Class Clinical Module RS/RHMT Version REVISED 29 Sept 2011

ClinicalC Assessment for Systems Strengthening (ClASS) CLINICAL MODULE for RS/RHMTs

Please note:  The Regional Health Management Team (RHMT), while being a part of the Regional Secretariat (RS) for all administrative and financial matters, is accountable to the Ministry of Health and Social Services (MOHSW) on all technical/clinical matters.  The Regional Medical Officer (RMO) heads the RS/RHMT and a Medical Officer In-Charge heads the Regional Referral Hospital.  The term “District Health Management Team” has been replaced by the more current term “Council Health Management Team” (CHMT). In practice, these might be used interchangeably.  The RS/RHMT is responsible for providing technical and clinical supervision of Regional Referral, District and Designated District Hospitals.  The District Hospital has its own District Hospital Management Team (DHMT) which is accountable to both its CHMT and the Regional Referral Hospital (if one exists in the Region)

INTRODUCTION TO THE TOOL

The Clinical Module for RS/RHMTs of the ClASS Toolkit is a guide, not a checklist, for reviewers conducting assessments of RS/RHMTs or organizations supporting health care services. This module will be used for understanding the RS/RHMTs’ capacity for coordination and supervision of HIV and AIDS services in selected regions.

Subject to guidance from CDC-Tanzania, key interviewees for the Clinical Module discussions may include: i) Regional Medical Officer (RMO); ii) Regional Nursing Officer (RNO); iii) Regional Health MIS Coordinator; iv) Regional AIDS Control Coordinator (RACC)

The Module is divided into five sections:

1. RS/RHMT Supportive Supervision and Mentoring at CHMT level 2. RS/RHMT Supportive Supervision and Mentoring at District/designated Hospital Level (with 3 sub- sections) 3. RS/RHMT Health Management Information System (HMIS) 4. RS/RHMT Monitoring and Evaluation Systems (M&E for evidence-based strategic planning) 5. RS/RHMT Communications

Each section begins with a set of core competencies followed by a series of questions that can be used to facilitate discussions with different stakeholders. Verification criteria for the most important core competencies and questions follow along with space for reviewers to make notes. Reviewers should not feel compelled to complete the tool sections in the order presented, but should proceed with flexibility to accommodate the time and availability of RS and RHMT staff.

ClASS Clinical Module |RS/RHMT version | REVISED 29 Sept 2011 It is assumed that there will be at least XX hours available to reviewers at each RS/RHMT in order to allow for completion of all sections of the tool. When time is limited, reviewers should determine which sections to prioritize. The choice on which sections to prioritize should be made after the opening presentation and in consultation with the team lead. In such a rapid visit, the highlighted elements in bold-face type can be addressed; est time: XX hrs.

Reviewers may find that not all sections of the tool will apply to all RS/RHMTs. As applicable, these should be noted as such for future use of the tool.

ClASS Clinical Module |RS/RHMT version | REVISED 29 Sept 2011 CLINICAL ASSESSMENT FOR SYSTEMS STRENGTHENING REVIEWERS: ______DATE: ______ClASS Clinical Module: RHMT: ______

RS/RHMTs KEY: Rapid visit items=Bold | Extended visit items=All

SECTION 1: RS/RHMT COORDINATION & SUPPORTIVE SUPERVISION FOR CHMTs

Core Competencies  The RS/RHMT has a clearly defined, participatory plan to progressively build the capacity of CHMTs and other sub-grantees in the region for all essential health services including a response to the HIV/AIDS epidemic  The RS/RHMT has the capacity to strengthen the capacity of regional and council health care systems to provide quality comprehensive, sustainable prevention, care, and support services  The RS/RHMT implements a woman- and girl-centered approach in its planning, technical and monitoring support to CHMTs  The RS/RHMT has the capacity to provide technical assistance to CHMTs regarding MOHSW policies and guidelines concerning HIV service delivery  The RS/RHMT has the capacity to hire or has processes to train program staff on monitoring guidelines and technical assistance options for CHMTs and sub-grantees  The RS/RHMT can demonstrate that all of its CHMTs have comprehensive council health plans (CCHPs) which are compliant with and address relevant elements of the MOHSW Health Sector Strategic Plan III (2009 – 15)  There are RS/RHMT policies with appropriate documents for CHMTs or sub-grantees to understand program reporting requirements and program monitoring policies and procedures.  The RS/RHMT has the capacity to carry out two (2) supervisory support visits annually to each CHMT and any other regional sub-grantees  RS/RHMTs have the capacity to prepare CHMT supervisory site visit reports which includes dissemination to CHMTs themselves

