Module 5 Facilitator's Guide_Monitoring and Evaluating Programmes

8/7/2019 Module 5 Facilitator's Guide_Monitoring and Evaluating Programmes

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THE PHC MAP SERIES OF MODULES. GUIDESAND REFERENCE MATERIALSEach module includes:o a User's guideo a Facilitator's guideo computer programsModule 1 Assessing information needsModule 2 Assessing community health needs and coverageModule 3 Planning and assessing health worker activitiesModule 4 Surveillan." olmerhidity and mortalityModule 5 Monitoring and evaluating programmesModule 6 Assessing the quality of serviceModule 7 Assessing the quality of managementModule 8 Cost analysisModule 9 Sustainability analysisManager's guides and referenceso Better management: 100 tipso Problem-solving. Computerso The computerised PRICOR thesaurusProduction Managers: Ronald Wilson, Aga Khan Foundation, Geneva, andThongchai Sapanuchart, Somboon Vacharotai Foundation,BangkokDesign & Layout: Helene Sackstein, FranceDesktop Publishing: Marilyn J. Murphy, Suracha Suntarasut, Somboon Vacha-rotai Foundation, Bangkok, Thailand and Atthapon Tanoi,

Dept. of Medical Sciences, ThailandFirst Printing: In 1993 by Thai Wattana Panich, Bangkok, ThailandSecond Printing: ln 1997 by Veteran Organization Printing Co,Ltd, ThailandPublished by the Aga Khan Foundation USA, Suite 700,1901L Street N.W., l,AhshingtonDC., USA Additonal copies are available at the Somboon \hcharotai Foundatioq 101Boromratchonanee Road, Glingchaq Bangkok 10170, Thaland Fax. (6621 44*ffi2


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ISBN: 1-882839-11-0Library of Congress Catalog Number: 93-72795


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Dedicated toDr. Duane L. Smith (7939'7992) ,Dr. William E. Steeler (7948'7992)and c,ll other health leaders, manogers o,nd utorkerswho follow their example in the effort to bting quality healthcare to all in need.


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The Primary Health Care Management AdvancementProgramme has been funded by theAga Khan FoundationCanada, the Commission of the European Communities,the Aga Khan Foundation U.S.A., the Aga KhanFoundation's head office in Geneva. the Rockefeller Foun-dation, the Canadian International Development Agency,Alberta Aid, and the United States Agency for Interna-tional Development under trvo matching grants to AKFUSA. The first of these grants was, "Strengthening theManagement, Monitoring and Evaluation of PHC Pro-grams in Selected Countries of Asia and Africa" (cooper-ative agreement no. OTR-0158-A-00-8161-00, 1988-1991); and the second was "strengthening the Effective-ness, Management and Sustainability of PHC,/Mother andChild Survival Programs in Asia and Africa" (cooperativeagreement no. PCD-0158-A-00-1102-00, l99L-L994).The development of Modules 6 and 7 was partially fundedthrough in-kind contributions from the Primary HealthCare Operations Research project (PRICOR)of the Centerfor Human Services under its cooperative agreement withusArD (DSpE-6920-A-00-104s-00).This support is gratefully acknowledged. The viewsand opinions expressed in the PHC MAP materials arethose of the authors and do not necessarily reflect thoseof the donors.All PHC MAP material (written and computer files) isin the public domain and may be |reely copied anddistributed to others.


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ContentsFOREWORD . 1SESSION L INTRODUCTION AND OVERVIEW ... "... ' 7

Tiansparencies5-1: Workshop objectives .. " " '145-2: PurposeJof module5..'. """"155-3: Monitoring .""""165-4: A systems diagram of management andsntui.nrelationships.... """"'175-5: An indicator is " " ' 185-6: Suggestedindicators """'195-7: Genlric indicator categories for PHC services " ' " ' ' '205-8: Generic indicatorcategories for PHC management ' ' ' ' " ' ' '2L5-9: Types of monitoring ... " "225-10' (eep It Straightforward and Simple ' " "235-11 The KISS aPProach .. " " '24

5-12: Steps in activity monitoring ' " ' "25SESSION 2: SPECIFY(srEP 1) ... THE MONITORING OBJECTIVES

ltansparency5-13: Session 2: OUpcfiveSESSION 3: DECIDE ON THE SCOPE AND SELECTTNDTCATORS(STEPS2AND3)... .....33Tiansparencies5-14: Session 3: Objectives . . . '. . .37

