INTEGRATED ACTIVITY FLAG: This activity is linked to the SI activities being implemented by MEASURE Evaluation (# 7621) linked to all PEPFAR/South Africa OVC partners and the Department of Social Development (DoSD).

SUMMARY: This activity aims to improve OVC information gathering and reporting systems for both the DoSD and PEPFAR OVC implementing partners. In addition, the activity aims to improve OVC service delivery and assess program effectiveness by generating information about OVC programs through a targeted evaluation. The major emphasis area for this activity is strategic information. Minor emphasis areas are targeted evaluation, local organizational capacity development, and training. The primary target populations are orphans and vulnerable children, host country government staff, specifically the staff of the DoSD at the national and provincial levels, USG in-country staff, and all PEPFAR funded OVC groups including community-based organizations, faith-based organizations, and non-governmental/private voluntary organizations.

BACKGROUND: This activity was initiated in the second half of FY 2005 and will continue through FY 2006 and FY 2007 with PEPFAR funding. This activity is being implemented by MEASURE Evaluation/Tulane University with additional assistance from other MEASURE Evaluation partners as needed, as well as South African sub-partners. In FY 2005 PEPFAR funds were used to work with the DoSD to recruit a resident advisor (RA) who was placed within the DoSD under the direction of Chief Director of the HIV and AIDS Unit. The RA is supporting the DoSD by developing the M&E component of the National Plan of Action for OVC and the DoSD's policy framework for OVC made vulnerable by HIV and AIDS, as well as developing an operational plan. In FY 2006 the M&E Advisor will provide program management support to the organization selected to develop a management information system (MIS) to track OVC. In addition, the RA will work to build the capacity of DoSD staff in M&E to ensure sustainability of the M&E systems that will be developed. In FY 2006, the USG PEPFAR Task Force has also requested that MEASURE adapt the global OVC TE protocol to the South Africa context.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: M&E Strategy The PEPFAR funded M&E RA to the DoSD will assist them to implement an M&E strategy that is being developed in FY 2006. A key component of the DoSD M&E system in South Africa will be the MIS for OVC co-funded by PEPFAR and the DoSD. The M&E RA will serve as the liaison between DoSD, the MIS contractor, implementing partners and other donor agencies; oversee major time-lines for the MIS Contractor, and provide technical assistance to the MIS Contractor in the following areas: guidance on database design issues relevant to DoSD's M&E strategy and operational plan to ensure key objectives of DoSD are met with the system; oversight on functionality and user interface; ensure that data quality and integrity is maintained; and coordinate training needs of the users at local and provincial level once the MIS system is fully developed. The expected result of this activity is a functional national MIS system for OVC programs.

ACTIVITY 2: M&E Capacity Development The M&E RA will continue to develop the M&E capacity of staff within the DoSD and local partners. A designated staff member within DoSD will eventually take over the M&E responsibilities thus ensuring the sustainability of the DoSD M&E system. The M&E RA will coordinate M&E training needs within the DoSD and of local implementing partners, conduct site visits to local and provincial sites in order to assess gaps in skills and knowledge in M&E and provide technical assistance to meet such needs. The M&E RA will evaluate and modify data utilization and flow within DoSD. The expected result of this activity is a sustainable M&E unit within the DoSD.

ACTIVITY 3: OVC Targeted Evaluation MEASURE Evaluation will adapt and implement the OVC Targeted Evaluation (TE) protocol that is currently under development for the global OVC TE with PEPFAR South Africa funds. Specifically this activity will involve conducting outcome evaluations of five OVC programs. Five programs will be selected that are implementing distinct models of care in

order to assess the relative impact of the diversity service delivery models. These models will be selected based on the case studies of all 25 PEPFAR/South Africa OVC partners that will be implemented in FY 2006. The TE will be implemented through a sub-agreement with a South African research group with technical support and guidance from MEASURE Evaluation. The expected result of this activity is to document the effectiveness of the OVC programs funded through the South Africa PEPFAR program and to provide information to the OVC partners that will help them improve the services they provide.

These activities will contribute to tracking the success of achieving the PEPFAR objective of 10 million people in care at both a local and global levels by providing valuable information for decision making.

INTEGRATED ACTIVITY FLAG:

This activity is linked to MEASURE Evaluation activities described in the Strategic Information Program Area (#7621).

