:
Overall M&E System Chart:
A system diagram that provides a summary depicting the connectedness of the different
data sources and flows including reporting lines. The overall chart depicts the four level
indicator continuum: inputs-output-outcome-impact indicators.
Thematic Areas in HIV/AIDS M&E Framework
Basing on the National Multi-sectoral Strategic Framework (NMSF) the M&E
Framework derives a set of indicators organized into four thematic areas of the Multisectoral
HIV/AIDS Response programme. In each thematic area there are a number of
strategic objectives, which provide the direction to which the end of the response effort
is committed. The thematic areas are summarized in the table below:
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Table 2: Thematic Areas in the National M&E Framework:
Thematic Area
Strategic Objectives (as in the NMSF)
1. Impact • Reduce the spread of HIV in the country
• Reduce HIV transmission to infants
2. Crosscutting issues
including enabling
Environment
1. Prevention
including gender
• District and municipalities have established new
partnerships and are effectively planning and
coordinating the local responses to HIV /
• Enhance government commitment to HIV/AIDS
interventions
• Create wide spread positive attitudes towards PLWHAs
and safeguard their Human Rights.
• Expand the Response to HIV /AIDS in major sectors of
society
• Improve advocacy efforts to enhance the Response to
HIV/AIDS
• Increase sexual behaviour change, care, support and
impact mitigation activities for specific vulnerable
groups
• Enhance the education and skills in young people to
safeguard their sexual and reproductive health.
• Increase condom use in young people
• Delay the age of inception to sex
• Reduce the prevalence of STIs
4. Care and Support • Increase the proportion of PLWHAs having access to
the best available treatment and medical care
• Increase the proportion of AIDS orphans having access
to adequate integrated, community-based support.
5. Mitigation of Socioeconomic
impact
• Reduce the adverse effects of HIV /AIDS on orphans
• Increase access to health services of HIV/AIDS /TB
patients who are poor
Within each thematic area a set of core indicators have been identified.(see Section 3.6
of the National M&E Framework). Some of the core indicators are adopted from the
UN General Assemble Special Session (UNGASS) recommended set of indicators. The
source of data for calculating each indicator is also shown together with the timing
when the measurement is expected.
The indicators in the NMEF are intended to save as a guide to monitoring progress
towards achieving goals set in the HIV/AIDS National Policy. The indicators are
categorized into either core or additional indicators. Core indicators are those developed
Page 40

to measure areas where particular emphasis is called for, and where progress needs to
be measured. Additional indicators are all other indicators that may be measured in
addition to core indicators. For a comprehensive review of indicators for each thematic
area please consult section 3.6 in the National Monitoring and Evaluation Framework
(NMEF) for HIV/AIDS
Illustration of indicators alignment
The table below gives an illustration on how indicators can be aligned for various
thematic areas. The format has been adopted from UNAIDS but uses areas relevant to
TACAIDS developed thematic areas as per NMEF. The details of indicator description
can be found in the relevant sections of the NMEF.
Table 3: illustrative indicators
Goal Indicator Data source
Impact level (health impact)
Prevention
Reduce the spread of HIV in the
country
Mitigation
Reduce adverse effect of HIV/AIDS
to PLWHA and orphans and other
vulnerable children (OVC)
Prevention
Increase knowledge and skills for
HIV prevention and AIDS coping
Mitigation
Increase PLWHA/OVC household
coping capacities
Output level (activities)
• Institutionalize and centralize
the coordination of HIV/AIDS
response
• Expand the response to
HIV/AIDS to include all sectors
• Increase public sector response
services
• HIV prevalence among (a) all
antenatal women (b) women aged
15-19 and (c) women aged 20-24
• HIV transmission proportion
from mothers to children
Increased quality of life for PLWHA
and orphans and other vulnerable
children (OVC)
Outcome level (behavioural outcomes)
• Percentage of respondents who
both correctly identify ways of
preventing the sexual
transmission of HIV and reject
major misconceptions about HIV
transmission and prevention
• Increased age of first sexual
activity and reduced occurrence
of unprotected sexual intercourse
• Reduced occurrence of
unprotected sexual intercourse
with non-regular partner
Increased PLWHA/OVC household
coping capacities
• TACAIDS committees
(directorates) and staff appointed
and functional
• TACAIDS work plans and
budget approved and funded
• TACAIDS financial,
procurement, implementation,
Antenatal surveillance by
MOH/NACP
Household surveys by TACAIDS
Behavioural surveillance and
social impact surveys
Behavioural surveillance and
social impact surveys
• TACAIDS departmental
reports
• TACAIDS general reports
• Health facility surveys
• Ministry and
District/Municipal council
reports
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Increase civil society involvement in
HIV/AIDS services and programmes
technical support and M&E
systems established
• Number and percentage of
district/municipal councils with
HIV/AIDS work plans and
budgets
• Number and percentage of line
Government ministries with
HIV/AIDS work plans and
budgets
• The number and percentage of
health facilities providing
HIV/AIDS care and support
services
• The number and percentage of
educational institutions
(primary/secondary/tertiary/unive
rsity) with HIV/AIDS
programmes for their students
and staff
• The number of district/municipal
councils with functioning social
welfare departments providing
grants to orphans and OVC
• Total AIDS services delivered by
public sector
• Number if civil society
organizations receiving
TACAIDS funding
• The percentage of overall funding
granted to civil society services
TACAIDS reports
Input level (personnel, training, equipment and funds
Paid staff, volunteers recruited, TACAIDS records
training conducted, equipment and
resources provided
Page 42