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Module 5: FG; contents


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5-15: Planning the scope of monitoring . . . .. . .385-16: Common indicator modifications . . . ....405-17:Formulationof indicators.... ....4L5-18: Frequency of data collection . . . ., .. .....45SESSION 4: CHOOSE DATA SOURCES AND COLLECTIONPROCEDURES(STEP4). ........45Tiansparencies5-19: Session 4: Objectives .... ..485-20:Data sources ........49S-Z!:Daia coiieciicn teehniques .......51SESSION 5: COLLECT, TABULAIE AND ANYALSE THE DAf,A(srEPs5AND6) ....53Tiansparency5-22:Session 5: Objectives... ....56SESSION 6: PRESENT FINDINGS AND TAKE ACTTON(STEPS7,8AND9)... .....59

Tiansparencies5-23:Session 6: Objectives.. .....63S-24:Report findings .....645-25:Take action ..... ....655-26:Monitoring review guidelines .....67

Module 5: FG; contents


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r!!it li:rirjForewordWhat is the purpose of the Facilitator's guide?

The Facilitator's guide contains a suggested workshop design for use byindividuals who wilf help PHC managers and staff learn how to use thepri-urv Health care Management Advancement Programme (PHC MAP)series. ih"r"is a Facilitatort guide for each module in the PHC MAP series'What information does it contain?

Each Facilitator's guide contains instructions for conducting a workshopon one of the modiles in the PHC MAP. series using the informationcontained in the User's guide.The instructions are arranged in one to two hour sessions. The numberof sessions depends on the amount of information and/or the number of.t"pr .o"tuined in the User's guide. The first page of each session listssession obiectives, major topic-treadings, time required, and materials anda;i;;"J The'following pages describe the instructional activities inoutline form.The outline is divided into two columns. The right-hand columnindicates what the facilitator says or does to conduct the session' Theleft-hand column lists the handouts, overhead transparencies, or othermaterials needed to support the activity' Copies of these materials, suitablefor duplication, upp"uiut tn" end of the session in which they are first used.Some transparencies are used in more than one session'How are the workshops organised?The first session of each workshop contains activities designed tointroduce the PHC MAP series and explain its importance to PHCprogrammes, present an overview of the workshop, explain the purpose ofih"--odrln, review specific terms or concepts used in the module, and

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acquaint the participants with the organisation and content of the User'sguide.The final session of each workshop contains activities designed to reviewkey points of the User's guide, if approprieite, help purti.ipunts prepare anaction plan, and brings the workshop to a formal'conclusion. The iessionsin between present the steps requiied to accomplish the purpose of themodule and provide an opportunity for participants to apply ir,ore-rtepsto their own programmes.Each workshop. is designed- to be given on consecutive days, uninter-rupted except for breaks, meals, and iest, if the workshop is longer thanone.day. It is recognised, however, that situations uury u.,i ttre pfic uaFmodules will be used.singly or in combination by'individuals and or-ganisations in the field and on university campuses. Therefore, it-isexpected that the workshops described in ihe Facilitator's guides will beadapted to fit a range of circumstances. Indeed, those who iacilitate pHtMAP workshops are encouraged to make adaptations to meet the needsof participants andlor specifiJpHC programmes.Who can be a facilitator?Ideally, the person who serves as facilitator has training and experiencein the fields of public health, management, planning unJ "iJuution, as wellas sampling and survey design. It is recommended-ihat this person also beskilful in working with smali groups.The facilitator should be someone from outside the pHC programme,perhaps from another agency or a university. As a person with no directinterest in the programme, the facilitator can be neutral in disagree-"ni,that may arise and help the-group members resorve un ir.u" objectivery.Having an.outside person as ficirititor also allow, tr," progiu-me director,who usually has a leadership role, to contribute his oi hei knowledge andexperience as a full participant in the work of the group.It is also recommended that a facilitator have i fuli set of pHC MApuser's guides and Facilitator's guides. It is sometimes ,,"."r.ury, in thecourse of completing one module, to refer to information in another module.Who should participate in the workshop?__ -The primary audience for the pHC MAp series is the team that managesPHC programmes or other popuration-based hearth pC;;;-"s in eitherthe public or private sector. An exampr" or u pi-ii il;;;;"nt team inthe public sector is the core staff of a district ,u"gi;-lrL too,oo0 to300,000 in size of population served.

