Ghs Monitoring & Evaluation Plan 2010-2013

8/10/2019 Ghs Monitoring & Evaluation Plan 2010-2013

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GHS MONITORING AND EVALUATION PLAN 2010-2013

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Monitoring and Evaluation Plan

GHANA HEALTH SERVICE


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jkl b t i dfghjkl GHS MONITORING AND EVALUATION PLAN 2010-2013

ACKNOWLEDGEMENT

The Development of this Monitoring and Evaluation Plan has been made possible

with the support of all the divisions within the Ghana Health Service. Key individuals

who contributed to the write up and technical review have been recognized in the

document. The Ghana Health Service is most grateful to all who took time of their

busy schedule to contribute their technical expertise to the development of this

document.

We are also very grateful to the Medical Sciences for Health who provided funding

for the writers workshop, the technical review meetings and the printing of this

document through the TB CARE 1 Project.

We humbly acknowledge the contributions of all other individuals who may have

contributed to the development of this document but have not been mentioned by


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FOREWORD

The Ghana Health Service has over the years been implementing different

programme of Work and have been reporting on its performance. There is an

elaborate system to ensure that the Ghana Health Service accounts for its

stewardship. The processes involved in doing this are in various documents. This

effort to document these monitoring and evaluation processes in one document is

one of the important steps in the overall attempt to improve the monitoring and

evaluation within the service and ensure accountability within the service.

It is hoped that this document will provide direction for Districts, Regions, Divisions

and Programs to better monitor and evaluate the implementation of their programme

of work.

Thank You


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LIST OF TABLES

Table 1: Participants at Writers Meeting

Table 2: Participants at Document Finalization Meeting

Table 3: Monitoring and Evaluation Calender

Table 4: Roles and Responsibilities of Divisions

Table 5: Stakeholders in the Health Sector

Table 6: Timeline for Data Submission

Table 7: Financial Reporting Framework

Table 8: M&E Activities

Table 9: Budget for M&E

LIST OF FIGURES

Fig 1: Institutional Monitoring and Evaluation Framework


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List of Acronyms

ACT Artemesinin Combination Therapy AFP Acute Flaccid Paralysis AIDS Acquired Immunodeficiency Syndrome ANC Ante Natal Care ART Anti-Retroviral Therapy ARV Anti-RetroviralBCG Bacillus Calmette-Gurin Vaccine

BMC Budget Management Centers CEmONC Comprehensive Emergency Obstetrics and Neonatal Care CHAG Christian Health Association of GhanaCHIM Centre for Health Information ManagementCHO Community Health OfficersCHPS Community-based Health Planning and ServicesCHW Community Health WorkersCSO Civil Society OrganizationCYP Couple Years of ProtectionDA District AssemblyDDHS Director of District Health ServicesD-G Director GeneralDHIMS District Health Information SystemsDHMT District Health Management TeamDHS Demographic and Household SurveyEmONC Emergency Obstetrics and Neonatal CareEPC Environmental Protection CouncilEPI Expanded Programme on Immunization


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LDP Leadership Development ProgrammeLI Legislative InstrumentMDG Millennium Development GoalsMICS Multi-Indicator Cluster SurveyMLGRD Ministry of Local Government and Rural DevelopmentMOFEP Ministry of Finance and Economic PlanningMOH Ministry of HealthMOWAC Min istry of Women and Childrens Affairs M&E Monitoring and Evaluation

NACP National AIDS Control ProgrammeNCD Non-Communicable DiseaseNDPC National Development Planning CommissionNGOs Non-Governmental OrganizationOPD Out-Patient DepartmentOPV Oral Polio VaccineNMCP National Malaria Control Programme

NTP National Tuberculosis Control ProgrammePHD Public Health DivisionPNC Post Natal CarePOW Programme of WorkPPME Policy Planning Monitoring and Evaluation DivisionPPP Public Private PartnershipsRDHS Regional Director of Health Services

RDT Rapid Diagnostic TestSBS Sector Budget SupportSD Skilled DeliverySP Sulfadoxine Pyrimethamine


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Table of Contents

LIST OF TABLES ................................................................................................................................. 4

1. INTRODUCTION ............................................................................................................................... 9

1.1. BACKGROUND ......................................................................................................................... 9

1.2. RATIONALE .............................................................................................................................. 9

1.3. PROCESS OF DEVELOPING THE M&E PLAN ........................................................................... 10

2. SITUATIONAL ANALYSIS ................................................................................................................ 12

2.1 SWOT Analysis of the GHS Monitoring and Evaluation System .................................................. 12

2.1.1. Strengths ....................................................................................................................... 12

2.1.2. Weaknesses................................................................................................................... 13

2.1.3. Opportunities ................................................................................................................ 14

2.1.4. Threats .......................................................................................................................... 14

3. PROGRAM DESCRIPTION AND FRAMEWORK ............................................................................... 15

4. INSTITUTIONAL ARRANGEMENT ................................................................................................... 39

4.1. MANDATE OF THE GHANA HEALTH SERVICE ........................................................................ 39

4 2 M&E MANDATE AND FUNCTIONS OF DIVISIONS 43


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8.3. USE OF DATA FOR DECISION-MAKING .................................................................................. 57

8.4. PLAN FOR EVALUTAION ........................................................................................................ 58

9. QUALITY ASSURANCE .................................................................................................................... 59

9.1. Ensuring Data Quality ........................................................................................................... 59

9.2. Improving the quality of data collection ............................................................................... 59

9.3. Standard Operating Procedures ........................................................................................... 60

9.4. Improving Timeliness, Completeness and Accuracy of Transmitted data ............................ 60

9.5. Data Quality Audit ................................................................................................................. 61

9.6. Feedback Processes .............................................................................................................. 61

9.7. Documentation ..................................................................................................................... 62

10. REPORTS .................................................................................................................................... 63

10.1. REPORTING MILESTONES .................................................................................................. 63

10.2. PROGRAMMES/PROJECT MONITORING ........................................................................... 63

10.3. FINANCIAL REPORTS ......................................................................................................... 63

10.4. FINANCIAL AUDIT REPORTS .............................................................................................. 64

10 5 GHANA HEALTH SERVICE REPORT 64


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1. INTRODUCTION1.1. BACKGROUND

The Ghana Health Service (GHS) annual program of work (POW) are developedfrom the Health Sector Medium-Term Development Plan (HSMTDP) - 2010-2013and they mirror the government s development agenda for the medium term and arealigned with the national objective of attaining middle income status by 2015. TheHSMTDP 2010- 2013 builds on the general principle of providing affordable primaryhealth care (PHC) that is both cost-effective and ensures equitable access tohealthcare for all people living in Ghana. The HSMTDP has been synchronized withthe third 5-year POW which is truncated to allow for consistency in the developmentand provision of health services.

The HSMTDP 2010 - 2013, was developed through an elaborate consultativeprocess involving key stakeholders including development partners, and non-governmental actors in Ghanas health industry. It is based on the broad guidelinesof the National Development Planning Commission (NDPC). The consultationprocess was further enhanced by a series of key stakeholder consultations at thenational, regional and district levels involving development partners, health sectorNGOs, health workers and other sector collaborators such as the Ministry of LocalGovernment and Rural Development (MLGRD), Ministry of Women and Childrens

Affairs (MOWAC) and Environmental Protection Council (EPC).

The GHS which is the largest service agency of the Ministry of Health (MoH) willcontribute significantly to the achievement of the sector indicators. GHS providespublic health and clinical services at both primary and secondary levels The


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and targets. It will also make an allowance for identifying challenges toimplementation for timely and appropriate remedial measures to be taken. The GHSM&E plan will also delineate the roles of Divisions and Programmes in the M&Eprocess and guide overall stakeholder involvement in measuring health sectorperformance.

