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UNIT An Introduction to 1 Project Management

Introduction

Welcome to Unit 1 of the module Monitoring and Evaluation for Health Services Improvement I.

Two terms – project and programme – will be explored and defined in the course of the first session of this unit.

In the second session, we will discuss the reasons for the development of projects and programme and, in the last, discuss the location, in terms of role and activities, of monitoring and evaluation activities within the life cycle of a programme / project.

Study Sessions

There are two Study Sessions in Unit 1.

Study Session 1: An Introduction to project management Study Session 2: The Programme Management Cycle

Learning outcomes of Unit 1

By the end of this unit, you should be able to:

 Define and distinguish between the terms “project” and “programme”  Describe the Programme Management Cycle  Understand the role of problem-identification in the development of programmes  Explain the role and purpose of Monitoring and Evaluation at each stage of the Programme Management Cycle

SOPH, UWC, Postgraduate Diploma in Public Health: Monitoring & Evaluation for health Services Improvement 1 – Unit 1 1 SOPH, UWC, Postgraduate Diploma in Public Health: Monitoring & Evaluation for health Services Improvement 1 – Unit 1 2 Unit 1 - Study Session 1 Differences between a programme and a project

Introduction

Welcome to your first study session.

We devote this session to clarifying key concepts in programme development and management.

The first that we shall tackle are the definitions of programmes and projects, as well as the similarities and differences. We will also explore the reasons projects and programmes are developed.

Contents

1 Learning outcomes of this session 2 Readings 3 Defining projects and programmes 4 Why are programmes developed? 5 Session summary

1 LEARNING OUTCOMES OF THIS SESSION

By the end of this session you should be able to:

 Understand the difference between a programme and a project  Understand the reasons for programmes(interventions)

2 READINGS

You will be referred to the following reading/s in this session.

SOPH, UWC, Postgraduate Diploma in Public Health: Monitoring & Evaluation for health Services Improvement 1 – Unit 1 3 Author/s Publication Details

Puoane, T., (2004). Improving the hospital management of Sanders, D., malnourished children by participatory Ashworth, A., Chopra, M., research. International Journal for Quality in Health Care, Strasser, S. & 16(1): 31 – 40. McCoy, D.

3 DEFINING PROJECTS AND PROGRAMMES

As a Public Health practitioner, you will have come across the terms “Programme “and “Project”. Did you ever wonder why these two terms were used? Why people didn’t just use one term and stop complicating things? Did you ever ask yourself whether there were any differences between these terms and what, if any, they were?

These terms both, essentially, refer to a set of planned activities to meet a certain outcome or goal – particularly, in our context, one related to meeting the health needs of populations. These terms are sometimes used interchangeably: However, there are some differences that we are going to note in this section. It’s important simply to note the implications in the use of these different terms.

To begin, please recall what you know of these terms and complete the following task.

TASK 1 – What is the difference between a “project” and a “programme”?

Now take a few minutes to think about these terms in relation to what you have heard before and write down your own definition of what each means.

Project:

______

______

______

Programme:

______

______

SOPH, UWC, Postgraduate Diploma in Public Health: Monitoring & Evaluation for health Services Improvement 1 – Unit 1 4 ______

______

FEEDBACK

Now compare your own definitions with the following:

A programme is a diverse set of activities, which progress over a long period of time in order to fulfil a variety of development needs, e.g. Maternal and Child Health programme, or MCH &Nutrition programme and The AIDS Control programme. A programme is therefore very broad and may contain several small projects.

A project is a subset or component of the programme, normally with a shorter timeframe, specific resources and outputs; designed to address a specific need or solve a specific problem. e.g. A child nutrition project. The project has a start–end time, each project is unique (no two projects are the same).

Although these are two different terms, they are similar in some ways.

3.1 Similarities between a Project and a Programme

 Both have goals and objectives – i.e., are directed towards the achievement of particular goals and objectives.  Both have a timeframe, which is longer in a programme and shorter in a project.