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An example of a PHC management team in the private sector is thecore staff of an NGO that provides PHC services to a specific populationin a given geographic area. The average size of the service population may,ungZ trom +O,OOO to 60,000, but may be as small as 10,000 or more than100,000. In either case, the management team should have:. the knowledge and skills needed to complete the steps in the module,. the time and resources required to collect and analyse the required data,the authority to plan and implement improvements in managementsystems and procedures based on this analysis.

If feasible, teams from several districts or from several PHC programmeswithin a given NGO, may work simultaneously with one facilitator tocomplete I module. It is recommended that one facilitator work with nomore than four teams or 20 people at one time.What does the facilitator do?' Ur,d"rst"nds the needs of participants. If the facilitator is workingwith one PHC programme, the most efficient way to gather informationabout participants and the programme in which they work is to meet withthe PHC director to determine:

The nature of the PHc programme (services provided, size and descrip-tion of area served, number and type of facilities, number and qualifica-tions of staff, community involvement, computer capability, strengths,major problems, etc.);if information needs have been clearly identified;previous staff training in management information systems or relatedtopics;resources available for training (time, space, equipment);possibility for subsequent technical assistance to workshop participants.Understands the content of Module 1. Read the User's guide andFacilitator's guide for Module 1 and consider options for workshop delivery.. The purpose of Module 1. is to help participants select priority informationneeds and to review some basic concepts underlying managementinformation systems. Depending on participant background, the amount

of time available, and the need to establish priorities among managementinformation needs, Module 1 can be presented in its entirety, limited toLevel l.: Quick start, limited to the PHC MAP systems framework, or in

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summary form as contained in the first session of the Facilitator's guidesfor Modules 2 through 9.. If information needs have not been clearly identified and participantshave no background in systems, then Module 1 should be presented infull. The selection of the next module willdepend upon priorities set bythe participants as they complete the steps in Module 1.. If information needs have been clearly identified and participants haveno background in systems, then that iortion of Module 1 can be addedto the first session of the selected module.. If information needs have been clearly identified and participants have abackground in systems, then the overview of PHC MAP in the selectedmodule will be sufficient.Understands the content of the selected module. Read the User'sguide and Facilitator's guide for the selected module and consider optionsfor workshop delivery.. Depending upon the length of the module and the availability of staff fortraining, the workshop sessions may be presented as described in theFacilitator's guide, or workshop sessions may be delivered at intervals (forexample, every morning for a certain number of days, one session perweek, or one day per week for three or four weeks).. If follow-on technical assistance is available, the content of the modulecould be presented in the workshop and the application of the procedureto the PHC programme could be conducted on the job.. Participants could plan steps in the workshop, complete them on the job,and bring the results to the next workshop session. This approach isparticularly applicable to Module 2 which requires development of a

questionnaire, selection of a survey sample, training of data collectors,and data collection. These steps cannot actually be carried out within thetime limits of the workshop as contained in the Module 2 Facilitator'sguide.. Other options are possible depending upon the circumstances of eachsituation.Determines what programme information, if any, is needed forcompletion of the module. For example, census data and lists of householdsare required to complete some of the steps in Module 3.



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Determines the most appropriate people to attend the workshop' For"*u-pl", Module 7 is best completed by those responsible for planning,training, supervision, logistics, and other management services'

Discusses the delivery options and participants with the PHC managerand make decisions regarding the most appropriate option and participantselection. Also deterriines if the needed information is available and if itis not, the alternatives for obtaining the information'Notifies participants of the date, time, and purpose of theworkshop and confirms attendance. Initial notice of the meeting may comefrom the PHC manager, with follow-up by the facilitator'Prepares the agenda, using as a modelthe sample in session

1of theFacilitator's guide for the selected module'

Inspects the room where the workshop willbe held and answers thesequestions:. Is the room large enough to seat all the participants?. Can chairs and tables be arranged in a variety of ways; all participantsu-una one table;participants in groups of three or four at smaller tables?. Is the lighting adequate?. Can temperature and humidity be controlled?. Is there an electrical outlet for an overhead projector?. Is a microphone necessary for everyone to hear and to be heard?. Are toilets conveniently located?. Is the site convenient to parking, restaurants and public transportation?. Are supporting facilities available and convenient duplication, word

processing, comPuters?Prepares notes to conduct the workshop using. the session outlines inthe Facilitator's guide for the selected module, and makes the necessaryadaptations. Reflr to the appropriate User's guide for content.

