Monitoring and Evaluating Development Projects

Some possible steps to carrying out monitoring and evaluation

1. Agree upon a rationale for conducting monitoring and evaluation
2. Secure funding (should have already been budgeted)
3. Identify stakeholders
4. Decide on a target audience
5. Involve stakeholders in decisions about the evaluation including the 7 steps of planning
6. Use 7 steps framework for planning evaluation
7. Finalize target audience for results and determine how findings will be used
8. Hire a consultant if necessary
9. Review detailed action plans (DAPs) and determine what you said you’d do and how you’d do it
10. Review the literature (both in country and globally) to find out what has already been done with respect to innovative evaluation methods and to the topic you are evaluating
11. Identify standard “tools”
12. Establish a conceptual framework
13. Design study (type as well as methods to be used)
14. Secure community permission to carry out the study
15. Secure institutional support as needed (IRB, agency itself)
16. Reach conclusions about sampling (methods, universe, sample size, selection of clusters, households, respondents, etc.)
17. Secure lists for sampling universe
18. Develop data collection instruments
19. Identify interviewers and supervisors
20. Develop interviewer and supervisor manuals
21. Train interviewers and supervisors including lots of field practice
22. Prepare for data collection
23. Carry out data collection
24. Supervise data collection, monitor quality of data collected
25. Enter, clean and manage data
26. Analyze data
27. Write reports
28. Disseminate and use results

Excellent resources on M&E

http://www.childsurvival.com/kpc2000/kpc2000_new_summary.cfm

http://www.childsurvival.com/tools/mon_eval.cfm

http://www.childsurvival.com/rhfa_1.cfm

http://www.childsurvival.com/documents/trms/update_trms.cfm

The last one includes M&E but also lots of other theme-specific and cross-cutting issues, for example, behavior change. These materials represent the latest thinking on a variety of topics.

Para los hispanohablantes (for all of you Spanish-speakers out there)…

Existen varios recursos para el trabajo a nivel comunitario. Los recursos mencionados abajo están en ingles (o en algunos casos, en español). Sin embargo, creo que se puede encontrar la mayoría de ellos en español.

La Desviación Positiva/Talleres Hogareños (un método que se puede usar no tan solo para la desnutrición pero también para otros temas):

http://www.coregroup.org/working_groups/Spanish_PD_Hearth.pdf

Capacitación en Cadena de Cambios (el tema tiene que ver con la alimentación de los niños; sin embargo, se puede usar el formato y la estrategia para otros temas también):

http://www.linkagesproject.org/media/publications/Training%20Modules/BCC_and_IF.pdf

La salud del adolescente:

http://www.familycareintl.org/es/issues/48

http://www.familycareintl.org/en/resources/publications/53

http://www.unicef.org/lifeskills/index_14926.html

El monitoreo y la evaluación:

http://www.childsurvival.com/documents/CSTS/C-HIS_Final.pdf

La investigación formativa:

http://www.linkagesproject.org/media/publications/Training%20Modules//Formative_Research_Module_2-23-04.pdf

El aprendizaje activo y la acción (muy buena manera para involucrar la comunidad en su propio aprendizaje):

http://www.ymca.net/downloads/publications_pla_guide.pdf

http://www.care.org/careswork/whatwedo/health/downloads/embracing_participitation/embracing_participitation_sp.pdf

http://www.childsurvival.com/kpc2000/kpc2007.cfm

Recursos generales de las ONGs:

www.coregroup.org

Looking for volunteers

If any of you are interested in volunteer work–especially related to infant and young child nutrition and/or emergency situations, let me know. I have a project that may be of interest to you. I can only accept 2 or 3 volunteers. You can do this work at home (sorry, no exotic travel involved).

BACKGROUND:

I teach at Boston University’s school of public health and was at BYU teaching international health until August of 2007. I am currently consulting with CARE to develop a manual on infant and young child feeding in emergency situations. While CARE is producing the manual, it is really meant for a variety of implementing organizations (UN Agencies and NGOs in particular). There has already been a tremendous interest in the Guide and we haven’t even finished it yet!

The Guide is designed to help local staff from implementing organizations (e.g., UN Agencies and NGOs) manage, clean, analyze and use information on infant feeding behaviors. The Guide helps them report on standard infant feeding indicators (for example, % of infants exclusively breastfed, dietary diversity and so on). There are lots of ‘how-to’ books out there but few that help walk individuals through the process of entering, managing and analyzing data.

I need 2-3 students who would be interested in reviewing the Guide (in detail). It would probably take 20 hours over several weeks. The work can get tedious but on the other hand, I think reviewers could benefit from some of the contents including some great things that can be done in Excel.