3.2 Differences between a Project and a Programme

 A programme is broader than a project, and often designed to meet various needs or solve various problems whereas a project is more specific and is designed to meet a particular need or solve a particular problem.  A programme may consist of a number of projects, for example a maternal and child health programme may consist of feeding projects, health education projects, etc.  A programme has a longer timeframe, which may take forever. For example, an immunization programme would be set to exist for as long as the health need that it meets continues. A project generally has a set time-frame and is often considered to be finite.

In this module, we are going refer to the term “Programme” a lot, but the concepts and skills you learn during the course may also apply to a project of your own that you will be required to monitor.

SOPH, UWC, Postgraduate Diploma in Public Health: Monitoring & Evaluation for health Services Improvement 1 – Unit 1 5 TASK 2 – Differentiating between a project and a programme using examples from your setting

In your setting, please state two services that may be termed “programme” or “project” within the definitions discussed above: Name one project and one programme.

 What differences do you notice in the nature of the two activities?

 Are there any additional differences that have not been mentioned in the previous section?

 Do you think these differences play a part in differentiating between the nature of a project and that of a programme, or are they only part of these activities that you have made?

FEEDBACK

Projects are quite narrow and directed to a limited set of goals or activities. Programmes, on the other hand, may encompass a varied set of goals and activities, with smaller projects following narrower tracks towards their own individual goals within the overall goal of the programme. Different, varied projects may be required to enable the programme to meet its overall goal. For instance, a child nutrition project, immunization, growth monitoring, prenatal care, and so forth, may be required – pursuing their individual goals and objectives – and all contributing to the overall programme goal of Maternal and Child Health.

One set of activities may differ from another due to the nature of these particular activities, and not necessarily refer to distinguishing features between a programme and a project.

4 WHY PROGRAMMES AND PROJECTS ARE DEVELOPED

Why are programmes and projects developed?

Programmes and projects are developed in an effort to deal with a problem that affects a number of people and has negative consequences which, if not attended to, may cost the country a lot in terms of money, services provided and time of personnel.

 A problem is identified

 The problem is big

SOPH, UWC, Postgraduate Diploma in Public Health: Monitoring & Evaluation for health Services Improvement 1 – Unit 1 6  It affects many people

 It has poor health outcomes or consequences

 If not dealt with, it will cost the country a lot of money.

For example, severe malnutrition: Severely malnourished children have low cognitive development, poor school performance, all of which will lead to poor job opportunities, poverty, severely malnourished children, ... . The cycle continues in the next generation. And moreover, the country must support them to prevent negative outcomes. This cycle may continue for generations, because each generation is not able to acquire the means to generate a living and passes the legacy on to the next generation.

The problem is costly: it costs lives, potential for human development, costs time and resources in giving medical support to the affected children, and continues to demand a financial cost through the lives of the children - and gets repeated into successive generations.

Accordingly, once having identified a problem, you develop a programme to manage it. This important point links to the Programme Management Cycle which we will deal with in Unit 3, and where you will see that problem identification is the first step in the Cycle.

TASK 3 – Identify the reasons for a project

Now read Box 1, “Improving the hospital management of malnourished children by participatory research”. This extract comes from a study conducted by the School of Public Health into severe malnutrition in a rural area in South Africa.

 Identify factors that may have led to the development of this project. Jot these factors for your own records.

BOX 1: IMPROVING THE HOSPITAL MANAGEMENT OF MALNOURISHED CHILDREN BY PARTICIPATORY RESEARCH

In 1998, the School of Public Health staff worked in collaboration with the Eastern Cape Department of Health to develop and implement interventions to improve the nutrition status of children under the age of five in the district. The first step in the implementation included undertaking a situational assessment to determine the extent of the nutrition related programmes in the district. One of the projects that were assessed was the hospital management of severely malnourished children. This entailed going through the ward register of the paediatric ward to count the number of children who had been admitted to the hospital with severe malnutrition over the past 12 months, and determining whether the child died, was discharged or absconded.

SOPH, UWC, Postgraduate Diploma in Public Health: Monitoring & Evaluation for health Services Improvement 1 – Unit 1 7 Upon going though the admission register in a paediatric ward, it was discovered that more than 50% of children admitted for severe malnutrition were dying during hospital treatment. This led to an investigation to find out which children were dying, when they died and the reason for dying.

