Papua New Guinea. National HIV and AIDS Strategy. Monitoring and Evaluation Framework

Transcription

1 Papua New Guinea National HIV and AIDS Strategy Monitoring and Evaluation Framework

2 Papua New Guinea National HIV and AIDS Strategy Monitoring and Evaluation Framework

3 Published in 2010 by the National AIDS Council of Papua New Guinea Copyright 2010, National AIDS Council of Papua New Guinea All rights reserved. ISBN: Papua New Guinea: National HIV and AIDS Strategy: : Monitoring and Evaluation Framework Design and Layout by Mairi Feeger Printed by Moore Printing, Scratchley Road, Badili, NCD, PNG The document was developed and written by several groups acknowledged here : National HIV and AIDS Strategy Core Group, National HIV and AIDS Strategy Technical Support Team, National HIV and AIDS Strategy Secretariat and Independent Review Group Key Stakeholders for your contributions and the National AIDS Council Secretariat for your leadership and direction. We would also like to thank our development partners, AusAID and UN Agencies for your financial and technical support in the development and publication of the National HIV and AIDS Strategy

4 Contents Acronyms iv Situation analysis of the monitoring and evaluation and surveillance environment in PNG 1 The scope and goals of the National Monitoring and Evaluation Framework 8 Structures for coordination and management of strategic information 9 Flow of data and reports 11 National indicators 15 Definitions for national indicators 22 Strategic information needs not addressed through national indicators 64 Guidelines for developing program monitoring and evaluation plans based on the National Monitoring and Evaluation Framework 67 Appendix I Inventory of questions to be included in surveys for measuring national indicators 68 Appendix II Repository of additional indicators for monitoring and evaluation of programs 72 Appendix III Glossary 80 Contents iii

5 Acronyms ADB AIDS ANC ART ARV AusAID BSS CBO CRIS CTX DHS FBO FHI GBV GFATM GoPNG HAMP Act HBC HCT HIV IBBS ICME IRG MARP MCH M&E MSM NAC NACS NASA NDoH NGO NHIS NHS NOC NRA Asian Development Bank acquired immune deficiency syndrome antenatal care antiretroviral therapy antiretroviral Australian Agency for International Development behavioural surveillance survey community based organisation Country Response Information System cotrimoxazole Demographic Health Survey faith based organisation Family Health International gender based violence Global Fund to Fight AIDS, Tuberculosis and Malaria Government of Papua New Guinea HIV and AIDS Management and Prevention Act home based care HIV counselling and testing human immunodeficiency virus Integrated Bio-Behavioural Survey Intelligence, Cross Cutting Issues and Monitoring and Evaluation Unit Independent Review Group more-at-risk population(s) Maternal and Child Health monitoring and evaluation men who have sex with men National AIDS Council National AIDS Council Secretariat National AIDS Spending Assessment National Department of Health non-government organisation National Health Information System National HIV and AIDS Strategy National M&E Oversight Committee National Research Agenda iv Acronyms

6 NRI NSO PA PAC PACS PACSO PCP PEP PHO PLHIV PLLSMA PMTCT PNG PNGIMR POC PPTCT ProMEST RAC RCU SAM SO SPA STI STWG TA TB UA UN UNAIDS UNDP National Research Institute National Statistical Office priority area Provincial AIDS Committee Provincial AIDS Committee Secretariat PNG Alliance of Civil Society Organisations pneumocystis jiroveci pneumonia post-exposure prophylaxis Provincial Health Office people living with HIV and AIDS Provincial and Local Level Service Monitoring Authority prevention of mother-to-child transmission Papua New Guinea Institute of Medical Research point-of-care prevention of parent-to-child transmission Provincial Monitoring Evaluation and Surveillance Teams Research Advisory Committee Research Coordination Unit service availability mapping strategic objective service provision assessment sexually transmitted infection Surveillance Technical Working Group technical assistance tuberculosis universal access United Nations Joint United Nations Programme on HIV and AIDS United Nations Development Programme UNGASS UNGASS United Nations General Assembly Special Session on HIV and AIDS USAID United States Agency for International Development VCT voluntary counselling and testing WHO World Health Organisation Acronyms v

7 Situation analysis of the monitoring and evaluation and surveillance environment in PNG The national Monitoring and Evaluation (M&E) system in PNG is guided by the third one of the three ones principles of having one national M&E system which is linked to the National HIV and AIDS Strategy (NHS). Like any fully functioning national HIV M&E system, it comprises the following 12 components: 1. Organisational structures with HIV M&E functions 2. Human resources capacity for HIV M&E 3. Partnerships to plan, coordinate and manage the HIV M&E system 4. National, multi-sectoral HIV M&E plan 5. Annual costed national HIV M&E work plan 6. Advocacy and communications culture for HIV M&E 7. Routine HIV program monitoring 8. Surveys and surveillance 9. National and sub-national HIV databases 10. Supportive supervision and data auditing 11. HIV evaluation and research 12. Data dissemination and use These 12 components will be integrated with each other following the three tiers depicted in Figure 1: people, partnerships and planning collecting, verifying and analysing data using data for decision making. 1 Situation analysis of the monitoring and evaluation and surveillance environment in PNG