Open-Ended Questions

ClASS Clinical Module |RS/RHMT version | REVISED 29 Sept 2011  What processes does the RS/RHMT have in place to build the capacity of CHMTs (and other sub-grantees) in the region to respond to the epidemic? Is it a clearly defined, participatory plan to progressively build capacity of CHMTs?  What are the key planning documents used by the RS/RHMT to strengthen the capacity of CHMTs and any other regional sub-grantees to in turn plan and implement HIV/AIDS treatment and care activities? When last were they updated? Approved by whom?  How does the RS/RHMT operationalize and implement these plans?  What processes does the RS/RHMT use to inform CHMTs regarding MOHSW policies and guidelines concerning HIV service delivery?  What processes does the RS/RHMT have in place to hire or train one (1) regional staff to perform management and oversight of program activities, including those at CHMT level, in the region?  Do all of the region’s CHMTs have comprehensive council health plans (CCHPs) which are compliant with MOHSW Health Sector Strategic Plan III (2009 – 15)?  How regularly does the RS/RHMT support the CHMTs update their CCHPs?  What RS/RHMT documents explain program monitoring policies and procedures at CHMT, Regional Referral Hospital, District Hospital and Designated District levels? Is that document disseminated to CHMTs (or sub-grantees)? How often are the documents reviewed, updated?

ClASS Clinical Module |RS/RHMT version | REVISED 29 Sept 2011  What RS/RHMT documents explain women-and girl-centered approaches in public health to CHMTs and health facility levels? How is the document disseminated to CHMTs or facilities? How often are the documents reviewed, updated? What processes does the RS/RHMT use to verify that these approaches are used?  Over the past year, how often has the RS/RHMT been able to provide supportive supervision visits to each of its CHMTs? What is the process to conduct monitoring visits for CHMTs or sub- grantees? o How are scheduled, or random monitoring, visits conducted? How often are they conducted? o What program or service areas are covered during the visits? How are these visits coordinated between departments? o What advance notice is provided to CHMTs or sub-grantees? o What feedback/findings of visits are shared with the CHMT (or sub-grantee) after the visit? With RS or RHMT management? o How are findings addressed and tracked following the visits? o How can CHMTs or sub-grantees access technical assistance to remedy findings? o Where have CHMTs been able to get prioritized technical assistance from? (which agencies?) o How is follow-up to visits conducted, if needed?  What is the mechanism to provide feedback to CHMTs and/or sub-grantees on supervisory site visit reports?  How are results of supportive supervisory visits to CHMTs or sub-grantees documented and shared with the MOHSW, RS and, where applicable, external donor(s)? Performance Criteria Verification Information Comments a. Is required every (how often?): b. Follows required format and content: CHMT or sub-grantee 1. c. Is a combination of program and reporting to the RS/RHMT: finance information: d. Feedback is shared with:

Capacity building plans for a. Are created in consultation with: use by RS/RHMTs for b. Have a stepwise progression for CHMTs (and other capacity building 2. regional sub-grantees): c. Are approved by: d. Are reviewed and modified every: e. Are shared with CHMTs every: a. Evidence based b. Realistic c. Achievable d. Measurable Quality of RS/RHMT Annual e. Culturally appropriate 3. Plans f. Consider underserved populations g. Include reasonable estimates of outcome targets, eg., number of sites to support, number to clients to reach h. Are collaborative a. Are in place for all CHMTs: b. Are updated by: c. Are updated how often: d. Cover the following areas: 4. CCHPs: treatment facility space assessments, patient flow, commodities supply chain management, and capital equipment management ClASS Clinical Module |RS/RHMT version | REVISED 29 Sept 2011 a. Are conducted by: b. Are conducted every: c. Include the following areas: treatment facility space assessments, SECTION 2: RS/RHMT SUPPORTIVE SUPERVISION AND MENTORING AT HOSPITAL LEVEL

