Rwanda National HIV and AIDS Mo by pengxiang

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									 RWANDA NATIONAL HIV AND AIDS
MONITORING AND EVALUATION PLAN
          2006-2009


 PART A : SYSTEMS AND FRAMEWORK




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Table of Contents
   TABLE OF CONTENTS ...................................................................................................... I
   LIST OF TABLES AND DIAGRAMS .................................................................................. III
DIAGRAMS ....................................................................................................................III
   ACRONYMS AND ABBREVIATIONS ................................................................................. IV
   ACKNOWLEDGEMENTS .................................................................................................. VI
1.0       NATIONAL HIV M&E CONCEPTUAL FRAMEWORK.............................. 1
   1.1       OVERVIEW OF HIV/AIDS STATUS IN RWANDA ................................................ 1
   1.2       NATIONAL STRATEGIC FRAMEWORK FOR HIV/AIDS ..................................... 1
   1.3       PRINCIPLES OF DEVELOPING AN M&E PLAN .................................................... 3
   1.4       METHODS/APPROACHES FOR THE DEVELOPMENT OF THE M&E PLAN .......... 4
   1.5       LOGICAL FRAMEWORK IN M&E....................................................................... 5
2.0       HIV NATIONAL MONITORING & EVALUATION ..................................... 7
IMPLEMENTATION STRATEGY ............................................................................... 7
   2.1     PURPOSE OF NATIONAL HIV M&E SYSTEM .................................................... 7
   2.2      RWANDA NATIONAL M&E INSTITUTIONAL FRAMEWORK ............................ 12
      2.2.1 National Level................................................................................................. 12
      2.2.2    District Level............................................................................................. 13
      2.2.3    Ministries/Public Sector Level.................................................................. 13
     2.2.4 National Level NGOs, Faith Based Organization, Umbrella Organizations
     & the Private Sector Level…………………………………………………………………14
3.0       DATA COLLECTION STRATEGY FOR M&E............................................ 26
   3.1     COORDINATION OF M&E................................................................................. 26
   3.2     DATA SOURCES: ............................................................................................... 26
   3.3     INFORMATION PRODUCTS AT NATIONAL LEVEL ............................................ 27
   3.4      REPORTING LEVELS AND DATA FLOW ............................................................ 29
      3.5.2       Reporting to the CDLS.............................................................................. 31
      3.5.3 Reporting of Health related Indicators: e.g. HIS/SIS to CNLS, TRAC to
      CNLS ......................................................................................................................... 32
      3.5.4 Reporting from Other Government ministries and institutions ..................... 33
      3.5.5 Reporting from the Civil Society, Umbrella Organizations and the Private
      sector......................................................................................................................... 33
4.0       THE ROLE OF STAKEHOLDERS IN HIV/AIDS M&E & ........................ 31
COORDINATION MECHANISMS ............................................................................ 31
   4.1    THE ROLE OF CNLS /M&E UNIT IN MONITORING NATIONAL RESPONSE .... 31
   4.2    THE ROLES AND RESPONSIBILITIES OF DISTRICT M&E FOCAL PERSONS .... 33
   4.3    THE ROLE OF GOVERNMENT MINISTRIES AND OTHER PUBLIC
   INSTITUTIONS/ORGANIZATIONS. .................................................................................. 33
   4.4 THE ROLE OF OTHER STAKEHOLDERS. ................................................................ 34
5.0       DISSEMINATION AND USE OF DATA/INFORMATION ......................... 31
6.0 STRENGTHING OF THE NATIONAL HIV M&E SYSTEM: THE
IMPLEMENTATION PLAN ........................................................................................ 31


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   6.1 HARMONIZATION AND IMPLEMENTATION OF THE NATIONAL HIV/AIDS M&E
   PLAN ............................................................................................................................. 31
   6.2    COMPONENTS/AREAS OF INTERVENTIONS ...................................................... 32
7.0 ANNEXES ................................................................................................................ 44




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List of Tables and Diagrams

Tables

Table   1:   M&E Results Pyramid ................................................................... 6
Table   2:   M&E Results Pathway................................................................... 6
Table   3:   Summary for the National Indicators for HIV/AIDS M&E System……15
Table   4:   Implementation Plan for Strengthening of M&E System ................ 35

Diagrams

Diagram 1:        National HIV/AIDS M&E System ............................................ 11
Diagram 2:        National HIV/AIDS Monitoring and Evaluation Data / Information
                  Flow ................................................................................... 30
Diagram 3:        Data Flow from CDLS to CNLS .............................................. 32




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Acronyms and Abbreviations


APELAS          Association du Privé et du Para-étatique pour la lutte contre
                le SIDA
ARV             Anti-Rétroviraux
ART             Antiretroviral Therapy
CAMERWA         Centrale d’Achat des Médicaments Essentiels au Rwanda
CBF             Common Basket Found
BCC             Behavioural Change Communication
CBO             Community Based Organization
CDC             Center for Disease Control
CCC             Country Coordination Mechanism
CNLS            Commission Nationale de Lutte contre le SIDA
CDLS            Commission de District de Lutte contre le SIDA
CTS             Centre de Transfusion sanguine
DHS             Demographic and Health Survey
DQA             Data Quality Assurance
EABC            Education, Abstinence, Fidélité et Usage de préservatifs
EDSR            Enquête Démographique et de Santé au Rwanda
FOSA            Formation Sanitaire
GIPA            Greater Involvement of People Living with HIV/AIDS
GLIA            Great Lakes Initiative on AIDS
GoR            Government of Rwanda
HIS            Health Information System
HIV            Human Immunodeficiency Virus
IEC            Information, Education, Communication
IO             Infections Opportunistes
IST            Infections Sexuellement Transmissibles
MAP            Multi-sectorial AIDS Program
MDG            Millennium Development Goals
M&E             Monitoring and Evaluation
MINADEF         Ministère de la Défense
MINALOC         Ministère de l’Administration Locale, de la Bonne
                Gouvernance, du Développement Communautaire et des
                Affaires Sociales
MINECOFIN       Ministère des Finances et de la Planification Economique
MINEDUC         Ministère de l’éducation, des Sciences, de la Recherche et de
                la Technologie
MIGEPROFE       Ministère du Genre et de la Promotion de la Famille


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MIFOTRA      Ministère de la Fonction Publique et du Travail
MIJESPOC     Ministère de la Jeunesse, de la Culture et des Sports
MINISANTE    Ministère de la Santé
MoH          Ministry of Health
NRL          National Referral Laboratory
NGO          Non-governmental Organization
ONUSIDA      Programme conjoint des Nations Unies contre le SIDA
OPDAS        Organisation des Premières Dames d’Afrique contre le SIDA
OVC          Orphelins et Autres Enfants Vulnérables
PEP          Prophylaxie Post Exposition
PEPFAR       President’s Emergency Plan For AIDS Relief
PMTCT/PMTE   Prevention of Mother To Child Transmission
PNLS         Programme National de Lutte contre le SIDA
PNM          Plan National Multisectoriel
PRSP         Poverty Reduction Strategic Paper
PVVIH         Personnes Vivant avec le VIH/SIDA
RCLS          Réseau des Confessions Religieuses de Lutte contre le SIDA
RGPH         Recensement Général de la Population et de l’Habitat
RRP+         Réseau des Personnes Vivant avec le VIH/SIDA
SIDA         Syndrome de l’Immunodéficience Acquise
SIS           Système d’Information Sanitaire
TB           Tuberculose
TRAC         Treatment and Research on AIDS Center
UA           Union Africaine
UNGASS       United Nations General Assembly Special Session on AIDS
VCT          Voluntary Counseling and Testing




                                                                         v
Acknowledgements

The development of a national HIV and AIDS monitoring and evaluation plan is
as an important a task as it is to track the progress in the implementation of
strategies for national response to HIV and AIDS. This plan would have been
incomplete and indeed lacking ownership without the consensus and a wider
participation from different stakeholders and partners for whom the CNLS is
particularly acknowledges their contribution to the finalization of this document.

The CNLS boasts of the active and committed national HIV and AIDS monitoring
and evaluation technical working group (M&E TWG). This committee has had
insightful technical contribution in all the process of development of this plan.

The conception of this document was made possible though technical team
comprised of Monitoring and Evaluation experts from the CNLS, USAID/PEPFAR,
MEASURE EVALUATION/Constella Futures Group, UNAIDS, Tulane University
and from the World Bank/GAMET.

We highly acknowledge the Rwanda USG/PEPFAR for providing financial support
to facilitate the whole process of conception, drafting, validation and
subsequently producing manuscripts of this important document.

Our appreciation also goes to all the CNLS staff, key development partners and
the umbrella organizations who participated in one way or the other in making
the production of this report possible.


The overall leadership and coordination role played by the Executive Secretary of
the CNLS, and the Directorate of Planning, Coordination, Monitoring and
Evaluation is highly appreciated.




Rev. Pastor Nathan Gasatura
President
National AIDS Control Commission, CNLS.




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The GoR has demonstrated a high level commitment to fight HIV/AIDS, through
a multi-sectoral response, involving a multidimensional and community based
approach. The creation of the National AIDS Control Commission (CNLS) in 2001,
and subsequent creation of the decentratilized coordination structures and the
umbrella organizations has enabled a harmonized coordination of the
implementation of HIV/AIDS interventions in the country.

To facilitate effective coordination of monitoring and evaluation of national
response to HIV/AIDS, the CNLS has developed a National HIV/AIDS Monitoring
and Evaluation Implementation Plan Part I that is a basis of enhancing national
HIV Monitoring and Evaluation (M&E) system. The following issues make the
establishment of a functional HIV M&E system mandatory in Rwanda:

    The GoR’s commitment to scale up existing HIV/AIDS interventions and
    effectively coordinate the same requires a comprehensive M&E system that
    would provide accurate and reliable data in a timely manner for decision
    making and targeting;

    There are different players and stakeholders who invest resources into
    HIV/AIDS programmes and are operating in different parts of the country.
    Tracking progress of their interventions and impact they are making requires
    a functional national HIV M&E system;

     Currently, there are many sources of funding for HIV/AIDS programmes in
    Rwanda, including bilateral agencies, the Global Fund to fight AIDS,
    Tuberculosis and Malaria, the World Bank’s Multi-country Programs (MAP) for
    Africa and the USA Presidential Emergency Plan for AIDS Relief (PEPFER). In
    this era of accountability and transparency, stakeholders and development
    partners within and outside the country demand effective performance and
    transparency in the use of funds. Besides, they demand to see what kind of
    outcomes and impacts are created by the invested resources. A functional
    HIV M&E system is essential in meeting these demands.

From this perspective, a functional national M&E system becomes a core
business in national response to HIV/AIDS. A functional system must be put in
place as: a source of information on the progress being made under various
interventions in the country. ii. A management tool for the CNLS and various
implementers at both national and district levels, across different public and
private sectors.

After many consultations with different stakeholders, the national M&E
Conceptual framework for the Multi−sectoral response to HIV/AIDS in RWANDA
is now finalized. The framework will be followed by the development of an M&E



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operational manual (users’ guides) targeting implementers of HIV/AIDS
interventions in the country.

The execution of this national HIV/AIDS M&E Plan requires human, financial and
physical resources. There is need, therefore, to build consensus on investment
strategy for enhancing national HIV M&E system. In this regard, all stakeholders
are reminded to give due emphasis to the M&E system by allocating enough
resources and enhancing the capacity of their own staff through training and
sharing their experiences and best practices.

Finally, I would like to take this opportunity to thank the development partners,
organizations and individuals that supported the development and finalization of
the National HIV/AIDS M&E Framework.


Dr Agnes BINAGWAHO
Secretary Executive of the CNLS




                                                                             viii
Organization of the Document

The National HIV and AIDS Monitoring and Evaluation Plan Part I
provides the conceptual framework and defines the Rwanda National HIV
Monitoring and Evaluation (M&E) System. This conceptual document is divided
into 6 Sections.

      Section I presents an overview of HIV/AIDS status in Rwanda, the
      principles and process of the development of this document and the
      logical framework in the M&E system;

      Section II describes the national HIV M&E system including the
      implementation strategy, institutional framework and national HIV
      indicators;

      Section III presents data collection strategy, data sources, information
      products and reporting levels/data flow;

      Section IV describes the role of different stakeholders: CNLS, CDLS,
      public sector, research institutions, and umbrella organizations, in
      HIV/AIDS M&E and coordination mechanisms; and

      Section V describes dissemination and use of data/information for
      decision making and evidence-based planning of HIV/AIDS activities in the
      country.

      Section VI describes the harmonization the national M&E plan and
      presents the framework for strengthening the CNLS M&E system,
      including specific areas of intervention, the indicative budget
      and sources of funding.

aof
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P this document (an operational manual / users’ guide) will be
    developed and published at a later date. This will be a technical
    document describing each data source, its data flow and
    frequency. The document will also have a costed national ‘road-
    map’ – detailed operational (work) plan for M&E at decentralized
    levels. It will also have formats of required information products.




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1.0     National HIV M&E Conceptual Framework

1.1     Overview of HIV/AIDS Status in Rwanda

The third Demographic and Health Survey conducted in 2005 indicates that in
Rwanda 3% of the people live with HIV. The data shows that women are
particularly vulnerable to HIV infection. About 3,6 per cent of women are
infected compared with 2,3 per percent of their male counterparts. Prevalence
rates according to rural and urban settings show a higher infection in urban
areas 7,3 percent compared to 2,2 percent in rural population. Kigali city showed
a comparatively highest proportion of population infected with HIV with 5,6
percent, followed by the Western Province 3,2 percent, Southern Province 2,7
percent, Eastern Province 2,5 percent and Northern Province with 2,2 percent.
According to TRAC report, January 2005, the prevalence rates from the sentinel
surveillance sites were between 2-4% in rural areas and 7-11% in urban areas. .
A nationwide PLACE study in 2005 shows that age of sex debut is less than 20
years, with important urban-rural differences in the selected sites. For youth
aged 15-19, 57 percent males and 60 percent females in urban areas started
sexual relations, compared with 44 percent males and 47 percent females in
rural areas. Likewise, use of condom is still low. The study indicates that many
young people are still engaged in risky sexual behaviour, for example, it is
indicated that during the last sexual intercourse, 75 percent males and 71
percent females in urban areas reported condom use, compared to 21 percent
males and 13 percent females in rural sites. Quantitative information about other
vulnerable groups such as refugees and prisoners are not readily available. This
also applies to most at risk populations such as MSM, sex workers and IDUs.

1.2     National Strategic Framework for HIV/AIDS

The National AIDS Control Commission (CNLS) has, in consultation with
stakeholders in the country, developed documents to guide the national response
to HIV/AIDS. These include the following:

      The National Strategic Framework for HIV/AIDS Control (2002-2006) and its
      operational Multisectoral National Plan for HIV/AIDS response;

      National HIV/AIDS Monitoring and Evaluation Plan 2002-2006;

      The revised National Strategic Framework for HIV/AIDS Control (2005-2009);
      and




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   The National Policy on HIV/AIDS (2005-2009).

In addition, several strategies and policies have been developed to respond to
specific thematic areas in an endeavor to prevent the chain of transmission of
the epidemic, treatment, care and support to infected and affected people as
well as improving socio-economic status of PLWA and other vulnerable groups.

Following the recommendations of the joint Mid-Term Review (MTR) of the
implementation of the National Multi-sectoral Plan for HIV/AIDS response (2002-
2006) concluded in January 2005, the is now a revised National Strategic
Framework for the program cycle of 2005-2009. The new Strategy has five
strategic components. These are as follows:

1. Reinforce measures of preventing HIV/AIDS transmission; with the
    following intermediate results:
I.1      Change (reduce) high risk sexual behavior (in the population);
I.2      Change behavior of health personnel to reduce the
        transmission of HIV/AIDS, STI, OI and TB;
I.3      Reduce transmission of HIV through medical prophylaxis; and
I.4      Create a cultural environment more favorable to preventing HIV and STI
         transmission.

2. Assure that the national response to HIV and AIDS is adapted to
     Rwanda’s evolving socio-economic & health conditions by using
     of surveillance and research results, with the following intermediate
     results:
II.1 Increase the usefulness of surveillance results with respect to the national
     response to HIV and AIDS;
II.2 Increase the usefulness of research results, studies and evaluations;
II.3 Facilitate the interpretation and use of surveillance and results for
     and by all stakeholders.

3. Improving HIV/AIDS-related treatment for persons infected and
      affected by AIDS; with the following intermediate results:
III.1 Increase access to high quality care and treatment at health facilities;
III.2 Increase access to high quality community-based care and treatment;
III.3 Assure that HIV/AIDS related care and treatment is sustainable.

4. Mitigate the socio-economic impact of HIV and AIDS, with the
      following intermediate results:
IV.1 Improve the social and economic conditions in Rwanda (and ensure
      vulnerable groups benefit as much as others);
IV.2: Defend and promote human rights; and
IV.3 Strengthen decision making capacities of associations involved in



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       HIV/AIDS notably through the concept of GIPA.

5.      Coordination of the Multi-sector response for increased cost-
        Effectiveness, with the following intermediate results:
V.1:    Improve the capacities of national HIV/AIDS coordination structures;
V.2:    Assure that HIV/AIDS strategies within national sector plans are
        Implemented;
V.3     Increase HIV/AIDS related regional initiatives that are jointly executed;
V.4.    Assure that intervention agencies benefit from national planning and
        monitoring as much as the coordination agencies; and
V.5     Jointly evaluate the multi-sectoral response to HIV and AIDS.


1.3 Principles of Developing an M&E Plan

Based on the nature of national response to HIV and AIDS and being committed
to the “Three Ones” principles, various partners at both national and
decentralized levels are committed to the development and operation of a
national HIV Monitoring and Evaluation (M&E) system. The following principles
guided the
development of the national HIV M&E Plan:

o      Building strategic dialogue and partnership for M&E: The multi-
sectoral approach to national response to HIV and AIDS builds on a continuous
dialogue and partnership among various stakeholders. This principle also applies
to the development of a functional national HIV M&E system.

o      Mainstreaming M&E into HIV/AIDS Programme: National HIV M&E
system will be mainstreamed into the national HIV and AIDS programme.
Enough financial resources will be mobilized and allocated for the establishment
of a functional M&E system.

o      Standardized core national system: A comprehensive national system
will have core national indicators and a standardized system / tools that would
enhance data collection, analysis, and production of national information
products for dissemination to various stakeholders at the international, national
and districts levels.