1.3. PROCESS OF DEVEL OPI NG THE M & E PLANThe M&E plan is built on existing M&E arrangements and processes in the healthsector. The indicators and milestones for assessing the performance of the Serviceare derived from sector wide indicators which were developed through elaborateconsultations with stakeholders facilitated by the Ministry of Health. Indicators andtargets from other strategic documents and some existing M&E plans were alsoadopted.

The process of developing the sector wide indicators began with internalconsultations at agency level. Following these, submissions were made to theMinistry of Health accentuating the need to either modify the tools for assessment ormodify targets, indicators, or milestones. These submissions were consolidated andcirculated widely to stakeholders for consideration and comments. Additionalcontributions were received from other stakeholders, particularly the health sectordevelopment partners.

The Divisions within the Service provided the targets for the various indicators asdefined under the Health Sector objectives.

The development of the GHS M&E plan began with a zero draft prepared by the


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9 Dr. Paul Ntodi Regional Hospital Medical Director Western Region10 Ms. Mabel Segbafah Health Educator - GHS11 Dr. Beatrice Heymann M & E Specialist - GHS12 Mr. Isaac Akumah Administrator, PPME13 Mr. Francis Victor Ekey Ag. Deputy Director, Planning - HRDD14 Dr. Cynthia Bannerman Ag. Director, Institutional Care Division15 Dr. Felix Afutu TB Control Program Officer16 Ms. Hilda Smith MSH TB Project Officer

17 Mr. Prince Asante Health Service Administrator18 Mrs. Esi Amanful Nutritionist GHS/HQ19 Mr. Daniel Darko Head, Centre for Health Information Management

20 Mr. Daniel Osei Ag. Director, Policy Planning Monitoring & EvaluationDivision - GHS

21 Dr. Edward Antwi Deputy Director, Public Health Greater Accra Region22 Dr. John Eleezar Deputy Director, Public Health Central Region

23 Dr. Alex Nazzar Public Health Specialist - GHS

24Dr. Constance Bart-Plange

Program Manager, National Malaria ControlProgramme (NMCP)

25 Dr. Daniel Asare Regional Hospital Medical Director Eastern Region26 Mr. Daniel Degbotse M & E Specialist - MOH27 Mr. Ransford Akorli Deputy Chief Accountant - GHS28 Dr. Kyei-Farried Deputy Director, Disease Control

29 Mrs. Ramatu UdeUmanta Ag. Director, Finance Division - GHS30 Mr. Bernard Asamany Ag. Deputy Director, Procurement and Logistics - GHS


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2. SITUATIONAL ANALYSIS

Monitoring and Evaluation within the GHS depends largely upon monthly routineservice data generated from all districts and sub-districts. In Ghana, almost all theyearly health sector reviews and the aide memoires have called for an improvementin the existing health information system for better decision-making and supportingthe health system to deliver on key interventions and to achieve set objectives withinthe PoW and the MDGs.

Apart from these routine data, the health sector also collaborates with stakeholderssuch as the Ghana Statistical Service (GSS) and research institutions to undertakeperiodic health surveys and sentinel studies including the Demographic andHousehold Survey (DHS) and the Multi-indicator Cluster Survey (MICS). Suchsurveys provide the health sector with additional information for monitoring andevaluation that contributes to policy-making and re-strategizing.

The Health Sector, in an attempt to improve access to an integrated service datadeveloped and successfully deployed the DHIMS software in 2008 within the healthsector. This was to help district, regional and national managers to improve on thecollation and analyses of routine service data.

Service registers are provided at service delivery points in all health facilities toaccumulate client demographic and healthcare information. This informationconstitutes the primary data sources for monitoring and evaluation within the service.Standard forms are used to manually summarize data from these service registers


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Inadequate monitoring of M&E plans at all levels Very little commitment to M&E processes Weak process monitoring. M&E not included in planning at all levels Lack of a platform to link service parameters to governance parameters Lack of two-way accountability at all levels No sector goals for M&E system Weak feedback mechanisms and use of data to revise planning and

implementation activities2.1.3. Opportunities

Health Training Institutions available to deepen understanding on M & EGlobal interest for results tracking and data management.Increasing availability of ICT solutions.

2.1.4. ThreatsPolitical influence and governments prioritiesGlobal economic instabilityDonor driven parallel M&E systems

To address these gaps strategies will be developed to address issues relating toHealth Workforce, resource management and Leadership and governance .


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3. PROGRAM DESCRIPTION AND FRAMEWORKHO1: Bridging equ i t y gaps in access to health care and nutrition services, and ensure sustainable

financing arrangements that protect the poor Strategies Priority action Activity Division

ResponsibleOutput Indicator Outcome

IndictorImpactIndicator

1.1Strengthen districthealth system with aparticular emphasis onprimary health care

1.1.1Improve coverageof PHC servicesat sub-districtlevel throughcommunity healthsystems

Review of theCHPS strategy

PPMED-GHS

Number of newfunctional zones

Percentage ofOPD casesseen andtreated byCHOs.

Outpatientsvisits per capita

Proportion of

Cases ofvaccinepreventablediseasesseen.

New functionalCHPS zonesoperationalised

DistrictHealthManagementTeams /RegionalHealthManagementTeams

Provideaccommodation,transportation andservice deliverykits

DistrictHealthManagementTeams /RegionalHealthManagementTeams

Number of functionalCHPS zones withService delivery kitsavailable.

1.1.2 Leadershipcapacitydevelopment ofdistrict and sub-district teams

Train sub-districtteams to supportapproved serviceproviders in thesub-district

HRD-GHS Number of sub-districtteams trained underLDP

MaternalMortalityratio


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StrengthenDHMTs anddevelop theDistrict Health

Departments tooperate inaccordance withLI 1961

HRD-GHS Number of DHMTstrained under LDP

funds obtainedfrom non-traditional(GOG) sources

1.2 Develop sustainablefinancing strategies thatprotect the poor andvulnerable

1.2.1 Developcomprehensivehealth financingframework

Develop anational healthfinancing strategy

Office of DG Team in place;Documents forfinancing strategyprepared.

Percentage ofOPD visits byinsured clients.

Percentage ofindigentsregisteredunder the NHIA

Update andinstitutionalizeNational Health

Accounts

GHS-DG Team in place;Number of fieldworkand analysis on NHA

undertaken by team

Provideleadership andsupport for thereview andpassage of theNHIS bill,including definitionof the "indigent"

GHS- DG Number of peoplecaptured underrevised definition ofpoor and indigent


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HO1: Bridging equity gaps in access to health care and nutrition services, and ensure sustainablefinancing arrangements that protect the poor

Strategies Priority action Activity DivisionResponsible

OutputIndicators

OutcomeIndicators

ImpactIndicators

1.3 Increaseavailability andefficiency ofhumanresources

1.3.1 Revise andimplement theHuman ResourceStrategy

Develop a newHR strategy

HRD-GHS New strategydocumentavailable

Nurse percapita ratio.

Doctor percapita ratio

Medical Assistant percapita ratio

Midwife percapita ratio

Reviewestablishments,staffing normsand develop andimplementdeployment plan

HRD-GHS

Agree andimplementincentivepackage topublic healthsector workers inunder-servedareas

HRD-GHS Number of staffin deprivedareas benefittingfrom Incentivepackage agreedupon.

Number of

residentcommunitynurses(CHO)

Proportion ofdoctorsworking indeprived areas .

Infantmortality rate

Under fivemortality rate

Maternalmortalityratio

HO2: Strengthen governance and improve the efficiency and effectiveness of the health


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systemStrategies Priority action Activity Division

ResponsibleOutputIndicators

OutcomeIndicators

ImpactIndicators

2.1 Developcapacity toenhance theperformance ofthe nationalhealth system

2.1.1 Leadership andmanagementdevelopment at alllevels

Design andimplement in-service trainingprogramme inleadership andmanagement forall managers inthe health sector

HRD -GHS Number ofseniormanagers(National,Regional andDistrict) trainedin Leadershipandmanagement

Number offunctionalmanagementteams in place

2.1.2 Performancecontracting

Review andrefine the system

for performancecontracting withinthe sector.

