Sebuliba Isaac, Lindan Christina, Baryamutuma Rose, Kyomugisha Charity, Muhumuza Simon, Bazeyo William, Akello Evelyn
Makerere University School of Public Health, Kampala, Uganda.
Institute for Global Health Sciences, University of California, San Francisco, California, United States of America.
East Afr J Appl Health Monitor Eval. 2018;2018(2).
Although district health teams (DHT) in Uganda are supposed to monitor and support facilities to ensure quality HIV data collection, reporting and use, they are often ill-equipped to do so. We implemented a program designed to build the capacity of districts to manage and use their own HIV-related program data and to assist facilities to collect and evaluate their own data.
We conducted a baseline assessment of the monitoring and evaluation (M&E) capacity of 38 districts. In the 10 worst-performing districts, we identified and trained district-level staff to become M&E mentors who in turn trained and supervised facility-level staff. We collected information on action plans developed by facilities to address major issues of concern. Following the intervention, we reassessed M&E capacity of the 10 targeted districts.
Among the 38 districts assessed, one-half did not have a biostatistician, less than one-quarter had staff trained in the basics of M&E or data analysis, and less than one-quarter had an M&E plan. The main concerns of facilities included lack of updated data collection tools, lack of supervision, inaccurate data recording, and limited ability to analyze and use data. In the 10 targeted districts, comparison before and after the intervention showed that the number of districts with trained M&E staff increased (4 to 9), the number of M&E plans increased (3 to 6), and the number using data for programming increased (4 to 8). Implementation of action plans by facilities successfully addressed many issues and led to improved programming.
Challenges of district M&E in Uganda mainly result from a lack of skilled human resources. On-the-job training and direct involvement of district staff to provide support to facilities can lead to improvements in data quality and use.
尽管乌干达的地区卫生团队（DHT）本应监测并支持各医疗机构，以确保高质量的艾滋病毒数据收集、报告和使用，但他们往往缺乏这样做的能力。我们实施了一项计划，旨在建设各地区管理和使用自身艾滋病毒相关项目数据的能力，并协助医疗机构收集和评估自身数据。
我们对38个地区的监测与评估（M&E）能力进行了基线评估。在表现最差的10个地区，我们确定并培训了地区级工作人员成为监测与评估导师，这些导师进而培训并监督医疗机构级工作人员。我们收集了各医疗机构制定的用以解决主要关切问题的行动计划的相关信息。干预措施实施后，我们重新评估了这10个目标地区的监测与评估能力。
在接受评估的38个地区中，一半没有生物统计学家，不到四分之一的地区有接受过监测与评估或数据分析基础知识培训的工作人员，不到四分之一的地区有监测与评估计划。医疗机构的主要关切包括缺乏更新的数据收集工具、缺乏监督、数据记录不准确以及分析和使用数据的能力有限。在10个目标地区，干预前后的对比显示，拥有经过培训的监测与评估工作人员的地区数量增加了（从4个增至9个），监测与评估计划的数量增加了（从3个增至6个），将数据用于项目规划的地区数量增加了（从4个增至8个）。医疗机构实施行动计划成功解决了许多问题，并改进了项目规划。
乌干达地区监测与评估面临的挑战主要源于缺乏技术熟练的人力资源。在职培训以及地区工作人员直接参与为医疗机构提供支持可提高数据质量和数据使用情况。