If you’re interested in this opportunity, let me know and I’ll send you the materials. I’ll also correspond with you by email to walk you through the process.

Thanks!

Kirk Dearden

Obtaining meaningful work in international health and development

Financing for not-for-profit work is filled with lots of ups and downs. Sometimes there is a lot of funding available for child survival work (for example, malaria, tuberculosis, HIV/AIDS) and sometimes it dries up. As a consequence, those wishing to work in international health and development need to be able to market themselves well and, ultimately, get jobs when funding is scarce. Here are 10 tips to getting started with your first (or second or third) internship (or job) in international health:

Strategies for Securing Meaningful Work in International Health:

1. Pursue a graduate degree (immediately after a bachelor’s degree in most cases)
• usually an MPH or a degree in a social science discipline
• clinical degree (MD, RN, CNM) with an MPH is also very good
• you may want to consider a doctorate in public health

2. Obtain practical experience in the field of international health
• Volunteer opportunities, paid internships, missionary service, full-time employment
• The more overseas experience you have, the better
• The greater the geographic coverage the better (Asia/Africa: high demand)

3. Learn at least one other language (Spanish, French, Portuguese, Arabic)

4. Develop and refine skills that are in demand in international health
• Behavior Change Communications (including social marketing)
• Epidemiology, biostatistics, demography
• Qualitative research methods
• Expertise in monitoring, evaluation and applied research
• Training of Trainers
• Community mobilization/community-based development
• Others

6. Publish peer-reviewed articles, manuals, etc.

7. Write proposals and secure funding

8. Be concise about your professional objectives

9. Don’t limit your hands-on work experience to local LDS-based not-for profits

10. Secure strong references

11. Network using open-ended questions (who else is working in X?)

12. Follow your bliss!

“But if a person has had the sense of the call—the feeling that there’s an adventure for him—and if he doesn’t follow that, but remains in the society because it’s safe and secure, then life dries up. And then he comes to that condition in late middle age: he’s gotten to the top of the ladder, and found that it’s against the wrong wall.”
–Joseph Campbell, An Open Life

Community-based Approaches with Joao Bueno

Sorry about the late notice, but Joao Bueno, a friend I met in Mozambique, will be in town, and has accepted an invitation for dinner this Wednesday, April 23. Please join us from 7:30-8:30pm for desserts and discussion about community-based interventions. Joao has spent the last 2 years (I think) in Mozambique as the program director for the Family Preservation Program, a community-based development program. (See here and here for details). RSVP here: unacceptableglobalhealth (at) gmail (dot) com

Brief Report from CORE Meeting

I’ve spent the past 3 days at the CORE Spring Meeting.

Outstanding. I’ve had a great time and learned a ton. Here are a few random thoughts:

• I am convinced that anyone involved in global health with an NGO should at least be aware of the CORE group. CORE’s opportunities for networking and mentoring, on-line manuals and resources, bi-annual conferences, working groups with active list serves, and emphasis on evidence-based practice are, in my opinion, crucial.
• Presentations by USAID and others gave an idea where global health will be heading in the coming years.
• Jim Ricca of CSTS gave a fascinating presentation on the Lives Saved Calculator, the same methodology used by the 2003 CS Lancet folks. It essentially allows one to predict how many lives would be saved with certain interventions.
• Sarah Kambou of the International Center for Research on Women gave the keynote presentation. She outlined 3 principles to global health/development:

1. Base all action on evidence
2. Trust in the power of partnership
3. Monitor progress and evaluate results

All of the presentations from the conference will (soon?) be found on the CORE website.

Needle/Condom Exchange vs. Moral & Ethical Behavior, should it conflict? by Natasha Antoniak