Training on newperformancecontract forms

Performancecontract too besigned betweenmanagers and

staff

DG-GHS Newperformance

contract formfinalized

Proportion ofsenior membersin the servicewho havesignedperformancecontracts by firstquarter.

Percentage ofmanagers whoassess theperformance oftheir staff usingthe contract atmidyear.

2.1.3 Enforce adherenceto sound publicfinancialmanagementpractices

Review andimplement publicfinancialmanagementstrengtheningplan

Finance/Internal Audit

Completed plan.

Functional auditresponse teamin place

Number offinancial issuesfrom GHSbrought beforethe Public


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Build Capacityfor resourcetracking

Number of stafftrained inresource

tracking

AccountsCommittee

PercentageDistribution offunds by levelswithin thehealth sector.

Percentage offunds used forintendedactivities ,


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HO2: Strengthen governance and improve the efficiency and effectiveness of thehealth system

Strategies Priority action Activity DivisionResponsible OutputIndicators OutcomeIndicators ImpactIndicators2.3 Strengthen

inter-sectoralcollaborationand public-privatepartnerships

2.3.1 Improve partnershipfor health byengaging the privatesector.

Implement theprivate sectorpolicy

GHS-DG Number ofPPP meetingsheld Number of

private publicpartnerships(MOUs)establishedwithin theservice.

Establish advisorycommittee onPPP

PPMED-GHS Advisorycommittee inplace

Promote inter-sectoral coordination

GHS to be part ofthe developmentof District

Assembliescompositeplanning

District HealthManagementTeams.

Number ofmeetings heldwith DA.

Number ofsocialservices sub-committeemeetingsattended byDDHS.

District planswith priorityHealthcomponentincluded

Percentage ofPriority healthprojects jointlyimplemented.

Infant mortalityrate

Maternalmortality ratio

Strengthen

FHD Number ofmeetings heldwith the

Nutritionalstatusindicators(


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Collaboration onschool healtheducationactivities at all

levels(healthylifestyles)

SHEPcoordinators

Number of

joint visitsundertaken

Wasting,stunting,underweightand obesity)

Collaborate withNationalCommission forCivic Education toengage in masspublic educationcampaigns topromote healthylifestyles in thepopulation

-Materialproduction-Advocacy for useof materials-Supportcampaigns

GHS- ICD/FHDHealth Promotionunit

Number andtypes ofhealtheducationmaterialsproduced forNCCE.Number ofadvocacy and

trainingsessions heldbetween GHSand NCCE.

Number ofJoint masscampaignsundertaken

Publicawarenessindicators.

Behaviourchange

indicators

HO2: Strengthen governance and improve the efficiency and effectiveness of thehealth system

Strategies Priority action Activity DivisionResponsible OutputIndicators OutcomeIndicators ImpactIndicators2.4

Strengthensystems thatuse evidencefor policyformulation

2.4.1 Develop amonitoring andevaluation plan

Prepare andimplement anational M& Eframework for theGhana HealthService.

PPME-GHS GHS M&Eplandeveloped.

Number ofME Reports

Improvedperformance using therelevantindicators-quality

Infant mortalityrate

Under- fivemortality rate


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Number ofME Feedback

-coverage-Case fatality-evidencebased

decisions

MaternalMortality ratio

Establish districtleague table andreward system

Regional HealthManagementTeams

Number ofRegions withDistrict leaguetable andrewardsystem inplace

Dropoutrates(Immunization drop-outrateCure rate/casedetection rate

Workloadindicators(Number of

childrenimmunized/each communityhealth nurse)

2.4.2 Implement andcoordinate a nationalresearch agenda

Allocate dedicatedrecurrent budgetto health research

DG Percentage ofItem 3GOG/SBS inring-fencedbudgetallocated toresearch.

Proportion ofresearchagendabudget thatfunds areprovided for.

.

Number ofresearchpublications.

Proportion ofresearchrecommendations carried topolicy


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Number ofapprovedresearchgrants.

Disseminate thenational healthresearch agenda

HRU Number ofResearchagendadisseminationfora.

Proportion ofresearchproposalssubmitted tothe Ethicsreview boardthat is alignedwith thenationalresearchagenda.

Conduct

operationalresearch /clinicaltrials.

HRU Number of

reportsavailable

Number of

policydecisions takenbased onresearchfindings

Strengthen healthinformationmanagement

Implement theDHIMS II

PPME Number ofdistricts/Headquartersdivisionstrained in theuse ofDHIMSII

Percentage ofdistricts usingDHIMS II.

Percentage ofDivisions,Programmes

anddepartmentssourcing datafrom DHIMSII

Morbidity andmortalityindicators.


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Percentage ofdistricts withevidence ofanalysis and

givingfeedback toreporting level

HO3: Improve access to quality maternal, neonatal, child andadolescent services

Strategies Priority actions Activities DivisionResponsible

OutputIndicators

OutcomeIndicators

ImpactIndicators

3.1 Reduce themajor causes

contributing tomaternal andneonataldeaths

3.1.1 Implement the MDG Acceleration

Framework Country Action Plan forimproved maternaland newborn care

Increase accessto modern FP

services

FHD Number offacilities

offering FPservices

ModernContraceptive

prevalence rate

Couple yearprotection

InstitutionalMaternal

mortality ratioIncreasecoverage ofskilled delivery

FHD Number ofmidwives perexpecteddeliveries.

Averagenumber of

ANC visits perregistrants

TotalDeliveries.

TotalstillbirthsTotal LiveBirths

Percentage of ANCRegistrants

Percentage of ANC clientsmaking 4+visits

Proportion ofregistrantsreceiving IPT1,IPT 2and IPT3

Tetanus toxoidcoverage rate


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Proportion ofstillbirths tototal deliveries

Proportion ofdeliveries byskilledattendants.

Proportion ofinstitutionalmaternaldeaths audited.

Finalize andimplement

recommendationsof the report onEmONCassessment

FHD National andRegional

EmONCReports

Percentage ofHealth Centres

providingBEmONC

Percentage ofDistrictHospitalsprovidingCEmONC

Institutionalmaternalmortality ratio

Strengthenimplementation ofLife Saving Skillsat district and sub-

district level andbuild RegionalResource Teams

FHD Percentage ofdistrict andsub-districtstaff trained in

LSS;

Proportion ofRegions withresourceteams

Total numberof vacuumdeliveriesperformed

Total numberof manualremovals ofplacenta done .


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HO 3: Improve access to quality maternal, neonatal, child andadolescent services

Strategies Priority actions Activities Division

Responsible

Output

Indicators

Outcome

Indicators

Impact

Indicators3.1 (cont) Reduce the majorcauses contributing tomaternal andneonatal deaths

Implement the MDG AccelerationFramework Country

Action Plan forimproved maternaland newborn care

Evaluate theimplementation ofthe free maternaldelivery

FHD Free maternaldeliveryevaluationreportavailable anddisseminated

Raise awarenesson socio-culturalbarriers to accessto maternal andnewborn care

GHS Improvedawareness

Improve access tosafe blood forexpectantmothers andnewborns

ICD Number ofNew bloodstoragefacilitiesprovided inhealthfacilities

Proportion ofrequestedblood forpregnantwomen thatare madeavailable

Totaltransfusionvolume

InstitutionalMaternalMortality Ratio.