Simplicity: Simplicity will guide data collection, analysis and dissemination of
information products to various stakeholders. This is to make data user friendly
and simple to use for decision making and programming.

o      Data Quality Assessment (DQA): A good M&E requires both internal
self-assessment and external verification of data/information. Thus,



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implementing partners will collect their own data but an external agency, in this
case the CNLS, will put in place DQA protocols to verify the completeness and
accuracy of the data collected. Consensus must be built on supervision visits for
both internal assessment and external verification of primary data.

o       Action Orientation:       Data colleted at the district or national levels
will be used for decision making and programming of HIV/AIDS interventions.
There will be a direct link among data collection, analysis, and decision making at
all levels of programme implementation.

o      Timeliness and Reliability of Data: Data collected, disseminated and
used through a good M&E system will be timely and reliable. All the
implementing partners will be required to be transparent and accountable to the
internal M&E system they have and the data they collect and provide to the
CDLS and CNLS.

These principles are to be put in mind all the time when any M&E activity is
planned for, undertaken or reviewed.


1.4     Methods/Approaches for the Development of the M&E Plan

Participatory and qualitative methods were used to develop this plan. This
participatory process was coordinated by the CNLS M&E Unit and was
spearheaded by the M&E Technical Working Group (TWG). An External
Consultant provided technical Assistance to the process. Specifically the
approaches used included the following:

      Review of both national and international documents on HIV/AIDS in general
      and M&E in particular. The documents included the National HIV/AIDS
      Strategic Framework 2005-2009; Annual M&E Report, 2005; DHS Report,
      UNGASS Report, UNAIDS Monitoring and Evaluation Modules, 2000; 2003;
      National HIV/AIDS Monitoring and Evaluation Plans for Ethiopia, Ghana,
      Kenya, Malawi and Uganda.

      Consultative meetings with the CNLS management and M&E focal persons to
      assess the M&E needs and build consensus on the way forward for the plan
      and strengthening the M&E system.

      Consultative meetings with members of the M&E Technical Working Group
      and various stakeholders from the umbrella groups, civil society and the
      development partners. This was to establish the M&E gaps and needs and
      build consensus on the M&E plan and how to strengthen national HIV M&E
      System.



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      A one day consultative and technical workshop with members of the M&E
      Technical Working Group was held to review draft plan and input into it.

      A one day national review meeting was also held, bringing together
      stakeholders from both the public and private sectors, the civil society
      organizations and the development partners, where the Draft plan was
      presented, discussed and consensus built on its content.

1.5     Logical Framework in M&E
There is a simple distinction between monitoring and evaluation. Monitoring is
the routine, regular assessment of ongoing activities and progress being made in
a programme or project. On the other hand, evaluation is the episodic
assessment of overall achievements and the extent to which they can be
attributed to specific interventions. In short, monitoring looks at what is being
done while evaluation examines the effectiveness of what is being done.
Evaluation draws from data generated by the monitoring system and links this to
primary beneficiaries to determine the impact of programmes. Monitoring must
be integrated within the programme management structure, whilst evaluation
with its comparative characteristics may not need such integral component.

An effective M&E system has a clear logical pathway of results which encompass
the major levels that include inputs, outputs, outcomes and impacts. Tables 1
and 2 demonstrate these interconnections where:
   i. Inputs are the people, training, equipment and resources that are put
      into a programme in order to achieve the delivery of services;
   ii. Outputs are the activities or services delivered, including HIV/AIDS
       prevention, care and support services, in order to either improve the well
       being of beneficiaries or change their behaviors;
   iii. Outcomes are changes in behavior or skills, especially safer HIV
        prevention practices and increased ability to cope with AIDS;
   iv. Impact is, for example, measurable health changes that are associated
       with outcomes, particularly reduced STI/HIV transmission.




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Table 1:     M&E Results Pyramid




Table 2:    M&E Results Pathway




           Input                   Output                Outcomes                Impact
      (Resources)              (Service Delivery)       (Intermediate           (Long-term
                                                            Effects)              Effects)




                           #   Staff Trained
           Staff                                       Provider Behavior   HIV Incid/Prev
                           #   Condoms Distributed
           Funds                                       Risk Behavior       Quality of Life
                           #   Test Kits Distributed
           Materials                                   Service Use         Social Norms
                           #   Clients Served
           Facilities                                  Behavior            STI Incid/Prev
                           #   Tests Conducted
           Supplies                                    Clinical Outcomes   AIDS Morb/Mor




                        Program-based Data                 Population-based Biological,
                                                             Behavioral & Social Data




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2.0 HIV NATIONAL MONITORING & EVALUATION
    IMPLEMENTATION STRATEGY

2.1    Purpose of National HIV M&E System

The goal of a National Multisectoral HIV Monitoring and Evaluation System is to
enable the CNLS and its partners to monitor the spread and impact of the
HIV/AIDS epidemic in Rwanda, to monitor the efficiency of the national response
to HIV, and to evaluate the effectiveness of the national response to HIV,
providing relevant and accurate HIV data for use in planning effective
interventions.
The specific objectives of the national M&E System are to:
•   Develop clear M&E strategies that will enable systematic collection of data
    that can be used to detect changes in the epidemic and effects of
    interventions (efficiency and effectiveness) and then inform and guide the
    national HIV response;

•   Define the roles of stakeholders – the CNLS, Ministries, Departments and
    Agencies, local government, networks and umbrella organizations and Civil
    Society organizations (CSOs) – in the systematic collection, collation, analysis
    and use of HIV data in order to avoid duplication of efforts;

•   Improve information sharing and dissemination of information and the use of
    data in planning interventions;

•   Promote creation of partnerships and linkages between various development
    stakeholders at the various levels of implementation;

•   Promote coordination of HIV services, and ensure equity in the provision of,
    access to and utilization of HIV services; and

•   Monitor the success of the national response as well as identifying lessons
    learnt and best practices for scaling up.




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The UNAIDS has provided Checklist of Features of a good and functioning M&E
system, which CNLS is committed to use in strengthening the national HIV M&E
System. These are summarized in Panel 1:

Panel 1: Checklist of Features of a Good and Functioning National M&E
System
-------------------------------------------------------------------------------------------
M&E Unit:
         An established and functional M&E Unit with qualified staff and adequate funding
and equipment. Such a unit has to be formally linked to the research institutions and
leading NGOs, development partners and NGOs. The unit should be able to process data
and package and the dissemination of information to various stakeholders.
------------------------------------------------------------------------------------------------------------
Clear Goals
         There has to be a clear and well-defined national HIV/AIDS programme with
clear goals, targets and implementation plan, where regular and participatory reviews
and evaluations of progress are undertaken on a regular basis. There are guidelines and
guidance to districts and linking M&E to other sectors. Besides, there is coordination of
the national and donor M&E needs.
------------------------------------------------------------------------------------------------------------
Indicators:
         A set of agreed upon routine and periodic indicators at different levels. Indicators
must be comparable over time, and a number of key indicators that are comparable with
other countries.
------------------------------------------------------------------------------------------------------------
Data Collection and Analysis:
         A national level data collection and analysis plan, including data quality
assurance plan. There has also to be a plan to collect data and analyze indicators at
different decentralized levels. There has to be second generation surveillance, where
behavioral data are linked to HIV/STI surveillance data.
------------------------------------------------------------------------------------------------------------
Data Dissemination:
         There has to be a national level data/information dissemination plan. This can be
in the form of a well-disseminated, informative annual report of the M&E unit, annual
meeting to disseminate and discuss M&E and research findings with policy-makers and
planners, a centralized data bank and library of all HIV/AIDS/STI-related data collection,
including on-going research, and a coordination of national and development partners’
M&E needs.

Source: Adapted from UNAIDS et al. (June 2000). National Aids Programme: A
       Guide to Monitoring and Evaluation. Geneva, Switzerland.


The Rwanda National HIV/AIDS M&E System is depicted in Diagram 1
below.




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Diagram 1: National HIV/AIDS M&E System

                                              National HIV/AIDS Strategic
                                              Framework


                                                                                  Basis for


                                                   National HIV/AIDS M&E
                                                   System
     A. National
        M&E
     Framework                      Priority Indicators:- To Assess Impact                                   E.    Stakeholders
                                                          To Assess Outcome                                  •    At National and
                                            Monitoring Programme Outputs
                                                                                                                  District levels:

     M&E Operational                                                                                         - Government
     Manual / Guides                        F. HIV/AIDS Domain                                     Provide   - Development partners
                                                                                                  funding    - Umbrella organizations
                                              Interventions:
                                            Promotion of ABC. Surveillance & research                        - Civil Society
                                            BCC.               . Care, Support & treatment
                                            VCT / PMTCT.      . Legal & human rights
                                                                                                               Organizations
                                            Coordination. Support to PLWHA. Capacity Bld.        And/Or      - NGOs
      B. Data Sources:
      BSS, program monitoring                                                                   Implement    - CBOs
      data, special studies, etc.                                        M&E results used to
                                                                        enhance interventions


      C.                                     D. Information Products:
                                                                                                                    Disseminated to
       CNLS: M&E Unit >                     Service coverage report. M&E Annual
                                                                                                                    stakeholders
            Develops                        Report. Research report. UNGASS report




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2.2    Rwanda National M&E Institutional Framework

As of 1st January 2006, the geo-political landscape in Rwanda changed when the
Government of Rwanda implemented its decentralisation policy. The 106 districts
and 12 provinces were amalgamated into 30 districts, and powers decentralised
to these 30 districts. With decentralisation in mind, the CNLS has disbanded the
CPLSs and created new CDLSs (District AIDS Coordinating Committees). For
now, the Commission has agreed with government that there will be one officer
at the district level to coordinate the HIV response. Besides, there is also one
office in charge of M&E / data at this level. There are also several NGOs running
program activities at both national and district levels. Besides, there are some
initiatives within the private sector.

In essence, the CNLS’s decentralisation implies: first, that all implementers of
HIV/AIDS interventions are to submit work plans in a standard format to the
districts, and report on the progress in the implementation of these work plans;
and, second, that all HIV interventions will be planned, coordinated and
monitored at the district level. Decentralization is to allow districts and
communities to focus on their unique challenges and activities specific to their
region as far as HIV/AIDS is concerned.

From this decentralization policy and a multi-sectoral approach to addressing
AIDS pandemic, the National M&E Institutional Framework / Structure is divided
into four levels for efficiency and effectiveness of monitoring and evaluating the
national response. These levels include the following: The National Level,
District Level, Ministries/Public Sector Level and NGOs/Private Sector Level.
Although described separately, these levels are linked and form an integral part
of the national response package.


2.2.1 National Level
The National AIDS Control Commission, CNLS, has the mandate of coordinating,
monitoring and evaluating the national response to HIV/AIDS in the country. The
Directorate of Planning, M&E, and Coordination, supported by the M&E Focal
Person and Data analysts are responsible for M&E. The CNLS has also created a
national HIV and AIDS M&E Technical Working Group (TWG), whose members
are the M&E experts from the UN agencies, multilateral and bilateral agencies,
CNLS umbrella organizations from the public and private sectors, academic and
research experts. This team is charged with the responsibility of providing
technical assistance in the course of implementation of the national monitoring
and evaluation roadmap, and providing training to the coordinating structures,
implementing agencies and stakeholders in M&E of programmes.




                                                                               12
The CNLS is developing a SQL database to capture all indicator information at
the district level. This database is functional, although it needs strengthening.


2.2.2   District Level
The District AIDS Coordinating Committees (CDLSs) will be chaired and
coordinated by one official in each of the 30 CDLS that have been created. There
will also be an officer in charge of M&E at this level. CDLS will monitoring and
evaluating HIV/AIDS program activities implemented by different players
including the public sector, NGOs, CBOs and the private sector operating at the
district level. They are also in-charge of submitting program activity data to the
CNLS. Other roles include the following:

-       Organizing district M&E dialogues involving programme implementers and
        communities; and
-       Participating in national M&E dialogues and reviews.

2.2.3   Ministries/Public Sector Level
HIV/AIDS is expected to be mainstreamed in each ministry, department and any
public sector in the country. Thus, there will be HIV/AIDS control units or
sections in each ministry and all public institutions. The role of these units is to:

-       Develop and mainstream HIV/AIDS activities at ministerial /public
        institution / organization level;
-       Monitor implementation of activities and progress being made as per the
        ministerial/public sector plan;
-       Submit HIV/AIDS activity data to the CNLS;
-       Participating in national M&E review dialogues; and
-       Contributing to annual M&E reports.

The role of TRAC and other research institutions is as follows:

♦       Development of policy, standards and directives 9on research;
♦       Development and dissemination of guidelines and training modules;
♦       Training of trainers;
♦       Supervision of research at the district level;
♦       Coordination of research on STI, OI, VCT/PMTCT, TB and care by ARV,
        Socio- behavioral aspects;
♦       Submitting data to MoH and the CNLS.




                                                                                  13
2.2.4 National Level NGOs, Faith Based Organization, Umbrella
       Organizations & the Private Sector Level
The national NGOs and umbrella organizations will be in-charge of monitoring
their own HIV/AIDS activities, lobbying and mobilizing resources for such
activities. Those NGOs/CBOs at the district level will be in charge of monitoring
programme activities and outputs, collecting and analysing activity data, and
providing / submitting the same to the CDLS in an agreed format. Specifically
there roles include the following:

-     Coordinate and mainstream HIV/AIDS activities in their specific
      organizations and umbrellas at different levels in the country;
-     Monitor and evaluate programme / projects outputs and progress being
      made as per the agreed objectives;
-     Submit HIV/AIDS programme activity data and information products to
      the CDLS and CNLS;
-     Participating in the national M&E review dialogues; and
-     Contributing to annual M&E reports.

2.3   Indicators for Monitoring and Evaluation of national response to
      HIV and AIDS

Core national indicators were selected for inclusion in this framework in a
participatory manner. This framework contains both the 62 national top priority
indicators and the additional ones as per the Axes (Table 3). Annex 1 presents
the indicators, the data sources and the operational definitions for the indicators.

The National M&E system has primarily two types of indicators. They include the
following:

1. Impact/outcome-level indicators (to measure the long-term and intermediary
   results in the results framework); and
2. Output/input-level indicators (to measure the activities that have been
  implemented under each domain).

These two types of indicators are complementary. Further more, all the
indicators are divided into two categories – medical-related indicators that focus
on those efforts driven by the health sector (i.e. those activities that take place
at health facilities and in the Ministry of Health and that is being collected by
TRAC), and community-related indicators that measure all other efforts in HIV
prevention, care, support and impact mitigation that takes place within
communities (not at health facilities).




                                                                                 14
Table 3: Indicators for Monitoring and Evaluation of national response to HIV and AIDS
                 Result1, Intermediate Result (IR), sub-IR               Core2                                             Indicator
    Axes
                          (domain d’intervention)

Assessing Impact
 Axe    Result: Reinforce measures of preventing                                  Indicator 1: Change in prevalence of HIV/AIDS in people aged 15-24
   I    HIV/ AIDS transmission                                                    years
                                                                                  (this is best proxy for change in incidence of HIV/AID for people 15-49)
Assessing Outcomes
Axe I   IR I.1; Change high risk sexual behavior (in                     c        Indicator I.1a Change in percentage 15-24 year-olds reporting condom
        the population)                                                           use last time they had sex with non-marital non-cohabitating partner
                                                                                  (this is measure of protected sex)

Axe I          IR I.1                                                    a        Indicator I.1b Change in percentage 15-24 year-olds reporting sex with
                                                                                  non-marital, non-cohabitating partner last 12 months
                                                                                  (this is measure of fidelity)
Axe I    IR I.2 Change behavior of health personnel to                   c        Indicator I.2. percent of facilities where team is practicing safe injections
         reduce transmission of HIV/AIDS, STI,OI and
         TB
Axe I    IR I.3 Reduce the transmission of HIV                           c        Indicator I.3 Proportion of all HIV+ pregnant women given medical
         through medical prophylaxis                                              prophylaxis
Axe I    IR I.4; Create a culture environment more                       c        Indicator I.4; Number of MSC stories that address change in cultural
         favorable to preventing HIV & STI                                        environment more favorable to preventing HIV & STI transmission
         transmission
Monitoring Programme Outputs
Axe I    Sub-IR I.1.1 Promote EABC (through IEC for                       c       Indicator I.1.1 Number of new messages that promote EABC
         behavior change)
Axe I    Sub-IR I.1.2 Increase access to and use of                       c       Indicator I.1.2a Number of condoms sold or distributed to end users
         condoms
1
    Result is IMPACT level; Intermediate Result = outcome level and Sub-IR = output level
2
    Core legend: c=indicator is included as top priority; a=additional indicator as per Axes




                                                                                                                                                      15
         Result1, Intermediate Result (IR), sub-IR     Core2                                           Indicator
 Axes
                  (domain d’intervention)

Axe 1                                                      a   Indicator I.1.2b Number of social marketing distribution points for
                                                               condoms.
Axe I   Sub-IR I.1.3 Educate youth on sexual           c       Indicator I.1.3; number schools that receive sex education and/or life-
        responsibility                                         skills curriculum AND teachers are trained in its use
Axe I   Sub-IR I.1.4 Increase the number of people     c        Indicator I.1.4 # of persons tested who come back to VCT centers for
        in the population that know their HIV/                 results
        serological status (Voluntary Counseling &
        Testing)
Axe I   Sub-IR I.1.5 Increase the proportion of the    c       Indicator I.1.5 Number of new messages targeting an increase in
        population that knows the causes, symptoms             knowledge of symptoms of STI, OIs and TB.
        and consequences of STI, OIs and TB


Axe I   Sub-IR I.2.1 Adopt universal precautions in    c       Indicator I.2.1 number of health care personnel who are trained in
        health care-related establishments                     Universal Precautions (UP)
Axe I   Sub-IR I.2.2 Adopt provider-initiated          c       Indicator I.2.2 # of persons who receive treatment for STI
        diagnosis of STIs, OIs and TB
Axe 1   Sub-IR I.2.3 Adopt blood safety measures       a       Indicator I.2.3 % transfused blood units which were screened in last 12
                                                               months

