MEASURE Evaluation, funded by the United States Agency for International Development (USAID), has been proud to serve for more than two decades to help improve data collection, data quality, and the global capacity for research. We have blazed new trails in rigorous methods for monitoring and evaluation, developed tools in use around the world to improve data quality and data use, and defined the components of high-functioning health information systems and effective means to improve them.
Our legacy can be seen in health improvements in low-resource settings and in strong cadres of health researchers who have been helped through our training and capacity strengthening. Our legacy lives here on these pages as well. As the project closes, these online resources remain available for free download to guide future projects and new professionals seeking to improve global health.
Moreover, three associate awards under MEASURE Evaluation continue work in the field to improve health and contribute knowledge for the global community. Learn more about their work at the links below.
Gaps in Global Monitoring and Evaluation of Adolescent and Youth Reproductive Health: Research Brief
MEASURE Evaluation, which is funded by the United States Agency for International Development, conducted the research presented in this brief to identify gaps in the M&E of adolescent and youth reproductive health (AYRH) programs. This process consisted of reviewing the landscape of M&E of AYRH interventions, outcomes, and impacts; identifying measurement gaps; and making recommendations to improve the M&E of AYRH activities and programs across a spectrum of RH categories.
The eMIS aimed to automate the business processes of community health and family planning workers, their supervisors, and providers working in first-line facilities (called Union Health and Family Welfare Center), based on mobile technologies. Web-based tools were also developed for managers at the subdistrict and district levels and for decision makers at the central level. The eMIS tools help users and managers of the DGFP gain the benefits of digitization, as well as enable the DGFP to become a data-driven organization. The eMIS reached a milestone with the declaration of a paperless Tangail on March 1, 2020 by the minister for health and family welfare.
The implementation of the eMIS was supported within a project framework, and carrying it forward requires internalizing it within the DGFP and making it sustainable. Key issues related to sustainability, such as the acquisition of hardware, software maintenance and development, capacity building (human resource development, skills, training), implementation mechanisms, and the use of data for decision making are discussed in this report, and relevant recommendations are provided, along with an action plan.
USAID/Madagascar supported the USAID-funded MEASURE Evaluation project to strengthen the country’s routine health information systems (RHIS) and integrated surveillance. In November 2016, we began technical assistance to strengthen Madagascar’s RHIS and malaria surveillance systems based on assessment results and to build capacity in the MPH to manage HIS through the placement of resident advisors. These activities included establishing a data quality assurance system; strengthening the RHIS through updated policies, improved real-time access to health data, and improved capacity; and providing support to strengthen malaria monitoring and evaluation and surveillance.
Soon after we began, the MPH, in collaboration with MEASURE Evaluation, convened a workshop in February 2017 in Antsirabe, bringing together stakeholders and drafting a nine-strategy implementation plan called the Road Map for the Sub-Committee on Health Information Systems. The MEASURE Evaluation study team used the Road Map as a key document to help us understand the activities that were planned to achieve the Road Map’s stated goal: “an efficient, unique and integrated health information system.”
In addition to the USAID-funded activities described above and as part of MEASURE Evaluation’s Learning Agenda (a collaborative and adaptive approach to documenting and applying results for health information system [HIS] strengthening), we conducted a study in Madagascar of the effects on HIS performance of all recent efforts by MEASURE Evaluation and also other stakeholders to strengthen the HIS. This study aimed to provide evidence to the MPH, USAID, and the broader community working on HIS on how to integrate key elements of the HIS effectively. This brief reports our study’s findings.
Also available in French: Étude prospective sur le renforcement des systèmes d’information sanitaire (SIS) à Madagascar: Intégration des systèmes d’information sanitaire de routine et de surveillance épidémiologique axés sur la lutte contre le paludisme
The goal of A2H was to improve adolescent sexual and reproductive health and family planning knowledge and access and use of related services for married and unmarried adolescents.