SUMMARY:

MEASURE Evaluation has been developing tools for a patient-focused assessment of adherence to and sustained participation in antiretroviral therapy (ART) and TB programs called "ADHERE: Evaluation for Sustaining and Enhancing Participation and Adherence in ARV and TB Treatment Programs". MEASURE Evaluation, at the request of the KwaZulu-Natal (KZN) Department of Health (DOH), will expand the use of the ADHERE tool in various sites in the province. MEASURE Evaluation will implement ADHERE in one site in each of the KZN districts that have been pre-selected in collaboration with the DOH. Sites were selected based on three criteria: urban/rural distribution; number of patients on ART; and perceived ease of developing collaborative relationships. The emphasis area for this activity is Strategic Information. Target populations include people living with HIV (PLHIV), caregivers, and public sector healthcare workers.

BACKGROUND:

This is an ongoing activity that has been jointly funded through the USAID/Washington core MEASURE Evaluation contract and FY 2006 PEPFAR support from South Africa. This activity is being implemented by MEASURE Evaluation in collaboration with the KZNDOH, McCord Hospital and an NGO, the Centre for HIV and AIDS Networking (HIVAN).

The tools are designed to add qualitative information about patients' experiences of the challenges and successes of long-term adherence, and to place the patients' perspective in a holistic context. The aim is to better equip ART program managers at the provincial and health district or facility level to improve programs and better interpret quantitative measures of adherence derived from patient record systems or other clinical measures, and to better appreciate forces that may be affecting adherence outside of the clinical context. Both positive and negative determinants of adherence are elicited. Phase 1 tools have been designed and developed to study adherence to long-term treatment. The tools are being implemented in six sites in KwaZulu-Natal with FY 2006 funds.

ACTIVITIES AND EXPECTED RESULTS:

With FY 2007 funds, the ADHERE project will begin the Phase 2 expansion and further validation of rapid ethnographic tools in five additional sites already identified by the KZNDOH. Based on Phase 1 analysis and results, tools applied during Phase 2 will be further refined and made more specific based on the KZNDOH needs.

Qualitative and quantitative data collection and analysis will be utilized to study three domains of influence on long-term therapy adherence: the clinical health system (e.g. institutional social factors that may promote or hamper sustained individual ART program participation); patient psychosocial support systems; and community variables (e.g. the interface of community and health system activities to promote individual and family well-being). These activities will be implemented with a focus on relevant health behaviors and beliefs and the contexts that shape them.

Proposed outputs are as follows:

1. Replicable and rapid evaluation procedures will be developed in order to generate program-relevant strategic information to enhance ART program participation and improve adherence. In addition, the project will produce procedures of best practice for program improvement. Finally, systems will be established to ensure the use of relevant routine service statistics and reporting indicators.

2. Findings and recommendations will be disseminated regarding positive and negative factors affecting adherence and participation. MEASURE Evaluation will work with the KZNDOH in order to address these factors in ongoing programs.

3. MEASURE Evaluation will look at issues around data use for program improvement. If applicable, M&E trainings will be provided at the local and provincial levels to ensure accurate and reliable routine data is captured and then utilized for decision making.

This activity will contribute to the overall PEPFAR objective of reaching 2 million people with treatment, by ensuring that once on treatment, people are adhering to the treatment to ensure a successful outcome.

INTEGRATED ACTIVITY FLAG:

This MEASURE Evaluation activity is linked to all South African PEPFAR partners. Given the focus of PEPFAR on strategic information (SI), almost all partners receive some sort of technical assistance in SI. In addition, this activity is linked to the MEASURE Evaluation OVC activity (#7622) and ARV Services activity (#7623). This activity is also linked to the Khulisa data quality assessments and data warehouse activity (#7945).

SUMMARY:

MEASURE Evaluation will provide a broad program of technical assistance and other targeted project support to improve the quality, availability and use of SI in South Africa. SI will contribute to strengthening programs, improving accountability and reporting, and information sharing within PEPFAR partners. The major emphasis area for this activity is monitoring, evaluation or reporting. Minor areas include USG Data Warehouse development, health management information systems (HMIS), proposed staff, and other SI activities. The primary target populations for this activity include: HIV and AIDS program managers, host country government, policy makers, USG in-country staff, other healthcare workers (information officers), and the following groups and organizations: community-based organizations, faith-based organizations, non-governmental/private voluntary organizations and other PEPFAR implementing organizations not included in the above categories. In addition, MEASURE Evaluation is collaborating with the University of Pretoria to develop local capacity in monitoring and evaluation (M&E).

