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Mainstreaming Community-led monitoring into the new Global AIDS Strategy 2021–2026: A call for bridging gaps in HIV services.

Bridging the gap between the science and service of HIV prevention requires strategic and systematic approaches for transferring effective research-based HIV prevention interventions to community AIDS service providers (Jeffrey A. et al., 2000). There is a need for mechanisms that would quickly transfer research-based HIV prevention methods to community-led HIV prevention service providers, where active engagement between researchers and service agencies could lead to more successful program uptake.

Monitoring inequalities in viral suppression

HIV remains a major public health issue that affects millions of people worldwide despite the world’s enhanced efforts on the fast track strategy to end the AIDS epidemic by 2030. As countries move towards the UNAIDS’s 95-95-95 targets and with strong evidence that undetectable equals untransmittable, it is increasingly considered vital to assess whether those with HIV are receiving antiretroviral therapy achieve viral suppression particularly during the time of commemorating the 2021’s World AIDS Day where different stakeholders reflect on their desired achievements.

December first of every year, the world celebrates World AIDS Day with a special focus on reaching people left behind. The theme of World AIDS Day 2021 is End inequalities. End AIDS” as WHO and its partners continue to highlight the growing inequalities in access to essential HIV services, including viral suppression. Disparities in access, HIV infections, and AIDS-related deaths resulting from inequalities have been observed from time to time.

The National Institutes of Health’s global estimates of viral suppression in children and adolescents, as compared to adults, reveal slower progress towards approaching the global target of 95% viral suppression. In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) set a goal of 95% of all people with HIV who are taking ART achieving viral suppression by 2030. This study thus calls for substantial efforts to reach the global viral suppression target for children and adolescents. UNAIDS claims that people with HIV who achieve viral suppression protect their immune health and prevent transmitting HIV to others.

Nevertheless, there are significant efforts in achieving this goal amongst countries, including the United Republic of Tanzania which is one of a few countries that account for 89% of all new HIV infections.

Tanzania through PEPFAR and USAID community-led monitoring supported projects are expected to improve implementation of the new Global AIDS Strategy 2021–2026, End Inequalities, End AIDS, is a bold approach that uses an inequalities lens to close the gaps preventing progress to end AIDS. Civil societies including the network of PLHIV have been supported to establish community-led monitoring (CLM) system to identify and report any potential HIV-related issues and then collaborate with local government authorities to set feasible approaches to address them. There are several potentials of CLM, especially in its capacity to transform community-led infrastructures for better services as outlined in the Global AIDS Strategy. These potentials include the ability to do the following: –

  • The support and use of community-generated data to customize solutions to the needs of individuals living with HIV and key populations, including young key populations, is essential.
  • The most comprehensive data collection strategy, as well as a publication of reliable and strategic information, including the capacity to methodically monitor progress, and track gaps.

The 2021 World AIDS Day report considers CLM as one of an effective package to measure improvement in HIV-related service provision. In this report, Community-led monitoring is becoming a fundamental mechanism for increasing accountability towards empowering networks of key populations, affected groups, or other community entities to systematically and routinely collect and analyze qualitative and quantitative data on HIV service delivery.

The Global AIDS Strategy 2021–2026 

Building on the fast track strategy, which is an agenda for quickening the pace of implementation, focus, and change at the global, regional, country, province, district, and city levels, the current Global AIDS Strategy uses an inequalities lens to close the gaps that prevent the progress to end AIDS and sets out bold new targets and policies to be reached by 2025, hence propelling new energy and commitment to ending AIDS.

The world continues to witness history’s most significant opportunity to end the AIDS epidemic as a public health threat which has been provided by a combination of impressive advances in science, political commitments and community activism, human rights advances, global solidarity with accompanying resources.

In recent times, community-led monitoring is seen being built into an increasing number of HIV programs in Africa, Asia, and Latin America, as more evidence emerges of the value and impact of community-led monitoring. According to PEPFAR, approaches, and principles on community-led monitoring allow communities to design, implement and conduct routine, ongoing monitoring of the quality and accessibility of HIV treatment and prevention services. On that account, PEPFAR-supported CLM should therefore be:

  • productive, collaborative, respectful, and solutions-oriented.
  • conducted by independent, local community organizations.
  • tailored to the needs identified by local communities, with communities determining the scope.
  • action-oriented with an associated follow-up process with the health facility for corrective public health action, including community advocacy to improve service outcomes
  • routine, with follow up and continuous improvement.
  • triangulated with other PEPFAR data streams.

For further reading regarding solutions and best practices in community-led monitoring, click here.