NATIONAL RESPONSE ON HIV/AIDS
TACAIDS PROGRAMME/ACTIVITY TRACKING FORM
INSTRUCTIONS FOR FILLING THIS FORM
a. Council HIV/AIDS Coordinators (CHAC), Ministries Technical AIDS
Coordinators (TAC) and Regional Facilitating Agencies (RFA) shall have
the responsibility for overall compilation of this form. CHAC and RFA
shall forward complete forms to both TACAIDS and RAS while TAC shall
forward directly to TACAIDS. The Private sector and informal sector
organizations shall directly to TACAIDS.
b. The form has three parts: Part A for non-health sectors; Part B for the
health sector and Part C which covers financial aspects and is to be filled
by all categories of stakeholders.
c. Programme and Financial forms should be submitted together.
Page 43

PART A
PROGRAMME/ACTIVITY MONITORING FORM
For Non-Health Sectors
Section One: Institutional Information
S/n Particulars of the Organization/Institution
1 Name of Organization/Institution
2 District
3 Region
4 Name of the Head of Organization/Institution
5 Title of the Head of Organization/Institution
6 Mailing Address;
7 Telephone (landline)
8 Mobile Telephone:
9 Fax:
10 Email:
S/n Designated HIV/AIDS Focal Point or Contact Person
1 Name
2 Title
3 Mailing Address:
4 Telephone( landline):
5 Mobile Telephone
6 Fax:
7 Email:
S/n Type of the Organisation/Institution Yes NO
1 National Non Governmental Organisation (NGO)
2 International Non Governmental Organisation
(NGO)
3 Community Based Organisation (CBO)
4 Faith Based Organisation (FBO)
5 Regional Facilitating Agency (RFA)
6 Government Ministry
7 Local Government Authority
8 Parastatal Organisation
9 Private Company
10 An Association
11 Informal Sector
12 Others (please specify)
Page 44

S/n
1
Reporting Details
Level of
Reporting
2 Reporting Period
Yes
Village
Kitongoji/Mtaa
Ward
District
Regional
National
Ministry
Institution
Others (specify)
Year
Quarterly
Semi-
(Specify)
Annual
Q1 Q2 Q3 Q4 H1 H2
No
Annual
Tanzania Commission for AIDS
P.O. Box 76987 Dar es Salaam
Email: tacaids@raha.com
Telephone: 255 22 2122651
fax: 255 22 2122427
Page 45