SUB-SECTION 2.1: CLINICAL/TECHNICAL SUPPORT CAPACITY

Core Competencies  The RS/RHMT provides clinical/technical support to various types of the health care facilities in the region (Regional Referral Hospital, District/Designated hospitals, other private/public facilities) on a regular basis.  The RS/RHMT directly supports a comprehensive range of integrated HIV care and treatment services at both Regional and District hospitals.  The RS/RHMT has the clinical/technical capacity in key service areas [(e.g., continuous quality improvement (CQI), laboratory, pharmacy, supply chain management (SCM), monitoring and evaluation (M&E), use of data and strategic information (SI), costing analysis, etc.)] to support HIV care and treatment in the region’s hospitals.  RS/RHMT has used or had access to USG or other funder resources or expertise in providing clinical/technical oversight to the region’s hospitals.  RS/RHMT supervisory visits includes support to Regional Referral Hospital, District and other Designated District Hospital Management Teams to carry out treatment facility operational reviews (re space assessments, patient flow, commodities supply chain management, and equipment logistics)  RS/RHMTs have the capacity to prepare health facility (Regional Referral Hospital, DHMT or Designated District Hospital) supervisory site visit reports which includes dissemination to CHMTs and health facilities which are reviewed

Open-Ended Questions  What support is provided by the RS/RHMT to various types of the health care facilities (Regional Referral Hospital, District/Designated hospitals, other private/public facilities)?  What does the RS/RHMT do to support of HIV care and treatment in the region? Provide examples.  What collaborations are there between the RS/RHMT and other MOHSW or PMORALG structures at District, Zonal, Regional and national level, other donors and/or implementing partners?  Does the RS/RHMT possess the clinical/technical capacity (e.g., staffing, equipment, and infrastructure) in key service areas to support HIV care and treatment (e.g., CQI, laboratory, pharmacy, SCM, M&E, use of data and SI, costing analysis, etc.)?  To what extent has the RS/RHMT used or had access to USG or other funder resources or expertise in providing clinical/technical oversight in the region?

Performance Criteria Verification Information Comments 1. Current beneficiaries of a. National/Regional/Council government (policy, RS/RHMT clinical/technical guidelines development, advocacy) support include: i. MOHSW at various levels: district/council, regional, zonal ii. Regional/District HIV/AIDS Control Program and/or related offices iii. Other regional administrative bodies (e.g. Regional Secretariat, PMORALG) b. Other local organizations: faith-based networks, universities, NGOs, PLWHA groups, CBOs, etc. i. Clinical sites: Regional Referral Hospital, District/Designated Hospitals, Health Centers and/or Dispensaries.

ClASS Clinical Module |RS/RHMT version | REVISED 29 Sept 2011 ii. Community-based service providers.

a. Primary health care, including preventive oral/dental care. b. Care and treatment and related services: HIV counseling and testing (HCT); voluntary counseling and testing (VCT); provider-initiated counseling and testing (PICT); adult and pediatric TB/HIV care. Clinical/technical areas of support includes: c. Prevention, including sexual health especially STIs, (specify the type of male circumcision, PwP, OIs, and abstinence-based 2. support provided in each programs. of the areas) d. Maternal, neonatal, and child health (MNCH), family planning (FP), prevention of mother-to-child transmission (PMTCT). e. Other support: home-based care, community-based care, orphans and vulnerable children (OVC) support, psycho-social care, and people living with HIV (PLHIV) empowerment. a. CQI, laboratory, pharmacy, SCM, M&E, SI/data use, costing analysis, facility operations including space assessments to ensure appropriate patient flow and The RS/RHMT has capacity commodities management etc. to support and supervise b. Direct support versus support-through-subcontracts 3. the following: for several or all areas identified in 3a. a. Clinical HIV care at: Ward, District, Region health facilities b. There is adequate RHMT staffing (i.e., levels and expertise/experience) to meet beneficiary needs. RS/RHMT utilizes, or has a. Discussion/confirmation of purpose, type, scale & 4. utilized, USG resources relevant date(s) and/or expertise. Notes:

ClASS Clinical Module |RS/RHMT version | REVISED 29 Sept 2011 SUB-SECTION 2.2: CLINICAL/TECHNICAL SUPPORT APPROACHES

Core Competencies  RS/RHMT uses evidence-based approaches to assess Regional Referral Hospital, District/Designated Hospital, other private/public facilities clinical training, mentoring, and supportive supervision needs.  A health facility CQI strategy/plan for the region is in place and ensures the monitoring, documentation and sharing of success stories and best practices

Open-Ended Questions  To what extent does the RS/RHMT use evidence-based approach to assess needs, train, mentor, and provide supportive supervision at Regional Referral Hospital, District/Designated Hospital, other private/public facility levels?  What plans does the RS/RHMT currently have to ensure monitoring, documentation and sharing of success stories and best practices/through CQI?

