USING DASHBOARDS TO COMMUNICATE M&E TO GOVERNMENT OF UTTAR PRADESH (UP) PROGRAM MANAGERS RMNCH+A DASHBOARD (REPRODUCTIVE, MATERNAL, NEWBORN, CHILD, ADOLESCENT HEALTH) European Evaluation Society Conference, Dublin, Ireland Simon Hirsch, Strategic Planning Specialist Centre for Global Public, University of Manitoba October 3, 2014
OUTLINE 1. Context of the Uttar Pradesh (UP) Situation 2. Role of the Uttar Pradesh Technical Support Unit (UP-TSU) 3. Use of M&E in UP & Challenges 4. Dashboard: Tool to improve communication of M&E 5. UP Dashboard Conceptual Framework 6. UP Dashboard Aim: to present a tool that communicates M&E to government program managers in order to facilitate effective planning, decision-making, monitoring, and review
UTTAR PRADESH IN CONTEXT Uttar Pradesh (UP) Situation UP has 204 million people (~16.5% of India) 5.3 million births/ year 25,000 maternal and newborn deaths/ year Maternal Mortality Ratio (MMR) UP: 292* per100,000 live births MMR India: 178* Infant Mortality Rate (IMR)UP: 53* per1,000 live births IMR India: 42* *Sample Registration System (SRS), 2012, Registrar General and Census Commissioner, Government of India Uttar Pradesh Technical Support Unit (UP-TSU) Support Government of Uttar Pradesh achieve its RMNCH+A health mandate 25 Districts (of 75 total Districts) 100 Blocks (of 294 total blocks in 25 districts) ~7,500 Facilities 4 Teams of UP-TSU 1. Program team: communities Community Resource Persons (100 blocks) 2. Technical team: facilities Nurse Mentors (100 blocks) 3. M&E team Concurrent monitoring: reliable data & verify routine data 4. Strategic planning team Communicate M&E of communities & facilities to guide state, district, block, and facility program planning, monitoring, and review
PROGRAM MANAGEMENT SITUATION & CHALLENGES IN UP Current M&E situation Different data sources located in different places Varying reliability & accuracy across data sources Different definitions of indicators across data sources Absence of independent, population-based data below district level Weak culture of data use 1. Low data quality within gov t system 2. Poor communication of M&E to program managers Challenges to effective M&E communication Different pictures (perceptions) of performance Incomplete pictures of performance (level) Incomplete narrative of performance (indicator) Access to data in one place Skills for summarizing data for analysis o Making sense of data Program management paralysis
PROGRAM MANAGEMENT PARALYSIS: CYCLE OF POOR M&E COMMUNICATION/ SYNTHESIS Spending problem, not funding problem General managers are handicapped by poor access to complete and summarized data Different & incomplete understandings of performance Flawed program planning Poor coverage & quality of health service provision Spent only 17% of entire Child health budget Weak decisionmaking mechanisms Corrective action is non-existent or misguided yielding little, no, or negative behavior change Poor Communication of M&E Missed opportunities for program learning Program review does not occur Robust evaluation impossible Weak benchmarking renders outcome targets and results meaningless
PROGRAM DASHBOARD: TO IMPROVE COMMUNICATION OF M&E Dashboard Purpose Support the Government of Uttar Pradesh at several levels state, district, block, and facility Track and gauge critical RMNCH+A performance indicators and drill down to health communities and facilities 7-10 indicators per RMNCH+A health domain 1. Plan program activities and strategies 2. Monitor program activities & implementation gaps Make informed decisions Initiate corrective action quickly 3. Review program performance create feedback loop to guide future planning Dashboard Tool Communicate M&E Engage program managers; get them excited about M&E Encourage program managers to ask critical questions What is the gap/ bottleneck? Why did the gap/ bottleneck occur? How can we resolve this gap/ bottleneck? Offer (initial) explanation to those questions
Management Level Applicability DASHBOARD DATA SOURCES BREAKDOWN: WHERE IS THE INFO COMING FROM & WHO CAN USE? Data Source Breakdown Monitoring type UP-TSU Concurrent monitoring Government of UP Routine service provider data Data type Survey Job Aid Survey Reported data Collected from Community Facility Community Facility Community Facility Data Source CBTS RFS/ Fac. mapping ETT m VHND-HRP tracker Case Sheet AHS/ DLHS MCTS HMIS NHM-UP KPIs & QIs State X X X X X X X X X X District X X X X X X X X X X Block X X X X X X X X X Facility X X X X X Village X X X X
DASHBOARD FRAMEWORK A. 5 Thematic Areas Inputs Outputs Outcome targets Impact goals B. Three functions of program managers 1) Planning: availability of resources 2) Implementation: service provision & utilization 3) Review: quality of service provision & utilization C. Performance of service provision in terms of: Performance vs. Targets Targets vs. Total need RMNCH+A Roadmap Program Management Functions Current performance vs. Targets vs. Total need R eproductive M aternal N ewborn C hild A dolescent
DASHBOARD CONCEPTUAL FRAMEWORK: MATERNAL HEALTH GoUP IMPACT goals Reproductive Maternal Reduce MMR: 345/100,000 Neonatal Child Adolescent GoUP OUTCOME targets A. Increase % of deliveries in facilities... 80% B. Increase % of pregnant women receiving full ANC services package.....80% Review Facility Community 11) % of deliveries where AMTSL was applied 12) % of deliveries with complications that were managed, referred to higher facility, transported, and followed up 10) % of high risk pregnancies tracked OUTPUT Services Implementation Facility Community 9) % of institutional deliveries: L1, L2, L3 5) % of pregnant women registered in first trimester 6) % of pregnant women receiving 3 ANC check ups 7) % of pregnant women receiving two TT injections 8) % of pregnant women receiving 100 IFA tablets INPUT Resources Planning System 1) Availability of delivery points per population and geography [L1, L2, L3] 2) Availability of critical Infrastructure 3) Availability of essential equipment, drugs, and supplies 4) Availability of required staff: ASHA, ANM, SN, MO, Gynecologist, Surgeon, Anesthesiologist