Monitoring and Evaluation

Monitoring and evaluation of the multi-sectoral response will require greater coordination of all players in the national HIV response in order to allow for optimal utilisation of available resources, sharing of experiences and foster evidence based reporting aligned to the provisions of the R-NASF. The National HIV/AIDS/STI/TB Council through the Policy and Planning Directorate will be responsible for the overall monitoring of the national multi-sectoral response. At the highest level the M&E system for the national response will be monitored using multiple data sets from multiple data systems within the broader Health Information System (HIS) held by the Ministry of Health and NAC.

These data sets converge where it is intended and are used to generate information products that support strengthening the national response. Most of the programme specific data pertinent to monitoring the national response – including ART, eMTCT, VMMC and HTC data - flows from facility level, through district and regional health offices, to national level. Data collection and analysis will continue to be undertaken using the following tools:

(i)    NACMIS and E-Mapping System: E-Mapping (www.zambianacmisonline.org) is an online stakeholder management and activity reporting system, which helps NAC and its partners to understand a number of M & E information details. The development of the E-mapping system has been supported throughout by NAC, the United Nations Joint Team, the World Bank, CDC and Volunteer Services Overseas (VSO). The system also includes an online National AIDS Reporting Form (NARF) tool that automatically generates graphs which compare the NARF data (at district, provincial and national levels) against the Millennium Development Goals (MDG) for Zambia.
(ii)     The Zambia Demographic and Health Survey (ZDHS): This is a robust instrument for tracking changes in knowledge and behaviors at a national level. It is conducted every five years, with the last having been conducted in 2007. At the time of reporting, the ZDHS was underway and was hoped to be completed in 2014.
(iii)     Health Management Information System (HMIS): This is the largest and most important M&E tool in Zambia. It provides for all clinical health related data on all diseases including HIV and AIDS. This tool has in the recent past been undergoing some upgrading to conform to latest developments in data capture and indicator tracking.  
(iv)    Stakeholders Activity Report Form (SAF): This refers to a generation of information from standard forms received by NAC on a regular basis from sub-national structures, including PATFs, DATFs and Government line ministries implementing HIV and AIDS interventions. The relevance of the form arises out of the fact that it summarizes the coverage achieved by organizations implementing HIV and AIDS interventions in the areas of prevention, care and support, M&E, impact mitigation and coordination and management. These forms, which are generic data reporting forms for HIV and AIDS activities, are collated at district, provincial and national levels on a quarterly basis.
(v)    Cohort Studies: Cohort studies are conducted for various purposes to monitor a group of individuals with similar characteristics to monitor the effectiveness of a service delivery programme or behaviours that may occur to a particular group of individuals when exposed to a specific event or situation.
(vi)    Education Management Information Systems (EMIS): The EMIS system collects HIV and AIDS information. The primary output is the percentage/proportion of teachers who have been trained in life skills education and who taught it during the previous academic year.
(vii)     National Commitments and Policy Instrument (NCPI): The NCPI covers four broad areas of policy, strategic planning, prevention, human rights, and care and support. A separate index is calculated for each policy area using specific policy indicators and calculating the overall percentage score. The relevance of this tool is in the computation of the National Composite Policy Index covering gender, workplace stigma and discrimination, human rights, CSO involvement, prevention, TCS, integration, mitigation services and M&E.
(viii)    Sentinel Surveillance Surveys: Biological surveillance of HIV has been primarily tracked through surveillance of sentinel populations. Surveillance data is collected from a sample of urban, rural and transitional rural sentinel sites in the country distributed throughout the provinces. Specified minimum samples for each type of site are set in advance and vary from year to year. Blood samples are drawn and testing for syphilis is done on site while the rest of the samples are sent to the University Teaching Hospital and the Tropical Diseases Research Centre (TDRC) for HIV testing. These surveys are relevant because they help in the determination of the incidence and prevalence of syphilis in women of reproductive age group in sentinel populations.
(ix)    Financial Expenditure Tracking: Financial surveys are useful for showing how efficiently and effectively HIV and AIDS funds are utilised to achieve set national targets.
(x)    Workplace Surveys: These surveys provide information on the extent to which workplaces develop policies to protect and mitigate the impact of HIV and AIDS on their respective employees. These surveys, which are relevant and critically 69 important for the preservation of people's human rights, are conducted on an annual basis.
(xi)    Zambia Health Facility Survey (ZHFS): The ZHFS is conducted to better understand provider/household linkages, provider performance, costs, quality and effectiveness, links between providers, and Government-provider linkages, where the relevance lies.
(xii)     Zambia Sexual Behavioural Survey (ZSBS): The ZSBS is carried out to monitor the extent to which the programmes to prevent HIV are successful.
(xiii)    Quarterly SARF Report: NAC produces the Quarterly SARF Report to provide information on coverage statistics per HIV programme area. The production of this report also ensures that NAC meets the Global Fund to Fight Tuberculosis, AIDS and Malaria (GFTAM) requirements in terms of minimum reporting standards and reports to its other basket donors.
(xiv)     Biennial GARPR Report: The Biennial GARPR Report is prepared to report on 17 specific indicators in a manner defined in the UNAIDS Guidelines for the Construction of Core Indicators. The report is one fulfillment of Zambia's signatory status to the 2001 Declaration of Commitment on HIV and AIDS at the United Nations Special Assembly Session on HIV and AIDS (UNGASS).
(xv)     The Joint Annual Review Process (JAPR): The JAPRs bring the Government of the Republic of Zambia, NAC, and its partners together to review, on a regular basis, the performance of the national HIV response. The last review was conducted in 2013.
(xvi)    SPECTRUM: SPECTRUM is a suite of easy to use policy models which provide policymakers with an analytical tool to support the decision making process. Spectrum as a software has seven sub-components - DemProj, FamPlan, Project Child Survival, AIDS Impact Model, Costs Implementing and HIV/AIDS programme, Resources for the Awareness of Population Impacts on Development and the Safe Motherhood Model. The Spectrum tool is relevant in the determination of the indicators with respect to determining the number of new infections annually.