Conducts the workshoP as Planned'Provides follow'on assistance, if appropriate'



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$SSi.i:'::ii:Session L Introduction and overviewObjectives: Participants will be able to:. Explain the purposes of Module 5.. Distinguish between routine and short-termmonitoring.. Name at least two guidelines in the KISS ap-proach to monitoring design.. Explain the basic steps to planning monitoring

procedures.Session outline I. Introduction (10 minutes)II. Overview of workshop (5 minutes)III. Introduction to Module 5 (40 minutes)IV. Module 5 User's guide (20 minutes)Materials: Module 5 User's guideHandout 5-1: Agenda

Tiansparency 5-1: WorkshopobjectiveTiansparency 5-2: Purpose of Module 5Tiansparency 5-3: MonitoringTiansparency 5-4: A systems diagram of ma-nagement and service re-lationshipsTiansparency 5-5: An indicator is...Tiansparency 5-6: Suggested indicatorsTiansparency 5-7: Generic indicator catego-ries for PHC services

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Equipment

Tiansparency $& Creneric indicator catego-ries for PHC managementfunctionsTlansparency $9: Types of monitoringTiansparency $1O KISSTiansparency F1L The KISS approachTiansparenc y SL2t Steps in acffvip monitoring

Flip chart, stand, markerg masking tapg, over-head projector and screen

Module S FG; session 1


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Session L Introduction and overviewI. Introduction (lO minutes)

Note: Omit Section I if you haue presented Mod'ule 7, or some other module, immediately prior tothe presentation ot' Module 5.A. OPENING REMARKS. Introduce self and other staff, as necessary.. Explain your role in the workshop'. If you do not know the participants, ask eachone to state his or her name, position title, andjob location.

Name tags or place cards Note: lt' the group is larger than 6 or 8, you maywish to haue them wear nQme tags or place cardswith their names at places where they are sitting.Flip chart . Ask each participant to complete this sen-tence: "As a result of attending this workshop,I expect ..." and write their responses on theflip chart.. When all responses have been recorded, saythat you will return to this list after giving anoverview of the workshoP.

B. OVERVIEW OF PHC MAPSee Module l User's . Explain why information is important forguide for this information PHC programmes.. Summarise PHC MAP programme,including:Purpose of PHC MAPTitle and purpose of each module and othermaterials.. Make the following points about PHC MAP'Has been field tested and revised to ensureusefulness to PHC programme staff.Module 5: FG; session 1


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Modules can be used in any sequence.Checklists and other materials can, andshould, be adapted to fit a particular situation.The procedures outlined in the modules canbe adopted as routine monitoring activities ina PHC programme.o Explain why MAP is being introduced in thisPHC programme.Note: The remarks here should be nilored to thespecific prcgramme and should provide the an-surers fo these questions:Why are we doingthis unrkshop?What do ure expect to achieue?It may be appropriate for the PHC manager tomakethereremarks

lI. Overview of workshop (5 minutes)'Iiansparency $1:Workshop oblectiveHandout Sl Agenda

. Review the workshop objective.. Distribute and review the workshop agend4describing the activities that will take place toaccomplish the workshop objective.o Review the expectations contributed by par-ticipants at the beginning of the session.Indlcate which ones willbe met and whichones will not and why.Suggest, if possible, alternatives for meet-ing the expectations that will not be met inthis workshop.. Ask for questions or comments.Ill.lntroduction to Module 5 (4O minutes)

Tiansparency- \2: _ . Explaln that the purposes of Module 5 are toPurpose of Module 5 help pHc programme managers to:Module 5: FG; session I


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Tiansparency 5-3:Monitoring'Iiansparencv S4:A systems diagram ofmanagement and servicerelationship

'liansparency F5:An indicator is."'liansparency FGSuggested indicatorstansparencv tzCsreric indicator categoriesfor PHC servicesTransparency F8:Generic indicatorcategories for PHCmanagement functionsTiansparency 59:Types of monitoring

Identify important PHC services andmanagement functions they wish to monitor.Select key indicators for these services andfunctions.Design and implement a simple monitoringsystem using these indicators.

