A syndrome of Irregular Enthusiasm:

Increasing the Utilisation of

Evaluation findings in the UPHOLD project

BY Apollo NkwakeVisit http://www.uphold.jsi.com

A conceptual framework

The experience

Lessons

Presentation Structure

The dilemma of utilization

Doing evaluations

Using evaluations for evidence based policy

How Evals are done•Time•Quality•Relevance•Credibility•Participation•Evidence validity/rigor•Dissemination/access

Behavioral andinstitutional factors•A culture of evaluation•Capacity to use findings

The Gap

About UPHOLD (1)

Six-year integrated social services program designed by the Government of Uganda and USAID

Operated in 34 districts covering 42% Uganda’s population (~ 11.8m people)

Overall project aim was to increase access and utilization of sustainable and quality social services in Education, Health and HIV/AIDS in support of USAID’s Strategic Objective 8 (SO8) which aims to improve human capacity

Partnered with >120 CSOs and 34 local government

To strengthen existing data collection and information systems for Grantees ( both LGs and CSOs)

To build district capacities in planning and evidence-based decision-making by making accurate annual data available

To utilize performance results to target interventions

To document and share key lessons learned

The UPHOLD ‘Information’ Mandate

Context for doing and using evaluations in UPHOLD

Uganda is decentralized Local governments are CSO actors are closer to the

ground and need more localized information for programming

DHS’ and other higher level sources do not provide information disaggregate to local levels

Capacity issues-low capacity to generate reliable information

Resource constraints Varied capacity levels-planning, collection, processing

and use of information Availability of information is not linked to service delivery

planning

Using LQAS as a cost effective and simple tool

Originally developed in the 1920s to control the quality of output in industrial production processes

Involves taking a small random sample of a manufactured batch (lot) and test the sampled items for quality

If the number of defective items in the sample exceeds a pre-determined criteria (decision rule), then the lot is rejected

The decision rule is based on the desired production standards and a statistically determined sample size ‘n’ is chosen so that the manager has a high probability of accepting lots that meet the quality standards and rejecting lots that fail to meet those standards

Adapting LQAS for public health programs

Can be used locally, at the level of a “County or sub-county,” to identify priority areas or indicators that are not reaching average coverage or an established benchmark

Can provide an accurate measure of coverage or Service system quality at a more aggregate level (e.g. District coverage)

A

BC

DE

F G

Assume a district has seven Counties

Each County is ‘supervised’ by one person

The level of ‘success’ in each county is to be measured

The Basic LQAS Principles - I

A

B

C

DE

F G

Good

Below Averageor EstablishedBenchmark

Good

Below Average or Established Benchmark

Identify the reasons for program problems

Develop targeted solutions

Maintain the program at the current level

Identify Supervisors that can help other workers improve their performance

What can be done in the circumstances?

Each District is a ‘Supervision Unit’ and each County or Health sub-District or sub-County is a ‘Supervision Area’

Sample units are the Households, schools and health facilities

What is evaluated is the overall success in delivering specific services

Application of LQAS to monitor UPHOLD and Partners’ programs

Using the LQAS method (1)

~ 200 partner staff trained for 2 weeks in the LQAS methodology in 2004, 2005, 2006 & 2007

LQAS was done on an annual basis in with in the 34 project districts, involving CSO and LG partners in 2004, 2005, 2006 & 2007

Districts are divided into supervision areas District officers are involved in planning, data

collection, analysis and dissemination Fitted with in the planning cycle

Using the LQAS method (2)

19 villages are sampled from each of the five ‘Supervision Areas’ in each district

Data is Collected From, Households, Schools, Health Facilities

5 households are sampled from each village and a different questionnaire administered to each of the sampled households (~12,300 households covered)

Schools and Health Facilities also surveyed (423 health Units and 1,449 Schools)

What LQAS can do

A sampling method that:– Can be used locally, at the level of a ‘supervision

area’ (e.g., district) to identify priority areas (e.g., county, sub-county) or indicators that are not reaching average coverage or an established benchmark

– Can provide an accurate measure of coverage or health system quality at a more aggregate level (e.g., district, program catchment area etc.)

– Not diagnostic

Why we supported CSO and LG partners to adopt LQAS

Low sample size needs (n=19 in most cases) Simple to apply yet has very specific conclusions District level people could be trained to entirely ‘own’ this

methodology Provides high quality information at low & affordable cost Fast – ‘supervision areas’ are able to conduct self-

evaluation and obtain results immediately after the survey

Results are locally relevant and can be utilized in district level annual planning and decision-making

Example: monitoring malaria prevention in Bushenyi district-W. Uganda

010.5

5.30

5.3 4.211.7

5.3 7.913.2

5.315.4

9.417.2

36.8

21.128.9

13.2

28.9 25.8 26.8

79

36.8

55.3 52.660.5 56.8

43.9

0

10

20

30

4050

60

70

80

90

100

Per

cent

age

2004 2005 2006 2007

% Under-5 sleeping under ITN the night before survey

Example: monitoring uptake of reproductive health services in Wakiso district-C Uganda

47.4

79

63.2

94.7 94.7

41

63.2

89.5

73.779

89.5

79

45.952.6

7984.2

73.7

84.274.7

50

68.4

94.7

84.2

10089.5 87.4

57.8

75.8

0102030405060708090

100

Busiro A Busiro B Busiro C Entebbe Kyadondo Dist. Total All UPHOLD

2004 2005 2006 2007

% of mothers who delivered at health centers

What we learned

Sequence: there should be strong link between evidence generation, planning, resource allocation and service delivery/policy

In a decentralized setting with conflicting political interests, a piece of evidence does much

Results based reviews are very empowering, and enthusing

Emphasizing use is strengthening quality• It is possible to make comparisons within and across

districts and measure success in comparison to national targets

• LQAS has fostered more equitable allocation of resources at district level due to ‘evidence-based’ planning

What we learned from supporting CSOs and LGs to use LQAS (Contd)

The methodology is simple to use and CSO & LG personnel can be trained to carry out and analyze the annual surveys

‘Start-up’ training costs may be high, but this is often a once-off as persons already employed at district level are utilized for the surveys

At a cost of ~2,700 USD per district, LQAS is suitable for annual routine data collection even in resource limited settings

Visit http://www.uphold.jsi.com