Yibeltal Assefa (MD, MSc, Federal HIV/AIDS Prevention and Control Office, Addis Ababa, Ethiopia)
Monitoring and Evaluation (M&E) of health programs and systems is crucial for program and policy design, program management, resource mobilization and accountability. In spite of these benefits, M&E Systems Strengthening (MESS) has not got adequate attention from countries and even Global Health Initiatives (GHIs). Many M&E efforts by donors have been directed towards narrow M&E of their own programs, and this has led to parallel systems, often undermining the overall M&E effort in countries. However, the situation is slowly changing now. Different stakeholders, both at global and local levels, are increasingly advocating for MESS. GHIs are doing so because of the limited resources available and the need for value for money: doing more with the same money. Efforts are increasingly being undertaken to link M&E of HIV programs with overall Health Information Systems. Towards that end, the Global Fund Technical evaluation Reference Group (TERG) has brought together PEPFAR, UNAIDS, WHO, GAVI and others around MESS.
I think there are two issues that need to be clear and understood in the effort towards MESS. First, what does a strong M&E system look like? Second, what should be done for MESS?
A strong M&E system provides quality data and information, is utilized by the relevant stakeholders and is sustainable in spite of changes in the system. With these clear objectives in mind, the HIV/AIDS program in Ethiopia has been aiming for MESS. We have been conducting the following:
1. An M&E systems assessment. An assessment was conducted in 2009, based on the twelve components of a functional M&E system, to identify its strengths and weaknesses.
2. An M&E plan was then developed based on the assessment and the above three critical areas.
3. We organized an M&E advocacy workshop to sell the plan and mobilize resources. We found that these kinds of meetings are indeed important for MESS.
4. Implementation and monitoring of the M&E plan.
As a result, we have been able to strengthen the capacity for M&E at all levels, generate routine performance data and reports, and conduct program reviews and evaluations.
Partnership, coordination and getting buy-in from key stakeholders have been instrumental in the drive towards MESS in Ethiopia. It is my conviction that M&E is vital for health programs and systems. It is also my firm belief that MESS is possible with clear vision and commitment.