o Review the definition and purpose ofmonitoring.o Review the systems framework for PHC

programmes presented in Module 1, ifnecessary.Explain the three categories (inputs,processes and outcomes)and give an exampleof each.Distinguish among outputs, effects, andinputs.Discuss the relationship between themanagement system components and theservice delivery system components.. Review the definition of indicator.. Explain that Module 5 suggests indicators forthe inputs, outputs, and effects for PHC serv-ices and management functions.. Present and explain the suggested indicatorcategories for PHC services.o Present and explain the suggested indicatorcategories for management functions.

o Ask for questions and comments.. Explain the two types of monitoring andgive an example of each type.RoutineShort-term. Explain the relationship between routine andshort-term monitoring.Module 5: FGr session 1


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Secsion 1: Introduction and overviewTiansparency 5-10: .KISSTiansparency 5-11:The KISS approach

Tiansparency 5-12: .Steps in activity .monitoring

Review guidelines for designing a monitoringsystem:Select only key indicators.Keep data collection to a minimum.Provide timely feedback.Use a clear and convenient reporting format.Discuss the limitations of activity monitoringand give examples:Important informationcollect.Important informationto collect.. Discuss other optionsand impacts.Review the steps in activity monitoring.Ask for quesiions and comments.

may be dlfficult tomay not be feasiblefor assessing effebts

IV. Module 5 User's guide (2O minutes)Module 5 User's guide o Distribute a User's guide to each participant.. Highlight key sections of the User's guide:The overview of PHC MAP with the descrip-tion of modules and other materials, whlchthey may wish to refer to for review of infor-

mation needs met by other modules.Quick start provides a procedure for moni-toring important performance indicators.An explanation of generic categories of in-dicators for PHC services and managementfunctions.Step-by-step directions for designing andimplementing a monitoring system.Appendices containing suggested indicatorsand blank worksheets.. Ask for questions or comments.



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SAMPLE AGENDAMODULE 5*Session 1

(1 hr, 15 mins)Session 2

(1 hr)Session 3

(1 hr, 20 mins)Session 4(1 hr)Session 5(1 hr, 15 mins)Session 6

(1 hr,20 mins)

Introduction and overviewSpecify the monitoring

objectives (Step 1)Decide on the scope andselect indicators(Steps 2 and 3)Develop data collectionprocedures (Step 4)

Collect, tabulate andanalyse the data(Steps 5 and 6)

Present findings and takeaction(Step 7,, 8 and 9)

'For an actual presentation, substitute the appropriate clock hours in the first column.

Module 5: FG: session 1; handout 5-1


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WORKSHOP OBJECTIVEPlan monitoring procedures for PHCand management services using thesteps and worksheets contained inModule 5

Module 5: FG; session 1; transparency 5-1


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PURPOSES OF MODULE 5To help PHC programme managers to:1. Identify important PHC services andmanagement functions theY wish tomonitor.2. Select key indicators for these services

and functions.3. Design and implement a simplemonitoring sYstem using theseindicators.



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MONITORINGDefinition: The periodic collection andanalysis of selected indicatorsPurpose Enables managers to determinewhether k"y activities arecarried out as planned and haveexpected effects on the target

populationValue: Identif y problems; takecorrective action; ffrdsureachievement of targets; assesstrends in health status

Module 5: FG; session L transparency 5-3


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AN INDICATOR rS...An indirect measure of an event orcondition.Example: indicator:weight-tor-age

condition:nutritionalstatus

MoCrrle 5: FQ session 1; transparency 5-5


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Module 5: FG; session 1r transparency 5-6


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GENERIC INDICATORCATEGORIES FOR PHCSERVICESO EFFECTSo Coverage (including behaviour)o Knowledge and skills (of the targetpopulation)O OUTPUTSo Utilisation of serviceso Quality of careo Contacts, visits

o Access to servicesO INPUTSo Availability of personnel, supplies,equipment, fundsModule 5: FG; session 1; transparency 5-7


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GENERIC INDICATORCANEGORIES FOR PHCMANAGEMENT

EFFECTSo PHC services available, accessibleo Staff performanceo Worker knowledge, skills, behaviouro Community satisfaction with serviceso Quality of PHC servicesOUTPUTSo Services or activities completedo Frequency of management activitieso Quality cjf management activitiesINPUTSo Availability of trained personnel, supplies,information, guidelin es/ protocols

o



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TYPES OF MONITORINGROUTINE:o regular, on-goingo core set of indicatorso tracks programme implementation

SHORT-TERM:o limited period of timeo tracks new activities or processeso collects information to help solve aproblem



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K EEPITS TRAIGHTFORIfrARDAI\DS IMPLE