Axe 1   Sub-IR I.3.1 Motivate more pregnant women      a       Indicator I.3.1 # of pregnant women who use PMTCT services
        and their partners to use PMTCT services
Axe I   Sub-IR 1.3.2 Increase access to high quality   a       Indicator I.3.2 Number of PMTCT sites using national protocol
        PMTCT services
Axe I   Sub-IR I.3.3 Assure Post Exposure              a       Indicator I.3.3 Number of public health facilities (FOSA) which have PEP
        Prophylaxis (PEP) for health care personnel            kits available
Axe I   Sub-IR I.3.4 Assure PEP for rape victims       a       Indicator I.3.4 Percentage of providers trained in identification, care and
                                                               treatment of rape victims




                                                                                                                                 16
           Result1, Intermediate Result (IR), sub-IR      Core2                                          Indicator
 Axes
                    (domain d’intervention)

Axe I     Sub-IR I.4.1 Promote (the retention of)         c       Indicator I.4.1 Number of new messages targeting retention of Rwanda
          Rwandan cultural practices that contribute to           cultural practice that contribute to preventing HIV, STI transmission
          preventing HIV and STI transmission

I.4.2a    Sub-IR I.4.2 Promote abandoning Rwandan         a       Indicator I.4.2 Number of new messages targeting abandoning cultural
          cultural practices that contribute to the               practices that contribute to the transmission of HIV and other STIs
          transmission of HIV and other STIs

Assessing Impact
         Result II: National response to HIV/AIDS                 Indicator II; Number of strategic planning/policy documents that have
 Axe     adapted to Rwanda’s conditions and                       references or citations of Rwanda-specific surveillance or research
   II    surveillance/research results                            documents.
Assessing Outcomes
Axe II   IR II.1 Increase the usefulness of               c       Indicator II.1 Number of articles submitted with a Rwandan among 1st 3
         surveillance results with respect to the                 authors to peer-review journals using HIV/AIDS related surveillance
         national response to HIV/AIDS                            and/or research data results.
Axe II   IR II.2 Increase the usefulness of research      c       Indicator II.2 Number of documents which reference Rwanda-specific
         results, studies and evaluations                         research or surveillance.
Axe II   IR II.3 Improve ability of stakeholders to       c       Indicator II.3; Number of MSC stories that address stakeholder ability to
         interpret and use surveillances and research             interpret and use surveillance and research results
         results
Monitoring Programme Outputs
Axe II   Sub-IR II.1.1 Improve national systems for       a       Indicator II.1.1a Percentage of all AIDS-related deaths that are reported
         case notification of morbidity and mortality             through national health information system
         related to AIDS
Axe II   Sub-IR II.1.1                                    a       Indicator II.1.1b Number of medical and non-medical people trained to
                                                                  accurately determine causes of deaths
Axe II    Sub-IR II.1.2 Establish a sustainable           c       Indicator II.1.2 annual report on behavioral change using National BSS
          behavioral surveillance system                          and other behavioral studies is regularly disseminated




                                                                                                                                   17
           Result1, Intermediate Result (IR), sub-IR      Core2                                           Indicator
 Axes
                    (domain d’intervention)

Axe II.   Sub-IR II.1.3 Improve the HIV sero-             a       Indicator II.1.3 Nat’l surveillance reports include prevalence of infections
          surveillance by including other HIV/AIDS                other than HIV
          related diseases

Axe II    Sub- II.1.4 Improve pharmacological             c       Indicator II.1.4 Annual report of HIV types (I, II) in Rwanda and level of
          sensitivity surveillance to improve AIDS                resistance to treatment « lignes” 1, 2, 3 used in Rwanda
          treatment

Axe II    Sub-IR II.1.5 Improve the statistical and       c       Indicator II.1.5 Number of Rwandans involved in surveillance that are
          analytic competencies of surveillance                   trained in statistics and data analysis
          technicians

Axe II    Sub-IR II.2.1 Improve the methodological        c       Indicator II.2.1 Number of Rwandans trained in research methodologies
          competencies of researchers

          Sub-IR II.2.2 Improve the statistical and       a       Indicator II.2.2 Number of Rwandans researchers that are trained in
Axe II    analytical competencies of researchers                  statistics and data analysis

          Sub-IR II.2.3 Involve people to be studied in   a       Indicator II.2.3 The number of protocols executed that include
Axe II    the identification, design and execution of             participation of the population that is being studied
          research
          Sub-IR II.3.1 Promote and facilitate the        c       Indicator II.3.1 number of new research studies disseminated at the
Axe II    routine availability of surveillance and                national annual research exchange conference
          research results
Axe II    Sub-IR II.3.2 Improve the analytical capacity   a       Indicator II.3.2 Number of non-technical persons trained in data analysis
          of all levels of beneficiaries and decision             and interpretation with Rwanda specific exercises or examples
          makers
Axe       Sub-IR II.3.3 Strengthen the capacity of        a       Indicator II.3.3 Number of people (technical and non-technical) trained in
          technicians and stakeholders to present                 data information presentation with Rwanda specific exercise or example
          results in various more useable formats




                                                                                                                                     18
           Result1, Intermediate Result (IR), sub-IR     Core2                                            Indicator
 Axes
                    (domain d’intervention)

Assessing Impact
        Result III: Improve HIV/AIDS treatment,                  Indicator III
 Axe    care and support for persons infected and                 Percentage of persons on ART that are alive 12 months after starting
  III   affected by HIV and AIDS                                 treatment

Assessing Outcomes
Axe III IR III.1 Increase access to high quality care    c       Indicator III.1 Percent of male and females with advanced HIV/AIDS
        and treatment at health facilities                       infection receiving ARV combination therapy

Axe III   IR III.2 Increase access to high quality the   c       Indicator III.2 Percent of eligible households that receive Rwanda’s
          community- based care and treatment                    minimum package (or more) of community-based services in their home
Axe III   IR III.3 Assure that HIV/AIDS related care     c       Indicator III.3 Number of objectives in the national sustainability plan that
          and treatment is sustainable                           are reached

Monitoring Programme Outputs
Axe III Sub-IR III.1.1 Assure equitable coverage of      c       Indicator III.1.1 % of health care and other facilities that are treating
         ART services with accent on pediatric care              HIV+ infants and adults according to national norms and procedures

Axe III   Sub-IR III.1.2 Improve treatment of OIs        c       Indicator III.1.2 % of all service providers trained in diagnosis and
          according to national norms and procedures             treatment of OI according to national guidelines
          Sub IR III.1.3 Reduce the real cost of         c       Indicator III.1.3 % of people that are TB+ who receive TB therapy
Axe III   accessing HIV/AIDS related care and
          treatment
          Sub IR III.1.4 Promote the approach            a       Indicator III.1.4 % of all service providers trained in diagnosis and
Axe III   “Provider Initiated Diagnosis” (PID)                   treatment of PID according to national guidelines
          Sub IR III.1.5 Improve the collaboration and   a       Indicator III.1.5 Number of joint sessions/meetings between medical
Axe III   the service referrals between health care              corps and community health care providers
          providers and community agents




                                                                                                                                     19
           Result1, Intermediate Result (IR), sub-IR       Core2                                           Indicator
 Axes
                    (domain d’intervention)

          Sub-IR III.1.6 Improve therapeutic nutritional   c       Indicator III.1.6 # of FOSA with capacity (trained personnel and
Axe III   support for people on ART                                equipment) to provide nutrition therapy as part of in-patient support to
                                                                   HIV/AIDS patients
Axe III   Sub-IR III.1.7 Integrate care and treatment of   a       Indicator III.1.7 % of health insurance providers (mutuelles de sante)
          OIs among other illnesses supported through              that have included OI in the list of illness covered
          health mutuals
Axe III   Sub-IR III.1.8 Strengthen health care            a       Indicator III.1.8 % of all employees working at FOSA trained in quality
          providers’ capacity to deliver the highest               assurance
          quality care.
Axe III   Sub-IR III.2.1 Assure equitable coverage of      a       Indicator III.2.1 percent of administrative sectors in which home-based
          community- based care and treatment                      care is provided
          services
          Sub-IR III.2.2 Improve the community-based       c       Indicator III.2.2 # of HIV+ people assisted in their homes for ART
Axe III   care and treatment of people living with                 adherence
          HIV/AIDS (medical, psychosocial and
          spiritual)
Axe III   Sub-IR III.2.3 Strengthen the technical          c       Indicator III.2.3 # of people trained in techniques for HIV/AIDS home
          capacity of people and organizations                     based care.
          providing community-based care and support
Axe III   Sub-IR III 2.4 Integrate home-based care and     c       Indicator III.2.4 # homes visited regularly by trained MOH Program
          treatment for PLWHA within community-                    d’Animateur de Sante (PAS) agents for HIV/AIDS-related care
          based health services                                    .
Axe III   Sub-IR III.2.5 Develop and standardize out-      a       Indicator III.2.5 # of rural administrative sectors visited by mobile
          patient and mobile treatment services                    treatment units that adhere to national standards and protocols
Axe III   Sub-III.2.6 Improve the nutritional status of    c       Indicator III.2.6 # of homes of PLWHA that are provided with nutritional
          people infected and affected by HIV/AIDS                 and/or food security support

Axe III   Sub-IR III 3.1 Improve decentralized                     Indicator III.3.1 # of FOSA that report no stock-outs for ARV or AZT or
          HIV/AIDS related procurement, management         a       IO
          and distribution systems (equipment, regents,
          consumable, medicine etc,)




                                                                                                                                      20
           Result1, Intermediate Result (IR), sub-IR   Core2                                           Indicator
 Axes
                    (domain d’intervention)

Axe III Sub-IR III.3.2 Increase Rwandan human          a       Indicator III.3.2 # of health care providers at FOSA qualified to provide
        resources needed for HIV/AIDS-related care             AIDS, OI or STI treatment
        and treatment
Axe III Sub-IR III.3.3 Establish system to supply      a       Indicator III.3.3 # of administrative sectors reporting no stock-outs of
        communities with required materials                    home-based care kits.
Axe III Sub-IR III.3.4 Execute a national plan to      a       Indicator III.3.4 % of activities in the annual operation plan of the
        assure that the expanded quality global care           national sustainability plan that are completed.
        and treatment is sustainable.
Assessing Impact

 Axe      Result IV: Mitigate the socio-economic               Indicator: Change in GDP
  IV      impact of HIV and AIDS

Assessing Outcomes
Axe IV  IR IV.1 Improve the socio-economic                     Indicator IV.1a Per capita income
        conditions in Rwanda (and assure vulnerable    c
        groups benefit as much as others)
Axe IV  IR IV.2 Defend and promote human rights        c       Indicator IV.2 number of cases that come to court claiming violation of
                                                               human rights with respect to HIV/AIDS have been used.

Axe IV   IR IV.3 Strengthen decision making            c       .
         capacities of associations involved in                Indicator IV.3 Number of organizations including PLWHA in their
         HIV/AIDS notably through the concept of               policy/planning development and program assessment.
         GIPA (Greater Involvement of People living
         with HIV/AIDS)
Monitoring Programme Outputs
Axe IV Sub-IR IV.1.1 Create employment                         Indicator IV.1.1 % of vulnerable people (members of associations of
         opportunities in particular for vulnerable    c       PLWHA ) who are unemployed
         groups




                                                                                                                                  21
          Result1, Intermediate Result (IR), sub-IR     Core2                                          Indicator
 Axes
                   (domain d’intervention)

Axe IV   Sub-IR IV.1.2 Assure access to credit for      c       Indicator IV.1.2a # of new loans given to vulnerable people (PLWHA)
         vulnerable groups

         Sub-IR IV.1.2                                  a       Indicator IV.1.2b total value of new loans given to vulnerable people
                                                                (PLWHA)

Axe IV   Sub-IR IV.1.3 Improve the equity and           a       Indicator IV.1.3 Female to male ratio of all grants and loans given to
         equality between women and men regarding               PLWHA for income generating activities given to PLWHA
         income generating activities and employment
         opportunities
Axe IV   Sub IR IV.1.4 Improve access to formal and     c       Indicator IV.1.4 # of OVCs and PLWHA supported to attend schools or
         informal education for target groups with an           receive vocational or literacy training
         accent on PLWHA and OVC
Axe IV   Sub-IR IV.2.1 Improve the judicial             c       Indicator IV 2.1 # of laws revised, adopted or repealed to ensure that
         environment for PLWA and OVC                           OVC and/or PLWHA rights are respected
Axe IV   Sub-IR IV.2.2 Increase the number of           c       Indicator IV.2.2 cumulative number of large enterprises and companies
         employers who have adopted or adapted                  which have adopted HIV/AIDS work-place policies and programmes for
         work place policies that take into account             the first time.
         PLWHA
Axe IV   Sub-IR IV.2.3 Protect young girls and          a       Indicator IV.2.3 # of cases of violence reported to local law
         women from domestic and sexual violence as             enforcement agencies
         well as sexual harassment
Axe IV   Sub-IR IV.2.4 Improve operational policies,    a       Indicator IV.2.4 # of operational policy documents revised or adopted
         norms and procedures to assure equitable               that specifically address issues of equity for PLWHA and OVCs
         access to services for PLWHA and OVCs
Axe IV   Sub-IR IV.3.1 Strengthen managerial            a       Indicator IV.3.1 # of association members trained for 5+ days on
         capacity of associations involved with                 management of HIV/AIDS interventions
         HIV/AIDS




                                                                                                                                  22
          Result1, Intermediate Result (IR), sub-IR      Core2                                          Indicator
 Axes
                   (domain d’intervention)

Axe IV   Sub-IR IV.3.2 Balance of the composition of c           Indicator IV.3.2a. # of association members trained for 5+ days on
         HIV/AIDS related associations (increase                 management of HIV/AIDS interventions
         proportion of male, middle class & HIV –
         members).
         Sub-IR IV.3.2                               a           Indicator IV.3.2b. % of members of associations of PLWHA not HIV+
Axe IV   Sub-IR IV.3.3 Increase involvement of       a           Indicator IV.3.3 # of associations of PLWHA involved in the planning,
         PLWHA in the planning, execution and review             implementation, and review of programmes /projects
         of programmes


Assessing Impact

 Axe     Result V: Coordinate the multi-sectoral                 Indicator V The ratio of the value of government expenditures on
   V     response for increased cost effectiveness               HIV/AIDS to value of external assistance for HIV/AIDS
Axe V    IR V.1 Improve the capacities of national       c       Indicator V.1; Number of MSC stories that address capacity of national
         HIV/AIDS coordination structures                        HIV/AIDS coordination structures

Axe V    IR V.2 Assure that HIV/AIDS strategies within   c       Indicator V.2 Number of HIV/AIDS-related objectives in national sector
         national sector plans are implemented                   plans that have been achieved..

Axe V    IR V.3 Increase HIV/AIDS related regional       c       Indicator V.3 Number of regional interventions that are jointly executed
         initiatives that are jointly executed

Axe V    IR V.4 Assure that intervention agencies        c       Indicator V.4; Number of MSC stories that address intervention agencies
         benefit from national planning and monitoring           perception of usefulness/benefits of contributing to national planning,
         as much as the coordination agencies                    M&E

Axe V    IR V.5 Jointly evaluate the multi-sector        c       Indicator V.5 mid-term review of HIV/AIDS national response (2007)
         response to HIV and AIDS                                and end-of period evaluation (2009/10) are jointly executed with
                                                                 representation from all stakeholders.




                                                                                                                                  23
           Result1, Intermediate Result (IR), sub-IR   Core2                                          Indicator
 Axes
                    (domain d’intervention)


Monitoring Programme Outputs
Axe V    Sub-IR V.1.1 Strengthen leadership capacity   c       Indicator V.1.1 # of members of coordination structures, trained in
         of personnel                                          leadership skills, meeting facilitation or public speaking
Axe V    Sub-IR V.1.2 Strengthen administrative and            Indicator V.1.2 # of members of coordination structures trained in
         managerial capacity of institutions                   administration and management.

Axe V    Sub-IR V.1.3                                  c       Indicator V.1.3 number of coordination structures that obtain and spend
          Assure that necessary resources for                  their annual budgets
         operations are available
Axe V    Sub-IR V.1.4 Harmonize the directives and     c       Indicator V.1.4 # of communications sent jointly by central coordinating
         communications across all intervention                authority
         domains
Axe V    Sub-V 2.1 Develop and disseminate             c       Indicator V.2.1 a. # of national sectors/ ministries that have
         approaches and methods for integrating                dissemination workshops reviewing methods for integrating HIV/AIDS
         HIV/AIDS into national sector plans
Axe V    Sub-IR V.2.2 Assure that leaders advocate     c       Indicator V.2.2
         for integrating HIV/AIDS in each sector                # of advocacy-related activities in multi-sector annual workplans that
                                                               have been completed.

Axe V    Sub-IR V.2.3 Establish an awards              c       Indicator V.2.3 Number of sectors holding annual award ceremonies in
         mechanism ceremony for best interventions             which HIV/AIDS interventions are recognized
         and agencies in each sector
Axe V    Sub-IR V 3.1 Harmonize regional and cross-    c       Indicator V.3.1
         border related HIV/AIDS policies and                  % of Rwandan national and sector-specific HIV/AIDS plans and
         frameworks/documents                                  frameworks are consistent with regional plans and framework
Axe V    Sub-IR V 3.2 Assure that jointly developed    c       Indicator V 3.2 # of joint cross-border workplans executed.
         cross-border activity plans are executed
Axe V    Sub-IR V 3.3. Make available necessary        c       Indicator V.3.3 number of regional HIV/AIDS interventions/initiatives
         resources (funds) for the execution of                that obtain and spend their annual budgets
         regional HIV/AIDS interventions




                                                                                                                                 24
         Result1, Intermediate Result (IR), sub-IR       Core2                                           Indicator
 Axes
                  (domain d’intervention)

Axe V   Sub-IR V 4.1 Simplify and harmonize              c       Indicator V.4.1 # variables collected by national coordination structures
        planning and monitoring tools                            and large bi/multi-lateral projects

Axe V   Sub-IR V 4.2 The level of detail needed for      c       Indicator V.4.2 number of activities identified in workplans submitted to
        national planning and workplan monitoring is             CNLS
        appropriate for national level reporting (in
        decentralized context)

Axe V   Sub-IR V 4.3 Strengthen capacity to facilitate   c       Indicators V.4.3 # coordination structure personnel trained in facilitating
        planning and monitoring workshops and                    planning workshops/meetings, and in reporting
        meetings
Axe V   Sub-IR V.4.4 Assure that the national                    Indicators V.4.4 % of activities identified in work plans submitted to
        HIV/AIDS strategic framework and M&E plan        c       CNLS that correctly identify the Axe, IR and sub-IR as well as the
        are used by all agencies for activity planning           indicator(s) to which they contribute
        & monitoring
Axe V   Sub-IR V.5.1 Harmonize and operationalize        c       Indicator Sub-IR V.5.1.a Indicator values submitted by intervention
        national indicators and M&E and planning                 agencies are comparable.
        tools
        Sub-IR V.5.1                                     c       Indicator Sub-IR V.5.1.b Same M&E and planning formats are used at
                                                                 district level by interveners

Axe V   Sub-IR V.5.2 Strengthen capacity at all levels   a       Indicator V.5.2 # of people trained in data use/interpretation using
        to evaluate the national response                        Rwanda indicators & data

Axe V   Sub-IR V.5.3 Jointly develop and validate        a       Indicator V.5.2 # of organizations regularly participating in TWG to
        information products from national evaluation            develop/modify/validate national M&E products

Axe V   Sub-IR V. 5.4 Assure that national M&E           c       Indicator V.5.4 # of M&E products that stakeholders have
        products are available and useable (to/by                obtained/accessed and find useable
        information providers and users).