Section Two: Thematic Areas
2.1 Multi-sectoral AIDS
Committee (MACs)
2.1.1 Council Mutisectoral
AIDS committee
2.1.2 Ward Mutisectoral AIDS
Committee
2.1.3 Mtaa committee
2.1.4 Village Multisectoral
AIDS committee
2.1.5 Kitongoji Multisectoral
AIDS Committee
2.1.6 Activities carried out by
MACs (List them)
Number of MACs
Formed
List MACS
Formed
• .
• .
• .
Number of Meetings
held
2.2 Mainstreaming
HIV/AIDS Plans
2.2.1 Type Organization (Tick)
Local Government
Authorities
Ministries
Independent
Government
Departments
Govt. Agencies
Private sector
Formal
Informal
2.2.2 Do you have HIV/AIDS
Strategic Plan? (Please
tick)
2.2.3 Have you integrated
HIV/AIDS into your
Comprehensive
Development Plans
(Please tick)
Civil Society
Organizations
Yes
Yes
NGO CBO FBO
No
No
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2.2.4
Do you have Workplace
intervention
programmes? (Please
tick)
If YES, indicate (tick) the
thematic areas covered
Impact
Yes
Cross Cutting
No
Prevention
Care, Support and
Treatment
Mitigation of Socio-
Economic Impact
2.3
Awarenes
s Creation
Number of
Sensitization
Workshops/contact
s
Men reached
Planne
d
Actual
Women
reached
Planne
d
Actua
l
Total
Participants
Planne
d
Actual
2.3.1 Outreach awareness contacts
(i)
(ii)
(v)
(v)
Bar
attendants
Refugees
Disabled
Others
(Specify)
2.3.2 Number of Public Health Education (PHE) programmes conducted
(i)
Out of
school
youth
Number of
Sensitization
Workshops/cont
acts
Men reached
Planne
d
Actual
Women
reached
Planne
d
Actua
l
Total
Participants
Planne
d
Actual
(ii)
In school
youth
Page 47

(iv)
Peer
Educators
trained in
workplace
HIV/AIDS
intervention
s
Page 48

2.4 Community Projects Number of
existing
projects
2.4.1 Peer Education on
HIV/AIDS Prevention
2.4.2. Orphan Care
(i) School Support (school
fees)
(ii) Food and Clothing
(iii) Counseling &
Psychological support
2.4.3 People Living with
HIV/AIDS (PLHA)
(i)
(ii)
(iii)
Counseling
Legal and Human
Rights Advocacy
projects
Income generating
activities
2.4.4 Widows
(i)
(ii)
Legal and Human
Rights Advocacy
projects
Income generating
activities
2.4.5 Widowers
(i)
(ii)
Legal and Human
Rights Advocacy
projects
Income generating
activities
Beneficiaries
F M Total
Implementing
Organization
2.5 Information Education and Communication (IEC)
Medium
# of
performances
Number of
Groups
Performing arts
2.5.1 Traditional
Dances
(i) Choir
(ii) Drama
(iii) Sports/clubs
(iv) Others (specify)
Coverage
(Areas
covered)
Estimated Total
Number of
Audience Reached
2.5.2 Structured Number of
HIV/AIDS
Programmes/
Productions
(i) Radio programs
Frequency Coverage Estimated Total
Number of People
Reached
Page 49

2.5.2 Structured Number of
HIV/AIDS
Programmes/
Productions
(ii) Television
programs
(iii) Video and Cinema
shows
(iv) Billboards
(v) Posters
(vi) Leaflets
(vii) Brochures
(viii) Newspapers
(ix) Magazine
(x) Newsletters
(xi) Meetings
(xi) Others (specify)
Frequency Coverage Estimated Total
Number of People
Reached
2.6 Life Skills Actual # of school
Primary Secondary Primary secondary
2.6.
1
2.6.
2
Number of schools
(Public) with
teachers trained
Number of schools
(Private) with
teachers trained
2.6.
3
2.6.
4
2.6.
5
2.6.
6
2.6.
7
2.6.
8
Number of teachers in Public
schools trained
Number of teachers in Private
schools trained
Number of young people (15-24)
trained (in school)
Number of young people (15-24)
trained (out of school)
Number of students (7-14)
trained (in school)
Number of peer educators in
schools trained
Male Female Total
2.6.
9
List life skills activities undertaken in the reporting period
Primary Schools Secondary Schools Colleges and Universities
1
Page 50

2
3
4
3. Community
Care/ home
based care
3.1 Number of
Orphanages
3.2 Number of
orphans in
orphanages
3.3 Number of
Orphans in the
households
3.4 PLHA’s support
groups
3.5 Number of
PLHAs
3.6 PLHA receiving
other support
(list them)
Total
Beneficiaries
F M Total
4. Orphans and
Vulnerable Children
(OVC)
4.1. Number of non-orphans(OVC) (below
age 10) attending school regularly
4.2 Number of OVC (below age 10))
attending school regularly (only father
dead)
4.3 Number of OVC (below age 10))
attending school regularly (only
mother dead)
4.4 Number of OVC (below age 10))
attending school regularly (both
parents dead)
4.5 Number of non OVC (age 10-14)
attending school regularly
4.6 Number of OVC (age 10-14)
attending school regularly (only father
dead)
4.7 Number of OVC (age 10-14)
attending school regularly (only
mother dead)
F M Total
Page 51

4. Orphans and
Vulnerable Children
(OVC)
4.8 Number of OVC (age 10-14)
attending school regularly (both
parents dead)
4.9 Number of non OVC (above age 14)
attending school regularly
4.10 Number of OVC (above age 14))
attending school regularly (only father
dead)
4.11 Number of OVC (above age 14))
attending school regularly (only
mother dead)
4.12 Number of OVC (above age 14))
attending school regularly (both
parents dead)
F M Total
Page 52

5. RESEARCH
Research/
Survey Area
5.1 Prevention
Title
of
Res
earc
h
Proj
ect
Name of
Researcher
(s)
Research
Period
Funding
Agency
Status (ongoing/finished)
Have results
been
disseminated
5.2 Care,
support
and
treatment
5.3 Social
economic
impact
5.4 Cross
cutting
issues
5.5 Impact of
HIV/AIDS
5.6 Others
specify
Page 53

PART B
PROGRAMME/ACTIVITY MONITORING FORM
For the Health Sector
Section One: Institutional Information
S/n Particulars of the Organization/Institution
1 Name of Organization/Institution
2 District
3 Region
4 Name of the Head of Organization/Institution
5 Title of the Head of Organization/Institution
6 Mailing Address;
7 Telephone (landline)
8 Mobile Telephone:
9 Fax:
10 Email:
S/n Designated HIV/AIDS Focal Point or Contact Person
1 Name
2 Title
3 Mailing Address:
4 Telephone( landline):
5 Mobile Telephone
6 Fax:
7 Email:
S/n Type of the Organisation/Institution Yes NO
1 National Non Governmental Organisation (NGO)
2 International Non Governmental Organisation
(NGO)
3 Community Based Organisation (CBO)
4 Faith Based Organisation (FBO)
5 Regional Facilitating Agency (RFA)
6 Government Ministry
7 Local Government Authority
8 Parastatal Organisation
9 Private Company
10 An Association
11 Informal Sector
12 Others (please specify)
Page 54

S/n
1
Reporting Details
Level of
Reporting
2 Reporting Period
Yes
Village
Kitongoji/Mtaa
Ward
District
Regional
National
Ministry
Institution
Others (specify)
Year
Quarterly
Semi-
(Specify)
Annual
Q1 Q2 Q3 Q4 H1 H2
No
Annual
Tanzania Commission for AIDS
P.O. Box 76987 Dar es Salaam
Email: tacaids@raha.com
Telephone: 255 22 2122651
fax: 255 22 2122427
Page 55

Section Two: Thematic Areas
Location
Rural
1.1: Number of pregnant mothers attending Ante Natal
Clinics (ANC) for the first time (first attendance)
Age Category
Under 15 yrs 15-19yrs 20-24yrs Over 24 yrs TOTAL
# +VE -VE # +VE -VE # +VE -VE # +VE -
V
E
# +VE
Urban
Total
Note: # = number of attendees ; +VE = number tested positive; -VE = number tested negative
1.2 Prevention of Mother to Child
Transmission (PMTCT)
Government-owned
Privateowned
Total
1.2.1 Number of Health facilities offering
PMTCT according to national guidelines
1.2.2 Number of women attending Antenatal
Clinic for the first visit
1.2.3 Number of pregnant women who tested
HIV positive for the reporting period
1.2.4 Number of women receiving counseling
services
1.2.5 Number of couples receiving counseling
services
1.2.6 Number of children born to HIV infected
mother for the reporting period
1.2.7 Number of women receiving ARV’s
1.2.8 Number of women receiving infants
feeding service
1.2.9 Total number of traditional birth
attendants
1.2.10 Number of traditional birth attendants
trained
Total
Number
1.2.11 Number of traditional birth attendants
trained and received delivery kit
1.3 Blood Safety
1.3.1 Number of blood screening centers
1.3.2 Number of blood donors
Total
Male Female Total Number
Page 56

screened
1.3.3 Number of blood donors screened and
tested
1.3.4 Number of blood donors tested
positive
1.4: Number of blood donors donating blood for the first time in the
reporting period
Age Category
Total
Location 15-19yrs 20-24yrs Over 24 yrs
Rural
Urban
Total
# of attendees # tested
positive
# of
attendees
# tested
positive
# of
attendees
# tested
positive
# of
attendees
# tested
positive
F M F M F M F M F M F M F M F M
1.5 Voluntary Counseling and
Testing (VCT)
1.5.1 Hospital providing VCT
services
1.5.2 Health Centres providing
VCT services
1.5.3 Dispensaries providing VCT
services
1.5.4 Stand alone VCT Centres
established
1.5.5 Hospitals with uninterrupted
supply of testing kits and
reagents
1.5.6 Health centres with
uninterrupted supply of
testing kits and reagents
1.5.6 Stand alone VCT Centres
with uninterrupted supply of
testing kits and reagents
Number of
Governmentowned
(a)
Number of
Privateowned
(b)
Total
of VCT
(a+b)
Number of
Counselors
1.5.7 Number of counselors trained
1.5.8 Number of people receiving
voluntary HIV Counseling
1.5.9 Number of people receiving
voluntary HIV Counseling and
Testing
1.5.10 Number of people counseled,
tested and received results of
their HIV status
1.5.11 Number of people receiving
voluntary HIV Counseling And
Tested positive
Male Female Total
Page 57

1.6 Sexually Transmitted Infections (STI’s) Governmentowned
1.6.1 Number of Health facilities
1.6.2 Health facilities providing STI management
according to the national guidelines.
1.6.3 Health facilities providing STI care with an
uninterrupted supply of drugs
1.6..4 Health facilities with shortage of STI drugs
1.6.5 Number of staff trained on STI Management
Private-owned
Total
1.7 Condoms
Distribution
1.7.1 Male
condoms
1.7.2 Female
condoms
No.
purchase
d
No
received
for free
Total No Sold No
provide
d for
free
Total
1.7.3 Condom
promoters
trained
1.7.3 Condom
distributors
trained
Number of
workshops
Male Female Total
2. Community
Care/ home
based care
2.1 Number of
home based
care centers
2.2 Number of
home based
care
programmes
2.3 Number of HBC
training
programs and
people trained
2.4 Number of
PLHAs
receiving
support
according to
national
standard
Total
Beneficiaries
F M Total
3. Treatment of
Opportunistic Infections
(OI’s) & provision ARVs
Number targeted
Number
reached
Page 58

3.1 Health Sites providing
ARVs according to the
national guidelines
3.2 Number of people
receiving ARV treatment
according to the national
guidelines
Adults =15 years Children below 14
and above
F M F M
3.3 Number of trained Health Workers to
provide ARVs
F M Total
Page 59

FORM C
FINANCIAL MONITORING TRACKING FORM
Instructions for filling this form
a) This form should be filled by the head of finance department of the
respective organization
b) The filled form should be handled to CHAC/TAC/RFA
Section One: Institutional Information
S/n Particulars of the Organization/Institution
1 Name of Organization/Institution
2 District
3 Region
4 Name of the Head of Organization/Institution
5 Title of the Head of Organization/Institution
6 Mailing Address;
7 Telephone (landline)
8 Mobile Telephone:
9 Fax:
10 Email:
S/n Designated HIV/AIDS Financial Activities Reporting Person
1 Name
2 Title
3 Mailing Address:
4 Telephone( landline):
5 Mobile Telephone
6 Fax:
7 Email:
S/n Type of the Organisation/Institution Yes NO
1 National Non Governmental Organisation (NGO)
2 International Non Governmental Organisation
(NGO)
3 Community Based Organisation (CBO)
4 Faith Based Organisation (FBO)
5 Regional Facilitating Agency (RFA)
6 Government Ministry
7 Local Government Authority
8 Parastatal Organisation
9 Private Company
Page 60