3.2 Reduce the

major causescontributing tochild morbidityand deaths

3.2.1 Implement the Child

Health Policy andStrategy

Increase the

uptake of EPIservices

PHD Number of

EPI outreachpoints

Measles

coverage forunder one year

Percentage ofchildrenimmunized byage one forPenta 3.

InstitutionalInfant mortalityrate


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Percentage ofchildrenimmunized byage one for

Polio 3

Percentage ofchildrenimmunized byage one forBCG

Infant mortalityrate(DHS)

Train healthworkers in IMNCIthe use of ORSand Zinc to

manage diarrhoea

FHD Number ofHealthworkerstrained in

IMNCI.

Proportion offacilities withfunctional ORTcorners.

Diarrhoea casefatality rate

Train relevantCommunityHealth Workers(CHWs) onintegratedCommunity CaseManagement ofDiarrhoea/Pneum

onia/Malaria

FHD Number ofCHW TrainedandimplementingCCM

Number ofdistrictstrained inCommunityCaseManagementfor majorchildhoodkillers

Percentage ofdistricts

implementingcommunitycasemanagementfor childhoodkillers


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Scale up schoolhealthprogrammes

FHD Number ofSchoolsinspected

Number ofchildrenreferred.

Nutritionalstatus ofchildren

Child mortalityrate

3.3 Improveadolescenthealth

3.3.1 Implementadolescent healthpolicy and strategy

Implement priorityactivities underadolescent healthstrategy

FHD- AdolescentHealth

Number ofPriorityactivitiesimplemented

Percentage ofpregnantwomenattendingantenatal whoareadolescents

3.4 Improvenutritional

status ofwomen andchildren

3.4.1 Develop andimplement National

Nutrition Policy andStrategy

Develop NationalNutritional policy

and strategy

FHD- Nutrition Documentsfinalized and

disseminated

Proportion ofdistricts with

nutrition priorityinterventionsreflecting intheir actionplans

Scale-up essentialnutrition actionsfor women andchildren

FHD-Nutrition Essentialnutritionactions scaledup to cover 3regions

Percentage ofunder five whoare underweightpresenting atfacility and

outreach.

Malnutritionrates(DHS)


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HO 4: Intensify prevention and control of communicable and non-communicable diseases and promotehealthy lifestyles

Strategies Priority Action Activity DivisionResponsible

OutputIndicator

OutcomeIndicator

Impact Indicator

4.1 Improve uponprevention,detection andcasemanagement ofcommunicablediseases.

4.1.1 Prevention andcontrol ofcommunicablediseases

Perform routineimmunization as well asImplementsupplementaryimmunization activities.

Provide immunization forselected epidemic pronediseases.

PHD-EPI Number ofroutine EPIoutreachpoints

Number ofnewvaccinesintroduced

Non-AFP Poliorate.

Immunizationcoverage

PercentageFullyimmunized

Drop-out rateLeft out rate

Vaccinewastage rate AEFI

Vaccinepreventablemorbidities andmortalities

4.1.2 Prevention, detectionand management ofHIV/AIDS, TB andMalaria

Implement nationalstrategic plans to reducenew HIV infections

PHD-NACP Number ofpeopletested andcounseledfor HIV.

Number/Per centage

tested HIVpositive

Number/Per centage ofeligible HIVclients on

ARV

.Number/Percentage ofcases alive andon ART.

Number/Proportion of

children born toHIV positivemothers put on

ART who arenegative after18months,

Percentage ofyoung womenand men aged15-24 who areHIV infected.

Survival rate ofcases put on ART.

ART Resistancelevel


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Number ofHIV positivepregnantwomen put

on ART.Implement nationalstrategic plans toincrease TB casenotification and treatmentsuccess rate

PHD -NTP Numberof newandrelapsecases.

Number/Percentage of newandpreviousl

y treatedTBpatientsconfirmedMDR-TB.

Number/Percentage of totalTB caseswho arehealthworkers

-TB casenotificationrate

TB treatmentsuccess rate

Case Fatalityrate for

Tuberculosis

Incidence andmortalityrate(WHO

Annual report)

Expand coverage ofITN/Ms

PHD-NMCP Number ofITN hanged

Percentagechildren underfive years whosleep underITNs.

Percentage ofpregnant


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women whosleep underITNs

Number/Percentage ofHouseholdswith hangednets

Implement nationalstrategic plans to reducemalaria case fatalityamong pregnant womenand children

PHD-NMCP Number ofprescriberstrained inthe newmalariatreatmentprotocols

Percentage ofpatients treatedwith ACT

Maternalmortality ratio

Under fivemortality rate

4.1.3 Prevention, detectionand management ofdiseases of epidemicpotential and thosetargeted foreradication

Maintain status andvalidate eradication ofguinea worm and polio

PHD-NMCP Number ofcases ofguineawormreported.)

Number ofcases ofwild polioconfirmed.

Non-Polio AFPrate.

Percentage ofguinea wormcasescontained

Increase activities for thecontrol of onchocerciasis,lymphaticfilariasis,schistosomiasis,Buruli and elimination ofyaws and leprosy

PHD-NTDs Number ofreportedcases ofNTD.

Coverage ofmasstreatment

Prevalencerate of theNTDs


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for Oncho,shisto, LFand soilhelminthes.

Flyinfectivityrate for

Early detection and rapidresponse to epidemicprone diseases

PHD-DCD/DS

Number ofepidemicpronediseasesconfirmed.

Case fatalityrate ofdiseases

4.2 Improveprevention,

detection andmanagement ofnoncommunicablediseases

4.2.1 ImplementRegenerative Health

and NutritionProgramme

Establish network of

stakeholders and trainthem to implement RHNP

Promote healthy lifestyleawareness among thegeneral population

FHD-HealthPromotion

Unit

Number ofstakeholder

s trainedand able tocarry outtheir roles inthe nationalstrategy.

Number andtypes ofRHNPprogrammes held

Number ofstakeholders

with definedworkplacearrangementsfor promotingRHNP.

Measure ofawareness

Practice ofHealthylifestyle(DHS)

4.2.2 Scale up detectionand management ofnon-communicablediseases

Establish National NCDSteering committee anddefine its terms ofreference.

PHD-NCD Committeeestablishedand active

Minutes,reportsandguidelines


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Expand screeningprogrammes for selectednon-communicablediseases: hypertension,

diabetes, sickle cell andselected cancers.

PHD-NCDICD

Number ofpersonsscreenedand treated

for selectedNCDs

Proportion ofInstitutionaldeaths

Attributable to

NCDs

Increase effective clinicalmanagement of NCDs

ICD Number offacilitieswithEssentialequipment

Number ofhospitalteamstrained tomanagenon-communicablediseases.

Number offacilities thathaveinstitutionalizedcollecting ofdata on riskdeterminantfor NCDsfrom OPDclients(egBP, BMI)

Percentage ofOPD casesthat is due toNCDs

Case fatalityrate For NCDs

Prevalence ofNCDs


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HO5 Improve institutional care, including mental health service deliveryStrategies Priority actions Activities Division

ResponsibleOutput

IndicatorOutcomeIndicator

Impact Indicator

5.1 Increase

access toMental HealthServices

5.1.1 Ensure the passage

andoperationalization ofthe Mental Health

Act

Advocate for the

passage of the MentalHealth Bill

ICD-Mental

Health

Mental

Health Actavailableandoperational

Decentralized

mental healthservices.

Number oftreatmentcenters formental Health.

Availability ofresource-humanfinancial and

medicationNumber ofhuman rights-abuses(chaining andmechanicalrestraints )reported

Develop communitymental health strategy

ICD-MentalHealth

Communitymentalhealth

strategydeveloped

5.1.2 Establish mentalhealth services in allhealth facilities

Establish community andfacility-based mentalhealth services

ICD/MentalHealth

Proportionof DistrictHospitalswith mentalhealth units

Registered

cases.