                                                                                                                                    25
         Result1, Intermediate Result (IR), sub-IR   Core2                                         Indicator
 Axes
                  (domain d’intervention)

Axe V   Sub-IR V.5.5. Coordinate research and        c       Indicator V.5.5a. existence and use of national long-term or annual
        training.                                            HIV/AIDS-related research plans

Axe V   Sub-IR V.5.5.                                a       Indicator V.5.5b existence and use of a national training database




                                                                                                                             26
3.0 DATA COLLECTION STRATEGY FOR M&E

3.1    Coordination of M&E

The CNLS will work closely with various stakeholders at both national and district
levels, in both public and private sectors, to coordinate collection of data that will
be used to generate information products. The CNLS will facilitate and coordinate
the standardization of instruments and methodologies for data collection.
Besides, it will establish data quality assessment protocols in a participatory and
consultative manner with all the stakeholders.

The 62 national and 23 district indicators that have already been agreed upon
(for a list of indicators and their definitions refer to Annex 1) will form the basis
for data collection for assessing program outputs, outcomes and impact of
HIV/AIDS interventions.

HIV/AIDS programme/project interventions, as described in the National
Strategic Framework for HIV/AIDS Control / Results Framework 2005-2009, will
provide programme monitoring data at the district and community levels. The
data collection strategy for the routine data at this level will entail CBOs and
NGOs compiling data from their interventions in various communities and
preparing monthly and quarterly progress reports. These information products
will then be submitted to the CDLS, and copied to their national umbrella
organizations. The modalities and the actual process of doing so will be agreed
upon and a district M&E operational plan developed in a participatory and
inclusive manner. The CNLS will supervise this exercise and make sure that
district-level operational manual/guideline is developed and disseminated widely
to all stakeholders.

To ensure accurate, comprehensive and timely reporting, the CNLS will
coordinate sustained capacity building and training programme in M&E at all
levels, especially in the areas of data collection, analysis, interpretation,
production of information products and use of the data for decision making and
programming. Strengthening M&E activities at the CDLS will be a key priority.

3.2 Data Sources:
In order for the national M&E system to function, core data sources of each of
the indicators have been identified and agreed upon (for details refer to
Annex 1). There two categories of data sources: those for output (routine)
indicators; and those for outcome/impact indicators. Some of the data sources
include the following:



                                                                                   26
   i.       Data source for routine (output) indicators: - These are routine reports
            from project / program implementers at various levels in both public
            and private sectors. They include the following:

            -     Program activity (routine) data from CBOs and NGOs at district
                  levels, umbrella organizations and the private sector: e.g.
                  District IEC/BCC report, VCT/PMTCT/ARV reports, and
            -     District and national health facility coverage report
            -     Service coverage reports
            -     DHT supervision reports
            -     Data from Sector monitoring system, e.g. HIS/SIS
            -     Data from national blood transfusion center
            -     Social agency marketing reports
            -     CNLS HIV/AIDS financial management report
            -     TRAC research reports
            -     MoH reports
            -     CNLS Database
            -     SIS database/reports
            -     Desk review reports

   ii.      Data sources for Impact/Outcome assessment from the following:
            -     Sentinel surveillance report
            -     Second generation surveillance
            -     Routine population based national surveys like DHS, population
                  census
            -     Special studies, e.g. Clinical studies, HIV/AIDS operational
                  research, impact assessment in key sectors and capacity
                  assessment).
            -     Health Facility Surveys (HFS)
            -      VCT site reports
            -     PMTC site report
            -     ART site reports

3.3 Information Products at National Level
For effective monitoring and evaluation of national response to HIV/AIDS, the
CLNS will develop information products, from the data sources mentioned above,
that will be disseminated to stakeholders at both national and district levels
Besides, some of the information products, for example UNGASS Report, are for
meeting the international requirements. The information products that will be
retrieved by the CNLS include the following:

         Quarterly Service Coverage Report: This report provides information
on coverage statistics per HIV programme area, and is essentially based on the
main interventions as envisaged in the Multi-sectoral National Plan. It therefore


                                                                                 27
depends largely on the information that the implementing agencies submit
quarterly to the district AIDS Control Commission (CDLS), and subsequent
analysis report that the monitoring and evaluation coordinator at the district
submits to the CNLS. The report from the implementing agencies to the district
and from the district level to the CNLS ought to conform to the terms of
minimum reporting standards, as well as CNLS reporting format.

       CNLS Bi-annual Report: This report provides the semiannual activities
on the national response to HIV/AIDS, and is based on the quarterly reports
which have been submitted by the CDLS and national umbrella organizations
(through PMU). The content of the report include issues to do with coordination,
implementation (results being achieved), M&E, emerging issues including
challenges and any special study report which has been submitted.

      National HIV/AIDS M&E Annual report: This report provides a
comprehensive overview of the national response to HIV in a year period. The
report is done by reporting on selected list of national level indicators as
contained in the national HIV/AIDS M&E Plan. It also provides key observations
and guidance for future implementation. The content of this report includes a
summary of quarterly reports on the community non-medical programmes
indicators which the district submits to the CNLS. The report on the medical
programme indicators is provided by TRAC, the National Laboratory, and the
Health Information system (HIS/SIS). All the relevant indicators from survey and
research findings conducted in the course of the year are also reported. The
National HIV/AIDS M&E annual report is finalised in February and its national
dissemination is done in March in an organised workshop, which brings together
a wide range of stakeholders and partners in the fight against HIV/AIDS.

      Annual PRSP progress report on HIV/AIDS. The CNLS will ensure
that every year that the data collection and analysis for the HIV/AIDS annual
report on review of poverty reduction strategies are reported to the Ministry of
Finance and Economic Planning (MINECOFIN) for eventual incorporation in the
overall national annual PRSP report.

        CNLS HIV/AIDS Database: - The National HIV/AIDS Database will be
updated from time to time and equipped with necessary equipment and
programmes for efficiency and effectiveness. The database will be linked to other
HMIS and micro M&E sub-systems in other government ministries and
institutions. From this database, the CNLS will produce the necessary periodic
updates on topical issues on HIV/AIDS in Rwanda.

      Ad hoc reports: In addition to the specific information products listed
above, some stakeholders/partners might have specific information needs at
some stage. Although the CNLS encourages the use of existing information



                                                                              28
products, it opts to assist if there are any specific and ad hoc information needs
that are not covered in one of the above information products. Such a request is
made in writing to the CNLS. If possible, the request will be accommodated
within the budget limitations of the Planning, Coordination, M&E Unit. If it is not
possible, the person/institution will be informed of the cost implications.

      Annual UNGASS report: Rwanda is a signatory to the 2001 Declaration
of Commitment on HIV/AIDS at the United Nations Special Session on HIV/AIDS
(UNGASS). Part of this Declaration of Commitment includes a set of indicators
that the Government of Rwanda has agreed to report on to UNAIDS on a periodic
basis. The CNLS collaborates with the UNAIDS to produce this report before
February of every year.


3.4   Reporting Levels and Data flow

This section presents the reporting linkages and data flow in general - from
programme implementers at the district level to CDLS, CDLS to CNLS; and from
health facilities through TRAC to CNLS (Diagrams 2 and 3). Specific data flow for
each data source will be described in detail in the M&E Implementation Plan Part
II.

3.4.1 Reporting to CNLS
An effective national M&E system requires that data flow structures and
reporting mechanisms are clearly defined to avoid the problem of double
counting. Diagram 2 is a pictorial presentation of data flow and the information
linkages from the district level (CDLS & health facilities) to CNLS.




                                                                                29
Diagram 2: Comprehensive HIV Monitoring and Evaluation Data / Information Flow


   Disseminate to                                                          Dissemination to Stakeholders
   Stakeholders


                                        CNLS                               Civil Society                   The Private
   Government / Public                  M&E                                                                Sector                    National
   Sector                               Unit:                                                                                        Level
                                        DataBase
                                        Ressource
                                                                                                             Structures
                                        Centre.                                                  Other       at National
   GoR                      4                                                                    Nation      Level ,e.g.
   Ministries     RIs &
                  Unive
                                                                                                 al          APELAS
                                                    Proj.                                        Associa
                  rsities                           Man.                        National         tions
                            TRAC                    Unit.       5   National    Umbrella
                                          2
       MOH                                                          NGOs        Organization



                                                                                            6
                            3
                                                                                                                                     District
                                         CDLS:                                                  Other                                Level
                                                                                                Assoc          Structures at
                                                                                 District       iation         District Level
   District                 Health       District M&E       1        District
                Resear                                                           s              s
   Gov.         ch
                            Facilitie    Coordinator                 s
                                                                                 CBOs
   Depts.       Work        s                                        NGOS




Key: Flow 1 = Red arrows: District based NGOs, CBOs, private sector, and Government district level structures.




                                                                                                                                30
        Reporting directly to CDLS



Flow 2: = Double black arrows: CDLS reports to CNLS and the later feeds back
          to the former.

Flow 3: = Green arrows: Health facilities to TRAC and MoH.

Flow 4: = Green arrows – national level: Public sector: Government Ministries
          and public institutions reporting to CNLS

Flow 5: = Sky blue arrows: National organizations/umbrellas reporting both
          financial and national coordination activities to PMU/development
          partners (sources of funding), who aggregate the data and report
          to CNLS M&E unit.

Flow 6: = Dotted arrows: Implementers at district level report to national
          umbrella organizations just for information. Organizations at
          national level not required to report this data to PMU/CNLS.



3.5.2   Reporting to the CDLS

Data collection and reporting system at the district level is depicted in Diagram 3
below:

   •    All the HIV/AIDS program implementers will provide regular quarterly
        reports to the CDLS using the CNLS data collection format.

   •    The CBOs and NGOs will compile monthly and quarterly progress reports
        and submit them to CDLS.

   •    Clinical data from health facilities will be sent to TRAC.

   •    To avoid double counting there will be one way reporting from
        implementing agencies to District and from District to CNLS.




                                          31
Diagram 3: Data Flow from CDLS to CNLS




         Community            District                    National
                                                                              CNLS



                                                  Ref.
                HC                HF              Hosp                TRACNET+
                                                  & Lab



              CBOs              CDLS                                  CNLS M & E Unit



              NGOs                                    Umbrella Org.



            FBO /                                     Donors : UN
            Work Place                                Agencies




The implementers will, as usual, be reporting to their funding agencies for
accountability. The funding agencies will not be required to report on this data to
the CNLS:

   •    Data collection forms will be submitted to the CDLS M&E Agents, who will
        quality control these forms and aggregate before sending them to the
        CNLS for data capture.

   •    The CNLS M&E unit will ensure that the data from each district are
        captured onto a central M&E database

To ensure effective, timely and non-duplication of data/information reported, all
the organisations and agencies implementing the HIV/AIDS community non-
medical interventions will report their activities on a quarterly basis to the District
AIDS Control Commission, CDLS.


3.5.3   Reporting of Health related Indicators: e.g. HIS/SIS to CNLS, TRAC to CNLS
The TRAC is in charge of coordinating and collecting and analyzing most of
health (clinical) related data. The clinical data will be collected at the health


                                          32
facilities in the country at all levels, using standardized and agreed upon tools.
Such data will be submitted to TRAC. The TRAC will analyze and aggregate the
data and produce information product and submit them to the Ministry of Health
(MoH), with a copy to the CNLS. The National Referral Laboratory and the
National Blood Transfusion Centre Health will collect and analyze data and submit
the same MoH - Information system (HIS/SIS). This also applies to any research
institution/organization undertaking clinical research in the country.


3.5.4 Reporting from Other Government ministries and institutions
The Government Ministries at national level and other public institutions will
monitor HIV/AIDS activities in their specific structures, produce information
products and submit the same to the CNLS in agreed format. The Ministries
headquarters will not submit information on activities implemented by
government departments at the district levels. To avoid the problem of double
counting, the government department at district levels will submit HIV/AIDS
related data/information directly to the CDLS, with a copy to their headquarters
at the national level. The CDLS will then submit such activities to the CNLS.


3.5.5 Reporting from the Civil Society, Umbrella Organizations and the Private
      sector
The National civil society and umbrella organizations operating in the country will
submit both financial and national programme activities, like coordination,
capacity building, advocacy and mobilization, to HIV/AIDS Programme
Management Unit (PMU) and relevant donors using an agreed format. To avoid
the problem of double counting, the NGOs, CBOs and other associations
implementing the HIV/AIDS activities at the district level will send monitoring
activity data directly to the CDLS, with a copy going to their parent organizations.
The CDLS will send such data to the CNLS. Umbrella organizations and other
associations at national level are not required to submit data on the district
based interventions by the organizations or associations they fund.




                                        33
4.0    THE ROLE OF STAKEHOLDERS IN HIV/AIDS M&E &
       COORDINATION MECHANISMS

4.1    The Role of CNLS /M&E Unit in Monitoring national response

As mentioned earlier, the National AIDS Control Commission, CNLS – one
national authority-, has the mandate of coordinating monitoring and evaluation
of the national response to HIV/AIDS in Rwanda. In a nut-shell, the role of the
CNLS in M&E includes the following:

   •   Coordination, supervision and provision of technical assistance and
       guidance to monitoring and evaluating national response and tracking
       progress made in the program activities at all levels;

   •   Coordination and provision of a national coherent plan for monitoring
       progress and evaluating outcomes of a comprehensive HIV/AIDS
       programme. CNLS is responsible for defining strategic objectives and
       targets; guiding and supervising systematic data collection, processing
       and analysis of data at various levels; and providing the platform for
       partnership, networking and collaboration between the national level and
       local level stakeholders in monitoring and evaluating;

   •   Creation of a multi-sectoral functional HIV M&E system, with a database,
       that links with other HIS systems, research organizations and other
       micro/M&E units in other government ministries, civil society
       organizations and the private sector. The CNLS has developed a
       simplified, but complete reporting format for use by all the
       stakeholders/partners;

   •   Supervision and data auditing: The responsibility of supervision as a
       component of coordination remains the key role of the CNLS secretariat.
       The commission will coordinate the standardization of M&E
       methodologies and tools across multiple actors at various programme
       levels so that meaningful comparisons could be made over time. The
       supervision mainly focuses to the reporting agencies to ensure that the
       data provided is audited for verification and credibility purposes, but also
       providing technical assistance in data collection, analysis and reporting.
       The commission also facilitates the standardization of M&E methodologies
       and tools across multiple actors at various programme levels so that
       meaningful comparisons could be made over time;

   •   Development of standardized tools and methodology for collecting non-
       clinical data and information production and reporting is an important
       activity in this exercise. Besides, the CNLS has to establish, in a


                                       31
       participatory manner, data quality assessment (DQA) protocol(s) that will
       coordinate and guide data collection, analysis and processing for quality
       assurance purposes;

   •   Generation of national information products, as agreed and demanded by
       both the national and international stakeholders, and disseminating these
       products in a user friendly and in a timely manner. Some of these
       products include National HIV/AIDS Annual Report, Rwanda Annual
       UNGASS Report. The CNLS will ensure and facilitate the annual national
       disseminations and review activities; and

   •   Coordinate and support all capacity building and training in M&E at both
       national and district levels. This is to ensure that the M&E systems, at the
       district level in particular, are functioning and have necessary resources.
       The CNLS will organize periodic supervision visits and reviews of district
       based M&E systems and organize for capacity building activities
       accordingly.

Although the CNLS Executive Secretary is the overall overseer of these roles,
the Directorate of Planning, M&E, and Coordination and M&E Focal Person and
his/her term are directly responsible in coordinating these M&E activities and
making sure that they are implemented efficiently and effectively, within an
agreed timeframe.




                                       32
4.2 The Roles and Responsibilities of District M&E Focal Persons
Given the decentralisation of the HIV/AIDS response in Rwanda, data collection
on the HIV/AIDS activities will be done by the districts. The CDLS will mainly
monitor programmme activity outputs level indicators, and will be in charge of
making sure that data is submitted to CNLS in an agreed format and in a timely
manner. Specifically, CDLS are expected to:

-     Register and submit names of NGOs and CBOs involved in the HIV/AIDS
      activities in the District to the CNLS;

-     Coordination and supervision of M&E at the district level;

-     Facilitate and demand for the filled standardized forms for data collection
      from the NGOS/CBOs;

-     Submit the data forms to the CNLS in an agreed format in a timely
      manner;

-     Sensitize and advocate for the use of information products for
      programming activities; and

-     Disseminate and sensitize partners at the District/community levels on the
      pandemic using information from the CNLS.

Therefore, a district-level coordination and programme monitoring
system will be developed. This will be the mechanism through which the CDLSs
obtain standard work plan data and standard data on the implementation of
activities in those work plans on an annual basis. Such a district-level
coordination and programme monitoring system is thus part of the government’s
national HIV/AIDS M&E plan.

4.3    The Role of Government ministries and other public
       institutions/organizations.

Specifically, such institutions are expected to:
-      Mainstream the HIV/AIDS interventions in their core business;
-      Mobilize resources and coordinate HIV/AIDS activities within their
       institutions;
-      Advocacy and sensitization on HIV/AIDS at workplace;
-      Facilitate training on the M&E for the staff;
-      Report on specific indicators for the institution to the CNLS using
       standardized reporting format and in a timely manner; and
-      Participate in annual HIV/AIDS annual reviews.




                                       33
4.4 The Role of other stakeholders.