BACKGROUND:

MEASURE Evaluation seeks to improve the collection, analysis, and use of SI in planning, policy-making, management, monitoring, and evaluation of the South Africa PEPFAR program. MEASURE Evaluation has been providing continuous assistance to the South Africa PEPFAR program since FY 2004. In addition to the prime MEASURE Evaluation Partner, University of North Carolina, this activity is implemented by Tulane University, John Snow Inc. (JSI), the University of Pretoria School of Health Systems and Public Health, and Conference Call. This activity supports all South African Government (SAG) entities that are supported by PEPFAR through SI technical assistance. In addition, all information/data generated by this activity is shared with the SAG.

Gender relations are a key driver to the HIV and AIDS epidemic. MEASURE will address gender by helping to ensure that appropriate and quality information is collected at all levels of program implementation and is used to feedback into improving gender-specific programs.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Partner Capacity Building

MEASURE Evaluation will work to strengthen the capacity of PEPFAR implementing partners to monitor and evaluate their programs. The MEASURE Evaluation M&E Capacity Building approach is multi-faceted and includes the following activities: (1) M&E capacity building workshops: The 5-day basic M&E workshop will be offered to PEPFAR partners three times a year with FY 2007 funding. (2) M&E workshops on specific topics: There is increasing interest among PEPFAR partners for more specialized M&E training on such topics as data analysis, qualitative methods and research and evaluation methods for program improvement. These trainings will be implemented in collaboration with the University of Pretoria and other training partners. (3) Partner-specific workshops: There are a number of large partners (or primes who have many subs or sites) that want to deepen their M&E capacity. FY 2007 funds will be used to conduct 10 partner-specific workshops to respond to this need. (4) Individual M&E TA to PEPFAR implementing partners: This TA will focus on areas identified through the M&E capacity assessment. (5) Collaboration with the University of Pretoria to increase their capacity to conduct M&E trainings. (6) Specialist TA from US-based MEASURE Evaluation specialists as needed, including in the areas of Data Demand and Information Use (DDIU), M&E capacity building and data quality. To date, MEASURE has trained 277 individuals through the M&E Capacity Building Workshops.

ACTIVITY 2: Collaboration with USG/South Africa (USG/SA) SI team

MEASURE Evaluation works closely with the USG/SA SI team on the development and implementation of SI systems for the PEPFAR program. Specific activities include: (1) South Africa Strategic Information Manual: Update and disseminate a compendium of information and procedures to support PEPFAR; (2) Partner M&E Meetings: Coordinate and facilitate partner meetings; and (3) Ongoing collaboration: Given the growing data and reporting demands of PEPFAR, MEASURE Evaluation responds and assists the USG/SA SI Team as needed.

ACTIVITY 3: Increased demand, availability and utilization of SI

MEASURE Evaluation will utilize multiple strategies for increasing the demand, availability and utilization of SI in South Africa by both USG and South African partners. In November 2004 MEASURE Evaluation contracted with Khulisa Management Services to develop the Data Warehouse (DW). Initially Khulisa focused on developing the PEPFAR reporting system, but in the future Khulisa plans to emphasize making the DW more useful for partners and USG staff. Specific activities include: (1) Data Warehouse: Subcontract with Khulisa for April 1 through September 30, 2007 period, based on the understanding that Khulisa will be directly funded in FY 2007, but will suffer a delay in receiving direct PEPFAR funding that will require JSI to extend its subcontract with Khulisa through September 2007; (2) targeted TA to Khulisa and PEPFAR implementing partners on development of partner-focused utilization and reporting tools, review of current and future software codes and the application of GIS as a monitoring tool. The MEASURE Evaluation team will work with Khulisa and PEPFAR implementing partners on their data and information needs to determine functions required. (3) Partner Level MIS Reviews: MEASURE Evaluation team will work in collaboration with the new CDC HMIS Specialist and the USAID Senior M&E Advisor to conduct information systems reviews, including data and information needs, reporting cycles (PEPFAR and non-PEPFAR), technical infrastructure, and human and financial resources.

ACTIVITY 4: National-level M&E Capacity Building

MEASURE Evaluation will work to strengthen national-level M&E capacity in South Africa through collaboration with national and provincial departments such as South African Department of Social Development, the National Defense Force, Department of Education, and Department of Corrections that are funded through PEPFAR. Specific activities include: training of M&E and program staff, facilitating the exchange of information on M&E strategies; and providing technical assistance related to different information systems.

MEASURE Evaluation will also support the Western Cape Provincial Department of Health by empowering health management teams to use information for strategic and operational decision making to improve the functioning of the healthcare system for HIV and AIDS and TB. The proposed technical assistance will further strengthen the capacities of health management teams to work within existing M&E systems while integrating sustainable systems of data quality management and use of information.

These activities contribute to the overall goals of PEPFAR at both a local and global levels by providing valuable information for decision making.