JSI will continue to support the United States Government (USG) country team to improve health

information systems, monitor and evaluate health programs and institute effective and evidence-based

programmatic decision making with the aid of quality data. While the principal emphasis of this activity will

be strengthening health management information systems (HMIS), other important emphasis areas include

support for monitoring and evaluation (M&E), and reporting for the President's Emergency Plan for AIDS

Relief (PEPFAR), and continued development and implementation of an USG reporting system for

community-based programs. Particular emphasis will be placed on strengthening data quality for reporting

and the use of program data for decision making. The primary target populations include staff at the UCC

(NACC) and the MOH (MSPP), health care workers, and program managers within community based

organizations (CBOs), faith-based organizations (FBOs), non-governmental organizations (NGOs) and

other PEPFAR implementing partners. The scope of this support is national as the HMIS extends to all

health districts while the community-based activities are conducted in all provinces.

BACKGROUND: The implementing organization has supported M&E activities in Haiti since 2001. Building

on this experience, the implementing organization will work at the national level coordinating with a variety

of stakeholders such as the Ministry of Health (MOH), UCC (Unité Centrale de Coordination du Programme

de Lutte contre les IST/VIH/SIDA), the Global Fund to fight AIDS, Tuburculosis and Malaria (GFATM), the

Inter-American Development Bank (BID) and PEPFAR implementing partners.

Sub-activity 1: Technical assistance support to the USAID/Haiti Social Services Strategy

The Technical Assistance will address four focus areas that are linked - (1) to build monitoring and

evaluation capacity (through mentoring, seminars etc.) of the USAID/Haiti health and education technical

staff; (2) to provide technical assistance to the health and education implementing partners to enable them

to have an adequate system for, and capacity to, monitor their respective program performance; (3) provide

technical assistance to both the USAID technical staff and the implementing partners on jointly monitoring

overall strategy performance towards achieving end of year and end of strategy results; 4) provide technical

assistance and strategic technical direction to the PEPFAR Haiti Program and 4) develop a data

management system for all implementing partner reporting data for the Health and Education Office .

Sub-activity 2: Development of a paper-based system for monitoring performance of non facility-based

interventions.

Activities in support of community level program information reporting for 2009 is a continuation of a

process begun in 2006. The community based activity reporting system began in 2007 (COP 2006) as a

USG implementing partner reporting system for PEPFAR indicators. Indicators were harmonized among

IPs and standardized forms and reports were created. Training was conducted for community level staff in

spring, 2008. In COP 2009 the emphasis will be on supervising and facilitating the comprehensive roll-out

of the system to all USG implementing partners. Supportive supervision and mentoring will be provided to

data managers and decision makers at the community level to ensure appropriate evidence-based decision

making, use of data for program management, and reporting of quality data. In COP 2009 the implementing

organization proposes to harmonize the information system for community based activities with the Haitian

National AIDS Control Program and programs supported by other international donors (e.g. the Global

Fund, UNICEF). Additionally, MEASURE Evaluation proposes to conduct a formal evaluation of the

effectiveness of the community based activity reporting system in monitoring programs and strengthening

program management. Funding for this activity will be used for consensus building meetings, site visits,

technical assistance visits by international-based staff as well as salary support for full time in-country and

international-based staff. MEASURE Evaluation would like to hire a full time staff member to foster the

comprehensive roll out of this important new system.