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Mainstreaming HIV into international cooperation work remains one of the most important strategies for such a multisectoral response. Through several steps, mainstreaming of HIV can take place in cooperation activities in various epidemiological contexts with various aid modalities – through bilateral cooperation, humanitarian aid, and multilateral aid.

Source: Click here

Therefore, mainstreaming community-led monitoring into the Global AIDS Strategy, in the context of our analysis at CLM Consultants Ltd, is considered potential to facilitate the journey to achieving the UNAIDS shared vision of zero new HIV infections, zero discrimination, and zero AIDS-related deaths. The basis for our analysis and understanding is guided by the following optimistic scenarios: –

  • Community-led monitoring adds vital missing perspectives and information that can be used to improve the quality and use of health services as it enables systematic documentation of experience and knowledge of service users, and for that case, if  
  • Community-led monitoring and the Global AIDS Strategy are put and work together, chances are higher to realize the desired UNAIDS’ 95-95-95 goals.
  • Furthermore, Community-led monitoring focuses tend to remain on getting input from recipients of HIV services in a routine and systematic manner that will translate into action and change.
  • Community-led monitoring helps bridge the gap between the best-laid plans of health strategies and the unruly ways in which they play out in reality.
  • With community-led monitoring, community members collect information at service sites and from service recipient, followed by using such information, in partnership with health providers and program managers, to quickly resolve problems that are identified; it can also be used, when needed, for advocacy to hold governments, donors and health programs accountable for improving service accessibility and quality.

Monitoring and Evaluation

Resources, software, and dashboards for M&E professionals

Monitoring and Evaluation (M&E) is becoming a job in demand as the demand for accountability and learning increases at different levels. Monetary resources are becoming scarce and donors are increasingly developing a donor fatigue syndrome so it is important that organizations become efficient and effective.

The collection, analysis, and reporting activities of data by donors and development partners are an important part of almost every development initiative and or any donor-related project. In addition to assessing stakeholder engagement, these activities also assist define future budgeting and programming decisions. 

Demand for monitoring and evaluation (M&E) specialists in the different development sectors is particularly high and fundamentally vital in ensuring accountability and learning through the strategic use of data. 

M&E Specialist plays leading roles in the design and implementation of a comprehensive monitoring and evaluation plan by developing appropriate indicators, implementing systems to safeguard the collection and management of program data, and recommending changes to annual work plans or data collection techniques as needed.

In addition, M&E Specialist sets specific program M&E targets and indicators; track activity achievements; records challenges encountered and mitigation pathways to ensure the quality and effectiveness of project implementation.

Technical categories of Monitoring and Evaluation

M&E is separated into two distinguished categories: evaluation and monitoring. An evaluation is a systematic and objective examination concerning the relevance, effectiveness, efficiency, and impact of activities in the light of specified objectives. The idea in evaluating projects is to isolate errors in order to avoid repeating them and to underline and promote the successful mechanisms for current and future projects.

An important goal of evaluation is to provide recommendations and lessons to the project managers and implementation teams that have worked on the projects and for the ones that will implement and work on similar projects.

An important goal for monitoring is the continuous and systematic assessment of project implementation based on targets set and activities planned during the planning phases of the work and the use of inputs, infrastructure, and services by project beneficiaries. Monitoring tracks the actual performance against what was planned or expected by collecting and analyzing data on the indicators according to pre-determined standards.

Source

Read IFRC, UNAIDS, INTRAC, and M&E Universe for more details about monitoring and evaluation. The M&E Universe has specifically been designed to support civil society organizations (CSOs) and draws many of its examples from the work of NGOs and other types of CSO.

Software designed for the global humanitarian and development partners

iMMAP

iMMAP’s ReportHub is an online reporting platform that addresses the gap in reporting operational data across organizations by streamlining the information flow between clusters, working groups, partners, and the Humanitarian Country Team in support of the Humanitarian Response Plan. The Multi-Sectoral Dashboard for Humanitarian Response Services provides a snapshot and overview of the information reported to ReportHubin Afghanistan by implementing partners compiled in November of 2021.

ActivityInfo

ActivityInfo has been used to support cluster management, care management, and interagency coordination with staff working on projects in locations including Iraq, Mali, Lebanon, Somalia, Yemen, the Central African Republic, and the Democratic Republic of the Congo. It is designed to support work on education, health, nonfood items, protection, shelter, and water and sanitation.

Used by: United Nations agencies, NGOs working in humanitarian operations

CommCare

Drag-and-drop tools help users build apps quickly and without the need for coding. They can then collect data, even when offline, use case management tools for built-in decision support and notifications, and link data from multiple forms to avoid duplication errors and track workforce performance. Reporting tools make it easy for users to aggregate and visualize data and spot trends. Other features include workforce performance tracking.