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36

5.2 Enforcestandards,guidelines andprotocols toimprove thequality ofinstitutionalcare

5.2.1 Ensure availabilityand use of standardsand protocols

Review and developstandard protocols andguidelines for institutionalcare including referrals

ICD Number ofhealthinstitutionswithStandardprotocolsandguidelinesforinstitutionalcare.

Proportionofguidelineswithchecklistand job aids

Clientsatisfaction

Providersatisfaction.

Treatmentoutcomemeasures e.g.Disabilityprevention,Case fatalityrate.

Ensure theavailability ofequipment andinfrastructure

Develop and implementmedical equipmentreplacement plan

HASS Equipmentreplacementplan inplace andimplemented

Availabilitymeasure

HO5 Improve institutional care, including mental health service deliveryStrategies Priority actions Activities Division

ResponsibleOutput

IndicatorOutcomeIndicator

Impact Indicator


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37

5.3 Strengthen thesystemcapacity foremergencyresponse

5.3.1 Develop andstrengthenframework foremergency response

Develop and disseminatenational strategies andguidelines for responseto accidents and medicalemergencies

ICD Number offacilitieswithemergencyresponseset up

Proportion offacilitiesmeeting theminimumacceptablestandards

Promote local initiativesto further expandemergency transport forpregnant women,children and others

ICD/FHD Number ofdistricts withLocalinitiativesforemergencytransport inplacearound thecountry

Case fatalityrate

Maternalmortalityratio(Institutional)

5.3.2 Strengthen capacityof Accident &Emergencydepartments ofhealth facilities

Train emergency medicalteams for district,regional and tertiaryhospitals

ICD Number ofRegionalHospitalswith trainedEmergencymedicalteams.


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38


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MONITORING AND EVALUATION FRAMEWORK OF GHANA HEALTH SERVICE

LOGICAL FRAMEWORK

Verifiable

indicators

Means of verification Assumptions

HEALTH

SECTOR

GOAL

To improve

access to

quality health

care

Maternal

Mortality ratio

Under-five

mortality rate

Neonatal

mortality rate.

Life expectancy

GDHS

MICS

An assumption is made that

improvement in access to

quality health care will reduce

mortality

PURPOSE1 Bridge equity

gaps in access

to health care

Number of CHPS

zones made

functional

Routine Service

reports

Provision of close to clients

service delivery using CHPS

will address the geographical


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the efficiency

and

effectiveness

of the health

system

management

Number offunctionalmanagementteams in place

service better at whatever

level they might be.

PURPOSE 3 Improve

access to

quality

maternal,

neonatal,

child andadolescent

health and

nutrition

services

Institutional

MaternalMortality Ratio.

Skilled deliverycoverage

Measlesvaccinationcoverage.

InstitutionalInfant mortalityrate

Infant mortalityRate

Percentage ofchildren underfive years whoare stunted

Routine Service

reports

DHS


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communicable

and non-communicable

diseases and

promote

healthy

lifestyles

PURPOSE 5 Improve

institutional

care, including

mental health

service

delivery

Number oftreatmentcenters formental Health.

Number ofdistrict Hospitalswith mental

health units

Bed occupancyrare

Average lengthof stay

Bed turn over

rate

BMC reports

BMC reports

Routine service

reports


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Fig 1.Levels of Monitoring in Ghana Health Service

4.2. M & E MANDATE AND FUNCTIONS OF DI VI SI ONS

Monitoring and Evaluation within the Divisions and Programs, is designed to provide managers

and stakeholders with the information necessary to guide the implementation of their action plans.It is therefore mandatory for all Districts, Regions, Programs and Divisions to include monitoringand evaluation activities in their respective action plans.


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45

Table 3: MONITORING AND EVALUATION CALENDAR Activities Time Frame Actors

1st Quarter 2nd Quarter 3 rd Quarter 4th Quarter

J a n

F e

b M a r

A p r

M a

y J u n

J u

l A u

g S e

p O c t

N o

v D e

c

Sub-district datavalidation meetings

Sub-district Teams

District datavalidation meetings

DHMT

Regional datavalidation meetings

RHMT

Supervision andMonitoring visits

DHMT,RHMT andIME-PPMED

Districtperformancereviews

Sub-District Teams,DHMT and RHMT

Regional Annualand Half yearperformancereviews

DHMT, RHMT ,GHSHeadquarters, MOHand DPs

National GHSHead-quarters

Annual and Halfyear Performancereviews

Divisions in GHS

Senior ManagersMeetings

GHS Headquarters,RHMTs,


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7. M&E ACTIVITIES

7.1. Roles and Responsibi l i t ies wi t hin GHSThe Divisions within the Ghana Health Service in implementing their mandate contributeto monitoring and evaluation process

Table 4 : Roles and Responsibilities of Divisions Category ofservice provision

Division Type of information Frequency

1. ClinicalCare

ICD Outpatient attendance Outpatient morbidity Inpatient admissions Inpatient deaths Death Audits Inpatient morbidity Inpatient mortality Differential use of services by

patient categories

Statement of In-Patient Admissions, Discharges andDeaths

Bed Occupancy Rates Surgical Operation Returns Total number of beds

Bed Turnover Rate Average length of stay Infection rate for caesarian

MonthlyMonthlyMonthlyMonthlyMonthlyMonthlyMonthlyMonthly

Monthly

MonthlyMonthlyMonthlyMonthlyMonthly

Monthly


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Institutional under fivemortality rate.

Underweight Stunting PMTCT Exclusive breastfeeding

coverage Assessment of facilities for

BFHI activities

Monthly

Monthly

Then Quarterly;Half year/Annual

Public Health PHD Immunization (specificallyMeasles and Penta-3 coverage)

Trend of other communicableand non communicablediseases.

Disease surveillance indicators(Timeliness, completeness,accuracy)

Monthly;

Monthly

Monthly

Then Quarterly;Halfyearly/Annually

PHD Trend on Diseases earmarkedfor eradication and orelimination.

Technical Support visits

Weekly

Quarterly

FHD Antenatal coverage Postnatal coverage IPT coverage Family planning coverage

Monthly,MonthlyMonthlyMonthly


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Revenue and expenditure dataFunds for Monthly Capitationsfor Primary care (NHIA)

Monthly

HASS State of public healthfacilities

State of Central &Regional Medical Stores

Equipment and logisticssituation of the public healthfacilities

Cost of replacingequipment

Equipment

Maintenance in the public healthfacilities

Planned preventivemaintenance activities

Status of projects underimplementation in the sector

Number of healthfacilities by level and location,including CHPS compounds and

Quarterly/Half-yearly/

Annually


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report (LMIS).

4. Percentage of facilities thatmaintain acceptable storageconditions (Warehousing)

5. Percentage availability ofTracer medicines (Product

Availability)

6. Percentage availability of non-medicine consumables(Product Availability)

7. Mean Absolute PercentageError (MAPE) betweenforecasted consumption and

Actual consumption(Forecasting)

8. Average percentage differencebetween consumption forecastsand actual consumption(Forecasting)

9. Percentage of stock wasteddue to expiration or damage(Warehousing and Inventorymanagement)


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RFQ

13. Average lead time from Awardof Contract to delivery(Procurement)

ICT

NCT

RFQ

14. Percentage of procurementexecuted through

ICT

NCT

RFQ

15. Percentage of staff trained inLogistics management (LMIS)

16. Percentage of Procurementand Supply Officers at post.

17. Percentage of procurementexecuted with PPA approval.


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Development Partners Provides technical assistance, financial

supportCivil Societies Advocacy for health, community and resource

mobilization community empowerment througheducation, demand accountability

Academia Support research, training, policy formulationand technical assistance

Faith based organization Support service delivery,

Private providers Support service delivery

7.4. M & E CONDI TIONS AND CAPACITI ES

7.4.1. CAPACITY FOR MONITORING AND EVALUATION

Traditionally, the GHS utilizes medium term plans (POW) drawn from the HSMTDP. Annual POW is also developed to guide the activities of the Service for each year. GHS

has personnel at all levels involved in the M&E process. However, the workloadespecially at sub-district, district and regional levels overwhelms staff strength andcapacities at these levels. The National level has an M&E unit within the PPMED but no


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Following on these, financial support will be required to resource the PPMED to

undertake regional monitoring and to equip the national, regional and all districts withmuch needed ICT infrastructure, internet access and anti-virus software to facilitate thefull adoption of the DHIMS 2 software.