The findings revealed that a large number of children were dying during hospital treatment. Those who did not die recovered very slowly and therefore spent a very long time in the hospital. A large percentage of children died during the early hours of the morning. Feeding practices were very poor; children were not fed at night, with a gap of 11 hours between the last feed at night and the first feed in the morning. Antibiotics and other treatment were not given as prescribed. The research also revealed shortages of supplies such as milk for feeding children, shortage of antibiotics, lack of weighing scales. Since there were no protocols for the management of severe malnutrition, nurses and doctors used outdated methods of care such as putting up a drip when the child did not want to take feeds. Wards were cold during the night due to intermittent supply of electricity.

Staff attitudes towards malnourished children were also a problem. Due to lack of knowledge about the predisposing causes of acute severe malnutrition and the physiological changes that take place in a child during the illness, nurses had negative attitudes toward mothers and blamed them for the illness of the child.

After presentation of these results to the stakeholders, a decision was made to train the paediatric staff so as to improve the quality of care of malnourished children and reduce the number of children dying during admission (case fatality rates). That was the birth of the “Improving the management of severe malnutrition project” in the province.

FEEDBACK

Projects come into existence for many different reasons, but all tend to be covered by the key factor that we mentioned before, that:

Programmes and projects are developed in an effort to deal with a problem that affects a number of people, and has negative [and costly] consequences

This task serves to illustrate how a project might come into existence.

Now compare your answer with the following.

The problems which lead to the development of the project include:  A large number of children dying during hospital admission  Lack of resources needed for the care of severe malnutrition  Use of outdated protocols which tended to contribute to the deaths of children rather than saving lives  Negative attitudes towards mothers/caregivers of malnourished children

Now, please read the following article, which is a fuller account of the project outlined above.

SOPH, UWC, Postgraduate Diploma in Public Health: Monitoring & Evaluation for health Services Improvement 1 – Unit 1 8 READING

Puoane, T., Sanders, D., Ashworth, A., Chopra, M., Strasser, S. & McCoy, D. (2004). Improving the hospital management of malnourished children by participatory research. International Journal for Quality in Health Care, 16(1): 31 – 40.

Once the programme has been developed, there are two things that need to be taken into consideration. These include programme management and the monitoring of the progress in the implementation of the programme. The next session therefore deals with the programme management cycle – which is a way to represent the running of a programme over its lifetime.

5 SESSION SUMMARY

In this session, we have introduced some of the important introductory concepts in the understanding and management of programmes and projects: You have discussed and explored the key characteristics of programmes and projects, as well as what distinguishes them. You also explored the reasons for the development of projects and programmes, which may be summarised in one phrase: problem identification.

In the next session, you will explore the Programme Management Cycle – of which problem identification is but one aspect – in full.

SOPH, UWC, Postgraduate Diploma in Public Health: Monitoring & Evaluation for health Services Improvement 1 – Unit 1 9 SOPH, UWC, Postgraduate Diploma in Public Health: Monitoring & Evaluation for health Services Improvement 1 – Unit 1 10 Unit 1 - Study Session 2 The Programme Management Cycle

Introduction

Welcome to the second session of Unit 1. In this session, you will learn about one of the important tools for understanding how a programme works - the Programme Management Cycle.

If you are thinking of developing a programme to solve the identified problem you need to go through a cycle, which is called the programme management cycle. Programme management goes through phases – from the identification of a problem, to implementation and delivery of services.

This tool is often represented in the form of a diagram which you may have seen before. The diagram is a “cycle”, and enables us to quickly and easily get an overview of the concept of the “Programme Management Cycle”. At the end of this session, you will have a better sense of where monitoring and evaluation activities can, or should fit, within the life cycle of a programme or a project.

