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What are Monitoring and Evaluation?

How do we think about M&E in the context of the LAM

Project?

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Objectives of Monitoring & Evaluation

Collect, analyze and use accurate and reliable information

Brazil

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Objectives of Monitoring & Evaluation

• Improve program planning

• Improve program performance

• Improve program management

• Determine outcomes of activities

• Evaluate program impact on beneficiaries

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Characteristics of Monitoring

• Occurs throughout project on a regular basis

• Provides early indication of progress, or a lack of progress

• Provides periodic oversight of activity implementation

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Characteristics of Monitoring

• Can be tasked to any staff, not a specific evaluation staff person

• Informs a project about strengths & weaknesses: do we refine our strategy?

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Characteristics of Monitoring

• Determines whether activities are being performed correctlyTo what extent are planned

intervention activities being realized? What services are provided, to

whom, when, how often, for how long and in what context?

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Is Monitoring Supervision?

• We monitor an intervention

• We supervise an individual

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Characteristics of Evaluation

• Time-bound• Systematic and objective• Assess performance and impact• Carried out selectively – costly & time

consuming• Process & Impact

Process: organization & managementImpact: effects on beneficiaries

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Types of Evaluations1. Baseline Surveys: provides project with

information about the target population at beginning of project intervention

Knowledge about breastfeeding, complementary feeding, maternal nutrition, and LAM (BCM/LAM)

Practices related to BCM/LAM Cultural beliefs related to BCM/LAM Household-based in the community Large, representative sample

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Types of Evaluations

2. Endline Surveys: provides project with information about the target population at the end of project intervention

The endline survey is compared to the baseline and like the baseline it is:

- Household-based in the community

- Large, representative sample

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Types of Evaluations

Endline Surveys: The endline asks the following questions:Did we meet our objectives?Did we have an impact: is there a measurable

difference in people’s knowledge & practice?Where were we strong and where were we

weak?What problems remain to be addressed?

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Types of Evaluations

3. Performance Monitoring: measures knowledge & skill levels of individuals trained in the field

Results are used to refine training strategy & define future training needs

Results are used for better supervisory visits

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Types of Evaluations

Performance Monitoring: Ideally, performance monitoring

evaluations are not necessary─ An effective supervisory system

would include on-going evaluation of field worker’s knowledge & skills (counseling, methodologies) following training

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Monitoring & Evaluation Indicators

How do we track & measure progress over time?

Guatemala

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What is an Indicator?

• A variable

• That measures

• One aspect of a program

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What is an Indicator?

• A measure of whether you are heading in the right direction

• A measure of what your program has achieved

• A measure of the behavior you’re monitoring

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An appropriate set of indicators will include at least one for

each significant element of the program

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Characteristics of Indicators

• Quantitatively or qualitatively measurable

• Relevant to the goals they represent

• Objectively verifiable & reliable

• Meet international professional standards

• Understandable & appreciated by project participants and other stakeholders

• Clarity on the appropriate levels: clinic-specific, country wide

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Characteristics of Indicators

• Clarity on the appropriate levels

Is the indicator clinic-specific? Is the indicator region-specific? Is the indicator country wide?

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Developing Indicators

• Establish during initial program planning

• Reflect overall objectives

• Link to behaviors

• Include with baseline

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How To Measure Indicators?

• Knowledge, practice and coverage surveys (KPC)

• Health Facility Records

• Health Information Systems

• Formative research to identify behaviors & indicators

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LAM Indicators

1. Exclusive Breastfeeding Rate, Infants 0

- < 6 months

Guatemala

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LAM Indicators

Exclusive Breastfeeding Rate, Infants 0 - < 6 months

Age range for LAM to be applied Eligible LAM users Optimal infant feeding message Includes ALL infants in the age range Can also be written 0 – 5 months

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Exclusive Breastfeeding Rate, Infants 0 - < 6 months

• WHO indicator using 24 hour recall• Reflects women eligible to use LAM• 1995: 46.1%• 1998 – 1999: 38.8%

Decrease of 7.3%

Source: Guatemala DHS Reports

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LAM Indicators2. LAM Rate:

Proportion of eligible women (infants less than 6 months), who choose LAM as a method of birth spacing

Altiplano, Bolivia

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LAM Rate

• Formula: Current LAM users divided by all women with infants 0 < 6 months

• Accuracy: A true estimate of LAM use by eligible women

• Data Source: Service statistics (MIS) & Household-level survey (DHS)

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LAM Indicators

3. LAM User Rate:

Proportion of all women of reproductive age who use a modern contraceptive method (few eligible to use LAM) who choose LAM as a method of birth spacingLlano, Bolivia

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LAM User Rate

• Formula: Current LAM users divided by all women of reproductive age who use a modern method of family planning

• Accuracy: Underestimates actual LAM use by eligible women

• Data Source: Service statistics (MIS) & DHS

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LAM Indicators

4. Appropriate LAM Rate: Proportion of women who give birth in a given period of time who consciously & deliberately accept LAM as a birth spacing method and meet the 3 LAM criteria Guatemala

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Appropriate LAM Rate

• Formula: Number of women who use LAM as a birth spacing method and meet the 3 LAM criteria divided by the total number of women with infants 0 < 6 months

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LAM Indicators

5. Model LAM Rate: Proportion of women who give birth in a given period of time who consciously & deliberately accept LAM as a birth spacing method, meet the 3 LAM criteria, and know the 3 LAM criteria

Jordan

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Model LAM Rate

• Formula: Number of women who use LAM as a birth spacing method, meet the 3 LAM criteria, and know the 3 LAM criteria divided by the total number of women with infants 0 < 6 months

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Denominators• Exclusive Breastfeeding Rate:

Infants 0 < 6 months• LAM Rate:

Women with infants 0 < 6 months• LAM User Rate:

Women of reproductive age using a modern contraceptive method

• Appropriate LAM Rate: Women with infants 0 < 6 months

• Model LAM Rate: Women with infants 0 < 6 months

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LAM Monitoring & Evaluation Strategies

• Integration of LAM as a contraceptive method into the national MIS

• LAM acceptors integrated into national MOH/FP data

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Lessons Learned

• Increase and sustain LAM UsersOptimal breastfeeding

practices Integrated & supportive

environment

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Lessons Learned• Data Collection

Monitor clinics for accurate data collection

Absolute LAM numbers do not reflect LAM success – need proportion

Additional information

- Age of infant

- Family Planning Transition information

- Length of time using LAM

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Lessons Learned

• Integrate the concept of MonitoringUtilize results of

supervisory checklist for program management

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Next Steps

• Review monthly and quarterly data for changing LAM trends

• Review MIS and supervision data on a regular basis

• Conduct regular review meetings and analysis for program management