7.4.2. TECHNICAL ASSISTANCE

GHS has completed the process of adopting the DHIMS 2 as the main software for datacollection and analysis; however some technical assistance is still required to addresspost implementation challenges. There has been some contact with the University ofOslo to this effect and as a result a memorandum of understanding has been signed tofacilitate the provision of Technical Assistance to continue the further improvement inDHIMS2 after it has been rolled out.

GHS will also require some technical assistance to evaluate the HSMTDP implementationat the end of 2013 to determine the scope of the Service activities and how these havecontributed to the overall reduction in morbidity and mortality in the Ghanaian population.

7.4.3. STORAGE OF INFORMATION

The kind of service data and information generated and stored varies among the different

levels within the Service. The category of M&E information that is stored also depends onthe level of the management centre managing the data as well as the sub-level at whichthe specific activity generating the data is being carried out. This in turn is dictated by the


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transmission of data by courier has adversely affected data completeness, quality, and

timeliness. It is hoped that the current HSMTDP will adequately address thesechallenges. The development and deployment of web-based software (DHIMS2) thatwould replace the existing data collecting software will enable collection of real-time datafrom the districts and improve timeliness.

7.4.4. EQUIPMENT AND LOGISTICS

To gain from the efficiency of real-time data collection requires that computers be placedwithin the consulting rooms of hospitals, and mobile devices like phones set-up within thesmaller health facilities and for other public health programmes. These systems willrequire internet access for efficient data transmission. Currently there is dire need forcomputers and accessories at all levels but more especially at the facilities and District

Health Directorates. For most districts there is a reliance largely on internet access viaUSB modems available on various mobile phone networks, raising issues withconnectivity and reliability.

Following these, there is recognition of the need to support facilities and districts withcomputers and reliable internet access. There will also be the need to support andresource the ICT department to maintain the existing computers and accessories in the

Service. Additionally the GHS needs to make investments in infrastructure and personnelto strengthen the capacity at its Center for Health Information Management (CHIM) to beable to maintain and run the proposed web-based data collection, analysis and reporting


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8. THE MONITORING AND EVALUATION PROCESS

8.1 COLLECTION, COLLA TION AND ANA LYSIS OF DATA

GHS should collect and collate routine data monthly from the districts. Send Reportsfrom CHPS zones, health centers and hospitals as well as private facilities to the districtsmonthly using the prescribed reporting forms. Ghana Health Service has been given themandate by the Ministry of Health to collect health service data from all facilities in the

district, including Private and CHAG facilities. This can be sent as a hard copy orelectronic using the DHIMS2. District validation teams should validate the reports before itis entered into the DHIMS2. The Districts should then enter the data into DHIMS2 tomake it available to the Regional level. Each unit at the district level should beresponsible for entering data from their service area. District Health Information Officerswill enter the data that do not have officers assigned. The Regional reports from theirrespective districts will be available to the National Level through the DHIMS2.

To augment the routine data collected, the health sector will work with some of itsstakeholders to undertake joint periodic health surveys such as the Demographic andHousehold Survey (DHS) and the Multi-indicator Cluster Survey (MICS). These surveyswill generate additional indicators for monitoring and evaluation.

8.2. REVIE W PROCESS I N TH E GHANA H EAL TH SERVI CE


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performance and to highlight their key challenges for discussion. This review should

culminate in a final district report based on the guidelines provided by the PPMED whichshould be submitted to the regional level.

The second level of collation and analysis should take place at the Regional level. Thismust be preceded by the regional performance hearing sessions, involving all DistrictHealth Directorates, district and regional hospitals, training institutions, CHAG facilities,Regional Health Directorates and other stakeholders at the regional level. National teams

attending these reviews should include health information officers, policy-makers, clinicaland public health specialists, health and development partners These reviews shouldculminate in a final regional report based on the guidelines provided by the PPMED. Thereport should be sent to the National level PPMED

At the National level, the first Senior Manage rs Meeting (SMM 1) should be organizedwithin the first quarter of the succeeding year and focused to reviewing Regional and

National Performances through a series of regional and divisional presentations. This willform the basis for preparing the GHS Annual Report. The National level PerformanceSessions should be attended by the GHS Council.

The GHS will make presentations on the performance of the year-under-review at theMoH- Inter-agency review and at the Health Summit. There will be an annualindependent performance review of the entire Health Sector by an independent team ofconsultants. This independent review should also include a review of the performance ofthe M&E System of the GHS.


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8.4. PLAN FOR EVALUTAIONEvaluation is at the heart of the decision-making process and determines the value of anintervention or programme, to inform its adoption, rejection or revision. Evaluation makesuse of assessment data in addition to many other data sources and measures how wellactivities have met expected objectives. The evaluation process provides valuableinformation for management and draws lessons for future actions.

At the end of the implementation of the HSMDP, the Ghana Health Service together withother agencies of the Ministry of Health will be involved at all levels to evaluate theperformance of the sector.

The following steps can be used at all levels in the service to evaluate programmeimplementation within the GHS

Identify and engage stakeholders Involve partners to work on the Logic Model for the evaluation

Define the outcome objectives and impact objectives

Gather credible data/evidence

Organize and interpret results and draw conclusions

Prepare and disseminate reports


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9. QUALITY ASSURANCE

9.1. Ensur ing Data Quality

Data veracity, put in a nutshell, its completeness, consistency, accuracy, integrity ispivotal to effective planning, implementation and improvement of health services as wellas programme evaluation. Authentic data informs enhanced patient care, better use of

health insurance, more appropriate and better defined priorities of the service.

Poor data quality is common in the health sector. The trail of upward reporting to eachlevel is beset with an array of data quality issues that range from inadequatedocumentation and storage, poor analysis and improper interpretation, poor presentationand non dissemination in many cases. The lack of integrity of data generated from thelower levels may well be in part the direct consequence of its low utilization in decision-

making in the service. These have been identified by a number of health sectorassessments in Ghana 1. It becomes tempting to blame the original source of data for anyand all errors that appear downstream. However, any efforts to improve data quality willonly be meaningful when these are part of an overarching quality culture that mustemanate from the apex of an organization. 2

Currently, existing GHS data quality audit activities conducted have been collected into a

useful data repository and these have been used to develop tools and training modules toensure correct and consistent data at every level in the Service. These activities areamong the nascent scheme the GHS is effecting to build a rigorous data quality


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compulsory participation of all service providers and supervisors. These activities will be

further augmented by institutions through monthly data validation sessions at all servicedelivery points before data reports are signed, stamped and forwarded by the officerdesignated for the purpose.

Where data is submitted upwards and to succeeding levels in hard copy, a hard copy ofthe original will be kept in the submitting institution s file. This will be well-labelled (dated,stamped, named, batched) and stored in an orderly fashion for easy retrieval. Where the

data are transmitted electronically using external storage devices (pen/flash drive, CD-Rom, external hard drive) the copy of the original should be filed properly in clearlyidentifiable folders with regular backup. Where data is transmitted by email, the originalemail should not be deleted.

