HMIS Monitoring

and Evaluation
(HMIS) Monitoring and Evaluation
• Monitoring. Is the systematic collection, analysis, and use of
information for three basic purposes:
1. Learning from experience
2. Accounting internally and externally for resources used
3. The results obtained and taking decisions
• Evaluation. Assessing an ongoing or completed program or policy as
systematically and as objectively as possible. The object is to be able to:
• Make statements about their relevance, effectiveness, efficiency, impact
and sustainability.
Evaluation Identifies if
changes need to
Functions:
be at a:
Learning • Policy level
Monitoring • Program level
 • The primary aim is to have a
strong M&E and review system
in place for the national health
strategic plan that comprises all
Purpose major disease programs and
health systems.
 •The national M&E plan
and system should
address all components
of the framework and lay
Plan the foundation for
regular reviews during
the implementation of
the national plan.
• Progress of any medical institution are monitored and evaluated
through various activities such as monitoring reports, HMIS, surveys
and evaluation studies.
• be primarily country-focused but also offer the basis for global
monitoring;
• address M&E needs for multiple users and purposes, including
monitoring program inputs, processes and results, tracking health
systems performance and evaluation;
• facilitate the identification of indicators and data sources, provide
tools and guidance for data analysis, and show how the data can
be communicated and used for decision-making
• bring together the monitoring and evaluation work in disease-
specific programs with cross-cutting efforts such as tracking
human resources, logistics and procurement, and health service
delivery.
 • The framework builds upon
principles derived from the Paris
declaration on aid harmonization
and effectiveness and the IHP+,
putting country health strategies,
and the related M&E processes such
Framework as annual health sector reviews, at
the center.
• The core is the strengthening of a
common country platform for M&E
of HSS, which should result in better
alignment of country and global
M&E systems
Relationship of Monitoring & Evaluation and
Indicators

• An indicator can be defined as a variable whose

value changes. It is a measurement that
measures the value of the change in meaningful
units that can be compared to past and future
units
 • HMIS is a source of routine
data that is necessary for
monitoring different aspects
of various health programs
implemented in the country.
Relationship The HMIS indicators have
between M&E been carefully selected to
with HMIS meet the key information
needs of monitoring the
Indicators performance of various
health programs and
services and provide a
snapshot of the available
health resources.
Example:

• Maternal Survival
Intervention
• Child Mortality and Child
Survival Intervention
• STOP TB Program
The Maternal Survival Strategy
and HMIS indicators
• The Maternal Survival Strategies lays down a
framework for achieving the fifth Millennium
Development Goal of reducing maternal
mortality. Given the complexity of the country
contexts and the determinants of maternal
health, none of the maternal survival intervention
alone can reduce the maternal mortality rate.
Rather, evidences support packaging of health
facility oriented interventions is highly effective
and has high coverage of the intended target
group.
HMIS indicators related to intrapartum care:
• Deliveries by skilled attendance (at health facilities)
• Deliveries by Health Extension Workers (HEW) (at
home of Health Posts)
• Institutional cases of maternal morbidity and
mortality due to Obstructed labor
 • 1stpostnatal care attendance
HMIS
indicators • Institutional cases of
maternal morbidity and
related to
mortality due to Postpartum
post-partum hemorrhage (PPH) and
care: Puerperal sepsis
 HMIS
indicators • Family planning method
related to acceptors (New and Repeat)
inter-partum • Family planning methods
(between issued by type of method
pregnancies)
period
 The Child Mortality and
Child Survival Interventions
• Ethiopia is one of those countries who have made great
strides towards reducing the under-5 mortalities based on
Ethiopia Maternal and Child Health Data (2012).
• However, under-5 mortalities still remain high at 106 per
1000 live births (LB) in 2010 and the country faces the
challenge of reducing it to 61/1000 LB by 2015.
• The EDHS 2011 estimated under-5 mortalities to be 88 per
1000 LB that is a 47% decline from 166/1000 LB in 2000.
Diarrhea, pneumonia, measles, malaria, HIV/AIDS, birth
asphyxia, preterm delivery, neonatal tetanus and neonatal
sepsis are the major causes of under-5 deaths in Ethiopia,
with under-nutrition attributing to over one third of these
deaths.
Ethiopia is implementing
interventions targeting under 5-
year-old children through:
• Universal Immunization Coverage,
• Nutrition program,
• Integrated Management of
Childhood Illnesses and the
Community Case Management of
Childhood Illnesses
• Through Health Development Army
to – improve water, sanitation and
hygiene– Malaria prevention
through Integrated Household
Spraying and distribution of
Insecticide Treated Nets (ITN)
(USAID, 2013).
In the context of the above these child survival
interventions, the related HMIS indicators are:
• Number of treatments for children under five provided by health
facility by disease : Diarrhea, dysentery, pneumonia, measles, malaria,
neonatal tetanus
• Number of infants immunized for measles
• Latrine coverage
• Safe water coverage
• Household with ITN
The STOP TB Program
• With the vision to have a TB free world, the goal of the STOP TB
Program (STP) is to dramatically reduce the global burden of TB by
2015, in line with the Millennium Development Goals and the Stop TB
Partnership targets of the World Health Organization (2006). One of
the main objectives of the program is to achieve universal access to
high-quality care (i.e. universal access to high quality diagnosis and
patient centered treatment) for all people with TB (including those
co-infected with HIV and those with drug-resistant TB).
 • TB case detection and
successful completion of the
treatment/cure of the TB
remains at the core of the
Stop TB Strategy. Hence one
of the targets linked to the
MDGs and endorsed by the
The STOP TB Stop TB Partnership is by
Program 2050 to reduce prevalence
and deaths due to TB by 50%
compared with a baseline of
1990.The following flowchart
puts the HMIS indicators (in
green shaded boxes) in the
context of the STOP TB
Program.
 • TB patients on DOTS
• Number of new smear pulmonary TB cases enrolled in the
cohort
• TB Case Detection
• Number of New smear positive pulmonary TB cases
detected
HMIS • Number of new smear negative pulmonary TB cases
detected
Indicators to
• Number of new extra pulmonary TB cases detected
Monitor STOP • HIV – TB – Co-infection
TB Program • Proportion of newly diagnosed TB cases tested to HIV
• HIV+ new TB patients enrolled in DOTS
• TB Treatment outcome
• Treatment completed PTB+
• Cured PTB+, Defaulted PTB+, Deaths PTB+