CommCare has been used in health care interventions for children under 5 in Burkina Faso, to deliver agricultural training, and support malaria prevention campaigns across Africa.

Used by: Rainforest Alliance, One Acre Fund, Catholic Relief Services, John Hopkins University, Partners in Health, Bill & Melinda Gates Foundation

DevResults

DevResults software includes interactive map features which have built-in intelligence on the country’s administrative boundaries and allows users a birds-eye view of the geographical context of their programs. Users can customize data disaggregation, define success indicators, and set up the program’s results framework. Other features support collaboration and management through photo galleries, work plans, and budget tracking tools.

Used by: USAID, Chemonics International, World Learning, Feed the Children

Granity

Granity is designed to support nonprofits and social enterprises with planning and reporting processes. Users can create checklists and surveys for routine tasks and procedures, or generate automated reports. Granity also works for mobile data collection and online data storage to support development workers in the field.

KoBoToolbox

Designed for data collection in “demanding contexts,” KoBoToolbox works online and offline and from mobile devices. It is used by humanitarian organizations, researchers, and aid workers to create forms, share projects with colleagues, and create summary reports with graphs and tables. Features also allow users to visualize collected data on a map, including heatmaps or clustering or disaggregate data in reports and maps by gender, region, or education level.

LogAlto

This software enables users to design logical frameworks, monitor indicators, and collect and upload data by project. Users can access live reports and create tables and charts. The software can also be used in offline mode and be accessed on a mobile app for custom forms.

Used by: NGOs, foundations, governments, ministries, donors

Magpi

Originally developed to support child vaccination campaigns around the world, Magpi is now used across health education, outbreak response, program coordination, monitoring, and evaluation. It provides solutions for mobile data collection, messaging, and visualization. It has specific tools which support: beneficiary registration; a collection of voice, mobile, and SMS data; conference polls; emergency alerts; data integration.

The software has been used to monitor humanitarian activities in Syria, improve polio programming in Nigeria, track newborn deaths in DRC, observe electoral progress in Tanzania, and facilitate communication with farmers in Chile.

Used by: U.N. Population Fund, Pact, UNICEF, Jon Sno, Inc

Mobenzi

Designed to support frontline workers operating in the field, Mobenzi’s features help M&E professionals create forms for mobile data collection and then share data insights through charts and maps. Other features support field worker management and performance reporting. Mobenzi has been used by primary health worker teams as well as for projects on education and early childhood development, and field research.

Used by: World Vision, USAID, Norwegian Refugee Council, Oxfam 

Open Data Kit

Free and open-source software for collecting, managing, and using data in “resource-constrained environments.” Open Data Kit has been used to monitor rainforests, observe elections, and track disease outbreaks.

Used by: World Health Organization, USAID, Red Cross, Jane Goodall Institute

Survey CTO

Designed for researchers and professionals working in offline settings, users can collect data using mobile phones or tablets then access it immediately. There are tools to help users design and test forms, monitor incoming data for quality, and visualize it as it comes in.

Survey CTO has been used for essential medicines programs in Uganda, WASH projects in West Africa, health and public policy evaluations in Kenya, HIV research in Rwanda, and newborn and child health programs in Ghana.

Used by: Innovations for Poverty Action, Abdul Latif Jameel Poverty Action Lab (J-PAL), World Bank, Elizabeth Glaser Pediatrics AIDS Foundation

TolaData

With the growing demand of donors for transparent and evidence-based reporting, the traditional practice of sharing results at the very end of the project cycle has become inadequate. 

TolaData enables users to track and measure the progress of their interventions continuously and consistently. Plus, visualize and share your most up-to-date results via dashboards with all your stakeholders and donors at every stage of the project cycle. 

TolaData has configurable dashboards for easy reporting and collaboration. It enables users to view and share their results in real-time and ensures transparency, accountability, and data-driven decision-making. Signup for a free trial.

Power BI Dashboard 

Dashboards are a great way to keep an eye on your business, obtain quick reports, and see key indicators. A Power BI dashboard is a one-page storyboard with visualizations. Because the dashboard is simply one page, it should feature only the most critical aspects of the tale.

Unify tables and columns to produce relevant visualizations. Charts and graphs provide an overview of a company’s operations. Single-page dashboards allow multiple departments to understand their business.

Source: beyondinternet

Using evidence for learning to improve people’s life: A community-led monitoring approach.

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Approaches like Community-led monitoring (CLM) allow communities to design, implement and carry out routine, ongoing monitoring service provision, accessibility, and utilization. Guided by this approach, CLM Consultants Ltd, a Tanzanian development management firm advocates for designing and strengthening monitoring, evaluation, and learning interventions through CLM.