Many stakeholders are involved in fighting the pandemic in one way or the other.
Chief among them is: the research organizations e.g. TRAC, Civil society
organizations, and Umbrella organizations including PLWA, Faith Based
Organizations, the private sector, and the development partners. Their role will
include the following:

o    Civil Society, Umbrella Organizations and The private sector:

    - Participate in the M&E Technical Working Group (TWG);

    - Ensure that their members are familiar with the National HIV/AIDS
      Framework/Plan;

    - Participate in strengthening their M&E units using the National M&E
      Framework/plan provided by the CNLS;

    - Submit national activities to the PMU and donors;

    - Those operating at district level to conduct program activity output
      monitoring;

    - Submit required data to CDLS using a standardized format based on an
      agreed timelines;

    - Sensitization and advocacy for M&E and use of data; and

    - Participation in the national M&E dialogue and reviews.

o    Research Organizations and Universities:

    - Participate in the development of the CNLS Research Strategy;

    - Conduct high quality research, in a timely manner;

    - Disseminate research findings to: the Ministry of Health – Research Unit,
      the CNLS: the M&E Unit and Research Unit, Program/Project
      Implementers;

    - Use research findings to inform policy and programs; and

    - Participation in the national M&E dialogue and reviews.

o    Development Partners:

The development partners play an important part in supporting the national
response to HIV/AIDS. They provide financial and TA support to the CNLS and


                                      34
various implementers at the national and district levels. In terms of M&E, they
are expected to:

    - Be part of the HIV/AIDS M&E Technical Working Group;

    - Support the strengthening of the national HV/AIDS M&E system;

    - Build the culture of M&E among their implementers and make it a
      mandatory requirement in their MoUs;

    - Build consensus on harmonizing information requirements and reporting
      framework to avoid using different frameworks or reporting system;

    - Participation in the national M&E dialogue and reviews.




                                      35
5.0 DISSEMINATION AND USE OF DATA
/INFORMATION

The reports produced by the CNLS are disseminated twice a year to stakeholders
and partners. This M&E cycle is synchronized with the annual planning and
programming cycle, thus maximizing the opportunity for the M&E results to be
used for decision making. From this perspective, therefore, data and information
from the DCLS, umbrella organizations, other public sectors and institutions must
also reach the CNLS in time in order for the same to be included in the
dissemination process. The dissemination plans will be developed and agreed
upon by all stakeholders in the country.

Using the data and information products from various sources and levels, the
CNLS will produce the Annual HIV/AIDS M&E Reports, using top priority
indicators to show the national response to the pandemic. It will also prepare the
annual PRSP progress report on HIV/AIDS and submit it to the Ministry of
Finance. The national level M&E results/findings will also be disseminated
through annual HIV surveillance reports, HIV/AIDS summary reports, electronic
and print media, and through special occasion gatherings like when celebrating
the HIV/AIDS day. These reports will also be submitted to the Minister of State
for national and regional dissemination. The CNLS will also participate in
preparing the Annual UNGASS report.

The CDLS will undertake dissemination of M&E results in their districts to
implementers and communities through organized meetings, religious institutions
and local leaders meetings.

The dissemination of the M&E results is expected to serve the following
purposes:

   Provide feedback to various implementers on the efforts being made,
   progress and the difference being made;

   Sharing and using the data and information for better targeting and planning
   of the HIV/AIDS interventions at the district and community levels in the
   country;

   Increase awareness and public commitment to the national response to
   HIV/AIDS;

   Provide feedback on efforts and resource utilization in the national response
   to HIV/AIDS and articulate lessons learned, gaps and challenges faced at the
   district and national levels; and

   Enhance networking, harmonization and resource mobilization for national
   response to HIV/AIDS.


                                       31
6.0 STRENGTHING OF THE NATIONAL HIV M&E
SYSTEM: THE IMPLEMENTATION PLAN

6.1 Harmonization and Implementation of the National HIV M&E
    System Plan

In line with the CNLS mandate to coordinate the national response to HIV/AIDS
and having one national M&E System, the execution of the national plan for the
M&E system requires commitment and partnership guided by the principles
articulated in Section 1.3 of this document. The following will be necessary for
the successful execution of the M&E system:

   Developing and building consensus on a national work plan (operation plan)
   for data collection and reporting at the national and district levels;

   Coordinating and harmonizing the M&E technical and financial support going
   to implementers at the district levels. The CNLS should receive and
   coordinate the distribution of the M&E support coming from different
   development partners and international NGOS;

   Building and strengthening a functional national M&E System, with a
   database linked to the HIS and other sub-systems;

   Establishing and strengthening the M&E units at the CDLS and the umbrella
   organizations;

   Mounting capacity building / training activities on M&E at the district levels
   and also targeting umbrella organizations. An M&E Training manual will have
   to be developed and a training work plan agreed upon by the stakeholders.

The execution of this national plan will require human, financial and physical
resources. There is need, therefore, to build consensus on the investment
strategy for M&E. From this perspective, any resources from the different
development partners and government, for the M&E activities need to be
channeled and coordinated by the CNLS.

The coordination of the various activities in this plan by the CNLS and the
support from the various stakeholders including the development partners will be
critical.




                                      31
6.2     Components/Areas of Interventions

Based on needs assessment of the existing HIV/AIDS needs assessment at the
CNLS and DCLS, the following areas of interventions are key priorities and need
strengthening within the strategic plan period. These include the following:

      Capacity Development for M&E at the CNLS, CDLS and Umbrella
      organizations

   This area of intervention targets enhancing the knowledge and skills of M&E
   focal persons at the CNLS, CDLS, the public sector and umbrella
   organizations. This is to enhance their capacity to effectively coordinate,
   conduct data collection and analysis, prepare information products and submit
   them to appropriate levels in a timely manner. Besides, it is to help them
   make use of data for decision making and programming of the HIV/AIDS
   activities. The specific activities include the following:

           o Sensitization, advocacy and sharing of the national HIV/AIDS M&E
             documents including the national M&E Plan;

           o Facilitation and development of the M&E training program/manual
             for CBOs, NGOs, the public sector and umbrella organizations;

           o Training the M&E focal persons/points at different levels in the new
             national M&E Implementation Plan (for example in data collection,
             development and use of information products, and reporting
             mechanisms;

           o Training of the M&E focal points in relevant M&E and data soft-
             ware and relevant management principles;

           o Organizing for dissemination and networking seminars and
             workshops for the exchange of new ideas in M&E.

      Institutional Strengthening

The intervention targets making the M&E systems at the CNLS and CDLS
functional and effective. Specific activities include:

           o Creation of a functional database at the CNLS and micro databases
             at the CDLS;

           o   Providing the CDLS with the necessary M&E ICT
               equipments/facilities, e.g. computers, soft-ware, lap-tops,
               telephone and internet facilities;



                                         32
         o   Linking the CDLS micro databases with the CNLS database;

         o   Linking the HIV/AIDS M&E with other HIS/SIS systems, TRAC an
             other public sectors e.g. MINECOFIN, MINEDUC;

         o   Carrying out supervision and data audit at all levels;

         o   Establishing a functioning resource center including virtual library;

         o   Organizing workshops / seminars to establish and enhance the
             culture of M&E, e.g. targeting advocacy and sensitization.

   Strengthening Data Collection, Analysis and Reporting
This component targets making data collection, analysis, and reporting more
efficient and timely. Besides, it is to enhance the quality of data and make it
available for decision making and programming for the HIV/AIDS activities at all
levels. The specific areas of interventions include:

         o Develop national HIV M&E operational guide (User’s guide)
         o Develop the DCLS level M&E annual data collection plan – with
           clear activities and timeframe;

         o   Establishing a baseline for core National HIV/AIDS indicators,
             where there are not available;

         o   Developing and building consensus on a standardized, user friendly
             data collection instrument (s) and reporting formats;

         o   Launch a data collection exercise at the DCLS, the public sector and
             the Umbrellas;

         o   Establish Data Quality Assessment Protocols and coordinating
             Supervision;

         o   Creation of functioning data bases at the CDLS and CNLS.

   Strengthening coordination of HIV/AIDS Research and Surveys

This component aims at enhancing the coordination of the HIV/AIDS research,
thus avoiding duplication and making research findings useful and available for
decision making and programming. Specific activities include the following:

         o Development of national the HIV/AIDS research protocol / norms;

         o Finalizing the development of national HIV/AIDS research strategy;

         o Enhancing the national steering committee of research by providing
           them with necessary facilities;


                                        33
          o Identifying and coordinating the carrying out of strategic non-
            medical research in identified sectors;

          o Enhancing reporting and dissemination of research results to the
            CNLS, national and regional forums including publications in
            international journals.

   Coordinating National Consultative Meetings and Reviews of the
   National M&E Plan.

This component of intervention targets dissemination of information products by
the CDLS, the public sector, umbrella organizations and CNLS to appropriate
stakeholders and implementers. The dissemination of information products has
to be coordinated to reach various stakeholders in time and in an effective
manner. Specific activities in this component include the following:

          o Organize the annual national stakeholders meeting on the
            HIV/AIDS response;

          o Organize workshops for the dissemination and discussion of results
            with HIV implementers in sentinel site Districts;

          o Organize dissemination workshops in all the districts for sharing
            good practice and lessons learned in the HIV/AIDS programme
            activity monitoring and district responses;

          o Organizing and supporting AIDS week/day celebrations at the
            national and district levels.

In the framework in Table 4 below, the interventions, budget and sources of
funding are just indicative and they are targeting strengthening the CNLS
monitoring and evaluation system only. The development partners interested and
willing to fund any of the interventions articulated in the table need to inform the
CNLS. It should be noted that the specific operational budget for M&E annual
work-plans at decentralized levels will have to be developed and agreed upon.




                                        34
           Table 4: Implementation Plan for Strengthening of the CNLS M&E System
                                                                                                Budget         Sources
                                                            Time Frame                          (Indicative)   of
                                                                                                               Funds
Areas/Component            i. Outputs / 2006                                          2009                     (Indicativ
s of Intervention          ii. Means of                                                                        e)
                                             Year 1         Year 2           Year 3   Year 4
                           verification
                                              Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
6.2.1.Ccapacity                                                                                  In US$
building for M&E at
CNLS,      CDLS      &
Umbrella
organizations
i.       Sensitization,    350       people
                           mobilized     &                                                                     MEASURE
advocacy and sharing                                                                                           Evaluation
of national HIV/AIDS       sensitized                                                             20,000       and Others
M&E        documents
                           -     Workshop
including the national
                           reports
M&E Plan (1 national
& 30 district     level
workshops x 1 day)
ii. Development &          M&E training                                                                        MEASURE
                                                                                                               Evaluation
revision of the M&E        program                                                                             And Others
training      program      module/manu                                                           25,000
module/manual      for     al
CBOs, NGOs, the
public sector and
umbrella
organizations
(including translation &
production).




                                                                     35                                        35
                                                            CNLS,
iii. Training M&E focal     70 M&E/data           100,000   MEASURE
persons/officers       in   people trained                   Evaluation
                                                            and
the districts: CDLS,                                         identified
CBOs & NGOs based           -   Workshop                    partners
on the new national         reports
M&E Implementation
Plan (for example in
data          collection,
development and use
of          information
products,            and
reporting
mechanisms             (5
days/district).
iv. Training of M&E         35         M&E                  CNLS and
                                                            identified
focal persons/officers      persons                         partners
in relevant M&E and         trained.              15,000
data soft-ware and
relevant management         -   Workshop
principles (5 days          reports
incl. trainers)




                                             36             36
v.    Organize      for   70      people                         Tulane
                                                                 University,
dissemination      and    attending                              MEASURE
networking seminars/      dissemination                          Evaluation
workshops for             workshops                              and
                                                                 identified
 exchange of                                           30,000     partners
new/emerging              -   Workshop
information in M&E        reports
(as need arises, but
at least once a year
per district = 1day).
                          a. Sub-Total             $   190,000



6.2.2
Institutional
Strengthening
i. Creation of a          Functional data                        Tulane
                          base created                           University
functional database                                    19,300
at CNLS and micro
databases at CDLS,        - Data       base
                          officially
including soft-ware
                          launched
ii. Providing CDLS                                     160,000   Identified
                          Facilities                             partners
with         necessary
M&E/ICT                   supplied       &
equipments/facilities,    available
e.g.30 computers, 32
                          - The facilities
laptops,     30 video     in    use      at
cameras, telephone,       various levels
one      vehicle    for
supervision




                                              37                 37
iii.   M&E     needs       CDLS       data              40,000    Tulane
                           bases linked to                        University
assessment at district                                            and
and linking CDLS           CNLS       data                        identified
micro databases with       base.                                  partners
CNLS database incl.
                           - M&E Needs
Internet connectivity      assessment
                           report
iv. Linking HIV/AIDS       Data base at                 10,000    MoH/TRAC
                           CNLS       linked                      /
M&E       with     other                                          MINICOFI
HIS/SIS        systems,    with        other                      N/
TRAC and other             HIS/TRAC/Minis                         CNLS
                           tries           &
public sectors e.g.
                           functional
MINECOFIN,
MINEDUC
v.    Carrying       out   No.           of             35,000    CNLS/UND
                           supervision                            P/
supervision and data                                              BAD
audit at district levels   carried out
(at      least       one
                           -Supervision
supervision per year)
                           report available

vi. Establishing &         Resource centre                        CNLS
updating              a    available    at              15,000
functioning resource       CNLS          &
center, including e-       accessible
library, acquisition of
                           - Reports from
books, journals etc        Library officer
                           b.        Sub-           $   299,300
                           Total




                                               38                 38
6.2.3
Strengthening
Data      Collection,
analysis Reporting
i. Develop national       Operation
M&E        operational    manual / plan           100,000   MEASUR
manual (users’ guide)     developed                         E
& DCLS level M&E                                            Evaluatio
                          -         Manual
annual data collection                                      n
                          available     at
Plan (incl translation    CNLS/CDLS is
& reproduction).          used         for
                          training

                                                  15,000
ii.        Establishing   Baseline figures                  CNLS
baseline for core         available    for
                          identified
National      HIV/AIDS
                          indicators
indicators,      where
there       are     not   -Consultant
available (Outsourced     report        on
consultant   &    M&E     indicators study
Team).
iii. Developing and       Standardized
building    consensus     tools        and
on a standardized,        format available
user friendly data                                3,000     CNLS
                          -     Consensus
collection instrument
                          building report
(s) &
 the         reporting
formats     (1    day
meeting           and
reproduction)




                                             39             39
iv. Launch a data         Data collected,
collection exercise at    analyzed & sent
DCLS,      the   public   to CNLS                                CNLS &
sector and the                                         15,000    identified
                          -           Data
Umbrellas (5 days                                                partners
                          collection
/districtx3people)        reports        &
                          information
                          products
v. Establish Data         DQP available
Quality Assessment                                       00      CNLS
Protocols          - Minutes of the
                          meetings      for
                          DQA

vi. Updating data Data    bases
bases at CDLS and updated  with                        25,400
CNLS.             new                                            CNLS
                          information
                          - Reports      of
                          updating
                          c. Sub-Total             $   158,400




6.2.4
Strengthening
Coordination        of
HIV/AIDS
Research             /
Surveys




                                              40                 40
Development/Review Research
of national HIV/AIDS protocol norms
research protocol / reviewed                             00    CNLS
norms
                         -       Research
                         Committee
                         report
Finalizing         the   Research
development         of   Strategy
national     HIV/AIDS    finalized                             CNLS
                         -      Workshop
                                                       3,000
research      strategy
                         report
(incl.     1       day
workshop)
                                                               MINICOFI
                                                               N,

                         Number of non-
                                                     100,000   CNLS
Identifying       and                                          and
                         medical studies                       identified
coordinating       the
                         done                                   partners.
carrying     out    of
strategic non-medical    -      Research
research in identified   reports
sectors (3 per year).
Dissemination       of                               10,000    CNLS and
                                                               identified
research results to                                            partners
CNLS, national and
regional forums (3
national meetings)
                         d. Sub-Total            $   113,000




                                            41                 41
6.2.5 Coordinating
National
Consultative
Meetings         and
Reviews of M&E
Plans
i. Organize Annual          One      annual
                            national                             CNLS and
national stakeholders                                            identified
meeting on HIV/AIDS         meeting                              partners
response                    organized per
                            year                        40,000
(Dissemination     of
                            - Report of the
annual M&E report).         meeting
iii.   Organize         a
                            No.           of                     MoH/Tulan
workshop             for                                         e
dissemination       and     dissemination               20,000   University
discussion of results       workshops
                            organized.
with                HIV
implementers           in   -Workshop
sentinel site Districts     reports

iv.          Organize       No.           of
                            dissemination                        CNLS and
dissemination                                           5,000     identified
workshop in all the         workshops                            partners
districts for sharing       organized.
good practice and
                            -Workshop
lessons learned.            reports

                            e. Sub-Total            $   65,000




                                               42                42
i. Total Financial
   Resources                                                                                                    835,700
Required
  (a+b+c+d+e)

         Budget Summary by Areas of Interventions:
         6.2.1. Capacity building for M&E at CNLS, CDLS & Umbrella organizations           …… 190,000
         6.2.2 Institutional Strengthening      ……………………………………………………….. 299,300
         6.2.3 Strengthening data collection, analysis and reporting        ……………………. 158,400
         6.2.4 Strengthening Coordination of HIV/AIDS Research / Surveys            …………..         113,000
         6.2.5 Coordinating National Consultative Meetings and Reviews of M&E Plans ….              65,000
                                                             ------------------------------------------------
                                                                            Total US$ …….          835,700




                                                                    43                                                    43
7.0 Annexes

Annex 1:

Indicators for Monitoring and Evaluation of national response to HIV and AIDS
         Result3, Intermediate                                                                                                               Data Source
Ref. on                                                  Core Indicators
           Result (IR), sub-IR                                                                             Definition                       (Responsible
 Axes
           (domain d’intervention)                                                                                                             agency)
Assessing Impact
 Axe    Result: Reinforce                     Indicator 1: Change in                        Percent of blood samples voluntarily        ANC Sentinel
   I    measures of                           prevalence of HIV/AIDS in                     given by pregnant women ages 15-24          surveillance
        preventing HIV/AIDS                   people aged 15-24 years                       at ANC clinics which test positive for      (TRAC)
        transmission                          (this is best proxy for change in incidence   HIV.                                        (One method of verification
                                              of HIV/AID for people 15-49)                                                              is retrospectively through
                                                                                                                                        DHS).
Assessing Outcomes
Axe I   IR I.1; Change high risk              Indicator I.1a Change in                        Percentage of persons ages 15-24          Nat’l Behavioral
        sexual behavior (in the               percentage 15-24 year-olds                    years reporting sex with a non-regular      Surveillance
        population)                           reporting sex with non-marital,               [non-marital, non-cohabiting] partner in    System (TRAC)
                                              non-cohabitating partner last                 the last 12 months
                                              12 months
                                              (this is measure of fidelity)
Axe I         IR I.1                          Indicator I.1b Change in                        Percentage of persons ages 15-24          Nat’l Behavioral
                                              percentage 15-24 year-olds                    years reporting condom use last time        Surveillance
                                              reporting condom use last time                they had sex with non-regular [non-         System (TRAC)
                                              they had sex with non-marital                 marital, non-cohabiting] partner in the
                                              non-cohabitating partner                      last 12 months.
                                              (this is measure of protected sex)
Axe I         IR I.2 Change behavior          Indicator I.2. percent facilities             Percent of health facilities in which all   Summary of site
              of health personnel to          where team is practicing safe                 team members are using safe injection       supervisions (DHT)
              reduce transmission of          injections                                    techniques as per National norms and        (if budgeted and
                                                                                                                                        programmed, can use
              HIV/AIDS, STI,OI and                                                          procedures (during calendar year).          facility-based surveys)
              TB
Axe I         IR I.3 Reduce the               Indicator I.3 Proportion of all               Percentage of HIV+ pregnant women           PMTCT site reports
              transmission of HIV             HIV+ pregnant women given                     attending PMTT sites that are given         (TRAC)
              through medical                 medical prophylaxis                           complete antiretroviral prophylaxis
              prophylaxis                                                                   according to current protocol in last 12
                                                                                            months
3
    Result is IMPACT level; Intermediate Result = outcome level and Sub-IR = output level

                                                                                   44                                                                             44
           Result3, Intermediate                                                                                      Data Source
Ref. on                                      Core Indicators
            Result (IR), sub-IR                                                      Definition                      (Responsible
 Axes
            (domain d’intervention)                                                                                     agency)
Axe I     IR I.4; Create a culture    Indicator I.4; Number of MSC     Most Significant Change stories that       Various
          environment more            stories that address change in   are submitted to CNLS and meet             intervention
          favorable to preventing     cultural environment more        review board criteria                      agencies (CNLS’
          HIV & STI transmission      favorable to preventing HIV &                                               MSC unit)
                                      STI transmission

Monitoring Programme Outputs
Axe I    Sub-IR I.1.1 Promote         Indicator I.1.1 Number of new    New or significantly different messages    Various
         EABC (through IEC for        messages that promote EABC       that promote ABC which are                 intervention
         behavior change)                                              disseminated in the year (i.e.             agencies (does not
                                                                       brochures, Radio and TV sports,            exist; outsource)
                                                                       leaflets).
Axe I     Sub-IR I.1.2 Increase       Indicator I.1.2a Number of       Number of condoms distributed              Social marketing
          access to and use of        condoms sold or distributed to   annually to end-users by government        agency reports
          condoms                     end users                        facilities and projects.                   (Camerwa, CNLS)
Axe 1                                 Indicator I.1.2b Number of       Number of social marketing distribution    Social marketing
                                      social marketing distribution    points for condoms.                        agency reports.
                                      points for condoms.                                                         (Camerwa, CNLS)
Axe I     Sub-IR I.1.3 Educate        Indicator I.1.3; number          Number of schools receiving copy of        annual or ad-hoc
          youth on sexual             schools that receive sex         nationally adopted sex education or life   reports (MINIDUC)
          responsibility              education and/or llfe-skills     skills curriculum including educational
                                      curriculum AND are trained in    support materials (e.g. audio-visual,
                                      its use                          exercise, stories, etc) and at least one
                                                                       teacher trained in 12 month period.
Axe I     Sub-IR I.1.4 Increase        Indicator I.1.4 # of persons    Number of persons tested in VCT            VCT site monthly
          the number of people in     tested who come back to VCT      centers which report to TRAC who           summary reports
          the population that know    centers for results              return to get their results.               (TRAC)
          their HIV/ serological
          status (Voluntary
          Counseling & Testing)
Axe I     Sub-IR I.1.5 Increase       Indicator I.1.5 Number of new    New or significantly different messages Intervention agency
          the proportion of the       messages targeting an            that promote increase in knowledge of reports. (does not exist;
          population that knows       increase in knowledge of         symptoms of STI, OIs and TB which       outsource)

          the causes, symptoms        symptoms of STI, OIs and TB.     are disseminated in the year (i.e.
          and consequences of                                          brochures, Radio and TV sports,
          STI, OIs and TB                                              leaflets).


                                                                45                                                                     45
           Result3, Intermediate                                                                                        Data Source
Ref. on                                      Core Indicators
            Result (IR), sub-IR                                                        Definition                      (Responsible
 Axes
            (domain d’intervention)                                                                                       agency)
Axe I     Sub-IR I.2.1 Adopt          Indicator I.2.1 number of         Number of health facility personnel         CNLS intervention
          universal precaution in     health care personnel who are     trained according to national training      monitoring
          health care-related         trained in Universal              criteria on one or more elements of         database (CNLS)
          establishments              Precautions (UP)                  universal precautions                       (would be better to
                                                                                                                    outsource a training
                                                                                                                    database)
Axe I     Sub-IR I.2.2 Adopt          Indicator I.2.2 # of persons      Number of persons treated for STI in        Annual reports
          provider-initiated          who receive treatment for STI     health facilities as documented in          (SIS)
          diagnosis of STIs                                             facility records.

Axe 1     Sub-IR I.2.3 Adopt blood Indicator I.2.3 % transfused          Percentage of transfused blood units       Annual report
          safety measures          blood units which were               which were screened in last 12 months       (CNTS)
                                   screened in last 12 months           according to national standards.

Axe 1     Sub-IR I.3.1 Motivate       Indicator I.3.1# of pregnant      Number of pregnant women tested for         PMTCT site reports
          more pregnant women         women who use PMTCT               HIV at PMTCT centers.                       (TRAC)
          and their partners to use   services
          PMTCT services

Axe I     Sub-IR 1.3.2 Increase       Indicator I.3.2 Number of         Number of sites offering PMTCT              DHT Supervision
          access to high quality      PMTCT sites using national        services according to the national          Reports (TRAC)
          PMTCT services              protocol                          protocol.

Axe I     Sub-IR I.3.3 Assure         Indicator I.3.3 Number of         Number of public health facilities          - DHT Supervision
          Post Exposure               public health facilities (FOSA)   (FOSA) that have a regular stock of         reports (CAMERWA)
          Prophylaxis (PEP) for       which have PEP kits available     PEP kits with in national standards
          health care personnel                                         Definition of national standards must
                                                                        include acceptable days stock-out and
                                                                        this number may change (reduce) over
                                                                        time)
Axe I     Sub-IR I.3.4 Assure         Indicator I.3.4 Percentage of      Percentage of providers completing         CNLS intervention
          PEP for rape victims        providers trained in              (during the reporting period) training of   monitoring
                                      identification, care and          5+ days in identification, care and         database (CNLS)
                                      treatment of rape victims         treatment of rape victims                   (would be better to
                                                                                                                    outsource a training
                                                                                                                    database)




                                                                46                                                                         46
            Result3, Intermediate                                                                                   Data Source
Ref. on                                       Core Indicators
             Result (IR), sub-IR                                                     Definition                    (Responsible
 Axes
              (domain d’intervention)                                                                                  agency)
I.4.2a    Sub-IR I.4.1 Promote          Indicator I.4.2 Number of new   New or significantly different messages Intervention agency
          (the retention of)            messages targeting retention    that promote retention of               reports. (does not
          Rwandan cultural              of Rwanda cultural practice     Rwanda cultural practices that          exist; outsource)
          practices that contribute     that contribute to preventing   contribute to the prevention of HIV and
          to preventing HIV, STI        HIV, STI transmission           other STIs which are disseminated in
          transmission                                                  the year (i.e. brochures, Radio and TV
                                                                        sports, leaflets).

          Sub-IR I.4.2 Promote          Indicator I.4.1 Number of new   New or significantly different messages Intervention agency
          abandoning Rwandan            messages targeting              that promote abandoning                 reports. (does not
          cultural practices that       abandoning cultural practices   Rwanda cultural practices that          exist; outsource)
          contribute to the             that contribute to the          contribute to the transmission of HIV
          transmission of HIV and       transmission of HIV and other   and other STIs which are disseminated
          other STIs                    STIs                            in the year (i.e. brochures, Radio and
                                                                        TV sports, leaflets).




Assessing Impact




                                                                47                                                               47
           Result3, Intermediate                                                                                                        Data Source
Ref. on                                       Core Indicators
            Result (IR), sub-IR                                                               Definition                               (Responsible
 Axes
             (domain d’intervention)                                                                                                      agency)
          Result II: National          Indicator II; Number of            Number of strategic planning/policy                        Desk review:
 Axe      response to HIV/AIDS         strategic planning/policy          documents that have references or                          (Outsourced)
  II      adapted to Rwanda’s          documents that have                citations of Rwanda-specific
          conditions and               references or citations of         surveillance or research documents in
          surveillance/research        Rwanda-specific surveillance       12 month period.
          results                      or research documents.             planning/policy documents include strategic plans
                                                                          from Rwandan institutions. Nat’l or operational policy
                                                                          documents, guidelines, national sector plans, District
                                                                          development plans
Assessing Outcomes
Axe II  IR II.1 Increase the           Indicator II.1 Number of           Number of articles with a Rwanda                           CNLS Desk review:
        usefulness of                  articles submitted with a          among first 3 authors submitted to                         (Outsourced)
        surveillance results with      Rwandan among 1st 3 authors        peer-review journals with data from
        respect to the national        to peer-review journals using      Rwanda’s HIV/AIDS surveillance
        response to HIV/AIDS           HIV/AIDS related surveillance      system.
                                       and/or research data results.      Note: articles do not have to be published. We will
                                                                          add submitted articles to nat’l HIV/AIDS digital library



Axe II    IR II.2 Increase the         Indicator II.2 Number of           Number of documents of any type         Desk review
          usefulness of research       documents which reference          which (1) are included in the “verified (outsource)
          results, studies and         Rwanda-specific research or        collection” of the national HIV/AIDS
          evaluations                  surveillance.                      digital library, (2) reference specific
                                                                          Rwandan research or surveillance data
                                                                          or results
                                                                          Note; study documents that reference other studies
                                                                          may be included


Axe II    IR II.3 Improve ability of   Indicator I.4; Number of MSC       Most Significant Change stories that                       CNLS’ MSC unit
          stakeholders to interpret    stories that address               are submitted to CNLS and meeting                          (CNLS)
          and use surveillances        stakeholder ability to interpret   review board criteria
          and research results         and use surveillance and
                                       research results

Monitoring Programme Outputs




                                                                  48                                                                                     48
           Result3, Intermediate                                                                                            Data Source
Ref. on                                        Core Indicators
             Result (IR), sub-IR                                                          Definition                       (Responsible
 Axes
              (domain d’intervention)                                                                                         agency)
Axe II    Sub-IR II.1.1 Improve         Indicator II.1.1 Percentage of     Percentage of all AIDS-related deaths        SIS
          national systems for          all AIDS-related deaths that       that are reported through national           (and ?? to estimate total
                                                                                                                        number AIDS-related
          case notification of          are reported through national      health information system                    deaths)
          morbidity and mortality       health information system
          related to AIDS
Axe II    Sub-IR II.1.1                 Indicator II.1.1b Number of        Number of medical and non-medical            CNLS intervention
                                        medical and non-medical            people completing training of 5+ days        monitoring
                                        people trained to accurately       to accurately determine causes of            database
                                        determine causes of deaths         deaths in 12 month period                    (would be better to
                                                                                                                        outsource a training
                                                                                                                        database)
Axe II    Sub-IR II.1.2 Establish a     Indicator II.1.2 annual report     National annual report on behavioral         Nat’l Behavioral
          sustainable behavioral        on behavioral change using         change using National BSS and other          Surveillance
          surveillance system           National BSS and other             behavioral studies is disseminated           System and other
                                        behavioral studies is              (proxy for sustainable system                behavioral studies
                                        disseminated                                                                    (TRAC)
Axe II.   Sub-IR II.1.3 Improve         Indicator II.1.3 Nat’l             TRAC uses blood samples obtained             Annual surveillance
          the HIV sero-                 surveillance reports include       during sentinel surveillance to test for     reports (NRL &
          surveillance by including     prevalence of infections other     pathogens other than HIV as evidence         TRAC)
          other HIV/AIDS related        than HIV                           in TRAC surveillance annual reports
          diseases
Axe II    Sub- II.1.4 Improve           Indicator II.1.4 Annual report     For each HIV serotype in Rwanda, the         NRL annual report
          pharmacological               of HIV types (I, II) in Rwanda     most recent pharmacy-sensitivity             (NRL)
          sensitivity surveillance      and level of resistance to         surveillance report identifies the level
          to improve AIDS               treatment « lignes” 1, 2, 3        of resistance to treatment “lines 1, 2, 3”
          treatment                     used in Rwanda                     used in Rwanda.
Axe II    Sub-IR II.1.5 Improve         Indicator II.1.5 Number of         Number of staff members of TRAC and          CNLS intervention
          the statistical and           Rwandans involved in               others involved in surveillance analysis     monitoring
          analytic competencies of      surveillance that are trained in   and reporting who completed training         database
          surveillance technicians      statistics and data analysis       of 5+ days statistics and data analysis      (would be better to
                                                                           Note; this is subset of II.2.2               outsource a training
                                                                                                                        database)




                                                                   49                                                                               49
           Result3, Intermediate                                                                                         Data Source
Ref. on                                        Core Indicators
             Result (IR), sub-IR                                                        Definition                      (Responsible
 Axes
             (domain d’intervention)                                                                                       agency)
Axe II    Sub-IR II.2.1 Improve         Indicator II.2.1 Number of       Number of Rwandans completing               CNLS intervention
          the methodological            Rwandans trained in research     (during the reporting period) training      monitoring
          competencies of               methodologies                    for 5+ days in research methods (with       database
          researchers                                                    exercises that use HIV/AIDS-related         (would be better to
                                                                         examples and/or data                        outsource a training
                                                                                                                     database)
          Sub-IR II.2.2 Improve         Indicator II.2.2 Number of       Number of Rwandan researchers who           CNLS intervention
Axe II    the statistical and           Rwandans researchers that        completed training of 5+ days statistics    monitoring
          analytical competencies       are trained in statistics and    and data analysis                           database
          of researchers                data analysis                                                                (would be better to
                                                                                                                     outsource a training
                                                                                                                     database)
          Sub-IR II.2.3 Involve         Indicator II.2.3 The number of   Number of study protocols approved          National HIV/AIDS
Axe II    people to be studied in       protocols executed that          by the CNLS Research Committee that         Research
          the identification, design    include participation of the     document the involvement of the             Committee annual
          and execution of              population that is being         population being studied in the design      report (CNLS)
          research                      studied                          and/or execution and/or analysis of the
                                                                         study
          Sub-IR II.3.1 Promote         Indicator II.3.1 number of       Number of new (not previously               National HIV/AIDS
Axe II    and facilitate the routine    new research studies             presented) research study abstracts         annual conference
          availability and              disseminated at the national     that are reviewed and approved for          report (CNLS)
          surveillance and              annual research exchange         dissemination by National HIV/AIDS
          research results              conference                       Research Committee at the national
                                                                         annual research exchange conference

Axe II    Sub-IR II.3.2 Improve         Indicator II.3.2 Number of       Number of non-technical and non-            CNLS intervention
          the analytical capacity of    non-technical persons trained    research/surveillance persons               monitoring
          all levels of beneficiaries   in data analysis and             completing training for 5 or more days      database
          and decision makers           interpretation with Rwanda       in data analysis and interpretation, with   (would be better to
                                        specific exercises or examples   Rwanda-specific exercises or                outsource a training
                                                                         examples in past 12 months                  database)




                                                                   50                                                                    50
           Result3, Intermediate                                                                                        Data Source
Ref. on                                       Core Indicators
             Result (IR), sub-IR                                                       Definition                      (Responsible
 Axes
             (domain d’intervention)                                                                                      agency)
Axe       Sub-IR II.3.3 Strengthen     Indicator II.3.3 Number of        Number of stakeholders, technical and      CNLS intervention
          the capacity of              people (technical and non-        non-technical, at all levels, completing   monitoring
          technicians and              technical) trained in data        (during the reporting period) training     database
          stakeholders to present      information presentation with     for 5 or more days in the presentation     (would be better to
          results in various more      Rwanda specific exercise or       of data and information with Rwanda-       outsource a training
          useable formats              example                           specific exercises or examples in past     database)
                                                                         12 months
Assessing Impact
        Result III: Improve            Indicator III                     Percent of adults and children who are
 Axe    HIV/AIDS treatment,             Percentage of persons on         still receiving ART – with absolute        ART site reports
  III   care and support for           ART that are alive 12 months      adherence - 12 months after starting       through TRACnet
        persons infected and           after starting treatment          treatment (measure of both survival        (TRAC)
        affected by AIDS                                                 and adherence)




Assessing Outcomes
Axe III IR III.1 Increase access       Indicator III.1 Percent of male   Percent of (estimated number of)           ART site reports
        to high quality care and       and females with advanced         advanced stage HIV+ people in              through TRACnet
        treatment at health            HIV/AIDS infection receiving      Rwanda who are receiving ARV               (TRAC)
        facilities                     ARV combination therapy

Axe III   IR III.2 Increase access     Indicator III.2 Percent of        Percent of eligible households             CNLS intervention
          to high quality the          eligible households that          identified by community FBOs and           monitoring
          community- based care        receive Rwanda’s minimum          umbrella organizations receiving at        database
          and treatment                package (or more) of              least Rwanda’s minimum package of
                                       community-based services in       home-based HIV/AIDS services
                                       their home
Axe III   IR III.3 Assure that         Indicator III.3 Number of         Number of objectives specified in the      CNLS annual
          HIV/AIDS related care        objectives in the national        National Sustainability Plan that are      report
          and treatment is             sustainability plan that are      reached, during each reporting year        (TRAC/CNLS)
          sustainable                  reached                           and cumulative through the time period
                                                                         of the plan. (a prerequisite is that a
                                                                         plan must be developed in 2006)
Monitoring Programme Outputs