Performance Criteria Verification Information Comments a. Reflect a needs assessment conducted with the involvement of beneficiary sites/organizations; b. Include centralized trainings (e.g., curriculum enhancement, didactic sessions, in-service upgrade training and other adult learning methodologies, RS/RHMT approaches to ToT, step down or cascade training); 1. clinical/technical support: c. Has a model training site d. Has a sustainable training model e. Incorporate “on-site” trainings and/or distance learning;

f. Provide real-time access to expertise via cell phone, e-mail and/or distance consultation.

a. Teams include experts on several specialties (e.g., site management, clinical, lab, CQI, M&E). b. Mentoring/supportive supervision can be verified Mentoring/supportive and/or assessed by examining the following: supervision is provided i. Monitoring or report forms documenting 2. through a frequency and duration of visits; multidisciplinary ii. Written trip reports, which contain both action RS/RHMT team. points and issues lists; and iii. Follow-up visits and subsequent reports providing an overview of progress to-date. CQI applied to clinical/ a. Outcome/performance measurement; and technical support 3. activities provided, b. Specific CQI activities (e.g., plan-do-check-act including: [PDCA] activities, small tests of change).

ClASS Clinical Module |RS/RHMT version | REVISED 29 Sept 2011 Notes:

SECTION 2.3: ONGOING PROGRAM SUPPORT - CRITICAL GAPS & TECHNICAL ASSISTANCE NEEDS

Core Competencies  The RS/RHMT has capacity to provide clinical supportive supervision/mentoring for all HIV/AIDS related programs/services.  The RS/RHMT has capacity to provide in-service training in comprehensive HIV/AIDS services for health workers, in accordance with national HIV/AIDS policies, guidelines , and training materials.  The RS/RHMT has capacity to conduct reviews of facility operations including space assessments to ensure appropriate patient flow and commodities management.

Open-Ended Questions  What services can the RS/RHMT fully support a) immediately; b) in the medium term, and c) only after significant capacity building has taken place?  How will the RS/RHMT monitor and maintain the quality of service delivery?  How will the RS/RHMT support in-service training in comprehensive HIV/AIDS services for health workers? o In particular, how will they promote evidence-based activities  What processes does the RS/RHMT use to identify gaps in service provision and to review facility operations (particularly patient flow and commodities management)?  Over the past year, how often has the RS/RHMT been able to provide supportive supervision visits to each District/Designated Hospital in the region as well as the Regional Referral Hospital (RRH)? What is the process to conduct monitoring visits to each District Hospital? How is the process different at the RRH? o How are visits scheduled or random monitoring visits conducted? How often are they conducted? o What program or service areas are covered during the visits? How are these visits coordinated between departments? o What advance notice is provided to the RRH and District Hospitals? o What feedback/findings of visits are shared with the Regional/District Hospital Management Teams after the visit? With Regional/District hospital staff? o How are findings addressed and tracked following the visits? o How can Regional/District Hospital Management Teams or hospital staff access technical assistance to remedy findings? o How is follow-up to visits conducted, if needed?  Over the past year, what sort of TA has the RS/RHMT been able to provide to the RRH and District Hospitals in the region? What is the process to identify and meet this TA need?  What are the critical gaps that are currently NOT being addressed for both types of health facility?  What are the common underlying issues that explain the gaps?  How can this underlying issue(s) be addressed? By whom? By when? What sorts of inputs will be needed?

Performance Criteria Verification Information Comments

ClASS Clinical Module |RS/RHMT version | REVISED 29 Sept 2011 RS/RHMT presently a. Which of the listed components does the possesses the capacity to RS/RHMT presently have the capacity to provide provide clinical oversight clinical oversight? for some or all of the b. Which of the listed components CAN the following program RS/RHMT rapidly take over with some capacity components: CQI, building? laboratory (diagnostic c. Which of the listed components is the RS/RHMT capacity) , pharmacy, UNABLE to take over without major capacity SCM, integration of building? 1. services, prevention: STI d. Which of the listed components does the management, HIV testing RS/RHMT plan to provide through subcontracts? and counseling, prevention with positives, PMTCT; HIV care and treatment, TB control, e. Identify the key remaining challenges and M&E/SI, proposed solutions related to the support of training/mentoring and service provision. supportive supervision.

Written plans are in place at the RS/RHMT to monitor and maintain the quality of 2. clinical/technical services at the RRH and District Hospitals, respectively?

ClASS Clinical Module |RS/RHMT version | REVISED 29 Sept 2011 SECTION 3: RS/RHMT HEALTH MANAGEMENT INFORMATION SYSTEMS Core Competencies HMIS System  The RS/RHMT has the capacity to collect, record, store, manage, retrieve and analyze program data for planning, monitoring, reporting and improving the quality of health services.  There are procedures to verify the quality of data (e.g., accuracy, completeness, and timeliness).  Management and planning processes demonstrate the effective use of data to inform and guide decision making.  The HMIS system is able to produce reports that respond to the needs of management, planners, and funders in a timely manner. Policies & Procedures  There are policies and procedures on the use, access, maintenance, and security of the HMIS systems.  The RS/RHMT has staff with appropriate experience and training to manage HMIS systems.  There are processes to ensure that all appropriate RHMT staff has adequate training on data management systems related to their assigned areas. o Specifically, the RS/RHMT has the capacity to hire and train two (2) data management staff Reporting  The RS/RHMT has ability to fulfill USG and other international partners’ reporting requirements.  The RS/RHMT has the capacity to compile one annual report from the Districts within the region to include regularly collected data according to MOHSW and PMORALG requirements.  The RS/RHMT has the capacity to report on data used and communicated to Districts regarding specific interpretations and guidance on program planning. Security & Access  The RS/RHMT has adequate systems to ensure the protection of organization, employee, and patient data.

Open-Ended Questions HMIS System  What are the routine systems used for collecting, reporting, and analyzing data (in terms of efficiency, frequency, and quality) on patient health status and organization services, human resources and finances?  How does the RS/RHMT address and provide timely resolution to equipment, software or data management problems?  What training has been provided for RS/RHMT staff on the HMIS system, equipment, and software? How often are updates provided?  If there are different systems capturing data within the RS/RHMT, how is information shared and compared?  How can the system be modified to accommodate new data requirements? How are new additions communicated to RS/RHMT data collection or other staff?

Policies & Procedures  How are RS/RHMT policies and procedures developed for HMIS? Who is involved in the process? How often are they updated?  How and to whom are RS/RHMT HMIS policies and procedures shared?

Reporting  What data reports are the RS/RHMT HMIS systems able to provide? Are they provided in a timely manner? Are these reports sufficient to meet MOHSW and donor needs?  What information gaps exist in the system? Are there system lags that cause delays in providing the needed

ClASS Clinical Module |RS/RHMT version | REVISED 29 Sept 2011 information/reports from CHMTs to the RS/RHMT? From the RS/RHMT to the RS and central MOHSW?

Security & Access  What security systems and processes are in place to protect the RHMT information systems? Are they sufficient?

HMIS SYSTEM Performance Criteria Verification Information Comments The RS/RHMT has a qualified person a. Regional M&E Officer 1. (s) responsible for health b. Other (specify) management information systems. a. Accounting software b. Excel spreadsheets c. Payroll software The RS/RHMT has automated 2. d. Clinical database/EMR systems to capture data. e. Human resources f. No automated system (describe what exists) a. LAN/WAN Describe the RS/RHMT IT 3. b. Standalone PCs/laptops infrastructure and architecture. c. Other (specify a. Are in line with National requirements b. Are linked to every program milestone Describe Indicators used by the 4. c. Are incorporated into program and RS/RHMT and financial reports d. Include some that are locally developed to address unique problems in the region/districts a. Data reports provided at each RS/RHMT meeting. b. RS/RHMT Meeting minutes indicate The RS/RHMT receive data reports how data is used. 5. that are used in decision making. c. RS/RHMT shares data with CHMTs d. There are procedures on how data is used for decision making at RS/ RHMT, CHMT and lower levels.

POLICIES & PROCEDURES Performance Criteria Verification Information Comments 1. Approved MOHSW/PMORALG HMIS a. Written P&P approved by MOHSW policies and procedures exist and are available (ask to see a copy). are adequate. b. P&P are known, but not written. c. P&P are updated periodically.(when was the last update?) d. P&P address focus areas, including data collection, maintenance, quality and security.