9.3. Standard Operating Procedur esGHS has developed a set of Standard Operating Procedures (SOPs) to guide datamanagement. These SOPs for improving data quality are a set of written instructions thatdocument the routine or repetitive activities to be followed by the various levels datacollection and aggregation in the GHS. It will detail regularly recurring work processesthat are to be conducted for data collection, data processing, use and transmission. TheSOP will also facilitate the way activities are performed to enhance compliance andmaintain consistency with technical and quality guidelines for quality data. Training will beorganized at all levels in the service in the use of the SOPs for data management.

9.4. I mproving Ti meli ness, Completeness and Accuracy of Tr ansmit ted data

Data must be collected collated analyzed and delivered within an agreed period To


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Regions to GHS HeadquartersGHS

Headquarters monthly

25 of thefollowingmonth

GHS Headquarters to MOH MOH Quarterly

Two monthafter thequarter

Transmitted data must be complete. The reported data must include inputs from allreporting units, all required fields must have valid data, and the document must be signedstamped and dated by the officer responsible.

All data submitted must be consistent with what is on the original file at all times. Thedeployment of the internet based DHIMS2 will contribute significantly to improving thetimeliness of reporting...

9.5. Data Quali ty Audi t

GHS has initiated its process of periodic audit of reported data at point of data collectionor aggregation. The audit teams must be made up of personnel from a higher level (e.g.national to regional; regional to district, district to facilities). These teams should makescheduled visits to data aggregation levels or facilities and audit their reported data. Thisexercise will provide the platform for a more robust and rigorous data managementsystem that would identify strengths and gaps in data.

This exercise will also include a data verification process to track published data to the


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accuracy of the report and submit a quick report to the sender. This immediate feedback

to the sender offers the opportunity for quick updates for completeness and correction ofminor errors and it serves as a capacity building activity.. Written feedback should be based on more in-depth analysis of data from varioussources. This technique of feedback unearths data inconsistencies, enables analysis andcomparison of trends and performance with peers. The process should look at thestandards, the performance of the various districts and facilities and the gaps that are to

be filled.

A technical data quality team preparing the feedback reports is to pay attention to qualityissues including data completeness and correctness

Regular feedback on all reports submitted will be encouraged at performance review

meetings. These should give opportunity to carry out peer comparison, receiveexplanations and opportunities for learning.

9.7. Documentation

Any feedback given, whether in relation to completeness, accuracy, timeliness orconsistency should be filed. In addition, any suggestions made to guide the resolution ofobserved gaps in the report should be documented and filed.

Data already submitted should only be changed when there is enough documentation onth f h d th d t t itt d t ll l l t th ti Thi


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10. REPORTS

10.1. REPORTI NG M I LE STONES All Districts, regions and divisions are expected to provide quarterly updates on theirroutine activities and any new initiatives planned for the year. The half-year and annualreports will also be expected to be produced by all Divisions, Regions, Districts andHospitals.

10.2. PROGRAM M ES/PROJECT M ONI TORIN GRegions and Divisions implementing programs and/or projects are to provide quarterlyupdates using the project/programs monitoring matrix. The required information includesbudget execution regarding the project or program, and the status of implementation.

10.3. FI NANCI AL REPORTS All BMCs in the GHS are to submit monthly and quarterly updates on their revenue andexpenditure depending on the type of financial data and the reporting level - as indicatedin the table below. Receipts from donors are reported as schedules in the consolidatedfinancial reports for the period under review.

TABLE: FINANCIAL REPORTING FRAMEWORK - CONSOLIDATED FINANCIALREPORT


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Consolidated Balance Sheet " quarterly /annually 3 monthsafter period

Consolidated Revenue and ExpenditureStatement "

quarterly /annually

3 monthsafter period

Cash Flow Statement "quarterly /annually


Consolidated Programme FinancialReports "

quarterly /annually


10.4. FI NANCIAL AUDIT REPORTS

10.5. GHANA H EAL TH SERVI CE REPORT

An annual progress report indicating the extent to which goals and objective of the POWare being achieved should be prepared every year by Districts, Regions, Programmes,Divisions and National. The report will rely on the various reviews carried out in theservice. Half year reports should also be written by the various levels to track the

performance against set targets.


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11. GOALS AND OBJECTIVES OF THE MONITORING AND EVALUATION SYSTEMWITHIN THE GHANA HEALTH SERVICE

The overall goal of the Ghana Health Service M&E system is to support the Ghana HealthService to achieve the impact and outcomes articulated in the Health Sector MediumTerm Development Plan, as well as the programme works developed from it. This will bedone by collecting, analyzing and disseminating data to:

1. Enhance understanding the of the trends in the various service outcomes2. Monitor progress with implementation of planned activities and interventions.3. Assess the effectiveness of the health interventions at national and sub-national

levels.4. Monitor funds provided for service activities

1. Inflows2. Expenditure

3. Budget5. Identify gaps and emerging needs.6. Guide the selection and application of solutions to address identified gaps and

emerging needs.7. Ensure accountability to stakeholders including.

11.1. STRATEGIES TO ADDRESS M ONITORIN G AND EVAL UATI ON GAPS

Work force gap


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2. Leadership and Governance gap

a. Make M&E a priority in PoWb. Advocate to increase budget allocation to create a more robust M&E system bothinternally and externally

c. Establish two-way feedback mechanisms to identify gaps requiring revision,greater coordination and alignment of process indicators.



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67

12. M&E ACTIVITIES, TIMELINES AND BUDGET

TABLE 8: M&E Act ivi t ies and Timel ines

Description of Majoractivities

Key Deliverables Timeframe Comments2010 2011 2012 2013

1.RESOURCEMANAGEMENT GAPa. Improve DataManagementDevelopment andDeployment ofDHIMS2(Web based datacollection software)

DHIMS2 Developed and deployedwith URL made available to all datamanagers

X X

District and RegionalData Validation meetings

District Regional Data validationteams meetings held in all districtsand regions

X X X Organized Monthly Nationalteams will visit few regionalvalidation meetings

Print and distributeprimary data captureforms/registers to bothprivate and public healthfacilities in the Districts.

Registers and data capture toolsavailable at all facilities/districts inGhana both private and public

X X X

JointMonitoring(Managerial)Visits to Regions andDistrict

Joint monitoring visits held. X X X Will be done twice in a year


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69

Develop pre-servicetraining modules forhealth service datamanagement for health

training schools

Pre-service modules developed inuse in the health training institutions

X X X

2. LEADERSHIP ANDGOVERNANCE GAP1. Improve the useof Data for decisionmaking

Annual Regionalperformance reviews

District and Regional Annual reviewsheld

X X X

Senior ManagersMeetings

Senior Managers Meetings Held X X X

GHS Headquarters Annual review meeting

GHS Headquarters annual reviewmeeting held

X X X



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TABLE 9: BUDGET FOR THE MONITORING AND EVALUATION PLAN

2011 2012 2013

N u m

b e r

P r o g r a m m

e

D e s c r i p t i o

n

D e s c r i p

t i o n

o f

I t e m

o r a c t i v

i t y

D e

t a i l

D e s c r i p

t i o n s

C o s

t $

D e

t a i l

D e s c r i p

t i o n s

C o s

t $

D e

t a i l

D e s c r i p

t i o n s

C o s

t $

T o

t a l C o s t

$

A Improve Data Management -Development and Deploymentof DHIMS2 (Web based datacollection software)

DHIMS2 Developed anddeployed with URL madeavailable to all data

managers

Developmentof DHIMS2 andtraining

900,000 Training ofmanagers onDHIMS2

460,000 Improvementin DHIMS2software

80,0001,440,000-

District and Regional DataValidation meetings

District Regional Datavalidation teams meetingsheld in all districts andregions

OrganizedMonthly National teamswill visit fewregionalvalidationmeetings

120,000 OrganizedMonthly National teamswill visit fewregionalvalidationmeetings

120,000 OrganizedMonthly National teamswill visit fewregionalvalidationmeetings

120,000 360,000-

Print and distribute primary datacapture forms/registers to bothprivate and public healthfacilities in the Districts.