                                                                 51                                                                     51
           Result3, Intermediate                                                                                                    Data Source
Ref. on                                         Core Indicators
            Result (IR), sub-IR                                                                    Definition                      (Responsible
 Axes
             (domain d’intervention)                                                                                                  agency)
Axe III   Sub-IR III.1.1 Assure        Indicator III.1.1 % of health                 Percent of all public and para-public      TRAC annual
          equitable coverage of        care and other facilities that               health facilities (FOSA) which treat        reports (TRAC)
          ART services with            are treating HIV+ infants and                HIV+ infants and adults according to
          accent on pediatric care     adults according to national                 national standards and procedures
                                       norms and procedures
                                                                                    Note: this is also a proxy for proportion
                                                                                    of all HIV+ infants who are on ARV.
Axe III   Sub-IR III.1.2 Improve       Indicator III.1.2 % of all                   Percent of all (appropriate) service        CNLS intervention
          treatment of OIs             service providers trained in                 providers that have been trained 5+         monitoring
          according to national        diagnosis and treatment of OI                days in diagnosis and treatment of OIs      database (CNLS)
          norms and procedures         according to national                        according to the national protocol.         (would be better to
                                       guidelines                                                                               outsource a training
                                                                                                                                database)
          Sub IR III.1.3 Reduce        Indicator III.1.3 % of people                 Percent of (estimated number of )          TRAC+ annual
Axe III   the real cost of             that are TB+ who receive TB                  TB+ people who received TB therapy          Report (TRAC+)
          accessing HIV/AIDS           therapy                                      during the 12 month reporting period
          related care and
          treatment                    Note: this is a proxy for reducing real-
                                       cost because, the greatest obstacle
                                       to people getting the free TB
                                       treatment, is the cost of their visiting a
                                       doctor to be diagnosed and eligible
                                       for the free treatment
          Sub IR III.1.4 Promote       Indicator III.1.4 % of all                   Percent of all (appropriate) service        CNLS intervention
Axe III   the approach “Provider       service providers trained in                 providers that have been trained 5+         monitoring
          Initiated Diagnosis”         diagnosis and treatment of PID               days in PID according to the national       database (CNLS)
          (PID)                        according to national                        protocol.                                   (would be better to
                                       guidelines                                                                               outsource a training
                                                                                                                                database)
          Sub IR III.1.5 Improve       Indicator III.1.5 Number of                  Number of joint sessions/meetings           CDLS and DHT
Axe III   the collaboration and the    joint sessions/meetings                      between medical corps (employees of         Report (CDLS)
          services referrals           between medical corps and                    FOSA) and community health care
          between health care          community health care                        providers (non medical corps)
          providers and                providers
          community agents




                                                                          52                                                                      52
           Result3, Intermediate                                                                                          Data Source
Ref. on                                       Core Indicators
             Result (IR), sub-IR                                                         Definition                      (Responsible
 Axes
             (domain d’intervention)                                                                                        agency)
          Sub-IR III.1.6 Improve       Indicator III.1.6 # of FOSA         Number of health facilities (FOSA) with    CNLS intervention
Axe III   therapeutic nutritional      with capacity (trained              both the necessary equipment,              monitoring
          support for people on        personnel and equipment) to         supplies, budget and trained personnel     database (CNLS)
          ART                          provide nutrition therapy as        to provide therapeutic nutrition           (would be better to
                                                                                                                      outsource a training
                                       part of in-patient support to       according to established norms             database)
                                       HIV/AIDS patients                   Note; this is a composite indicator        + Districts/MOH for
                                                                                                                      info on budgets,
                                                                                                                      plans, equipment
Axe III   Sub-IR III.1.7 Integrate     Indicator III.1.7 % of health       Percent of all Number of mutual health     MoH ad-hoc
          care and treatment of        insurance providers (mutuelles      insurance societies that have included     reports (MOH)
          OIs among other              de sante) that have included        OIs (Specify eligible OIs) among the
          illnesses supported          OI in the list of illness covered   list of insured illnesses
          through health mutuals                                           .
Axe III   Sub-IR III.1.8               Indicator III.1.8 % of all          Percent of all employees at FOSA           CNLS intervention
          Strengthen health care       employees working at FOSA           (FOSA team) that have been trained         monitoring
          providers’ capacity to       trained in quality assurance        5+ days in (one or more components         database (CNLS)
          deliver the highest                                              of) quality assurance)                     (would be better to
                                                                                                                      outsource a training
          quality care.                                                                                               database)
Axe III   Sub-IR III.2.1 Assure        Indicator III.2.1 percent of        Percent of all administrative "secteurs"   CDLS reports
          equitable coverage of        administrative sectors in which     in which home-based care is provided       (CDLS)
          community-based care         home-based care is provided         as reported by implementers to CDLS.
          and treatment services
          Sub-IR III.2 Improve the     Indicator III.2.2 # of HIV+         Number of HIV+ people on ARVs who          CDLS reports
Axe III   community-based care         people assisted in their homes      are assisted with adherence (DOT) in       (CDLS)
          and treatment of people      for ART adherence                   their homes.
          living with HIV/AIDS
          (medical, psychosocial       Note: if ART adherence (DOT)
          and spiritual)               is part of minimum HBC
                                       package, then this is
                                       redundant with indicator III.2
Axe III   Sub-IR III.2.3               Indicator III.2.3 # of people       Number of non-medical people               CNLS intervention
          Strengthen the technical     trained in techniques for           completing 5+ day training in              monitoring
          capacity of people and       HIV/AIDS home based care.           techniques for HIV/AIDS home care          database (CNLS)
          organizations providing                                          during 12 month reporting period.          (would be better to
                                                                                                                      outsource a training
          community-based care                                                                                        database)
          and support


                                                                   53                                                                        53
            Result3, Intermediate                                                                                         Data Source
Ref. on                                       Core Indicators
             Result (IR), sub-IR                                                         Definition                      (Responsible
 Axes
             (domain d’intervention)                                                                                        agency)
Axe III   Sub-IR III 2.4 Integrate     Indicator III.2.4 # homes          Number of homes visited 12+ times by        CNLS intervention
          home-based care and          visited regularly by trained       MOH PAS agents - trained in                 monitoring
          treatment for PLWHA          MOH Program d’Animateur de         HIV/AIDS home-based care during the         database (CNLS)
          within community-based       Sante (PAS) agents for             12 month reporting period..                 (would be better to
                                                                                                                      outsource a training
          health services              HIV/AIDS-related care              Note; counting only PAS visits is a         database)
                                       .                                  proxy for all agency HBC visits             + Districts/MOH for
                                                                          Also, note; this is a composite indicator   info on PAS visits
Axe III   Sub-IR III.2.5 Develop       Indicator III.2.5 # of rural       Number of rural administrative sectors      CDLS report
          and standardize out-         administrative sectors visited     visited by mobile treatment units that      (CDLS)
          patient and mobile           by mobile treatment units that     adhere to national standards and
          treatment services           adhere to national standards       protocols
                                       and protocols
Axe III   Sub-III.2.6 Improve the      Indicator III.2.6 # of homes of    Number of homes of PLWHA which              CDLS / RRP+
          nutritional status of        PLWHA that are provided with       are provided with food and nutrition
          people infected and          nutritional and/or food security   counseling and/or assistance with
          affected by HIV/AIDS         support                            growing and preparing foods and/or
                                                                          school feeding programs.
                                                                          Note: if nutritional support is part of
                                                                          minimum HBC package, then this is
                                                                          redundant with indicator III.2
Axe III   Sub-IR III 3.1 Improve       Indicator III.3.1 # of FOSA        Number of facilities (FOSA) reporting       FOSA reports
          decentralized HIV/AIDS       that report no stock-outs for      no stock-outs of three drugs -- ARV or      through TRACNet
          related procurement,         ARV or AZT or IO                   AZT or Cotrimoxizole                        (TRAC+)
          management and
          distribution systems t
          (equipment, regents,
          consumable, medicine
          etc,)
Axe III   Sub-IR III.3.2 Increase      Indicator III.3.2 # of health      Number of health care providers at          MOH/District
          Rwandan human                care providers at FOSA             health facilities (FOSA) who are            reports (MOH,
          resources needed for         qualified to provide AIDS, OI      authorized to provide - and providing -     DHT)
          HIV/AIDS-related care        or STI treatment                   treatment in AIDS, OIs, or STIs.
          and treatment                                                   (assumes have been trained)




                                                                  54                                                                         54
           Result3, Intermediate                                                                                       Data Source
Ref. on                                       Core Indicators
            Result (IR), sub-IR                                                          Definition                   (Responsible
 Axes
             (domain d’intervention)                                                                                     agency)
Axe III   Sub-IR III.3.3 Establish     Indicator III.3.3 # of              Number of administrative «sectors»      CDLS annual
          system to supply             administrative sectors              which report no stockouts of home-      report (CDLS)???
          communities with             reporting no stock-outs of          based care kits
          required materials           home-based care kits.
                                                                           Must define HBC “kit” and Need to
                                                                           define acceptable stock out standard
Axe III   Sub-IR III.3.4 Execute a     Indicator III.3.4 % of activities     Percent of all planned activities in the CNLS Report
          national plan to assure      in the annual operation plan of     annual operation plan of the national
          that the expanded global     the national sustainability plan    sustainability plan which were
          care and treatment is        that are completed.                 completed during the 12 month
          sustainable.                                                     reporting period




Assessing Impact
                                                                           market value of all final goods and     MINECOFIN
Axe       Result IV: Mitigate the      Indicator: increase in GDP          services produced in Rwanda during
IV        socio-economic of HIV                                            the 12 month reporting period
          and AIDS




Assessing Outcomes
Axe IV   IR IV.1 Improve the           Indicator IV.1a Per capita          Total income divided by the total       Ministry of
         socio-economic                income)                             population…                             Planning;
         conditions in Rwanda                                                                                      MINECOFIN
         (and assure vulnerable                                                                                    Reports
         groups benefit as much
         as others)




                                                                    55                                                                55
           Result3, Intermediate                                                                                       Data Source
Ref. on                                       Core Indicators
             Result (IR), sub-IR                                                        Definition                    (Responsible
 Axes
             (domain d’intervention)                                                                                     agency)
Axe IV    IR IV.2 Defend and           Indicator IV.2 number of           number of cases that come to court        Prosecutor
          promote human rights         cases that come to court           claiming violation of human rights with   General’s Office-
                                       claiming violation of human        respect to HIV/AIDS have been used.
                                       rights with respect to HIV/AIDS    .
                                       have been used.


Axe IV    IR IV.3 Strengthen           .                                  Number of non-HIV/AIDS                   RRP+ reports
          decision making              Indicator IV.3 Number of           organizations which have included a
          capacity of associations     organizations including            PLWHA association or HIV infected
          involved in HIV/AIDS         PLWHA in their policy/planning     person in development of their policies,
          notably though the           development and program            plans and/or program assessment
          concept of GIPA              assessment.
          (Greater Involvement of
          People living with
          HIV/AIDS)
Monitoring Programme Outputs
Axe IV    Sub-IR IV.1.1 Create         Indicator IV.1.1                   % of vulnerable people (members of        Ad-hoc report
          employment                   % of vulnerable people             association of PLWHA) who are             (MINILOC/RRP+)
          opportunities in             (members of associations of        unemployed
          particular for vulnerable    PLWHA ) who are unemployed
          groups
Axe IV    Sub-IR IV.1.2 Assure         Indicator IV.1.2a # of new         Number of new loans given for income      annual reports
          access to credit for         loans given to vulnerable          generating activities to vulnerable       (RRP+)
          vulnerable groups            people (PLWHA                      people (members of associations of
                                                                          PLWHA) during the reporting period.

          Sub-IR IV.1.2                Indicator IV.1.2b total value of   Total value of new loans given for        annual reports
                                       new loans given to vulnerable      income generating activities to           (RRP+)
                                       people (PLWHA)                     vulnerable people (members of
                                                                          associations of PLWHA) during the
                                                                          reporting period.




                                                                  56                                                                    56
            Result3, Intermediate                                                                                       Data Source
Ref. on                                        Core Indicators
             Result (IR), sub-IR                                                        Definition                     (Responsible
 Axes
              (domain d’intervention)                                                                                     agency)
Axe IV    Sub-IR IV.1.3 Improve         Indicator IV.1.3 Female to        total value (FRw) of grants and loans      CDLS reports
          the equity and equality       male ratio of all grants and      given to female PLWHA : total value
          between women and             loans given to PLWHA for          (FRw) given to male PLWHA for
          men regarding income          income generating activities      income generating activities. during the
          generating activities and     given to PLWHA                    reporting period
          employment
          opportunities
Axe IV    Sub IR IV.1.4 Improve         Indicator IV.1.4 # of OVCs        Number of OVC and PLWHA given              CDLS reports
          access to formal and          and PLWHA supported to            material or financial support to attend
          informal education for        attend schools or receive         secondary school, vocational training,
          target groups with an         vocational or literacy training   or literacy programmes.
          accent on PLWHA and
          OVC
Axe IV    Sub-IR IV.2.1 Improve         Indicator IV 2.1 # of laws        # of laws revised, adopted or repealed     Government
          the judicial environment      revised, adopted or repealed      to ensure that OVC and/or PLWHA            Gazette
          for PLWA and OVC              to ensure that OVC and/or         rights are respected                       (Primature)
                                        PLWHA rights are respected
Axe IV    Sub-IR IV.2.2 Increase        Indicator IV.2.2 cumulative         cumulative number of large               APPELAS,
          the number of                 number of large enterprises       enterprises and companies which have       umbrella of public
          employers who have            and companies which have          adopted HIV/AIDS work-place policies       sector.
          adopted or adapted            adopted HIV/AIDS work-place       and programmes for the first time.
          workplace policies that       policies and programmes for       a workplan policy/program should
          take into account             the first time.                   include (1) promotion of VCT (2)
          PLWHA                                                           provide or pay (direct or indirect
                                                                          through insurance) for ARV (3)
                                                                          prevention (4) non discrimination (5)
                                                                          workplace plan of action

Axe IV    Sub-IR IV.2.3 Protect         Indicator IV.2.3 # of cases of    # of cases of violence reported to local   Ad-hoc report
          young girls and women         violence reported to local law    law enforcement agencies                   (ministry of internal
          from domestic and             enforcement agencies              Violence included is “rape”, sexual        affairs)
          sexual violence as well                                         harassment, assault and battery.
          as sexual harassment




                                                                    57                                                                    57
            Result3, Intermediate                                                                                        Data Source
Ref. on                                        Core Indicators
             Result (IR), sub-IR                                                        Definition                      (Responsible
 Axes
              (domain d’intervention)                                                                                      agency)
Axe IV    Sub-IR IV.2.4 Improve         Indicator IV.2.4 # of            Number of operational government            MoH/Umbrella
          operational policies,         operational policy documents     policy documents revised or adopted         organizations/NGO
          norms and procedures          revised or adopted that          to specifically address issues of equity    s > Public Sector
          to assure equitable           specifically address issues of   for PLWHA and OVCs, in the past             report
          access to services for        equity for PLWHA and OVCs        year.
          PLWHA and OVCs
Axe IV    Sub-IR IV.3.1                 Indicator IV.3.1 # of            Number of members of associations           CNLS intervention
          Strengthen managerial         association members trained      involved with HIV/AIDS who completed        monitoring
          capacity of associations      for 5+ days on management of     training in management for 5+ days          database (CNLS)
          involved with HIV/AIDS        HIV/AIDS interventions           during the reporting period.                (would be better to
                                                                         Note; training must include orientation     outsource a training
                                                                         to use of the RRP+ Administration &         database)
                                                                         Finance Manual
Axe IV    Sub-IR IV.3.2 Balance         Indicator IV.3.2a. % of            Percent of new members who had            RRP+ membership
          of the composition of         members of associations of       secondary school education or more at       records
          HIV/AIDS related              PLWA with secondary school       the time of joining, during the reporting
          associations (increase        education or higher              period.
          proportion of male,
          middle class & HIV –
          members).

          Sub-IR IV.3.2                 Indicator IV.3.2b. % of            Percent new registered members of         RRP+ membership
                                        members of associations of       PLWA associations during the                records
                                        PLWHA not HIV+                   reporting period
Axe IV    Sub-IR IV.3.3 Increase        Indicator IV.3.3 # of            Number of associations of PLWHA             RRP+ reports
          involvement of PLWHA          associations of PLWHA            association members who were
          in the planning,              involved in the planning,        involved in the planning,
          execution and review of       implementation, and review of    implementation, and/or review of
          programmes                    programmes /projects             programmes or projects, during the
                                                                         reporting period.


Assessing Impact




                                                                  58                                                                   58
           Result3, Intermediate                                                                                      Data Source
Ref. on                                      Core Indicators
            Result (IR), sub-IR                                                       Definition                     (Responsible
 Axes
            (domain d’intervention)                                                                                     agency)
                                      The ratio of the value of         The ratio of the adjusted value of        outsource
Axe       Result V: Coordinate the    government expenditures on        government expenditures on HIV/AIDS
V         multi-sector response       HIV/AIDS to value of external     to value of external assistance for
          for increased cost-         assistance for HIV/AIDS           HIV/AIDS The adjust value of
          effectiveness                                                 government expenditures is
                                                                        determined by applying average
                                                                        external assistance values for human
                                                                        resources to government human
                                                                        resources.
Assessing Outcomes
Axe V    IR V.1 Improve the           Indicator V.1; Number of MSC      Most Significant Change stories that      Various
         capacities of national       stories that address capacity     are submitted to CNLS and meet            intervention
         HIV/AIDS coordination        of national HIV/AIDS              review board criteria                     agencies (CNLS’
         structures                   coordination structures                                                     MSC unit)
Axe V    IR V.2 Assure that           Indicator V.2 Number of           Number of HIV/AIDS related objectives     Desk review of
         HIV/AIDS strategies          HIV/AIDS-related objectives in    across all (sum total) of the sector      sector plans for
         within national sector       national sector plans that have   plans, which have been achieved           MTR (CNLS)
         plans are implemented        been achieved..