CLM Consultants’ experts have vested capabilities in a range of monitoring, evaluation, and learning to design and use mixed-methods (i.e. both quantitative and qualitative), including the ability to integrate Monitoring and Result Measurement (MRM) standards of the Donor Committee for Enterprise Development into innovative community-led monitoring data collection approach.  

At CLM Consultants, the data management approach is driven by the passion to improve people’s life by ensuring quality services succeed by providing state-of-the-art M&E systems to capture best practices using Community-led monitoring data. Through our services, both service providers and service recipients can work together to fine-tune and strengthen their intervention strategies, by articulating problematic issues as they emerge in the process of service delivery, access, and utilization. 

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Source: Technical Brief: Measurement of M&E System Strengthening

CLM Consultants adopts a participatory approach for strategic people-centered project implementation to ensure active involvement of all key stakeholders taking into consideration of gender. Our team keeps updated on key M&E trends and plays an active role in a membership-based professional association such as  Tanzania Evaluation Association by attending various seminars and training including gender-related training opportunities such as  Equity-Focused and Gender-Responsive Evaluations.

CLM Consultants’ capabilities include making use of the different recommendations to ensure that community-led monitoring enables different stakeholders to respond to health impacts of climate change challenges and climate variability’s future risks to human health. This can be done through strategic integration and innovative monitoring programs taking into consideration of the National Climate Change and Health Adaptation Plan and the Tanzania Climate Change Gender Action Plan is imperative. 

Strengthening Eye Healthcare Systems Through Community-Led Monitoring Approach.

Tanzania, like many other national governments, commemorates the World Sight Day while implementing its government-led Covid-19 campaign by bringing together various eye care stakeholders and implementation partners. World Sight Day is a global awareness day observed every year on the second Thursday in October to draw attention to vision impairment, including blindness. This year’s World Sight Day theme is “Love Your Eyes”.  Enhancing community-led monitoring (CLM) approach to strengthen eye healthcare systems is therefore imperative. Placing communities and patients at the center of the eye care responsive health systems is critical to strengthening eye healthcare systems.

Strengthening eye healthcare systems may request adequate capacities in data demand and use through community-led monitoring approach, which is vital to improving vision care systems and services. Mactaggart, I (2014) claims that improving eye health in the community can only be done in partnership with the community itself. According to the 74th World Health Assembly(WHA), interventions that address the needs associated with uncorrected refractive error and un-operated cataract are among the most cost-effective and feasible health interventions available. WHA further reports that to meet these goals, all stakeholders, including governments, civil society, international organizations, intergovernmental organizations, and the WHO Secretariat, must collaborate in creative ways to serve the population’s eye care requirements. Uncorrected refractive error was the largest cause of global vision loss in 2020.

Globally, at least 2.2 billion people have a near or distance vision impairment due to uncorrected refractive error, unoperated cataract, age-related macular degeneration, glaucoma, diabetic retinopathy, corneal opacity, and trachoma, but most of these preventable cases have yet to be addressed. It is important to use the current data on the causes of vision impairment and blindness to inform public health policy recommendations.

Key issues in working with communities to improve their eye health.

Because each community is unique, and there may be special beliefs and customs that influence community members’ readiness to change their habits or behavior, improving eye health in the community can only be done in collaboration with the community itself, claims Mactaggart. In fact, there are many reasons as to why communities may at some point decide not to use eye health services, even when they are available due to certain constraints, including cultural factors. Essentially, any program’s success hinges on demonstrating respect for the community and including them in both the design and implementation of services. This is where the essence of using inclusive project cycle management in non-communicable diseases is considered fundamental in working with communities to improve eye health.

Mactaggart continues to claim that understanding potential barriers to uptake of services is a key way that may contribute to improving eye health at the community level. Therefore, it is important to note that some barriers, varying from community to community may require different solutions including culturally appropriate initiatives, depending on circumstances and available resources.

Addressing visual problems through screening using school teachers.

Visual problems continue to be detrimental to educational achievement especially when timely recognition of such health problem among community members. This has long-term consequences not only for the individual child, but also for society as educational and economic advancements are stifled. Few teachers understand how vision affects reading and learning. Several studies by Burnett. A.M., et al found that where the numbers of eye-care specialists are insufficient, training teachers in vision screening enables the provision of a good-quality and cost–effective service. When teachers learn about vision qualities and their impact on reading and learning, they understand why some students have reading difficulties, low motivation, low self-esteem, and difficulty concentrating. With these insights, Burnett. A.M., et al assure that more students can be assisted in reaching their full potential.