To assess the program, the USAID-funded projects Research for Decision Makers, based at the International Centre for Diarrhoeal Diseases Research, Bangladesh, and MEASURE Evaluation, based at the University of North Carolina at Chapel Hill (USA), conducted a household survey from July–September 2018 among 8,501 girls ages 15–19 years from the two selected program areas and 3,005 similar girls from a comparison area. This report presents findings from an analysis of this survey.
In 2018, Ghana’s MOGCSP, with support from UNICEF, developed a concept note for an information system that would capture data for child protection and social welfare services. This system aims to strengthen the coordinated delivery of social services across the areas of social protection, community development, gender-based violence, justice for children, child protection, education, and health. Alternative care will be included in the system, with the plan to eventually provide access to RHCs.
The SWIMS will adopt an open-source case management software, developed by UNICEF headquarters, called Protection Related Information Management System, or “Primero.” This online platform is designed to be adapted to the country-specific context and can be configured to the specific system of child welfare services in Ghana.
To support preparations for the SWIMS deployment, MEASURE Evaluation gathered information for some of the requirements for the rollout of a national Ghana SWIMS. This report presents our findings.
MEASURE Evaluation, which is funded by the United States Agency for International Development (USAID), has used RHIS data in numerous evaluations over the past 20 years. This brief shares field experiences from this work and key considerations for the use of RHIS data in evaluation.
This guide serves as a reference document for participants who attended the MEASURE Evaluation training sessions. It also serves as a self-learning guide for people who do M&E work but who were unable to attend the training. It is expected that the guide’s users will apply key M&E concepts in their daily work. Because this is a self-learning material, there is no opportunity to discuss new concepts in a group setting or to ask questions. It is therefore suggested that users visit the MEASURE Evaluation website (www.measureevaluation.org/resources) for additional M&E materials.
Access related reports from work done in Nigeria, Kenya, and Zambia.
A team from the USAID- and PEPFAR-funded MEASURE Evaluation project conducted a legacy evaluation of the PHFS in 2018. We identified several compelling lessons for successful PMTCT programs from the ways the project was implemented in the participating countries. These lessons are broadly applicable to countries and facilities that are working to reduce mother-to-child transmission of HIV, increase retention in antiretroviral therapy (ART), support better nutrition practices, and improve clients’ health-seeking behaviors.
Although many of the lessons are cited in the PHFS legacy evaluation report (Hales, Davis, Munson, & Bobrow, 2019; www.measureevaluation.org/resources/publications/tr-18-314), this document was prepared to provide practical guidance for identifying and implementing appropriate activities in the local context. It includes descriptions of the key lessons, tips, and an extensive checklist to help decision makers and implementers understand how and why to launch, implement, and sustain the critical activities in the PHFS approach. Access the resource.
Access a separate, editable Word file of the checklists at www.measureevaluation.org/resources/publications/tl-20-80/
A version for printing is available here.
Les contributions phares de cette activité comprennent tout d’abord l’élaboration des définitions de cas communautaires pour chacune des maladies prioritaires pour la SBC, en concertation avec les experts techniques des Ministères de la Santé, de l’Environnement, de l’Elevage et des partenaires techniques intervenants dans la surveillance.
MEASURE Evaluation a soutenu le développement de la plateforme électronique dénommée mInfoSanté, accessible via internet et permettant aux agents communautaires de la santé d’envoyer par SMS des signaux de maladies prioritaires sous surveillance et recevoir des instructions et retro informations des infirmiers et agents de l’élevage.
Un curriculum, des guides et outils de formation ont été développés dans un processus participatif en collaboration avec le Haut Conseil de la Sécurité Sanitaire Mondiale (HCNSSM) et les secteurs parties prenantes.
Des formations en cascade des professionnels des secteurs de la santé humaine, animale et environnementale et des comités de veille et d’alerte communautaire (CVAC) ont eu lieu dans les six district pilotes. En outre, MEASURE Evaluation a réalisé en collaboration avec le Ministère de l’éducation, l’orientation de 391 lycéens sur l’approche « Une Seule Santé » et les maladies prioritaires sous surveillance, dans un lycée de chacun des districts pilotes.
Enfin, le guide technique national pour l’opérationnalisation de la SBC dans une approche « Une Seule Santé » a été élaboré dans une approche participative.
