Introduction
Health Programmes undertaken in specific locality or on a broader scale such as the National Health Care delivery systems embed several elements whose execution implies the implementation and performance of many parallel and complex activities: clear identification of the problem, identification of feasible solutions, priority setting, determination of the types and quantity of inputs, determination on the type and quantity of human resources for health, location and allocation of health resources, establishment of monitoring systems, formative research to design and adapt materials and resources, etc. At each step in this process and to improve the quality of services, these intricate activities need to be managed through a well established monitoring and evaluation system. As the combined wording might suggest, ‘Monitoring’ and ‘Evaluation’ in the delivery of health care is essentially a management tool that involves a systematic assessment of the progress of a specific health programme or a national health care system towards its defined goals. Separately seen, monitoring refers to the routine or the day–to-day tracking of the health programme’s ongoing activities or specific conditions of behaviors in a population and whether they are in the right direction compared to the plan. Evaluation may build on monitoring, but it focuses on addressing specific questions about the performance of a programme or the adequacy of planning. Monitoring and evaluation (M&E) have become a major new field of scientific endeavor primarily because of issues of accountability in the expenditure of public or private funds. However, it has been demonstrated that M&E plays a critical role in the regular improvement of the quality of services and programmes. It is now considered an essential management tool for all interventions.
Monitoring and evaluation of a health programme or a national health delivery system refers to the application of scientific methods intended to systematically monitor and evaluate performance in terms of
organization, process, output, outcome and impact. Higginson (1994) defines several broad forms of M&E, including organizational M&E, intending to assess the structure and process of health care delivery, whereas clinical and medical M&E often focus on the measurement of output and outcome of care. Two other broad classes of M&E can be noted: the M&E of policy and policy decision[-making, and the M&E of the impact of programmes on specific diseases and overall levels of health.
For M&E to be an effective management tool, therefore, there should be three important and essential elements: An M&E system that clearly identified and embraced a set of highly relevant, efficient and coherent performance indicators. The availability and design of such M&E system is critical in the measurement of the programme impact both during the execution and the post-evaluation phases. The availability of such system will allow the ascertainment or verification of whether the objectives identified in the health programme design phase were or will be effectively achieved. The second important element is the availability of a well organized and effective HMIS system. This implies the availability and hence the implementation of a health information system throughout the health delivery system that ensures the timely availability of quality data and other relevant documentation based on the needs. Without such a system, it will be very difficult to ensure a structured M&E system that could be robust and reliable. The third most important element is the M&E structure the inevitable availability of a highly trained corps of health monitoring and evaluation professionals to help design and operate this system, and to interpret and use the data to help decision-makers improve policies and programmes. These are critical issues and the one appearing to be the greatest challenge for many health care systems in developing countries.
established as a stand-alone profession,with its own methods and theories. In view of the pressing and the growing pressure on the health sector of Ethiopia to closely monitor and evaluate government interventions in relation to poverty reduction including health MDGs, the absence of appropriate professionals in the area of health M&E should undoubtedly be seen as the main trigger for initiating such professional training in Ethiopia.
Cognizant of the growing needs for a professional M&E specialization in the health care delivery system of Ethiopia, Jimma University in collaboration with its national and international partners has become the pioneer amongst the Universities in Ethiopia in starting a post– graduate programme leading to both a Post-graduate Diploma and an MSc course with the aim of fulfilling the long-term requirement of the National Health Care System of Ethiopia in the area of M&E specialization. This course is the first of its kind in Africa, and only second in the world after the initial start and success in Brazil under the leadership of the Brazilian National School of Public Health – Oswaldo Cruz Foundation ( FIOCRUZ).
The design of the training programme will incorporate skills and content from various areas of health science, including epidemiology, biostatistics, management, and health economics. It will focus on four areas (called Tracks, below) we have defined as: The Social, Cultural, Political and Economic Context of Health; Logical Models of Health Programmes; Logical Models of Evaluation; and Communication, Networking and Information Technology. Students will also be rigorously trained in the application of new technology, including computer assisted learning, distance learning, use of the internet and website design, as well as traditional skills in writing and public presentation. The rigorous curriculum contains theoretical, community-based, and practical training.
