The importance of Impact Evaluation of HIV/TB workplace

programmes

Nathea Nicolay

AIDS Risk Consulting

2 April 2009

Agenda

• What is Monitoring and Evaluation?

• Performance measurement of HIV/TB workplace programmes

• Step 1: Goals and objectives

• Step 2: Select Indicators

• Step 3: Identify sources and methods of data collection

• Step 4: Data collection

• Step 5: Interpreting and sharing the results

• Workshop: case studies

• Workshop: reporting back

• Impact indicators to determine return on investment and impact on financial bottom line

What is Monitoring and Evaluation?

• Business world uses: Performance measurements and results

• Public health sector uses: Monitoring and Evaluation

• Monitoring is the routine, daily assessment of ongoing activities and progress.

• Evaluation is the episodic assessment of overall achievements.

• Both M&E are necessary for a co-ordinated national response to the epidemic.

• Monitoring and Evaluation

HIV and AIDSRisk Management

Measure

Manage

Monitor

Monitoring and Evaluation

INPUT

Resources:PoliciesPeopleMoneyEquipment

PROCESS

TrainingManagementActivities

OUTPUT

Short term output

OUTCOME

Results:BehavioursPractices

IMPACT

Long term effect:IncidencePrevalenceMortalityMorbidity

Monitoring of Process Measuring of Outcomes and Impact

HIV/TB WORKPLACE PROGRAMME: Goals and objectives

• Step 1: What is the goal of the programme?– Broad statement:– “Reduce HIV and TB related workplace costs”

• What are the objectives?– Specific– Measurable– Appropriate– Realistic– Time-bound– “Reduce HIV and TB related workplace costs by 10%

in one year.”

World-wide recession

HIV/TB WORKPLACE PROGRAMME: Examples

• Reduce new infections:– peer education– condom distribution– awareness campaigns

• Increase take-up on treatment:– wellness days– VCT

• Increase adherence to treatment– HIV disease management– Education

HIV/TB WORKPLACE PROGRAMME: Treatment

Increase take-up on treatment of HIV and TB through wellness days– Fewer deaths, disability claims– Reduced HR costs – absenteeism, training

and recruitment– Reduced medical expenses– Reduced HIV and TB related workplace costs

HIV/TB WORKPLACE PROGRAMME: Treatment

• Step 2: What are your indicators?– Process and Input indicators for wellness

days– No of people reached– No of people tested– No tested positive– Cost of wellness days– Time taken to roll-out

HIV/TB WORKPLACE PROGRAMME: Treatment

– Outputs• No enrolled out of those positive

– Outcomes• Cumulative number on treatment increased from 300 to 400

– Impact– Take-up on treatment increased to 40%

– Mortality reduced

– Morbidity reduced

– Absenteeism reduced

– Medical costs reduced

– Linked to finances: HIV and AIDS related costs – reduced by 15%

HIV/TB WORKPLACE PROGRAMME: Treatment

• Step 3: Identify sources and methods of data collection– Specify data needed to wellness day service

provider– Or HR train staff to collect data themselves

during wellness days

• Step 4: Collecting the data

• Step 5: Interpreting and sharing the results

Example of Impact Indicators

• HIV and AIDS actuarial Impact Assessment• Quick and cheap• Illustrates:

– Fewer deaths, disabilities– Reduced EB costs: Group Life Assurance, Permanent

Health Insurance– Reduced HR costs – absenteeism, training and

recruitment– Reduced medical expenses– Reduced HIV and TB related workplace costs

-

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

Year

No Treatment Current Treatment Effective Treatment

Demographic Impact Assessment: AIDS deaths per mille

Total HIV/TB related workplace costs

-

2,000,000

4,000,000

6,000,000

8,000,000

10,000,000

12,000,000

14,000,000

No Treatment Current Treatment Effective Treatment

-

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Current Treatment Savings Potential Treatment Savings

Total savings due to 60% treatment take-up

-

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

8,000,000

9,000,000

10,000,000

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

20

15

20

16

Total EB costs Total HR costs Total medical costs

Total HIV/AIDS related costs broken down for 2008 with current 60% take-up

on ART

Cost Estimated cost (R million)

% payroll

Death benefits costs 1.8 0.6

Disability benefits costs 1.6 0.5

Sick leave costs 0.5 0.2

Productivity costs 1.5 0.5

Training costs 0.2 0.1

Medical costs 2 0.6

Total 7.6 2.5

Summary of HIV/AIDS related costs in 2006

Cost Estimated cost (R million)

% payroll

Death benefits costs 1.62 0.5

Disability benefits costs 1.44 0.5

Sick leave costs 0.45 0.1

Productivity costs 1.35 0.4

Training costs 0.18 0.1

Medical costs 1.8 0.6

Total 6.84 2.0

Summary of HIV/AIDS related costs in 2007

Conclusion

• Year on year HIV/TB related workplace costs have reduced by 10%

• Compared to a baseline of No treatment of TB/HIV – savings of R3.5 million were made

Conclusion

• Monitoring and evaluation is needed to assess the outcomes and impact of HIV/TB workplace interventions

• Several layers of M&E needed for valuable assessment

• Importance of data and training

• Importance of communication to the stakeholders