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Advances in Social Sciences Research Journal – Vol. 11, No. 9

Publication Date: September 25, 2024

DOI:10.14738/assrj.119.17537.

Odiga, L. Y., Onyango, L., & Pido, O. (2024). Challenges in Sustaining Donor Initiated Monitoring and Evaluation System for HIV and

AIDS at the Service Delivery Level; Examples from APHIA Plus Project in Kakamega County. Advances in Social Sciences Research

Journal, 11(9). 62-70.

Services for Science and Education – United Kingdom

Challenges in Sustaining Donor Initiated Monitoring and

Evaluation System for HIV and AIDS at the Service Delivery Level;

Examples from APHIA Plus Project in Kakamega County

Leonard Yosi Odiga

Department of Urban Management,

School of Planning and Architecture, Maseno University

Leah Onyango

Department of Urban Management,

School of Planning and Architecture, Maseno University

Odoch Pido

Department of Design and Creative Media,

School of Creative Arts and Technologies, Technical University of Kenya

ABSTRACT

HIV/AIDS remains a major global public health issue, with Sub-Saharan Africa being

the hardest hit and housing over 1.7 million people living with HIV. Kenya's long- term success in combating AIDS requires decentralization, allowing counties and

local networks to take an active role in developing, implementing, and monitoring

evidence-based initiatives. Current frameworks for Monitoring and Evaluating

(M&E) HIV/AIDS programs are primarily focused on data collection to inform

decisions at the county and national levels. As a result, there's a pressing need to

boost M&E capacity at the service delivery level to ensure effective HIV/AIDS

programs. This paper interrogates the AIDS, Population, and Health Integrated

Assistance (APHIA plus) Western Project's success in enhancing local M&E capacity

at the service delivery level in Kakamega County and the challenges of sustaining

the gains beyond the project period. The study sampled 110 health facilities

offering HIV/AIDS services in Kakamega County. and established It established that

the APHIAplus Western Project made significant strides in strengthening the M&E

system by establishing M&E departments, improving collection, quality and

dissemination of M&E data and hiring trained staff. The study identified the main

challenges to the sustainability of the M&E system which included heavy reliance

on external funding and inadequate dedicated M&E staff in county health facilities

where 62% of staff carrying out M&E functions/duties were hired by the project. It

also identified a challenge in the likely compromise to the prerequisites for quality

M&E data after the exit of the project since there was no clear transition plan from

project to county. The study results indicate that that 70% of the facilities were

collecting monthly data using specified tools and storing the data in an automated

system. ANOVA yields a statistically significant difference in the length of years the

APHIAplus Western project has supported the health facilities and the frequency of

M&E data collection at the service delivery level. The study further identified a

challenge in the likely discontinuation of fora/platforms organized monthly in 94%

of the facilities for dissemination of M&E findings and supported by APHIAplus

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Odiga, L. Y., Onyango, L., & Pido, O. (2024). Challenges in Sustaining Donor Initiated Monitoring and Evaluation System for HIV and AIDS at the

Service Delivery Level; Examples from APHIA Plus Project in Kakamega County. Advances in Social Sciences Research Journal, 11(9). 62-70.

URL: http://dx.doi.org/10.14738/assrj.119.17537

Western Project. The study recommends increasing the number of dedicated M&E

staff in county health facilities by developing a phased transition plan for M&E staff

contracted by the project with a clear handover schedule to County Government of

Kakamega, and advocating for increased budget allocation for M&E activities at the

service delivery level. Additionally, health facilities are encouraged to explore

strategies for diversifying funding sources for M&E activities.

Keywords: Monitoring and Evaluation, HIV and AIDS, Service Delivery Level, Sustainable

System.

INTRODUCTION

According to the World Health Organization (WHO, 2022), HIV remains a significant global

public health issue, with over 40.1 million lives lost to date and an estimated 38.4 million people

living with HIV by the end of 2021, predominant in the African Region where 25.6 million

reside. Since the first case was officially recorded in 1984, the Kenya World AIDS Report 2022

estimates more than 2 million AIDS-related deaths, with at least 1.5 million Kenyans reported

living with HIV by the end of 2019 (National Syndemic Diseases Control Council (NSDCC),

2022). The report highlighted the necessity for increased efforts to accelerate decentralization

of the response, enabling districts and local networks to engage actively in developing,

implementing, and monitoring evidence-based initiatives aimed at addressing the epidemic. To

design and execute the best possible service delivery, in-depth data on care models is necessary

given the changing landscape of care and support, particularly the growing accessibility of

treatment (WHO 2014) hence the studies focus on service delivery level which addresses the

M&E needs expressed by NACC and NASCOP (2012), WHO (2011) and UNAIDS, (2006). Current

frameworks for Monitoring and Evaluating (M&E) HIV/AIDS programs are primarily focused

on data collection to inform decisions at the county and national levels. As a result, there's a

pressing need to boost M&E capacity at the service delivery level to ensure effective HIV/AIDS

programs.