Successes and remaining challenges in eye care.

During the past 30 years, the World report on vision reveal significant concerted actions leading to remarkable many successes. This include (i) launching of global advocacy efforts; (ii) adoption of World Health Assembly resolutions; (iii) implementation of actions plans. Despite the recent scientific and technological developments promise to further accelerate these advances, progress is not keeping pace with population eye care needs, registering global challenges as eye care needs continue to rise sharply due to changes in demographics and lifestyle. Lack of data and weak health information systems continue to hamper strategic planning. Besides, poor integration of eye care into health systems and poor coordination of eye care workforce is still a challenge.

Why community-led monitoring for eye healthcare systems?.

Community-led monitoring approach trains, supports, equips, and pays members of directly affected communities to themselves carry out routine, ongoing monitoring of the quality and accessibility of services. Baptiste. S., et al (2020) remark on the role of CLM mechanisms in improving service delivery at facility-level, health system-wide infrastructure and health outcomes among recipients of care. Baptiste and colleagues reveal that proper identification and replication of successful CLM practices is a key pathway to equitable access to overall health services, which include eye health. Besides, the recent national eye health system assessment report recommends that local, national and international stakeholders to establish mechanisms for the regular monitoring of cataract surgery outcomes while developing new eye health initiatives, policies and projects. It is from this perspective, CLM Consultants recommends for strengthening eye healthcare systems through CLM approach.

Using community-led monitoring data and business intelligence to improve mental health services

On World Mental Health Day, October 10th, 2021, at CLM Consultants, we’re challenging the stigma, starting conversations, and sharing community-led monitoring educational resources and strategies for mental health data demand and use (DDU), knowledge management and communication (KMC), monitoring, evaluation, and learning (MEL) systems, that will make a real difference in how we talk and think about mental health.

CLM Consultants is urging different mental health stakeholders to embrace the role of community-led monitoring to ensure that recipients and providers of mental health services in Tanzania, as well as globally, have a common goal of improving access and utilization of better mental healthcare services.

Source: click here

Healthcare is currently representing one of the fastest growing business segments for Business Intelligence (BI). Power BI is finding its way in to healthcare organizations worldwide where it’s being used to improve quality, performance and productivity. There is a significant potential to use “Business Inteligence” in promoting the use of community-led monitoring approach for better access and utilization of mental health data amongst mental health service recepients and providers. Community-led monitoring is imperative to enabling healthcare service stakeholders to get answers quickly with rich dashboards available on every device of your choice.

Transforming community-led monitoring data for better services:- Identifying data-driven solutions

Since the main characteristics of CLM is its focus on getting input from recipients of services in a routine and systematic approach that will translate into action and change, putting and capturing their needs, and voices at the center of the national response then requires identification of data-driven solutions.

What Do We Mean by Data-Driven?

Data-drivenness is about building tools, abilities, and, most crucially, a culture that acts on data touching upon the whole analytics value chain, indeed the whole organization. Refer to What Do We Mean by Data-Driven? – Creating a Data-Driven Organization [Book] (oreilly.com)

Mainstreaming Data analytics in CLM may be of great support to local civil society organizations in assisting their funders and the public institutions at large in identifying issues of service access that have resulted in chronic problems, obstacles, and hurdles for long-term service consumption.

According to Thomas H. Davenport & Jeanne G. Harris, (2007), data analytics means the extensive use of data, statistical and quantitative analysis, explanatory and predictive models, and fact-based management to drive decisions and actions. Refer to Thomas H. Davenport & Jeanne G. Harris. (2007). Competing on Analytics: The New Science of Winning (Vol. 148). https://www.pdfdrive.com/competing-on-analytics-the-new-science-of-winning-e193192329.html

Using data analytics will enhance CLM’s mission in the strategic identification of data-driven solutions, which will ultimately lead stakeholders in eliminating the prevailing barriers, while at the same time ensuring that beneficiaries continue to receive optimal client-centered services.

Transforming community-led monitoring data for better services

Community-led monitoring (CLM) is a technique initiated and implemented by local community-based organizations, civil society groups, people living with HIV, and other marginalized groups or communities that collect quantitative and qualitative data about services. The main characteristics is its focus on getting input from recipients of services in a routine and systematic approach that will translate into action and change.

Thus, CLM helps puts communities, their needs, and their voices at the center of the national response.

A CLM approach led by local civil society organizations assists funders and public institutions in identifying issues of service access that have resulted in chronic problems, obstacles, and hurdles for long-term service consumption. CLM’s mission is to identify data-driven solutions to eliminate barriers, while at the same time ensuring that beneficiaries receive optimal client-centered services.