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THE KISS APPROACHo Key indicatorso Minimum data collectiono Timely feedbacko Usable report format

Module 5; FG; session 1; transparency 5-11


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STEPS IN ACTIVITYMONITORINGPLANNING:

1. Specify objectives2. Decide on scopeSelect the indicators and standards4. Choose information sources; developdata collection Procedures

IMPLEMENTATION:5. Collect the data6. Tabulate and analYse the data7. Present/report the findings8. Take appropriate action

ASSESSMENT9. Decide whether to continue monitoring



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Session Specify the monitoringobjectives (Step 1)Obiectivesr

Session outline:

Equlpment

Participants will be able to follow the directionsin the Module 5 User's guide to speclfu the moni-toring objectives for their PHC programme.I. Introduction (10 minutes)II. Specify the objectives (50 minutes)Module 5 User's guideTiansparency 5-13: Session 2: ObjectiveHandout 5-2: Worksheet for specifyingthe monitoring objectivesFlip chart, stand, markerq masking tape, over-head projector and screen



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I. Introduction (1O minutes)Tiansparency 5-13:Session 2 Obiectives o Review the session objective.. Explain that the activity monitoring proce-dures can be applied to:short-term monitoring of selected indicatorsroutine monitoring of all indicatorsimprove upon an existing MIS

II. Specify the objectives (5O minutes). Explain that specifying monitoring objectivesinvolves determining:What is going to be monitoredFor what purposeFor whom. If Module t has been completed, instructparticipants to review the PHC and manage-mept services they prioritised.. If Module t has not been completed, instructparticipants to review the list of the mostcommon functions and services.Choose which services to monitor from thelist in Appendix A.Choose which management services tomonitor from the list in Appendix B.Rank services to be monitored on a scale ofL to L0 (highest).Determine whether to monitor input, out-put or effect indicators for these services.

Handout 5-2: worksheet . Distribute the worksheet for specifying thefor specifying the monitoring objectives and expliin whJt in-monitoring obpctir'res formationloes in each column and how thatinformation is determined.

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SESSION 2zOBJECTIVESpecify monitoring objectives for yourPHC programme

Module 5: FG; session ! transparency 5-13


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Session 3: Decide on the scope and selectindicators (Steps 2 and 3)Objectives:

Session outline:

Materials:

Participants will be able to follow the directionsin the Module 5 User's guide to:. Decide on the scope of the monitoring.. Select the indicators and performance stand-ards.

I. Introduction (5 minutes)II. Decide on the scope of the monitoring (30minutes)III. Select the indicators and performancestandards (45 minutes)Module 5 User's guideTiansparen cy 5-L4: Session 3: Objectivesliansparency 5-15: Planning the scope ofmonitoringTiansparency 5-16, Common indicator modi-ficationsTiansparency 5-17: Formulation of indicatorsTiansparency 5-18: Frequency of data collec-tlonHandout 5- 3: Worksheet for specifyingthe scope of monitoring

Handout 5-4, Worksheet for selectingindicators and standards



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34Equipment: Flip chart, stand, markers, masking tape, over-head projector and screen



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session 3: Decide on the scope and select indicators(StePs 2 and 3)I. Introduction (5 minutes)

-Iiansparency 5-14: . Review objectives for session 3.Session 3 objectives

monitoring ing, and the factors involved in each:GeograPhic areaFacilities or sub-ProjectsPersonnel involvedDurationshort-term vs. routinedeadlinesHandout 5-3: Worksheet . Distribute the worksheet and direct partic-itiip".ryi.g th" ttop" ipants to complete Handout 5-3. using theof monitoring model on page 23 in the User's guide as neces-sry.. Ask for questions and comments'

ill. s"l""t th" i,,di..too.nd performance standards (45 minutes)

tI. O""ia. on the scope of the monitoring (3O minutes)Tiansnarencv 5-15: . Discuss the four areas that need to bept"ii"i"glnZ siope of addressed in planning the scope of monitor-

. Refer participants to Appendices A -and B,and explain that input, output, and effectindicators are suggested for each PHC andmanagement service.. Direct participants to review the indicatorslisted and the information contained in thefootnotes.. Explain that:Participants will probably need to modifythe indicators to fit their own situations'

User's guide



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'liansparency 5-16Common indicatormodificationsTiansparency F17:Formulation of indicatorsHandout $4: \Abrksheetfor selectinq indicatorsand standafos