Contents

1 Learning outcomes of this session 2 Readings 3 The Programme Management Cycle 4 The role of monitoring and implementation in the Programme Management Cycle 5 Session summary

SOPH, UWC, Postgraduate Diploma in Public Health: Monitoring & Evaluation for health Services Improvement 1 – Unit 1 11 1 LEARNING OUTCOMES OF THIS SESSION

By the end of this session you should be able to:

 Describe the programme Management cycle.  Describe the role of Monitoring and Evaluation in the Programme Management Cycle.

2 READINGS

There are no readings in this session.

3 THE PROGRAMME MANAGEMENT CYCLE

The Programme Management Cycle is a model of a programme management tool. The Programme Management Cycle is simply a planning framework or tool developed to assist managers and personnel in conceptualizing, planning and implementing projects. It is one of various models used to illustrate, and assist in, the conceptualisation and implementation of interventions. Its value is to demonstrate that programme implementation is a continuous process.

Project /programme cycle management. A tool for understanding the tasks and management functions to be performed in the course of a project or programme’s lifetime. - United Nations (date unknown)

The Programme Management Cycle is a model which depicts all the processes that go into planning and implementing interventions. For example, in programme planning, the programme manager and his or her team start by identifying and analysing the problem that requires intervention. They then go on to develop programme aims and objectives followed by a process of designing and implementing intervention strategies.

- School of Public Health, UWC (2005)

The Programme Management Cycle is, as we have mentioned before, often represented as a diagram. The diagram is a short, graphic way to represent the elements – or, in different contexts – the “stages” of a programme. In this case, there is no significant difference between a “programme” and a “project”, as the Programme Management Cycle is a useful instrument for conceptualising both. SOPH, UWC, Postgraduate Diploma in Public Health: Monitoring & Evaluation for health Services Improvement 1 – Unit 1 12 Problem Identification and Cause Analysis

Implementation Monitoring Goal and and and Objective Service Delivery Evaluation Setting

Designing Implementation Plan

- Mwadime, et al. (1999).

We can distinguish four key phases in the life cycle of a programme. However, a significant value of this planning framework is to illustrate that the phases follow upon, and feed into, one another in a continuous cycle as long as the programme lasts.

In the Programme Management Cycle, the development of a programme is understood to take place in four essential and distinct, steps:

 Problem identification and cause analysis: In this phase, the problem needing intervention is identified and the causes of the problem analysed; this leads to the development of a programme to address this problem. You have seen an illustration of this step in the previous session.

 Goal and objective setting for the programme: In order to address the problem, what should the intervention aim to do? This is the question answered in this phase, and the goals that the intervention is to meet are identified. Specific, Measurable, Achievable, Relevant and Time bound objectives (referred to as SMART objectives) are derived from the goal/s; these are the specific achievements that the intervention should have in order to meet the goal. This step will be explored in greater detail in the next unit.

 Designing implementation plan: In this phases, the details of how the goals and objectives will be met are laid out in specific detail – this includes the inputs (staff, resources, e.g.), outputs (the goods and services actually

SOPH, UWC, Postgraduate Diploma in Public Health: Monitoring & Evaluation for health Services Improvement 1 – Unit 1 13 delivered by the programme), the outcomes (which are changes in behaviour or practices as a result of the intervention), processes (actual activities carried out in the programme), impacts (the effects on the beneficiaries coming about as a result of the intervention). This step will be dealt with in the forthcoming units, beginning with the development of a conceptual framework for the programme in Unit 3.

 Implementation and service delivery: The implementation is set in motion, actually delivering the goods and services specified in the plan, and which are expected to lead to the goals and objectives being achieved and thus, the problem alleviated to the specifications outlined in the goals and objectives.

 A fifth “phase” – Monitoring and Evaluation – is located in the centre of the diagram. Placing Monitoring and Evaluation in the centre of all the activity is intended to illustrate the fact that this phase is linked to all the other phases. In other words, Monitoring and Evaluation is a feature of all the four phases outlined above. Units 4 and 5 will deal with Monitoring and Evaluation.

TASK 1

Study the programme management cycle again and answer the following questions:

Does the diagram clearly show what the linkages are between M&E & the four represented stages of the project?

 What role does M&E play in each stage?

 How does M&E fit into each stage?

 What would the M&E officer look for in each stage?