Axe V     IR V.3 Increase             Indicator V.3 Number of           Number of cross-border activities         CNLS reports on
          HIV/AIDS related            regional interventions that are   executed by Rwandans for which there      regional joint
          regional activities that    jointly executed                  are similar, coordinated activities       interventions.
          are jointly executed                                          executed by the country sharing that
                                                                        border and for which there are
                                                                        meetings to plan and/or exchange
                                                                        experiences/ideas
                                                                        Note; the cross-border activities are a
                                                                        proxy for all regional interventions
                                                                        even those that are not cross-border




                                                                 59                                                                  59
            Result3, Intermediate                                                                                          Data Source
Ref. on                                        Core Indicators
             Result (IR), sub-IR                                                          Definition                      (Responsible
 Axes
              (domain d’intervention)                                                                                        agency)
Axe V     IR V.4 Assure that            Indicator V.1; Number of MSC       Most Significant Change stories that        Various
          intervention agencies         stories that address               are submitted to CNLS and meet              intervention
          benefit from national         intervention agencies              review board criteria                       agencies (CNLS’
          planning and monitoring       perception of                                                                  MSC unit)
          as much as the                usefulness/benefits of
          coordination agencies         contributing to national
                                        planning, M&E

Axe V     IR V.5 Jointly evaluate       Indicator V.5 mid-term review      Joint Multisectoral reviews which have      Ad-hoc report
          the multi-sector              of HIV/AIDS national response      ensured the participation of a wider        (CCM or similar
          response to HIV/AIDS          (2007) and end-of period           segment of stakeholders in annual of        structure or
                                        evaluation (2009/10) are jointly   mid-term review. Stakeholders include       outsourced)
                                        executed with representation       beneficiaries, implementers, donors,
                                        from all stakeholders.             and coordination structures (CNLS,
                                                                           TRAC, CDLS, umbrellas).




Monitoring Programme Outputs
Axe V     Sub-IR V.1.1 Strengthen       Indicator v.1.1 # of members       Increase in Number of members of            CNLS intervention
          leadership capacity of        of coordination structures,        coordination structures completing          monitoring
          personnel                     trained in leadership skills,      training of 5+ days in leadership skills:   database (CNLS)
                                        meeting facilitation or public     meeting or workshop facilitation or         (would be better to
                                        speaking                           public speaking during the 12 month         outsource a training
                                                                           reporting period.                           database)
Axe V     Sub-IR V.1.2 Strengthen       Indicator V.1.2 # of members       Increase in Number of members of            CNLS intervention
          administrative and            of coordination structures         coordination structures training for 5+     monitoring
          managerial capacity of        trained in administration and      days in administration and                  database (CNLS)
          institutions                  management.                        management during the 12 month              (would be better to
                                                                           reporting period                            outsource a training
                                                                                                                       database)




                                                                   60                                                                    60
           Result3, Intermediate                                                                                        Data Source
Ref. on                                       Core Indicators
             Result (IR), sub-IR                                                         Definition                    (Responsible
 Axes
             (domain d’intervention)                                                                                      agency)
Axe V     Sub-IR V.1.3                 Indicator V.1.3 number of           Increase in number of coordination        CNLS/development
           Assure that necessary       coordination structures that        structures out of the sum total of all    partners/umbrellas
          resources for operations     obtain and spend their annual       identified that obtain > 80% needed       MINECOFIN
          are available for            budgets                             funding for their annual budgets and
          coordinating structures                                          spend 80% of money obtained within
                                                                           the funding year.
                                                                           current list of coordinating structures
                                                                           include CNLS, office of Minister of
                                                                           state for HIV/AIDS and other infectious
                                                                           diseases, office of the president, 30
                                                                           different CDLS, APELAS, AOR, RRP+,
                                                                           Forum des OGN.
Axe V     Sub-IR V.1.4 Harmonize       Indicator V.1.4 # of                Increase in number of formal written      Ad-hoc report
          the directives and           communications sent jointly by      directives, statements, requests          (CCM or similar
          communications across        central coordinating authority      issued in 12 reporting period which       structure or
          all intervention domains                                         were signed by 2 or more implicated       outsourced)
                                                                           coordinating authorities
                                                                           Incl: CNLS, office of Minister of state
                                                                           for HIV/AIDS and other infectious
                                                                           diseases, office of the president, 30
                                                                           different CDLS
Axe V     Sub-V 2.1 Develop and        Indicator V.2.1 a. # of national    Cumulative number of national sectors     CNLS report:
          disseminate approaches       sectors/ ministries that have       which held a workshop to review           CNLS review of
          and methods for              dissemination workshops             methods for integrating HIV/AIDS into     sector plans and
          integrating HIV/AIDS         reviewing methods for               their national plans (excluding the       workshop reports
          into national sector         integrating HIV/AIDS                EDPRS process).
          plans                                                            The 14 sectors include health, educa-
                                                                           tion, agriculture, infrastructure, ICT
                                                                           tele-communications, commerce &
                                                                           trade, and others.
Axe V     Sub-IR V.2.2 Assure          Indicator V.2.                                                                analysis of
          that leaders advocate        a. # of advocacy-related            # of advocacy-related activities in       workplans during
          for integrating HIV/AIDS     activities in multi-sector annual   multi-sector annual workplans as          annual workplan
          in each sector               workplans that have been            developed and presented through the       presentation by FP
                                       completed.                          HIV/AIDS focal points that have been      (CNLS)
                                                                           completed.


                                                                   61                                                                   61
            Result3, Intermediate                                                                                            Data Source
Ref. on                                        Core Indicators
             Result (IR), sub-IR                                                          Definition                        (Responsible
 Axes
              (domain d’intervention)                                                                                          agency)
Axe V     Sub-IR V.2.3 Establish        Indicator V.2.3 Number of          The number of sectors holding annual           review of Sector
          an awards mechanism           sectors holding annual award       award ceremonies in which HIV/AIDS            Annual Reports
          ceremony for best             ceremonies in which HIV/AIDS       interventions are recognized, in the 12       (CNLS)
          interventions and             interventions are recognized       month reporting period
          agencies in each sector
Axe V     Sub-IR V 3.1 Harmonize        Indicator V.3.1                    % national and sector-specific                GLIA report. (GLIA
          the [regional] HIV/AIDS       % of Rwandan national and          HIV/AIDS plans and frameworks are             secretariat or
          policies and                  sector-specific HIV/AIDS plans     consistent with regional plans and            outsourced)
          frameworks/documents          and frameworks are consistent      framework
                                        with regional plans and            Note; will identify and list the plans and
                                        framework                          frameworks to be compared
Axe V     Sub-IR V 3.2 Assure           Indicator V 3.2 # of joint cross   # of joint cross border workplans             GLIA report. (GLIA
          that jointly developed        border workplans executed.         executed                                      secretariat )
          cross-border HIV/AIDS
          activity plans are
          executed
Axe V     Sub-IR V 3.3. Make            Indicator V.1.4 number of          Increase in number of regional                Regional
          available necessary           regional HIV/AIDS                  HIV/AIDS interventions/initiative out of      secretariat e.g.
          resources (funds) for the     interventions/initiatives that     the sum total of all identified that obtain   GLIA > CNLS
          execution of regional         obtain and spend their annual      > 80% needed funding for their annual         report
          HIV/AIDS interventions        budgets                            budgets and spend 80% of money
                                                                           obtained within the funding year.

Axe V     Sub-IR V 4.1 Simplify         Indicator V.4.1 # variables        # variables collected by national             Ad-hoc review:
          and harmonize planning        collected by national              coordination structures and large             planning and
          and monitoring tools          coordination structures and        bi/multi-lateral projects (CNLS, MAP,         monitoring tools
                                        large bi/multi-lateral projects    GF, PEPFAR)                                   (CNLS)
                                                                           Note: this is a proxy for time it takes to
                                                                           report.
Axe V     Sub-IR V 4.2 The level        Indicator V.4.2 number of          Reduction in the sum total of all             Ad hoc report
          of detail needed for          activities identified in           interventions (activities, tasks,             (CNLS or
          national planning and         workplans submitted to CNLS        milestones, etc) identified across all        outsourced)
          workplan monitoring is                                           work plans submitted to CNLS during
          appropriate for national                                         12 month reporting period.
          level reporting (in
          decentralized context)


                                                                    62                                                                       62
           Result3, Intermediate                                                                                            Data Source
Ref. on                                       Core Indicators
             Result (IR), sub-IR                                                          Definition                       (Responsible
 Axes
             (domain d’intervention)                                                                                          agency)
Axe V     Sub-IR V 4.3 Strengthen      Indicators V.4.3 #                  Number of coordination structure             CNLS intervention
          capacity to facilitate       coordination structure              personnel completing training for 5+         monitoring
          planning and monitoring      personnel trained in facilitating   days in facilitating planning                database (CNLS)
          workshops and                planning workshops/meetings,        workshops/meetings, and in reporting         (would be better to
          meetings                     and in reporting                    during the 12 month reporting period         outsource a training
                                                                                                                        database)
Axe V     Sub-IR V.4.4 Assure          Indicators V.4.4 % of activities    % of activities identified in work plans     Ad hoc report
          that the national            identified in work plans            submitted to CNLS that correctly             (CNLS or
          HIV/AIDS strategic           submitted to CNLS that              identify the Axe, IR and sub-IR as well      outsourced)
          framework and M&E            correctly identify the Axe, IR      as the indicator(s) to which they
          plan are used by all         and sub-IR as well as the           contribute
          agencies for activity        indicator(s) to which they
          planning & monitoring        contribute
Axe V     Sub-IR V.5.1 Harmonize       Indicator Sub-IR V.5.1 a)           Indicator values submitted by                Annual data
          and operationalize           Indicator values submitted by       intervention agencies are comparable.        quality/reliability
          national indicators, M&E     intervention agencies are           Comparable is defined as all agencies        studies (CNLS and
          and planning tools           comparable.                         understanding and applying the same          TRAC)
                                                                           operational definition in their reporting.
          Sub-IR V.5.1                 Indicator Sub-IR V.5.1 b)
                                       Same M&E and planning
                                       format are used at district level
                                       by interveners

Axe V     Sub-IR V.5.2 Strengthen      Indicator V.5.2                     Number of people completing (during          CNLS intervention
          capacity at all levels to    # of people trained in data         the reporting period) training for 5+        monitoring
          evaluate the national        use/interpretation using            days in data interpretation and use,         database (CNLS)
          response                      indicators & data                  with Rwandan indicators & data.              (would be better to
                                                                           During the 12 month reporting period         outsource a training
                                                                                                                        database)
Axe V     Sub-IR V.5.3 Jointly         Indicator V.5.2 # of                # of organizations regularly participat-     Summary of TWG
          develop and validate         organizations regularly             ing in TWG to develop/modify/validate        meeting minutes
          information products         participating in TWG to             national M&E products                        (CNLS & TRAC)
          from national                develop/modify/validate
          evaluations                  national M&E products




                                                                     63                                                                   63
            Result3, Intermediate                                                                                       Data Source
Ref. on                                        Core Indicators
             Result (IR), sub-IR                                                        Definition                     (Responsible
 Axes
              (domain d’intervention)                                                                                     agency)
Axe V     Sub-IR V. 5.4 Assure          Indicator V.5.4 # of M&E        # of M&E products that stakeholders         Email /phone
          that national M&E             products that stakeholders      have obtained/accessed and, if they         survey (CNLS or
          products are available        have obtained/accessed.         have tried to use them, they find them      outsourced)
          and useable (to/by                                            useable
          information providers                                         M&E products are: all CNLS M&E
          and users).                                                   reports, Nat’l virtual library, UNGASS
                                                                        report, outputs from intervention
                                                                        database, etc (to be identified in
                                                                        separate indicator target table (part II)
Axe V     Sub-IR V.5.5.                 Indicator V.5.4a. existence and If annual and/or long-term plan for         Desk review (CNLS
          Coordinate research           use of national long-term or    HIV/AIDS research exists, then              or outsource)
          and training.                 annual HIV/AIDS-related         evidence from meeting minutes and
                                        research plans                  other sources demonstrate that it was
                                                                        used to coordinate research.

          Sub-IR V.5.5                  Indicator V.5.4b existence and    If a national training database exists    Desk review (CNLS
                                        use of a national training        and evidence from meeting minutes         or outsource)
                                        database                          and other sources demonstrate that it
                                                                          was used to coordinate training.




                                                                  64                                                                  64
Indicators CNLS will track for use during Mid-Term reviews, end of period evaluation and monitoring Global HIV/AIDS and project
specific (response) but are not necessarily sensitive to national response and are not analyzed in CNLS’ annual M&E reports

Axe I     IR. I.1                   prevalence of HIV/AIDS in                                                   ANC Sentinel
                                    people aged 15-49 years                                                     surveillance
                                                                                                                (TRAC)
Axe I     IR I.2                    % of transfused blood units      a. Numerator: Number of transfused         CNTS
                                    which were screened in last 12   blood units which were screened in
                                    months                           last 12 months according to WHO or
                                                                     national standards, x 100.
                                                                       Denominator: Number of transfused
                                                                     blood units.
Axe I     Sub-IR I.1.5              % of the population who know     The percent of the population              - BSS
                                    the symptoms of STI, OIs and     recognizing xx6 of the following 14        - MICS
                                    TB for which care should be      HIV/AIDS-related symptoms for which        (Operational study:
                                    sought”                          they should seek medical care: painful     new yearly
                                                                     urination, genital sore/ulcer/wart,        evidence report).
                                                                     discharge from penis, unusual
                                                                     bleeding or discharge from vagina,
                                                                     burning pain or itching in penis/vagina,
                                                                     enlarged lymph nodes, white patches
                                                                     in mouth (oral thrush), weight loss,
                                                                     persistent diarrhea, fevers, night
                                                                     sweats, persistent cough, shortness of
                                                                     breath, difficulty breathing

                                                                     xxNote: **symptom list needs review.
                                                                     xxSTI, OI, and TB symptoms below
                                                                     are from various sources including
                                                                     CDC, WHO, DHS, FOCUS M&E guide.
                                                                     I could not find indicators of knowledge
                                                                     of these conditions; Anne selected
                                                                     symptoms mentioned in multiple
                                                                     sources and, when possible,
                                                                     mentioned for more than one disease.




                                                              65                                                                  65
Sub-IR I.1.5        % of persons with STI           % of persons with one or more STI           - BSS
                    symptoms in last 12 months      symptoms in last 12 months (painful         - MICS
                    who sought care from a          urination, genital sore/ulcer/wart,         (Operational study:
                    service provider                discharge from penis, unusual               new yearly
                                                    bleeding or discharge from vagina,          evidence report).
                                                    burning pain or itching in penis/vagina)
                                                    who sought care from a service
                                                    provider
IR III.2            Proportion of eligible            Numerator: Number of eligible             Ad-hoc report
                    households that receive 2 or    households identified by FBOs and           (CDLS-> CNLS)
                    more of 4 types of community-   umbrella organizations receiving 2 or
                    based services in their home    more types of community-based
                                                    services in their homes, x 100.
                                                      Denominator: Number of eligible
                                                    households identified by
                                                    FBOs/umbrella organizations.

                                                       Eligible = adult age 18-59 chronically
                                                    ill for 3 or more months or ill for 3 or
                                                    more months before death (PEPFAR)
                                                       Types of services are: medical,
                                                    emotional/psychological, material, and
                                                    other. Note: PEPFAR needs data on
                                                    % receiving all 4 types.


IV.2                Ratio of orphaned to non-       Number of non-orphaned 10-14 yr olds
                    orphaned children aged 10-14    : number of orphaned 10=-14 yr olds         MINEDUC Annual
                    currently attending school.                                                 Report.
                                                    An orphan is a child having lost both       -Census- NBS
                                                    parents (should review definition to        -Special study
                                                    assure is same as current int’l norm)

IV.1                 Ratio women/men of per         GDP/population for women :                  Ministry of
                    capita income                   GDP/population for men                      Planning;
                                                                                                MINECOFIN
                                                                                                Reports
I, II, III, IV, V   AIDS Program Effort Index       Score on AIDS Program Effort Index          CNLS/UNAIDS
                    (API) score                                                                 report



                                              66                                                                  66
BIBLIOGRAPHY

  1. CNLS/RWANDA, Cadre Stratégique Multisectoriel de lutte contre le SIDA           au RWANDA 2005-
     2009, Kigali, 19 décembre, 2005.

  2. CNLS/RWANDA, Plan National de Suivi et Evaluation pour les programmes du VIH/SIDA, 2002-
     2006, Kigali, Janvier, 2003.

  3. WHO, UNAIDS, GLOBAL FUND, USAID, MEASURE Evaluation, Family Health International
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  4. WHO, UNAIDS, Office of the United States Global AIDS Coordination, USAID, Patient monitoring
     guidelines for HIV Care and antiretroviral Therapy (ART), Geneva, 2005.

  5. Malawi National AIDS Commission, National HIV/AIDS, Monitoring and Evaluation Plan.Part
     B/Operations plan, Lilongwe 3, Malawi, July 2003.

  6.    Department of Health, Monitoring     and Evaluation South Africa, Monitoring and Evaluation
       framework for the comprehensive HIV/AIDS Care, Management and Treatment for South Africa.
       Technical notes: indicators, Numerators and denominators for the comprehensive HIV and AIDS
       Care, Management and treatment Plan South Africa/2004. South Africa, 2004

  7. WHO, Monitoring the Declarational of commitment on construction of core indicators Geneva,
     Switzerland August 2003.

  8. Prevention and Control Office (HAPCO). National Monitoring and evaluation Framework for
     Multisectoral Response to HIV/AIDS in Ethiopia National HIV/AIDS, Ethiopia December 2003

  9. GHANA AIDS Commission, USAID, The National Monitoring and Evaluation Plan for HIV/AIDS
     in Ghana 2001-2005, Ghana, 2001

  10. NACC/KENYA, National HIV/AIDS Monitoring and evaluation Framework). Nairobi July 2005.

  11. NAC/MALAWI, National HIV/AIDS Monitoring and Evaluation Plan (Part A: Conceptual
      Framework), Lilongwe July 2003.

  12. LaFond A, Frankel Nina, Staff Handbook on Capacity Building in Monitoring and Evaluation,
      Measure Evaluation Project, Carolina Population Centre, University of North Carolina at Chapel Hill,
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  13. CNLS/Rwanda : Community HIV and AIDS Programs Monitoring Operational Guide, Draft document,
      2006

  14. CNLS/RWANDA : Reports of National HIV and AIDS Planning, Monitoring and Evaluation Technical
      Working Group, 2005-2006




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