Dans cette phase pilote, un total de 1650 signaux a été reçus à la date du 31 mai 2019, soit 135 par les infirmiers chefs de poste (ICP) et chefs de poste vétérinaire (CPV) pour les zoonoses et 1515 par les ICP pour les autres maladies prioritaires. Parmi les signaux, 999 ont été vérifiés, dont 744 dans les 48 heures, pour 617 cas suspects. La proportion de signaux vérifiés est de 60%, celle des cas suspects parmi les signaux vérifiés est de 62%. La diarrhée sanglante est la maladie la plus signalée avec 976 signaux, soit 59% de l’ensemble des signaux. Vient ensuite la rougeole avec 322 signaux, soit 20%. Parmi les zoonoses, la tuberculose bovine reste la maladie la plus fréquemment signalée avec 58 signaux, soit 37% de tous les signaux de maladies zoonotiques y compris la maladie à virus Ebola, qui est sous surveillance depuis le début de la phase pilote en 2017. Elle est suivie de la rage avec 38 signaux, soit 24%.
La Surveillance à base communautaire des maladies et zoonoses prioritaires au Sénégal
MEval-TZ addressed three intermediate results (IRs):
IR 1: Policy makers use quality data to develop policies and guidelines, and advocate for community health and social service programs (activities to strengthen national-level M&E systems, data quality, and data use)
IR 2: Quality data routinely used by local governments, community providers, and facilities to improve program planning, budgeting, and program implementation (subnational strengthening of M&E, data quality, and data use with health management teams, local government, and implementing partners)
IR 3: Increased evidence base for community health and social service programs (crosscutting activities to strengthen the evidence base and enhance capacity for M&E and research)
The project’s technical approach assumed that health and social service programmes are more successful when supported by relevant, robust, and timely information to guide resource allocations and programming. Two complementary pillars were described to achieve this: (1) the foundation of an enhanced evidence base derived from evaluation, monitoring, and focused research; and (2) widespread use of this evidence to develop policies and guidelines; advocacy for community health and social service programmes; and the details of programme planning, budgeting, and implementation. The project worked at the national and subnational levels.
Underpinning the project’s work were the principles of collaboration, gender integration, and sustainability. Working in a collaborative and participatory manner while fostering relationships with government and non-governmental partners, the project sought to establish and strengthen systems that would be sustained through enhanced local capacity. By focusing on gender as a crosscutting issue, the project sought to highlight gender disparities in health access, programming, and health outcomes, and to promote investigation and action to address those issues to ensure the best services for all Tanzanians. Gender integration encompassed three strategies: (1) gender-focused M&E training with M&E staff at selected ministries; (2) increased availability of sex-disaggregated and gender-specific data; and (3) support for special studies related to gender.
Download a PDF of the full course or download the individual modules below. The course is also available in French.
To access the online course for certification, go to www.memalaria.org.
Promoting Appropriate Care for Children: Report on a Workshop on Case Management Information Systems
- Provide leadership in implementing a structured assessment of national care reform systems and strategies using a standardized framework/tool.
- Identify gaps and continuing needs in care reform.
- Develop plans to address priority needs.
- Establish indicators and systems for the regular assessment of progress and monitoring of results against country plans for care reform.
Efforts to build digital information systems have been made in the four focus countries, with lessons learned about what is working well and what can be strengthened. In light of the increased interest in advancing digital solutions for the case management1 of children in various settings, USAID/DCOF asked MEval to convene a group of experts from December 4–6, 2019, at Palladium’s office in Washington, DC, on case management information systems (CMIS). This report outlines the workshop sessions and provides highlights, key discussion points, and action items.
Access Ignite presentations from the workshop.
MEASURE Evaluation, which is funded by the United States Agency for International Development, conducted the research presented in this report to identify gaps in the M&E of adolescent and youth reproductive health (AYRH) programs. This process consisted of reviewing the landscape of M&E of AYRH interventions, outcomes, and impacts; identifying measurement gaps; and making recommendations to improve the M&E of AYRH activities and programs across a spectrum of RH categories.