 What critical M&E issues should be of focus in each stage?

FEEDBACK

We will address these issues in the section that follows.

SOPH, UWC, Postgraduate Diploma in Public Health: Monitoring & Evaluation for health Services Improvement 1 – Unit 1 14 4 THE ROLE OF MONITORING AND EVALUATION IN THE PROGRAMME CYCLE

If you want to solve a problem you have to put together a protocol – something like a proposal stating the objectives, methods, who will do what, ... . When you are doing that you should also identify what information will tell you whether the problem is improving or not.  This is monitoring and evaluation; it is what will tell you whether your programme is effective or not.

This means that when putting together a proposal for an intervention, you should try to identify what information will tell you that your programme is effective. You should also think about who will collect the information when and how often. This will help in selecting indicators – measurable statements about the operation of the programme – that will be useful in assessing the success of the program. This will also helps in collecting the identified indicators before the implementation of the program, referred to as baseline data. Baseline data tells you exactly what the situation is at the time you start the intervention; later, when you want to assess whether the programme is having an effect, you can judge the situation pertaining at that time against what it was when you began. This will enable you to make judgements about whether any progress is taking place or not. All this explain the role of Monitoring and Evaluation in the course of the delivery of an intervention. We will go into more detail about how M & E can be of use in each of the identified stages of the Programme Cycle.

In stage 1 – Problem identification and cause analysis – M&E can be used to ensure that the problem is identified and analyzed fully by all the stakeholders facing the problem, such that the right problem is addressed. For example, in the “Improving the management of severe malnutrition project” the identified problem was the large number of children dying during hospital treatment. The causes of deaths were found to be related to lack of resources, poor feeding practices, use of outdated practices and staff attitudes.

At stage 2 – Goal and objective setting – M & E regulates the converting of the identified problem into objectives or activities – SMART objectives to be agreed upon by the stakeholders. (SMART objectives will be discussed later.)

At stage 3 – the design stage (Designing implementation plans) – M & E guarantees that activities and processes engaged in are related to the goals and objectives of the project. For example, in the “Improving severe malnutrition programme”, the training of the staff was one of the activities aimed at improving the knowledge of staff in order to change their attitudes towards malnourished children.

At stage 4 – Implementation and service delivery – M & E ensures that the proposals in stage 3 are adhered to. It is where the checks & balance systems are occupied.

The Programme Management Cycle therefore suggests that monitoring and evaluation is regarded as a continuous process, which is applied throughout the SOPH, UWC, Postgraduate Diploma in Public Health: Monitoring & Evaluation for health Services Improvement 1 – Unit 1 15 programme cycle. This cycle also shows the importance of building in of monitoring and evaluation at the planning stage of the programme.

Monitoring & Evaluation is primarily performed to inform management decision making. M & E has a very important role in that it informs the programme design, implementation and assessment; and thus should be incorporated in all stages of the project life cycle. Specifically, M&E is useful to management in the following ways:

 M&E data provides empirical data for evidence based decision making: it points to areas that need timely corrective action which management can then act upon.  Self evaluation: M&E results provide opportunities for self assessments which contribute to improved service delivery.

5 SESSION SUMMARY

In this Unit, the concepts programme and project were defined. Differences and similarities were also outlined. The elements of the programme management (programme management cycle) and the importance of each component were described. In unit 2, the concepts “monitoring” and “evaluation” will be defined.

6 REFERENCES

 United Nations. (Date Unknown.) www.un.org/Depts/oios/mecd/mecd_glossary/documents/glossary/set_p/proje ct_pcm.htm

 School of Public Health, UWC. (2005). Monitoring & Evaluation in Health & Development Programmes. UWC: Bellville.

 Mwadime, R. et al. (1999). Monitoring and Evaluation of Nutrition and Nutrition-Related Programmes. A Training Manual for Programme Managers and Implementers. The Applied Nutrition Programme, University of Nairobi School of Nutrition and Policy, & Tufts University.

SOPH, UWC, Postgraduate Diploma in Public Health: Monitoring & Evaluation for health Services Improvement 1 – Unit 1 16

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