ClASS Clinical Module |RS/RHMT version | REVISED 29 Sept 2011 e. No formal P&P exist. a. Each department has a verification process. There are procedures to verify the b. Data accuracy checklists are 2. quality of data (accuracy, completed prior to report acceptance. completeness, and timeliness). c. Quality audit reviews of data are conducted at regular intervals. d. No data quality processes in place. a. Processes in written policies and Name: procedures. RS/RHMT staff knows processes to b. RS/RHMT decides process. 3. address equipment and c. RS/RHMT HMIS Department software/program problems. responds to requests. d. Process not clear/known. REPORTING Performance Criteria Comments The RS/RHMT is able to meet all data reporting requirements and requests. 1. Regional Clinic staff are able to request system modifications to accommodate new 2. data reporting requirements. Describe.

Notes:

ClASS Clinical Module |RS/RHMT version | REVISED 29 Sept 2011 ClASS Clinical Module |RS/RHMT version | REVISED 29 Sept 2011 SECTION 4: RS/RHMT MONITORING AND EVALUATION CAPACITY

Core Competencies  The RS/RHMT has capacity to construct a substantial, high quality Monitoring and Evaluation team.  The RS/RHMT has capacity to ensure and monitor HIV/AIDS program quality assurance, quality improvement, and quality of care standards;  The RS/RHMT has capacity to develop and implement a robust plan for conducting evaluations of PEPFAR- supported project’s performance  The RS/RHMT has capacity to evaluate the effectiveness of national, regional and facility-based systems to select, procure, store, track, and distribute essential drugs  The RS/RHMT has capacity to support program evaluations using qualitative and quantitative techniques to assess the impact of programs and interventions on specific populations.

Open-Ended Questions  What is the composition and caliber of the RS/RHMT’s monitoring and evaluation team? Are all positions in the team filled?  How does the RS/RHMT’s monitor HIV/AIDS program quality?  How does the RS/RHMT’s monitor HIV/AIDS program quality improvement?  How does the RS/RHMT’s monitor HIV/AIDS quality of care standards are met?  Is the monitoring and evaluation plan consistent with the principles of the "Three Ones1?  What is the system for reviewing and adjusting program activities based on monitoring information (innovative, participatory methods and standard approaches)?  Is the plan to measure outcomes of the intervention, and the manner in which they will be provided, adequate?  How does the RS/RHMT develop, validate and/or evaluate public health programs?  How are the results from validated programs or program evaluations used?  How are results shared?  How are evidence based programs scaled up?

M&E SYSTEM Performance Criteria Verification Information Comments The RS/RHMT has a qualified person a. M&E Director 1. responsible for monitoring and b. Regional M&E Officer evaluation. c. Other (specify) 2 The RS/RHMT has qualified staff for a. Epidemiologist M&E b. Biostatistician

1 The Emergency Plan supports the multi-sectoral national responses in host nations, adapting U.S. support to the individual needs and challenges of each nation where the Emergency Plan is at work. Countries and communities are at different stages of HIV/AIDS response and have unique drivers of HIV, distinctive social and cultural patterns (particularly with regard to the status of women), and different political and economic conditions. Effective interventions must be informed by local circumstances and coordinated with local efforts. In April 2004, OGAC, working with UNAIDS, the World Bank, and the U.K. Department for International Development (DfID), organized and co-chaired a major international conference in Washington for major donors and national partners to consider and adopt key principles for supporting coordinated country-driven action against HIV/AIDS. These principles became known as the “Three Ones": - one national plan, one national coordinating authority, and one national monitoring and evaluation system in each of the host countries in which organizations work. Rather than mandating that all contributors do the same things in the same ways, the Three Ones facilitate complementary and efficient action in support of host nations.