Sub-activity 3: Data Demand and Information Utilization (DDIU)

Good program management depends on quality data for effective decision making. The data demand and

information utilization curriculum devised by MEASURE Evaluation stresses the identification of important

stakeholders and linking these to the critical management decisions they are required to make, as well as

the sources where these data can be found. In COP '09 MEASURE Evaluation will build capacity in Haiti at

all levels of the heatlh system (National, Implementing Partner, Service Delivery Sites) but particular focus

will be placed on decisions made and demand for information at the community level and in health care

facilities. MEASURE Evaluation will implement a stepwise approach to stimulating demand and improving

use of data; (1) perform a DDIU assessment; (2) use the information from Step 1 to identify and define

strategic opportunities in terms of the entry point of DDIU activity, beneficiaries, and stakeholders and

anticipated results; (3) select the DDIU tools and approaches that will be applied; and (4) document the

impact of DDIU activities in terms of the anticipated results from Step 2. In 2009, MEASURE Evaluation will

support the extension of the DDIU curricula to the level of the health care facility/implementing

site/community-based program. In addition, MEASURE Evaluation proposes to identify needs for

secondary data analysis of PEPFAR program data and develop the capacity within local organizations to

conduct such analyses. Funding for this activity in 2009 will be designated for conducting regional trainings

for data use, conducting site visits for data quality control and data use mentoring , and evaluations of

information needs at the organizational level and for preparing guidelines for secondary data analysis of

PEPFAR data. Support for in-country and international-based salaries will also be required.

Sub-activity 4: Strengthening the integration of HIV/AIDS HIS into the overall HIS.

This activity was suspended in FY 2006 due to a lack of support by the MOH and re-prioritization of needs

by USG. It is hoped that in accordance with a renewed emphasis on health information system

strengthening by the Office of the Global AIDS Coordinator (OGAC), this activity will have the necessary

support for implementation in COP '09. The COP 2009 proposes implementing a strategic plan to integrate

HIV/AIDS data into the overall HMIS in Haiti. USG support enables the HIS system to meet both short and

long term HIV/AIDS health information goals, including meeting the information needs of diverse

international donor organizations, including PEPFAR, GFATM, UNICEF, and the MOH, in a harmonized

Activity Narrative: system (the "Three Ones"). In FY 2009 the implementing organization plans to 1) ensure that the HIS

regularly reports quality HIV/AIDS data to PEPFAR and GFATM, 2) implement and monitor performance of

the patient referral system within the health care system; and 3) provide technical assistance to the 10

health departmental offices to strengthen their capacity to validate, analyze, and use data.

Sub-activity 5: General HMIS Strengthening

The development and strengthening of a routine facility-based health information system (RHIS) is an

integral part of the strategic information plan and a critical element for fostering sustainability of SI in Haiti.

The USG has supported Haiti in building a sustainable HIS that permits generation of information necessary

for rational decision making at each level of the health system. MEASURE Evaluation will build on work

conducted in previous years by; 1) strengthening the RHIS management capacity at Ministry offices

responsible for RHIS management (Division of Epidemiology and Laboratories, Division of Planning and

Evaluation) through focused technical assistance in database development and management, data

analysis, monitoring and evaluation, and reporting; 2) assisting the MOH in the elaboration of the Haiti

Annual Report (annual activity); 3) organizing workshops on data review, use and dissemination (including

the publication of departmental newsletters and feedback reports); 4) organizing refresher training for facility

personnel on data collection form completion (e.g. registers, monthly report form); 5) providing training for

regional RHIS managers on best practices for RHIS management and implementation (e.g. performance

monitoring and evaluation); 6) monitoring the quality of RHIS data and intervening where appropriate; and

7) working with USG to harmonize the RHIS with existing reporting systems (e.g. MESI for HIV/AIDS). To

that effect, the RHIS database will be enhanced to allow the exportation of an XML data file for easy

integration into the MESI system. Making the RHIS data available via the online MESI system will make

RHIS program managers more accountable by increasing the visibility of the strengths and weaknesses of

the RHIS data. Additionally, the increased access to data afforded by the online data will make the RHIS

more effective at enabling evidence-based decisions system wide. Other potential areas for integration

include the Inter-American Development Bank's pilot project for strengthening health systems at the level of

the UCS.

New/Continuing Activity: Continuing Activity

Continuing Activity: 18846

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18846 18846.08 U.S. Agency for John Snow, Inc. 7725 7725.08 MEASURE $550,000

International Evaluation Track

Development Order

Table 3.3.17: