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It is essential for today’s organisations to properly monitor and evaluate their own programmes and disclose the results. Zambia National AIDS Network (ZNAN) is no exception, as it must monitor and evaluate its programmes to win the understanding and support of the Zambian public and cooperating partners.

ZNAN decided to establish an internal Monitoring and Evaluation System to improve the quality of its programmes. It is in response to that need that this document – “Monitoring and Evaluation Framework for ZNAN,” has been prepared.

This document will provide an extensive look at ZNAN Monitoring and Evaluation systems. Therefore, ZNAN plans to revise this document as it becomes necessary.

Due to the severe fiscal situation of our country, organisations, from National to Local, are under pressure to carry out their programmes or projects both effectively and efficiently. As the main tool for this effort the government collects information and produces indicators related to HIV/AIDS through Education Management System, Health Management Information System, Demographic Health Survey and a number of clinical, epidemiological, behavioural and impact studies. Sentinel surveillance system for HIV and population based studies have been used to monitor the trend of the HIV epidemic. Through a decentralised data collection more updated information/data has been made available, but there is also need for a functional M & E and MIS system to consolidate this data. At a National Level an M & E technical working group within National AIDS Council (NAC) coordinates efforts in the development of a National M & E system.

The Monitoring and Evaluation method introduced in this document would allow the evaluator to evaluate the series of objective-means relationships concerning the policy, program and project levels at the same time and with consistency. It will also allow M & E officers within ZNAN to set vision maps through participatory Monitoring and Evaluation of various programmes.

It is our wish that this document is used by a wider constituency of AIDS service organisations and sub recipients.

Zambia National AIDS Network (ZNAN)

ACRONYMS

AIDS Acquired Immune Deficiency Syndrome

CBO Community based Organisation

CBOH Central Board of Health

CCM Country Coordinating Mechanism

CSO Central Statistic Office

G.F. Global Fund

GFATM Global Fund to fight AIDS, TB and Malaria

HIV Human Immunodeficiency Virus

LFA Local Fund Agent

M&E Monitoring and Evaluation

MOH Ministry of Health

NAC National AIDS/STI/TB Council

NGO Non Governmental Organisation

OVCs Orphans and Vulnerable Children

PLHAs People Living with HIV/AIDS

PMTCT Prevention of Mother to Child Transmission.

PPTC Project Proposal Technical Committee

PR Principal Recipient

STARZ Strengthening HIV/AIDS Response in Zambia

TB Tuberculosis

UNAIDS Joint United Nations Program on HIV/AIDS

ZDES Zambia Demographic Education Survey

ZNAN Zambia National AIDS Network

ZSBS Zambia Sexual Behavior Survey

1.0. EXECUTIVE SUMMARY

1.1. Key Considerations:

ZNAN raises a number of key considerations to be addressed by the Monitoring and Evaluation (M&E) Framework. The most important of these are listed below:

1.2. Objectives and Indicators

In order to track the achievements of the programme objectives and evaluate the impact, ZNAN has developed indicators to monitor the changes that will result from the Sub granting programme through various interventions by sub recipients. ZNAN will disburse funds to the NGOs, CBOs, groups of people living with HIV/AIDS and private sector organisations involved in HIV/AIDS work for implementation of their programme activities on the basis of agreed indicators in their work plans. Sub recipients will provide baseline information relating to the indicators before implementation and it will be compared to actual results after implementation.

1.3. Work plan and Budget

NGOs, CBOs, groups of people living with HIV/AIDS and private sector organisations will submit project proposals accompanied with quarterly work plans covering a minimum period of six months, outlining objectives and indicators to be reported on per quarter. The work plans will form a basis for funds disbursement. The Internal and External Technical Review Committees have been put in place to review and approve these proposals and work plans being submitted to ZNAN in accordance with the criteria set out in the grants manual.

1.4. Reporting against planned activities

Fifteen days after the end of each quarter, sub recipients accessing grants directly from ZNAN will produce and submit quarterly reports showing progress in achieving the intended results to ZNAN, while sub recipients accessing grants through Lead Agencies will submit reports to Lead Agencies for consolidation into a final report to be forwarded to ZNAN. To easy the burden of reporting, ZNAN has developed a reporting form to be used by these sub recipients when reporting. ZNAN shall consolidate and submit quarterly reports to the Global Fund 45 days after the end of each quarter. These quarterly reports will be consolidated by the M&E unit.

1.5. Data verification and quality control

The M&E officer and internal auditor will make random monitoring visits to verify the data submitted by sub recipients. Sub recipients will keep documentary evidence and individual activity reports that will form the basis for their quarterly reports. These reports will be made available during monitoring visits to assist the process of data verification.

The NGO/CBO support officers and Grants Manager will make random spot checks through field visits to assess the capacity needs and quality of the activities being implemented and whether they are contributing to the attainment of the ZNAN objectives.

1.6. Tracking results

ZNAN has developed indicators or benchmarks for the Global Fund programme. Data on the indicators will be collected using the reporting form and analysed in order to assess the extent to which indicators have been achieved. This will involve comparing the intended results against the achieved results. Baseline data on the indicators will also be established to measure the effect of the programme.

All sub recipients will be required to have baseline information on their activities to enable them show the changes as a result of utilising the Global Fund.

1.7. Impact assessment

Routine information collected by the M&E officer and internal auditor will provide data for analysing the impact of the programme. To ensure that all data required for the Global Fund programme is available, data collection tools have been developed and adjusted to fill all the existing gaps.

Specific surveys carried out by the Ministry of Health (MOH/CBOH) in conjunction with Central Statistics Office (CSO), periodically will be used to assess trends in disease burden and the status of specific health indicators at the national level. These surveys include: the Zambia Demographic Health Survey (ZDHS), Zambia Sexual Behaviour Survey (ZSBS) and National Health Indicators.

External evaluations will be carried out to provide in-depth data on the efficiency and impact of specific activities or initiatives in selected projects.

1.8. Operationalisation of the M&E system

The roles and responsibilities of each stakeholder have been identified. It is important that these stakeholders take individual responsibility for the identified roles during the implementation of the sub granting programme.

Key staff who will be involved in the implementation of this M&E system will be trained to ensure that it is effectively implemented at all levels.

1.9. Technical Assistance and Capacity Building

An external consultant will be contracted to assist in the operationalising of this M&E system. The consultant will work with ZNAN M&E staff to field-test and refine the entire M&E system. The consultant will also build in-house capacity for the M&E staff, and provide on-going technical assistance on a need basis, specifically in data analysis and report production and ensuring that the systems are fully implemented.

1.10. Monitoring and Evaluation Responsibilities of Lead Agencies

Lead Agencies will provide funding to smaller NGOs, CBOs, PLHA groups and Private sector organisations to scale up activities contemplated in their approved work plans by Lead Agencies. The Lead Agencies will be responsible for all resources they receive from ZNAN (for their own use and sub recipient’s projects) and the results their sub recipients are to accomplish. Lead Agencies will provide reports (i.e. quarterly, annual and interim) to ZNAN, as outlined in their contracts

1.11. Use of Data by Country Coordinating Mechanism (CCM)

This will involve submitting routine reports on a quarterly basis by ZNAN to the CCM. These routine reports will contain progress reports on the implementation, information on achieved impacts, progress towards meeting pre-agreed indicators and financial expenditure returns.

1.12. Use of Data by National HIV/AIDS/ STI/ TB Council (NAC)

Zambia has made progress in implementing the three-ones. Therefore, the results from HIV/AIDS and TB interventions of all HIV/AIDS implementing organisations in the country will be done to realize the goals as outlined in the National HIV/AIDS/TB Intervention Strategic Plan. Therefore, ZNAN will submit quarterly reports on the sub granting programme to the NAC. NAC is a national coordinating body that supports monitoring and evaluation of the multi-sectoral national response for the prevention, treatment, care and support of persons infected with or affected by HIV/AIDS and TB in the country, in order to reduce the personal, social and economic impact of HIV/AIDS.

1.13. Use of Data by Sub recipients

The information obtained through the M&E activities by ZNAN will be shared with all the sub recipients to allow feedback and enable them make appropriate adjustments to ensure the success of their programmes. Therefore, all M&E reports will be shared with the Lead Agencies and sub recipients in order for them to make necessary adjustments in their programmes.

2.0. INTRODUCTION

2.1. BACKROUND

2.1.1. HIV/AIDS

WHO/UNAIDS estimate that over 40 million people worldwide were living with HIV/AIDS at the end of 2003. Southern Africa accounts for up to 40% of these people, and this has resulted in grave political, economic and social problems.

In Zambia a recent demographic and health survey reports that 16% of adults aged 15 to 49 years are HIV infected. In addition, the survey also shows that the HIV/AIDS prevalence varies across the country: 25-35% of the urban population and 8 – 16% of the rural population age 15 to 49 years respectively being HIV infected. It is estimated that close to one million Zambians are living with HIV/AIDS with approximately 200,000 PLWHA needing immediate Antiretroviral Therapy (ART).

Deaths due to HIV/AIDS have continued to escalate, affecting the most productive of the population. This has resulted in increased leaves of poverty and children headed house holds. The increasing number of HIV/AIDS patients has also seriously overwhelmed the health care services. In major hospitals for example, HIV/AIDS patients now occupy more than half of hospital beds.

Highly Active Antiretroviral Therapy (HAART) became available in the developed country in 1996. This therapy has lead to a significant improvement in the quality of life of people with HIV/AIDS. Although this therapy in itself is not a cure for HIV/AIDS, ARV delay progression of disease allowing people with HIV/AIDS to live longer, healthier and more productive lives than would be the case without it.

Based on scientific and practical experience, the Zambian government in 2002 took a policy decision to make Anti Retroviral Therapy (ART) widely available to its citizen in line with the Specific Objective 5, Output 2 of the National HIV/AIDS/STI/TB intervention strategic plan. Prior to this decision, ART was available only in the non- government health facilities with an estimated 2,000 PLWHA access this therapy.

Zambia has recently embraced the WHO/UNAIDS global 3 by 5 ART programme whose aim is to have 3 million people in the developing countries on antiretroviral treatment by the end of the year 2005. Through this programme the Zambian government intends scaling up access to ART from the current 4,000 to 100,000 PLWHA by the end of 2005. It is hoped that all the 72 districts in Zambia will be in a position to provide ART to its residents.

2.1.2. Tube