Building the Capacity of Faith-Based Organizations in Support of Their Essential Role in the Global Fight Against HIV René Berger USAID/Kenya April 14, 2015 Outline • • • • • PEPFAR Pivot Mechanisms to Improve Monitoring and Evaluation Improving Data Management Systems Tracking Service Provision Q&A The PEPFAR Pivot What’s new? • Focus on using epidemiology to determine what and where we work to reach epidemic control (and 90-90-90 goals) • Move away from doing all things everywhere – and being all things to everyone PEPFAR Pivot (con’t) What does this mean? • Going where the virus is…means we may disrupt existing networks. Also means we have to ensure we cover those most likely to transmit (e.g. discordant couples, key populations, etc.) • Using data…means we may transition support from one site to another or one partner to another. Also means we will ask partners to help us collect and use data more efficiently Nairobi Homa Bay Kisumu Siaya Migori Kisii Nakuru Kakamega Mombasa Kiambu Turkana Muranga Machakos Uasin Gishu Bomet Kilifi Busia Nyamira Narok Makueni Trans Nzoia Bungoma Meru Kajiado Nyeri Kitui Kwale Nandi Kericho Nyandarua Kirinyaga Embu Vihiga Taita Taveta Baringo Laikipia Tharaka Nithi West Pokot Samburu Elgeyo Marakwet Mandera Garissa Isiolo Lamu Marsabit Tana River Wajir Kenyans living with HIV 15.0 135,000 90,000 HIV Prevalence Where the virus is… 225,000 22.5 40% PLHIV (5 Counties) 80% PLHIV (20 Counties) Unmet Need 20% PLHIV (27 Counties) 180,000 7.5 45,000 Current on ART (APR 14) HIV Prevalence 0.0 New PEPFAR M&E Tools/Systems • Site Improvement though Monitoring System (SIMS) – Quality assurance tool (not quality improvement) – Core essential elements (covers program areas) for facility, community, and above site level indicators. New PEPFAR M&E Tools/Systems • Data for Accountability, Transparency, and Impact (DATIM) - PEPFAR’s version of DHIS2 – Incorporates data collection forms for the following PEPFAR data sets: ○ MER indicators ○ Site Improvement through Monitoring System (SIMS) ○ Evaluation Standards of Practice (ESOP) reporting ○ Expenditure Analysis (EA) data – DATIM captures data at the level of the health facility and community and supports the roll‐up of this data to the relevant levels of aggregation. – DATIM is designed for use by implementing partners and PEPFAR country teams and supports in‐country and headquarters user roles and the necessary submit/accept workflows. – DATIM is an interoperable system and will soon integrate with MoH and partner systems. (See data exchange section for more detail) New PEPFAR M&E Tools/Systems • Expenditure Analysis – Unit costs for various program areas based on “outlays” from prior years. New PEPFAR M&E Tools/Systems • Sustainability Index Dashboard (SID) – 5 domains, 15 elements and 68 core questions – Fosters stakeholder engagement and dialogue – Feeds into Country Health Partnership process What we know about you! • FBO’s have substantial role in service delivery • Provide core set of PEPFAR interventions • Have broad geographic coverage and networks • Well respected in their communities ART Coverage Kenya Targets from FBOs Results as a whole Percent from FBOs SAPR FY14 68,064 651,494 10.4% Tanzania Targets from FBOs Results as a whole Percent from FBOs SAPR FY14 89,343 451,461 19.8% Uganda Targets from FBOs Results as a whole Percent from FBOs SAPR FY14 84,921 568,037 14.9% Zambia Targets from FBOs Results as a whole Percent from FBOs SAPR FY14 58,213 578,872 10.1% What might have to change? • Where you work…networks may be affected by focus on high prevalence/high burden geographic areas • How you work…may be required to cover more types of services within a geographic area – from testing among different populations to treatment and care • Who you work with…may have to create more integrated networks for service provision, including working closer with public sector facilities and key populations What are we sustaining? • Many possible meanings in this context: – – – – Resources Activities Patients Our own agreements • Need to change the dialogue… – What about cost recovery? • What can we learn from you about fee for services, health insurance networks, etc. – What about integrated services – for key and other populations • How do we better use the community linkages you have? – Advocacy opportunities • With host governments, with PEPFAR, Global Fund, etc. And now… Discussion & Questions!