'liansparency $1&Frequency of datacollection

The most common modifications are:the definition of the target groupterminologyIndicators can be expressed in differentways.

o Distribute Handout 5-4.Direct participants to selecVmodify indica-tors for their PHC programme and formulateeach one.Direct participants to present the indica-tors they have formulated and to explain anymodifications or additions.Note: Check selected indicators for consistencywith monitoring objectiws established in Session2" and help participants make adjustments asneeded

. Explain that a performance standard, some-times referred to as a target, is set for eachindicator.to establish a point at which it canbe agreed that the target has been achieved.Demonstrate how those standards areused to calculate the effectiveness of perform-ance.Direct participants to set standards for theindicators they have selected or modified andrecord them on the worksheet.r Discuss some of the factors considered inestablishing frequency of data collection.Direct participants to establish frequenciesfor their selected indicators and record themon the worksheet.. Ask for question or comments on Steps 2 and 3.



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SESSION 3: OBJECTIVESDecide on the scope of monitoring

o Select the indicators and performancestandards



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PLANNING THE SCOPEOFMONITORINGo Geographic areao Facilities or sub-projectso Personnel involvedo Duration

o Short-term vs. routineo Deadlines



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COMMONINDICATORMODIFICAfIONSo Definition of target group(s)

TerminologyPhrasingo Addition or deletion of indicators



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FORMULATION OFINDICATORSCount:Rate:Ratio:Proportion:

Percentage:

Simplest type of measureMeasures frequency ofeventsA fraction or a decimalMe?sures relationshipbetween a part and thewholeA proportion multipliedby 100



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FREQUENCY OF DATACOLLECTIONo Consider how often users want to

examine resultso Establish the minimum frequencYnecessaryo Continuous data collection exactnumber of times an event occurso Periodic data collection - determine if aprocedure is being carried out as

expected



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Session 4z Choose data sources andcollection procedures (Step 4)Objectives;

Session outline:

Materials:

Equipment:

Participants will follow the directions in theModule 5 User's guide to:. Choose information sources. Select data collection techniquesI. Introduction (10 minutes)IL ldentify existing data sources (1.0 minutes)III. Develop new data collection instruments (40minutes)Module 5 User's guideTiansparency 5-19: Session 4 objectivesTiansparency 5-20: Data sourcesTiansparency 5-2L: Data collection techni-quesHandout 5-5: Worksheet to select datasources and techniquesFlip chart, stand, markers, masking tape,.over-head projector and screen



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Session 4: Choose data sources and collection procedures(Step 4)I. Introduction (1O minutes)

. Su.mmarise the outcomes of Steps 1,2, and 3.Tiansparency 5-19: . Discuss the objectives for Session 4.Session 4: Objectives

II. Choose information sources (lO minutes)liansparency 5-20:Data sourcesHandout 5-5: Worksheetto select data sourcesand technioues

. Provide examples of possible informationsources.. Distribute Handout 5-5 and direct partici-pants to list the indicators they have selectedin Step 3 and enter appropriate source of datafor each.

III. Develop data collection techniques (4O minutes)liansparency 5-21Data collectiontechniques

. Define and give examples of techniques forgathering monitoring data.. Explain that instruments to collect data bymethods other than record review can befound in other MAP modules.Module 2 contains rapid surveys to identifyhealth needs.Module 5 contains checklists for assessingquality of PHC services delivered to meetthose needs.Module 6 contains checklists for assessingthe quality of management functions that sup-port service delivery.

o Explain that if existing records do not supplynecessary data for monitoring, forms can oftenbe modified so that staff can record the infor-mation needed.



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'Iiansparency F12Steps in activitiesmonitoring

. Dlrect participants to complete Handout 5-6by writing in the techniques appropriate foreach indicator and have them highlightthose techniques that will require either mod-ification of existing forms or development ofnew instruments.. Ask for questions and comments.. Remind participants that this is the final stepin the planning phase. The next phase to bediscussed is implementation.



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SESSION 4: OBJECTIVES:Choose information sourcesSelect data collection techniques



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DATA SOURCESExisting sourceso Routine recordso Logistics recordso Tieatment registerso Patient recordso ActivitY rePortso Population-based recordsModification of current forms

- DeveloP new instruments

Module 5: FG; session 4; transpatency 5-20


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Documents

Module 5 Facilitator's Guide_Monitoring and Evaluating Programmes