Rationale of the Post Graduate Training Programme
Ethiopia is now committed to achieving the MDGs by the year 2015. Such commitments , especially in the health sector requires the close monitoring and evaluation of priority health programmes, especially HIV/AIDS, Malaria, Tuberculosis, and maternal and child health . However many studies and reviews on the health sector in Ethiopia have shown that the weakest link in the implementation of HSDP is the lack of information about how programmes are implemented and working. A well organized system of health data collection and use is called a Health Management Information System (HMIS), and is an essential component of an M&E system. In addition to these routine reporting systems, programmes needevaluation to identify obstacles and develop solutions for improvement. It is not only that the HMIS and other elements of the Monitoring and Evaluation system are not well implemented nationally, but that there are virtually no professional Monitoring and Evaluation experts available to the health sector in the country. It is therefore very important for the health sector to acquire such expertise to provide critical leadership in the organization of an effective monitoring and evaluation system.
Objectives of the training
General Objective of the Post graduate Programme
The general objective of the graduate programme is to develop a corps of new professionals in Health Monitoring and Evaluation who, after completing the prescribed academic course, will work in the Public Health Sector of Ethiopia. Envisioned are two levels of training. One, a higher diploma course would be primarily for professionals in other fields who already have a Master’s degree and don’t wish to pursue a second Masters degree. The MSc degree would be primarily for those wishing to complete an original research project and thesis, and who wish to develop a professional identification as an Evaluator.
Specific Objectives of the Higher Diploma Programme
1. To train M&E specialists who will provide critical leadership to achieve sustained improvement in the coverage and quality of health programmes,
2. To develop M&E specialists who will be capable of understanding the organization and delivery of health programmes, including the justification and assumptions embedded in such programmes.
3. To develop M&E specialists capable of designing and implementing monitoring and evaluation plans for priority health programmes, including health policy,
4. To develop M&E specialists, who at every level of the health system can advise in the use of data for evidence based decision making
5. To develop M&E specialists capable of using new technologies to achieve their goals.
6. To train a cadre of M&E specialists who will professionalize the field of M&E in Ethiopia and lead the successful development of this field.
Specific Objectives of the MSc Programme
In addition to the objectives expressed above, the MSc degree holder will be capable of conducting and directing independent and original M&E research, and be capable of preparing written reports and publications for international and national peer reviewed publications.
Philosophy, Faculty and Teaching
Philosophy: the programme adopts the educational philosophy of Jimma University - community based education - with the adult active learning strategies utilized by the National School of Public Health in Brazil. The teaching staff will combine faculty from Jimma University with national and international specialists.
At least initially, this is an in-service long-term training programme, and specially funded. Students will be health care professionals attached to the national health system. Training will take advantage of this in-service attachment. The University anticipates that the programme will expand to include a broader range of students, funded through a range of sources.
Teaching-learning methods
The teaching methodology uses innovative and adult teaching approach with active participatory learning and integrated training over the year. This means that the course will rely on class problematization, class discussions and other group activities as well as – or more than- a traditional lecture-based approach.
National and international experts in health programmes and M&E will present to the students to ensure adequate exposure and familiarity with global M&E systems.
Students will be provided computers for their use during the training. The programme will make available access to the internet, and reference materials, including computer based and distance learning.
Site visits will be built into the course to familiarize students with environments and organizations they will be working with
The course is designed to be taught in blocks at two month intervals and to be continuous across the time period.
Graduate Profile
After completion of their coursework graduates at the level of Diploma will be:
1. Creative and well versed M&E professionals
2. Capable of understanding programmes that are relevant to and that address issues related to national public health priorities 3. Capable of understanding basic principles of monitoring and
evaluation including design, monitoring and evaluation tools, implementation of M&E systems, and the collection, analysis and critical appraisal of information
4. Capable of understanding processes in programme or project management
5. Capable of developing an integrated and comprehensive Monitoring and Evaluation Plan
6. Excellent at interpersonal skills, capable of organizing and influencing groups to use M&E data
After completion of their coursework graduates at the level of Masters will be:
1. Capable of independently designing and implementing an M&E plan for a specific program or problem.
Admission Criteria
The following candidates are eligible for the post graduate Diploma and MSc in Health M&E
A minimum of a first-degree in the field of health sciences Show a keen interest for the profession of M&E
Can provide evidence of sponsorship and recommendations from his or her current employer
Score at least the minimum grade in the entrance examination of the Jimma University
Fulfill other relevant criteria required by the University A minimum of 2 years experience in the health sector
These admission criteria may be expanded in subsequent cohorts.
Assessment of students during training
The students will be evaluated using the following methods of academic performance appraisal:
Post Graduate Diploma in M&E
Assignments as required including community based assignments at their work sites
Class attendance and active participation in the teaching-learning process
M&E field work assignment and presentation of field activity report
Seminar presentations
Writing examination papers for each track at the end of the year Preparation of a Project Proposal and oral defense of the proposal Community-based training will be conducted through supervised
assignments at student worksites 11
Because the course is organized around year long tracks, exams will take place at the end of the training. Each learning unit will contribute questions to the final exam, and be weighted to reflect credit hours contributed to the track. An overall score of 70 or above (“B” or above) in all four tracks will be required to achieve a passing grade in the Tracks.
