6 Programme Management and Organizational Capacity-building
Box 6.1
Case example: Establishing a national quality standard for sex worker interventions in Côte d’ Ivoire
In Côte d’ Ivoire, community-based and clinic-based HIV prevention activities for female sex workers began in 1991, with the establishment of a dedicated clinic in the capital city. Based on the success of this programme, multiple international and national partners supported national scale-up of the model from 1996. In order to standardize and ensure high-quality services for sex workers, the National Programme for HIV Prevention among Highly Vulnerable Populations and its partners developed a“ Minimum Package of Prevention and Care Activities for Sex Workers” in 2007. Quality standards for each of these activities were developed during a two-year process involving all partners. A technical working group drafted a set of standards, which fell into three categories:
1. Input( health infrastructure, staff, etc.) 2. Process( clinical guidelines, procedures, algorithms) 3. Output( patient satisfaction, coverage of target population).
A consistent format was used for each standard: a statement of the standard; criteria describing the elements required to meet the standard; and indicators for measuring the criteria. A validation workshop with 50 participants was held, resulting in a finalized and endorsed national guide with quality standards in 2009. They were then implemented across the country with on-site training of implementing agencies, ongoing coaching, deployment of tools for measuring standards and quality audits.
6.2.2 Establish a data monitoring system for management
A routine data collection system is needed that aggregates and consolidates information so that dashboard 6 indicators may be monitored, and to enable“ drilling down”, i. e. the ability to look at detailed reports from lower levels. Central( national) management should be able to see data from the level of states / provinces and districts, while state / province managers and implementing organizations should be able to drill down to reports from frontline workers. This allows managers to identify areas or implementing sites whose performance is significantly different from others’( for example, low condom and lubricant distribution, or low coverage of the estimated sex worker population) and that may need additional management attention for improvement.
A well-designed monitoring system:
• allows reported indicators to be developed from data that are routinely collected and that are useful for programme and management decisions at the level where they are collected. Data that are not useful and used at the level of collection will not be prioritized and will often not be of high quality. Note that at each level of implementation and management, additional data may be collected that are not reported upwards but are used instead to improve services.
• captures the sex worker’ s interactions with community outreach workers or clinical services( e. g. formal contact with a community outreach worker, attended a clinic, was referred for a service, etc.) with minimal error( limited transfer and cross-posting of data)
• has clear indicator definitions and ongoing control of data quality
• aggregates data upwards but retains drill-down capability.
6 Dashboard indicators are the most important programme monitoring indicators, aggregated to a national level. They provide an overview of how well the programme is functioning( rather like the gauges on the dashboard of a car inform the driver how well the engine is running).
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