In June 2016, informed by a rigorous investment analysis, a “Treat All” policy was launched to provide all people living with HIV (PLHIV) in Botswana–regardless of disease state—with free, publicly-financed lifesaving treatment. By “leaving no one behind”—a key principle of Botswana’s National Development Plan 2017–2023 (NDP 11)—this policy shift seeks to optimize investments in the national AIDS response and accelerate progress towards epidemic control, with a view to end AIDS as a public health threat by 2030.
To date, the implementation of the “Treat All” policy has focused on providing this free, publicly financed antiretroviral therapy (ART) only to citizens, leaving noncitizens behind. Botswana’s 170,000 noncitizens in residence constitute 7 percent of the country’s total population; of these, an estimated 30,000 are living with HIV. Most noncitizens originate from India, South Africa, Zambia, Zimbabwe, and the United Kingdom, and 80 percent of them are between the ages of 15 and 49: the age group that is most sexually active and economically productive. Only 29 percent of all noncitizens living with HIV are accessing HIV treatment.
Recognizing that multiple concurrent partnerships increase the spread of HIV through sexual networks, the government acknowledges that without fully implementing the Treat All strategy, by covering treatment both of citizens and noncitizens, there will be no epidemic control. Rather, the government would face more new HIV infections and a growing HIV expenditure.
To address the HIV treatment of noncitizens in Botswana, the government would need an additional total investment of US$18 million for the period 2018 through 2030—an average of US$1.4 million per year. This translates into an additional 1.2 percent of spending on the current ART program (estimated at US$103 million per year) and would help achieve 90-90-90 and 95-95-95 treatment targets by 2020 and 2030, respectively, among the noncitizen population.
Treating noncitizens is another way of protecting the citizen population. By treating noncitizens, Botswana can save 22,745 citizens from HIV infection and 1,373 citizens from tuberculosis (TB) infection. The country would also avert 6,741 deaths from AIDS. Compared with treating citizens only, this strategic investment yields 64 percent more new HIV infections averted, at a cost of only 1.2 percent more. Other benefits of enacting a policy change to provide access to HIV treatment for noncitizens are US$112 million in savings on HIV treatment (which the government would incur to treat citizens if infections are not averted) and US$4 million in savings on TB treatment (which would occur among noncitizens living with HIV who are not on treatment). Additionally, US$30 million in productivity gains would accrue to the economy owing to increased productivity yielded by treatment and avoided infections among previously untreated noncitizens living with HIV.
Overall, for every U.S. dollar invested in treating noncitizens, the country gets US$8 in return.
By not acting now, the government increases the risk of not meeting the Treat All goals for epidemic control. Moreover, the government will incur an additional US$116 million expenditure to treat HIV and TB infections. The country will be exposed to an additional 23,000 new HIV infections among citizens, as well as an economic loss of US$30 million in worker productivity owing to untreated HIV.
As a way forward, we recommend investment in treating both citizens and noncitizens through the Treat All program. This will accelerate epidemic control, improve financial sustainability of the Treat All program, and produce long-term healthcare savings. To implement this policy recommendation sustainably, potential pathways are to work with development partners to fund the initial phase of the program, followed by transition to full financing by the Government of Botswana as cost savings are realized.
NMCPs conduct data review meetings with subnational levels to give feedback on the quality of malaria data from routine health information systems and use the data to improve service delivery. These data review meetings are held regularly—often quarterly or monthly. Subnational levels that participate in these meetings range from the lowest level, or the health facility, to intermediate levels, such as districts, provinces, or states, depending on the country’s health infrastructure. Other stakeholders, including partners, may participate in and provide input for these meetings. Information on how countries conduct data review meetings is limited and not publicly available. MEASURE Evaluation—a project funded by the United States Agency for International Development and the U.S. President’s Malaria Initiative (PMI)—conducted an assessment to understand better the processes and tools used in data review meetings in five malaria-endemic countries.
Access this resource and a related guide for conducting malaria data review meetings.
Access the reproductive empowerment scale and related reports sharing findings from a study in Zambia and findings from a study in Kenya.
Evaluate 