ClASS Clinical Module |RS/RHMT version | REVISED 29 Sept 2011 c. Social Scientist (demographer, anthropologist, sociologist) d. IT staff e. Other: a. Quantitative data  Proposal writing including questionnaires timelines and budget  Training  Data collection  Data base creation  Data entry  Data cleaning  Dataset creation  Data analysis  Interpretation  Dissemination b. Qualitative data The following skills are available at  Proposal writing including 3 the RS/RHMT (in-house) or are interview/observation guides sourced as needed timelines and budget  Training  Data collection  Data base creation  Data entry  Data cleaning  Dataset creation  Data analysis  Interpretation  Dissemination c. Evaluation  Planning  Budgeting  Implementing  Work ethics  Professional ethics 4 Staff is trained in ethics including  Research ethics There is documented instruction on how to protect respondent confidentiality and data a. Staff Adequate resources are available, b. Hardware 5 can be sourced, or are planned to c. Software conduct M&E d. Vehicles a. Community Monitoring and Evaluations of HIV, b. NGOs and other local organizations 5. TB and related program areas are c. Hospitals/CHMT done in collaboration with d. Other Regional bodies e. Other National bodies

ClASS Clinical Module |RS/RHMT version | REVISED 29 Sept 2011 f. International bodies a. Is linked to the national M&E plan b. Goals and objectives align with national strategy, are time bound and 6. There is a M&E plan. measurable c. Indicators are relevant, linked to objectives, and include PEPFAR indicators d. Indicators can be used to monitor:  HIV/AIDS program QA  HIV/AIDS program QI  Quality of care standards e. There is a indicator matrix describing numerators/denominators, level of disaggregation, data sources and data collection timeframes f. There is an indicator logical framework including baseline and target information g. Evaluations include  Action Research  Participatory Research  Performance evaluation  Intervention trials  Effectiveness trials  Impact evaluations h. Reporting  Requirements are specified (format, what is to be reported, when, to whom)  Feedback on quality, timeliness, and errors is provided  Late, inaccurate, incomplete reporting is addressed a. Lists activities b. Time frame c. Implementation status 7 There is a M&E workplan d. Documentation requirements e. Responsible persons f. Costing/budgeting g. Funding source 8 Monitoring data can be a. Different programs areas (eg. disaggregated by and evaluations MNCH, HIV) consider the following b. Supply chain management c. Laboratory services d. Demographics i. Age ii. Gender iii. Socio-economic class

ClASS Clinical Module |RS/RHMT version | REVISED 29 Sept 2011 iv. Special populations a. Data reports provided at each RS/RHMT meeting. b. RS/RHMT Meeting minutes indicate The RS/RHMT receive data reports 9. how data is used. that are used in decision making. c. RS/RHMT shares data with CHMTs and how it is used. d. Other.

Notes:

SECTION 5: RS/RHMT COMMUNICATIONS

Core Competencies  The RS/RHMT meets regularly (weekly/monthly) to plan and coordinate implementation of its Annual Plan  RS/RHMT members meet regularly with CHMTs  The RS/RHMT convenes regional and district HIV/AIDS planning and coordination meetings quarterly  The RS/RHMT conducts consultative community meetings at least twice per annum Open-Ended Questions  How does RS/RHMT management address and provide timely resolution to problems? What level of documentation is kept on resolutions?  How often does the RS/RHMT meet?  How often are RS/RHMT and CHMT planning & coordination meetings held?  How often does the RS/RHMT hold consultative forums at community level in the region? Who attends and sets the agenda? How is follow-up conducted?  What part of your region is considered the most remote and underserved? How would you describe the capacity of the RS/RHMT to access these communities for HIV/AIDS treatment and care purposes either directly or via the nearest CHMT, or both?  What behavior change communication (BCC) tools have been used by the RS/RHMT to target communities that frequently fall outside the reach of traditional media? How were local language needs met? Performance Criteria Verification Information Comments 1. RS/RHMT meetings are held: a. Meeting frequency: b. Meetings are not held:

ClASS Clinical Module |RS/RHMT version | REVISED 29 Sept 2011 c. How are meetings documented? a. Meeting frequency: b. Main purpose/agenda items: RS/RHMT managers meet regularly 2. c. Meetings not held: with CHMTs: d. How are meetings documented?

a. Meeting frequency: RS/RHMT convene consultative 3. b. Meetings are not held: meetings directly with communities: c. How are meetings documented? a. Name of most remote area(s): RS/RHMT has the capacity to access b. Frequency of contact by RS/RHMT or the most remote communities for 4. CHMT: HIV/AIDS treatment and care c. Logistics issues, if any: purposes either directly or via CHMT: d. Local language requirements:

Notes:

ClASS Clinical Module |RS/RHMT version | REVISED 29 Sept 2011