I often say “should” is a funny word. It denotes an expectation or assumes that there is a “right/wrong” with whatever the situation is. However, in my opinion, this thought process detracts from what is most important in terms of treatment and prevention, specifically among the situation of Needle & Condom exchanges. Some think theses exchanges goes against moral and/or religious belief. Some think ethics are involved because of the use of resource & seemingly “controllable behavior” and therefore, it conflicts with ‘correct conduct of life.’ Others take into account the age of responsibility (i.e. it would seem ok to give out condoms and needles to people 18+ yrs (say in community health centers) but that it would be wrong to distribute to anybody younger (such as in schools) since it is under the parents jurisdiction because the kids are still considered minors). We also know the risk of HIV/AIDS and many other STD’s could significantly be decreased because of these distributions, not to mention the cost of health care would decrease because of the prevention and treatment going on. I think it is a matter of learning how to view the situation and discerning what is best vs. what people think is right/wrong. Joseph Smith, a religious leader, once said, “Teach correct principles & let them govern themselves.” Meaning, we can do our best in educating but what it comes down to is that it doesn’t matter who, how, what or why these people are doing what they are doing. We have a stewardship, as part of humanity, to take care of each other and not judge each others actions & behaviors. Yes, we can educate, encourage, and seek to prevent but it would be to global health’s detriment if we withheld our support and resources. I understand that this can be a controversial subject as it becomes a matter of judging. But how grateful we can be for our ever-growing knowledge and use of resource! For ex., this type of thought process can be carried down to the smallest & quite typical example of the girl in school or the church group that gets pregnant. Her peers or members of the congregation have a choice to make in whether they will support or shun her because they don’t want to seem to condone her behavior. Rather, this isn’t the most relevant issue at all. Let us look past the behavior and realize the health of the girl and the baby is what becomes most relevant. My point with all this is that this same principle and perspective parallels the needle and condom exchange controversy. It is about being humane and understanding the worth of a soul and the worth of its body and our stewardship over such gifts & people. May we seek the greatest quality of health for all people.

Family-Based Global Health by Elise Best

This past week I had opportunity to attend the first annual Mother, Child, and Newborn Health Conference at Brigham Young University. I was impressed with the breadth of the topics covered at this conference, but was especially intrigued by the concept of family-based initiatives that are currently being implemented in the Americas under the supervision of PAHO.

As the family unit serves as a place of learning and setting behaviors that will persist throughout time, it seems only natural to target families as a whole when trying to improve health behaviors among a population. It is within the bonds of a family, regardless of situation, that crucial health behaviors are molded and perpetuated whether for better or worse. Looking at a family as a whole, rather than targeting individuals, would seem a logical approach to cultivate improved health situations in communities across the globe.

As these family-based health initiatives are showing great success and promise in developing countries, the possibility of implementing the same types of initiatives here in the United States should be taken into consideration. In a country where focus is largely placed on the individual, an attempt to shift focus to the family unit and its potential influence on developing and sustaining healthy behaviors could prove to have great impacts on improving health conditions not only globally, but here in the United States as well.

Medical Care in the U.S. by Sachika Walden

I remember reading the article a year ago in MSN with a title: Maryland boy, 12, dies after bacteria from tooth spread to his brain.

Although I could not find the exact article (it has expired), the story was like this:

Twelve-year-old Deamonte Driver died of a toothache Sunday.
A routine, $80 tooth extraction might have saved him.
If his mother had been insured.
If his family had not lost its Medicaid.
If Medicaid dentists weren’t so hard to find.
If his mother hadn’t been focused on getting a dentist for his brother, who had six rotted teeth.
By the time Deamonte’s own aching tooth got any attention, the bacteria from the abscess had spread to his brain, doctors said.

(Source from http://www.abovetopsecret.com/forum/thread270108/pg1)

I remember I was shocked reading this article. I even discussed with my husband and talked how important to have a routine checkup at least every year.

As I am from Japan, I was surprised how expensive medical care is in the United States. I don’t know if it is an actual cost, or they are trying to make a huge profit, or they are trying to cover other people’s unpaid medical bills and even out. Even without insurance, a routine checkup at the dentist is only $18 and fillings are $30 in Japan. Doesn’t it sound about right? I heard a story that people going to Mexico for fixing their teeth. They told me that they get it done cheaper for the same quality, even paying for a round trip airplane tickets.

It is sad to hear that the boy was not insured and lost his Medicaid. Money is always a big issue when you go to any kind of doctor.

I know a foreigner couple who came to UT for their honeymoon. They didn’t have travel insurance for one week of their stay. The wife got sick and had to go to the ER. Her appendix was removed and later bowel obstruction (what a honeymoon, right?). So, one week of hospitalization, the bill was $40,000. However, the hospital told them that if they pay within two weeks, the bill is going to be 50% off – what a deal. They maximized their credit cards, their parents sent them money, and went home three weeks later.

I’ve heard that some hospitals had to close down because the patients never paid the medical bills. This is a problem, too, but I strongly feel that a “reasonable” medical bill should be made, not the 50% off thing. The couple even felt that the ER doctor and nurses were not nice and service was not good. I guess the price does not equal to its quality in the US hospitals. I know that there are many public services to help medical bills, including CHIP, Medicaid, and Medicare, but I hope someday that all US citizens have reliable health insurance for affordable price. And when you travel overseas, make sure you have insurance, too!