10 An Association
11 Informal Sector
12 Others (please specify)
S/n
1
Reporting Details
Level of
Reporting
2 Reporting Period
Yes
Village
Kitongoji/Mtaa
Ward
District
Regional
National
Ministry
Institution
Others (specify)
Year
Quarterly
Semi-
(Specify)
Annual
Q1 Q2 Q3 Q4 H1 H2
No
Annual
Page 61

1. BANK INFORMATION:
Does your organization have a separate Bank Account for HIV/AIDS
activities? YES _[__]
NO_[___]
If YES provide: Name of the bank----------------------------------A/C No--------------
--
2. SOURCE OF FUNDS FOR HIV/AIDS INTERVENTIONS BEING
IMPLEMENTED
Source of Funds
(Specify)
Funds
requested
Funds
Approved
Funds
Received
Deposited
In Sub
Vote no.
Sub-Vote
Title
Fund
Used
Balance
Page 62

3. DOES YOUR SECTOR/0RGANIZATION DISBURSE FUNDS TO LOWER
LEVEL AFTER RECEIVING?
Yes___
No___
List of
Recipients
When
Application/
cash
Flow
received
When
Funds
Last
disbursed
How
Much
requested
How
Much
disbursed Balance Remarks
Total
funds
(in Tshs)
4. HIV/AIDS EXPENDITURE BY THEMATIC AREA
Amount in Tshs.
Requeste
d
Approve
d
Receive
d
Spent Balance Remarks
4.1 Crosscutting
issues
Develop and
mainstream HIV/AIDS
HIV/AIDS and poverty
reduction work
Workplace
interventions
PLHAs
groups/networks
Fighting stigma &
discrimination
Capacity building to
Health Workers
Monitoring and
Evaluation of HIV/AIDS
activities
Advocacy work
IEC production and
dissemination
Others (Specify)
4.2 Prevention
including gender
Life skills at school
Page 63

youth
Life skills out of school
youth
Control and case
management of STIs
Condom promotion
and distribution
PMTCT campaign
Voluntary Counseling
and Testing
Others (Specify)
4.3 HIV/AIDS care and
support
Treatment of
opportunistic infections
Anti retroviral therapy
Home based care
programs
Train staff in care and
treatment
Community/ homebased
care support
according to national
guidelines
Others (Specify)
4.4 Socio-economic
impact
mitigation
Support to OVC
Others (Specify)
Page 64

5. RESEARCH
Program/Activity
5.1 Research
Proposals
Studies
Publications
Others (Specify)
Amount in Tshs.
Requested Approve
d
Received Spent Balance Remarks
6. PROCUREMENT OF GOODS AND SERVICES TO SUPPORT HIV/AIDS
INTERVENTIONS
Programme /Activity
Goods/services
purchased
Amount
Remarks
Page 65