MSC in Health M&E (In addition to successful completion of 1st year) DTTP (as specified below)
Preparation of a thesis with oral defense
Monitoring and Evaluation of the training programme Feed back from graduates
Feed back from stakeholders
Supervision and feedback from student mentors Student scores on assignments and exams
Quality of proposal, thesis and other written products and presentations
Diploma/Degree Awarded
After successful completion of course work the graduates will be awarded the Jimma University Post Graduate Diploma in Health Monitoring and Evaluation (JUDipHME). The graduates of the 2nd year of the programme will be awarded a Master of Science (MSc.) in Health Monitoring and Evaluation.
LIST OF ACADEMIC STAFF AT THE FACULTY OF PUBLIC HEALTH of Jimma University Lecturer Assistant professor Associat e professo r Profess or Tot al 3 7 4 1 15
Number of Prospective students
Type of students Expected
(2006)
Expected (2007) Post graduate diploma
and MSc in Health M&E
Training to be offered
As an integrated programme, specific learning units from public health, social sciences, management, IT and related fields are organized into Tracks, which specify the particular training goals. Learning units of each track will be taught across the three blocks as four single courses.
1. Tracks required for M&E of Health Programmes
Track Course No. Cr. hrs Contact hrs
Track 1: Social-Political-Economic and Cultural context of Health
MEHP-501
5 80
Track 2: Logical models of Health Programmes
MEHP-502 10 160
Track 3: Logical Models of Evaluation MEHP-503 10 160 Track 4: Communication, Networking & IT MEHP-504 5 80 DTTP DTTP-601 3 240 Thesis MESR-602 6 480 Total 39 1200
DTTP and Thesis 1 CrHr = 80 contact hours
2. Track Descriptions
Track 1: Social-Political-Economic and Cultural context of Health (MEHP501)
Describes the context of health and health systems in Ethiopia. It formally articulates the relations among the social, cultural, political and economic contributors to health status, health behaviors, and the performance of the health system. These connected learning units build a comprehensive understanding of how these distal determinants are connected to more proximate causes of disease, and how they set the foundation for the performance of the formal and informal health system. This track also provides training in certain methodologies associated with the embedded fields of knowledge, such as qualitative methodology, and health economics.
Track 2: Logical Model of Health Programmes (MEHP502)
At the core of the evaulator’s skill is the ability to understand the nature of health problems and the elements and sequences of activities embedded in the response to the health problem. This track focuses on developing the knowledge and skills required to understand the nature and magnitude of priority health problems in Ethiopia, and to critically analyse the assumptions and activities of interventions. Necessary to understanding the nature and
magnitude of health problems are the traditional core skills of public health: epidemiology and biostatistics, and they are included in this track. The track is called logical model of health programmes
because all the elements of the learning units contribute to the student’s ability to critically analyse health interventions and
Track 3: Logical model of Evaluation (MEHP503)
This track is the core of the Monitoring and Evaluation focus of the Diploma and Masters programme. Students will be required to develop a special competence in evaluation theory and methods. Students will learn distinct forms of evaluation and monitoring such as process evaluation, economic evaluation, and qualitative evaluation. At the completion of the course the students will be able to design monitoring systems and evaluations for priority health programmes, collect and analyse data and develop recommendations for programmes.
Track 4: Communication, Networking and IT (MEHP504)
This track incorporates a combination of skills from different areas that may be used to organize, transmit and utilize evaluation results. Evaluators must be equipped to work with diverse professionals to conduct evaluability assessments, stakeholder analyses and to conduct M&E activities. Evaluators must perform as neutral and supportive professionals in interpersonal work settings that may be conflictive. They must have skills to negotiate in these settings and to resolve personal and operational crises. Evaluators must also assist policy makers and program heads and staffs to accept and use the findings from M&E activities. Personal and professional networking skills are important for these tasks, but we will use the topic of interpersonal networking to build a national and international M&E network to support the activities of our students. Evaluators also need to know how to present findings concisely and effectively to a range of audiences. Finally, students will be exposed to the latest microcomputer and web-based programs, to be utilized in the planning, implementation, analysis and use of M&E data for program improvement. Literacy in these technologies will maximize
the utility of these M&E professionals and equip them to respond to the multiple demands placed on them at their worksite.