Registers and data capturetools available at allfacilities/districts in Ghanaboth private and public

Printing ofregisters anddata collectiontools(once ayear)

200,000 Printing ofregisters anddata collectiontools(once ayear)

250,000 Printing ofregisters anddata collectiontools(once ayear)

300,000 750,000-

Joint Monitoring(Managerial)Visits to Regions and District

Joint monitoring visits held. Will be donetwice in a year

100,000 Will be donetwice in a year

100,000 Will be donetwice in a year 100,000

300,000-

Technical Monitoring visits toRegions and Districts

Technical Monitoring visitsheld. Will be donetwice in a year

13,000 Will be donetwice in a year

13,000Will be done

twice in a year 13,000-

39,000

B Improve ICT infrastructure -



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71

Procure Office equipment (desktop, lap tops, printers scanners,accessories and internetmodems

ICT equipment procured forregions and CHIM (Servers,computers, printers andUSB modems.

Aim to equipall districts withICT equipment

350,000 Aim to provideservers for allRegions andstrengthenCHIM

1,000,000 New districtsequipped

75,000 1,425,000

Host and maintain Server forDHIMS2

Server for DHIMS hostedand accessible for dataentry, analysis andreporting.

Payment willbe annually

40,000 Payment willbe annually

40,000 Payment willbe annually

40,000 120,000

Workforce GapDevelop Human Capacity for M&E

Train National, Regional andDistrict Teams on Monitoringand Evaluation

National, Regional andDistrict Teams trained inMonitoring an evaluation

Will aim tobuild capacityover the fouryears of theHSMTDPimplementation

350,00 Will aim tobuild capacityover the fouryears of theHSMTDP

implementation

200,000

Will aim to buildcapacity overthe four yearsof the HSMTDPimplementation

100,00 650,000

Train National, Regional andDistrict Teams on Data Quality

Audit

National, Regional andDistrict Teams trained indata quality audit

Training ofRegionalTeams to traindistrict teams

350,000 Training ofRegionalTeams to traindistrict teams

350,000 Training ofnew districts

120,000 670,000

Train District and RegionalTeams on SOPs on datamanagement and DataUtilization.

Regional and DistrictTeams trained

SOPs will bedevelopedDistrict/regionalteams trained

Develop pre-service trainingmodules for health service datamanagement for health training

schools

Pre-service modulesdeveloped in use in thehealth training institutions

Moduleswill bedeveloped

15,000 Training oftutors ofschools

250,000 265,000

Leadership And Governance Gap-

Improve the use of Data for decision making-

Annual Regional performancereviews

District and Regional Annual reviews held

Held once ayear in all theRegions

800,000 Held once ayear in all theRegions

850,000 Held once ayear in all theRegions

900,0002,550,000



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72

Senior Managers MeetingsSenior Managers MeetingsHeld

Held fourtimes in theyear

50,000 50,000 60,000 160,000

GHS Headquarters Annualreview meeting

GHS Headquarters annualreview meeting held

Held once ayear

4,000 Held once ayear

4,000Held once a

year

5,00013,000

-Half Year Review performancereview meetings held at theRegional Level

Half year review meetingsheld

Held by allRegions oncea year

500,000 Held by allRegions oncea year

500,000 Held by allRegions once ayear

600,000 1,600,000

Improving Data Quality

Standard Operation ProcedureManual Development

Develop SOP datacollection

Technicalmeetings todevelop SOP,Stakeholderinteractions ondocument

62,000

Train staff in the use ofSOP

Regional TOTTraining onSOPs

10,000 Districttrainings onSOPS

120,000 130,000

Review SOP Documentannually

Review ofSOP

20,000 Review andreprinting 150,000 170,000

Data validation routinesSet up data validation teamat each level of datamanagement

Meeting withRegional DatavalidationTeams

13,000 Formation ofDistrict DatavalidationTeams

210,00 223,000

Develop work plan for datavalidation

Technicalmeetings todevelop datavalidation workplan

2,000 2,000

Hold data validationmeetings

Regional andNational Datavalidationmeetings heldquarterly

76,000 Regional andNational Datavalidationmeetings heldquarterly

80,000 Regional andNational Datavalidationmeetings heldquarterly

85,000 241,000

Data TransmissionProcure data transmissionequipments e.g., externalstorage device, back-up

Procuremodems for alldistricts

10,200 10,200



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system, modems, routers

Establish data transmissionmechanism e.g. Internetconnectivity for CHIM

Payment ofbills once a

year

3,000 Payment ofbills once a

year

3,000 Payment ofbills once ayear

3,000 9,000

GRAND TOTAL 3,968,0000 4,620,000 2,751,000 11,339,000



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74

APPENDIX 1.

INDICATORS TARGETS AND MILESTONES FOR MONITORING AND EVALUATION

INDICATOR2010

Baseline2011

Target2012

Target2013

TargetData

sourcesMeasurement Monitoring

FrequencyResponsibility

HO1 Bridgeequity gaps inaccess tohealth careand nutritionservices andensure

sustainablefinancingarrangementsthat protectthe poor No. offunctionalCHPS zones

840 840 900 RoutineDate-District/Regional Reports

Number ofCHPS zoneswith CHOsoffering homevisits andother services(Home visitentails ANC,PNC,Immunization,Growthmonitoring,Nutrition

Bi-annual Annual

DDHS/RDHS


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76/129

76

INDICATOR2010

Baseline2011

Target2012

Target2013

TargetData



in the

catchmentarea of all thefunctionalCHPS zones.

Denominator :

TotalPopulation ofthe District

Population todoctor ratio

11,500 10,500 9,700 9,500 HumanResource

andDevelopmen

t DivisionReports i

The ratio ofthe number ofpeople to onepublic sector

doctor

Numerator: Total

population

Denominator:

Number ofdoctors in thepublic sector

Annual RDHS/DirectorHuman Resourceand Development

Division

Population tomedicalassistants/phys 48,641 43,340 38,634 30,709

HumanResource

and

The ratio ofthe number ofpeople to one

Annual Director HumanRDHS/Resource

and Development



77/129

77

INDICATOR2010

Baseline2011

Target2012

Target2013

TargetData



ician assistant

ratio

Developmen

t DivisionReports

public sector

medicalassistant/physi

cian assistant

Numerator: Total

population

Denominator:Number of

medical

assistants/physician

assistant inthe public

sector

Division

Population tonurse (allcategories)ratio

1:1,100 1:1,000 1:900 1:800 HumanResource

andDevelopmen

t DivisionReports

The ratio ofthe number ofpeople to onepublic sector

nurse (allcategories)

Numerator:Total

Population.

Denominator:


Division



78/129

78

INDICATOR2010

Baseline2011

Target2012

Target2013

TargetData



Total number

of nurses inthe Public

Sector

Population tomidwives ratio

8,336 7,431 6,625 5,800 HumanResource

andDevelopmen

t DivisionReports

The ratio ofthe number ofpeople to one

midwife

Numerator:Total

Population.

Denominator:Total number

of midwives


Division

Percentage ofUnder fiveyears who areunder weightpresenting at

facility andOutreach

11.32 9.98 8.64 7.3 District andRegionalHealthServicesReports

Percentage ofchildren under5 who werefound to beunderweight(weight forage below -2Z score )facility andOutreachNumerator:Total numberof Childrenfound to be

Annual Regional Directorsof HealthServices/DDHS



79/129

79

INDICATOR2010

Baseline2011

Target2012

Target2013

TargetData



underweight(

Ghs Monitoring & Evaluation Plan 2010-2013

Documents

Transcript of Ghs Monitoring & Evaluation Plan 2010-2013