Of any research undertaking

24.10.2022
Theme: Data collection, analysis and planning
Once a decision has been made about what to measure, a coherent plan must be made. This plan foresees all necessary indicators and takes into account all major data collection efforts within the country, leading to the most efficient use of resources in data collection. For example, a large and nationally representative household survey on reproductive and sexual health may be planned. Such surveys are expensive and generally infrequent; they represent an opportunity to collect a range of data that may be important for monitoring progress in the national programme. They may, for instance, be expanded to include questions on antenatal care service use which could be used in the analysis of HIV prevalence data, or questions on orphans within the household which may be used in the analysis of orphan support data. The best-known international household survey programme is the Demographic and Health Surveys (DHS). In many developing countries, DHS surveys are conducted once every five years or so. In addition, regular census rounds, typically held every 10 years, can include questions which can help monitor some areas of programming, especially demographic and household impact.
The inclusion of an AIDS module in the DHS may be sufficient to obtain data on a number of key indicators at the national and sub-national level. Therefore, if possible, the timing of the last and next DHS should be taken into account in devising a data collection plan.
Data collection plans should not forget to include data that are already collected by agencies not directly involved in HIV work, and that can help in monitoring HIV-related trends or behaviours. Data generated by TB programmes can be useful in illustrating trends in HIV, particularly in the male population where sentinel surveillance data for HIV is scarce. Reproductive health programmes may already have data on service use or sexual behaviour which can eliminate the need for some data collection in general population surveys or health facility surveys. The data collection plan should stipulate systems by which data from other sources will be collected, reported and analysed by the M&E system for HIV.
A data collection plan will detail the sampling frame and the frequency of data collection. It will stipulate who is responsible for what, how much it will cost and who will pay. Since few countries have the financial or human resources to collect every bit of data they would like to monitor their programmes, the process of detailing responsibilities and a budget will often lead to a re-examination of priorities.
A national M&E system should act as a clearinghouse for both generating and disseminating data. A formal mechanism for screening data collection efforts can ensure that whatever is collected best meets the country’s M&E needs. In general, every extra layer of bureaucracy carries with it the potential for unnecessary delays. The “clearinghouse” function should not be viewed as an approval process. Rather, it should be a registration and rapid review mechanism that ensures that the national programme is aware of all data collection efforts that could contribute to national needs. It also allows the programme to check that suggested indicators conform to the national standards chosen by the programme, so that comparisons can be made between different populations and across time. This is especially useful in countries where responsibility for data collection has devolved to the provincial or district level.
A centralised database or library of all HIV/AIDS/STI-related data collection contributes immensely to the efficiency of M&E efforts. What has already been done should be noted and tracked to avoid duplicating studies unnecessarily. Biological and behavioural data generated by the second generation surveillance system, baseline studies, academic research and project evaluation reports should all be centrally filed and universally available. (Tracking and accessing evaluation reports are the most problematic, since many government agencies, NGOs and donor agencies involved in programming are reluctant to share evaluation reports, especially if the project in question has achieved less than spectacular results.) The database should list ongoing data collection efforts as well as those already completed, to avoid the duplication of studies before their results are published. It is also exceptionally useful to keep a record of research protocols and questionnaires so that they can be repeated to maintain consistency between populations and over time.
Unfortunately - partly because M&E of HIV/AIDS/STI-related interventions have been so fragmented to date - donors all have their own institutional requirements. Most programme managers are all too familiar with a repetitive and seemingly endless stream of reporting forms, log frames and mid- and end-of-cycle evaluations. Each of these may require indicators which differ only marginally but which require a new data collection effort each time. Even when donors are funding the data collection, the cost in time and national expertise of meeting all these different demands can be considerable. And yet where resources are strained, it is hard for national programmes to refuse to jump through the hoops set up by the many different supporters of the national response. A national M&E system should take into account the needs of the countries and the requirements of the donors, so that duplication of efforts and waste of resources can be minimised. Donors are increasingly aware of the need to adapt their own reporting needs to fit in with a national monitoring and evaluation system that is well designed and well co-ordinated. The indicators suggested in this guide have been endorsed by a large number of international supporters of HIV programmes.
Many countries are now engaged in decentralising their health systems, bringing decision-making, planning and resource allocation to the provincial or even district level. Part of the impetus for this move is a belief that decisions made at the local level will be more relevant to the beneficiaries than decisions made in a distant capital. In the best case scenario, monitoring of HIV prevalence and evaluation of the response at the local level does indeed provide information that is locally relevant. This information is far more likely to be acted upon in a decentralised system than more general, nationally aggregated information. Where M&E systems do function at a local level, there is still a need for central co-ordination of the M&E system.