The HIV M&E Capacity Rapid Needs Assessment (Mbondo et al., 2013) identified several gaps

in Kenya's HIV M&E system, including limited use of data for program improvement and

insufficient capacity for data management at the facility level. Kenya Legal and Ethical Issues

Network on HIV and AIDS (KELIN) (2017) highlighted weaknesses in the HIV/AIDS M&E

Framework, noting its lack of clarity on the purpose and intended users of M&E information.

The MEASURE Evaluation PIMA project, funded by USAID in 2018, conducted evaluations of

M&E capacities across 17 Kenyan counties, including Kakamega County. The findings from this

assessment unveiled significant M&E issues. These issues included poor M&E coordination,

undeveloped governance and partnership structures, insufficient costed work plans for M&E

and insufficient county-level programs to promote M&E which resulted in the counties' budgets

having insufficient funds allocated to essential M&E operations.

Long-term strategy for developing M&E systems at service delivery level that is consistent with

national reporting standards is needed. Policymakers and donors should actively promote and

recognize the importance of M&E as both a reporting tool and a management practice in order

to secure greater support from health facility staff and program personnel (Ogungbemi, et al.,

2012). Literature illustrates that there are existing standard M&E frameworks for HIV &AIDS

that are expected to realise set objectives but they need some improvements if they are to

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Advances in Social Sciences Research Journal (ASSRJ) Vol. 11, Issue 9, September-2024

Services for Science and Education – United Kingdom

realise the set goals of a sustainable M&E in HIV and AIDS at service delivery level. These

changes can be realised through capacity building which is espoused in the project objectives

of the APHIAplus Western Project.

The AIDS, Population, and Health Integrated Assistance Program (APHIA plus) Western Kenya

was a six-year USAID/PEPFAR-funded project led by PATH, to enhance M&E system capacity

at health facilities delivering HIV/AIDS interventions. Its objectives included supporting health

facilities to provide quality services and involving communities in identifying and addressing

health issues. The project aimed to establish essential M&E capacities (such as dedicated M&E

units with clear mandates), develop M&E plans and indicators, and conduct regular monitoring

(data collection, analysis, and reporting). Key Result Areas focused on increasing the use of

quality health services and information by building local capacity within government

frameworks. The project aimed to address deficiencies in HIV/AIDS M&E systems and provide

evidence for improving M&E practices at the service delivery level, which could be replicated

by other providers. This paper intends to assess the achievements of APHIAplus Western

project efforts for additional capacity of an HIV/AIDS M&E system at service delivery level and

the challenges of sustaining the gains beyond the project period.

RESEARCH METHODOLOGY

The study was carried out in Kakamega County, situated in the western region of Kenya. Health

facilities in the County have received support for HIV/AIDS programming from APHIAplus

Western project and that is why it was the appropriate choice for this study. The research

distributed questionnaires to two individuals in each of the 107 health facilities located within

Kakamega County. The two respondents included the person in charge of the health facility's

HIV/AIDS program and a staff member responsible for M&E functions at the health facility. The

study utilized semi-structured questionnaires comprising both open-ended and closed-ended

questions, along with in-depth interviews, for data collection. The study also conducted

interviews with both the County Health Department staff and project staff. This was

complimented by Interview to the County HIV/AIDS coordinator to understand the HIV/AIDS

programs, footprint & role of APHIAplus Western project, Staffing for the HIV Programming.

Secondary sources such as County HIV/AIDS M&E guides & APHIAplus Western project

quarterly report were reviewed. Data was analysed using both qualitative and quantitative

methods.

RESULTS AND DISCUSSIONS

Organisational Structure

The results s showed that 56% of the health facilities in Kakamega County had a unit called the

Health Records and Information department led by a Health Information Records Officer

(HRIO) who reported to the in-charge of the health facility. Those at sub-county level had the

title of Sub-County Health Records and Information Officer (SCHRIO) while the one at County

level bears the title of County Health Records and Information Officer (CHRIO). These

departments are responsible for conducting M&E activities at the health facility, Sub-County

and County levels respectively. Results of the study show that 86.7% of the health facilities in

Kakamega County had staff with M&E responsibilities.

Analysis of M&E staffing at the health facilities revealed that 56% of the sampled health

facilities had Health Records and Information staff who perform M&E roles. The results of the