7. ANY RECOMMENDATIONS FOR FUTURE PROGRAMME
IMPROVEMENT (LIST)
Page 66

GUIDE TO FACILITATORS
This guide is prepared to enable facilitators to plan and execute the training programme
on monitoring and evaluation for HIV/AIDS successfully. The guide is only meant to
assist facilitator to effectively plan and run their training programmes; the guide is not
exhaustive and is not intended to substitute the facilitator role in using his or her
potential in creating a facilitative environment for the learning process.
Attributes of a Facilitator in the Area of Monitoring and Evaluation of HIV/AIDS
Programmes
The following suggestions are made to encourage and give confidence to persons
developing and running a training programme in M&E of HIV/AIDS programmes. The
value of any training programme is greatly dependent upon the effectiveness of the
facilitator. This is especially true in the area of HIV/AIDS programmes. The facilitator
is the crucial factor in the success of the training programme. Persons who facilitate an
M&E training programme for HIV/AIDS programmes should possess the following
attributes:
• Positive attitude toward HIV/AIDS intervention programmes
• Adequate factual knowledge of HIV/AIDS
• Adequate understanding of M&E processes conceptually and pragmatically
• Ability to communicate comfortably with adult and youth learners
• Appropriate professional attitude
• Ability to create a supportive attitude in the training room so participants (trainees)
will be encouraged to ask questions and express feelings
• Knowledge of community resources and practices so as to present diverse
viewpoints or to provide current insights into selected topics
• Desire to keep up to date in the field by attending workshops and conferences and
being current with research findings in the area of facilitation
• Must identify with the general norms of trainees and the general community
• Genuine Respect
• Must be interested in the subject area and individual learners
• Has a sense of humour
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• Good role model
Note: The degree of success of a facilitator has in the training room is not determined as
much by his or her age, sex, marital status, or social position, but by the combination of
personal qualities that a person exhibits plus knowledge and communication skills.
Do’s and Don’ts of Training (partly adopted from Pathfinder International, 2002)
DO’S
• Do maintain good eye contact
• Do prepare in advance
• Do involve participants
• Do use visual aids
• Do speak loud enough
• Do encourage questions
• Do recap at the end of each session
• Do use good time management
• Do give feedback
• Do be aware of participants’ body language
• Do provide instructions
• Do move around
DONT’S
• Don’t talk to the flip chart of power point
• Don’t block the visual aids
• Don’t ignore participants’ comments and feedback (verbal and non verbal)
• Don’t read fro your notes
• Don’t shout at the participants
Page 68

General Requirements for a Training Programme
The actual requirements for the training programme will depend on the nature of the
training and participants, venue, and availability of resources. Trainers are advised to be
creative in looking for training resources that will maximize the participation and
maintain the enthusiasm of their participants. The following list of requirements may be
used as a guide in preparing the resources/checklist for the training.
• Markers
• Flip chart
• Pens/Pencils
• Note books (writing pads)
• Masking tapes
• Power point projector
• Lap top computer
• Manila sheets/cards
• Transparency papers
• Overhead projector
• Screen
General training/learning methodology
As for requirements, the list below is only suggestive and not exhaustive. The exact
method to employ in running a particular should be chosen by the facilitator as deemed
appropriate. The catching point here is that the facilitator should choose a method that
allows active participation of participants and sustains the interest of trainees
throughout the lesson. The following methods may be used:
• Trainer brief presentation
• Role plays
• Discussion
• Group works
Page 69

• Activities and exercises
• Demonstration
• Brainstorming
• Case Study
• Seminar Method
• Drama
• Panel Discussion
• Field Trips
• Peer Training
• Film Shows
Some of the questions to ask/consider in choosing a technique:
• What is the focus of learning? Is it aimed at knowledge-creation or skill-building
• Is the method facilitative in creating a learning environment
• Does the method promote learners’ involvement
• Does the method sustain interest in learners
• Does the method create mutuality of experience among participants
• Am I competent at using the method
• Modeling
Evaluation of the Training Programme
Every training programme should be evaluated to measure progress and success.
Evaluation can be done prior to the commencement (pre-test) of the training programe,
during the training programme, or post training programme. Pre-training evaluations are
aimed at assessing the knowledge base of trainees prior to the commencement of the
training programme so that the facilitator is positioned appropriately. Mid-session
Evaluations (formative) are a corrective tool to enable the facilitator to reflect back on
the training programme to determine whether he or she is achieving the intended results
or not. For maximum advantage, each evaluation undertaken should be analyzed and
feedback given. Thus the following types of evaluation may be used:
• Pre-training test
Page 70

• Post-training test
• Day reflections
• Daily evaluation forms
• Overall evaluation forms.
Basic steps in Planning a Training Programme
• Decide on the subjects which will meet the needs
• Choose the best form for the programme (workshop, seminar, conference, meeting,
etc.)
• Make a budget
• Choose the venue commensurate your budget limits
• Decide on the time-table (months, days of the week, hours)
• Recruit facilitators
• Recruit participants
• Inform participants in good time
• Find suitable methods and materials/requirements.
Page 71