8 Figure 1: Situation analysis of the monitoring and evaluation and surveillance environment in PNG Organisational structures with M&E M&E advocacy, communications and culture Routine programme monitoring Surveys and surveillance HIV evaluation research and learning Human capacity for M&E Data dissemination and use Costed M&E work plan Supervision and data auditing M&E database M&E partnerships M&E plan In the National HIV and AIDS Strategy and the accompanying NHS Implementation Framework, M&E is envisaged as an integral part of the NHS and found in many of the strategic objectives and major activity areas. M&E is also specifically addressed in Priority area 3, Systems strengthening. Situation analysis of the monitoring and evaluation and surveillance environment in PNG 2

9 Situational analysis: Integration of the twelve components in national monitoring and evaluation in PNG This section conducts a situation analysis for each of the 12 components listed above that make up a functioning national HIV M&E system. The situational analysis was current at June Organisational structures for HIV M&E functions There has been a lot of progress in ensuring that all M&E functions are realigned to existing structures and that these functions are strengthened and fully implemented. The NACS Intelligence, Cross Cutting Issues and Monitoring and Evaluation Unit (ICME) at the National AIDS Council Secretariat (NACS), the Surveillance Unit at the National Health Information System (NHIS) and the Surveillance and Monitoring and Evaluation Unit within the National STI and HIV and AIDS Program at the National Department of Health (NDoH) are the three main national structures with HIV M&E functions. At the sub-national level, Provincial Monitoring Evaluation and Surveillance Teams (ProMEST) have been established. The NACS Research Coordination Unit (RCU) is the main coordinating body for all HIV related research in PNG. The National Research Institute (NRI) and the PNG Institute of Medical Research (PNGIMR) are the two main research institutions that design and implement many of the HIV-related surveillance and survey studies. The main challenge is to ensure that there is regular and meaningful communication between the coordinating bodies and with all stakeholders to ensure that the comprehensive HIV and AIDS response is monitored through this structure and monitoring reports are utilised to inform programming. 2. Human resource capacity for HIV M&E The NACS ICME and the NDoH Surveillance/NHIS units are struggling to address the planning, programming and logistical demands involved in coordinating the national M&E framework. NDoH has strived to increase its capacity to strengthen the STI, HIV and AIDS surveillance and M&E program. Staff have expertise in epidemiology, demography, statistics and mathematics. Four regional program M&E staff have been recruited to support M&E and surveillance at the sub-national level. Continuous shortand long-term capacity building of staff involved in M&E at national and sub-national levels is critical to ensure quality monitoring outcomes. At the provincial level most Provincial AIDS Committee Secretariats (PACS) do not have positions or staff dedicated to M&E. There is a need for ongoing capacity development for all people engaged in HIV M&E, including partners in civil society. Although development partners have invested heavily in this area, a more coordinated approach to capacity development within the national M&E framework is required and needs to be a higher priority for stakeholders, especially development partners. 3 Situation analysis of the monitoring and evaluation and surveillance environment in PNG

10 3. Partnerships to plan, coordinate and manage the HIV M&E system The National Monitoring and Evaluation Oversight Committee (NOC) is still in its initial stages of development. The key task for this committee is to coordinate all HIV and AIDS related M&E activities amongst all stakeholders at national and sub-national levels. At the technical level, a Surveillance Technical Working Group (STWG) exists at NDoH which is responsible for providing coordinated technical oversight for all STI, HIV and AIDS data gathering and management requirements, guidelines, and procedures. The STWG is chaired by NDoH and comprises representatives from NDoH, NACS, NRI, Asian Development Bank (ADB), World Health Organisation (WHO), Joint United Nations Programme on HIV and AIDS (UNAIDS), United Nations Development Programme (UNDP), Family Health International (FHI), Igat Hope (an organisation of people living with HIV), PNGIMR, the University of PNG and the Australian Agency for International Development (AusAID). Currently, the STWG only deals with technical issues specific to program monitoring data for the health sector and HIV and AIDS behavioural and biological surveillance. The key challenge for the HIV and AIDS M&E system in this area is to ensure adequate coordination at both high and technical levels and ensure provision of necessary M&E support to sub-national levels, where implementation occurs. 4. National multi-sectoral HIV M&E plan A key achievement of the National Strategic Plan for HIV/AIDS, was the development of an overarching M&E framework that formed the basis for monitoring of the HIV response. This new national HIV M&E framework has been developed in alignment with the new National HIV Strategy, and will form the basis of monitoring the national response to the epidemic over the next five years. The main challenge for the NHS and its implementers will be to ensure that the M&E framework is target driven and realistic enough to adequately monitor the trends in HIV and its associated risk behaviours to enable a better response. Another important challenge is for the M&E plan to embrace, to the extent possible, all the reporting commitments of PNG and for the development partners to limit their reporting requirements to the national HIV M&E plan. 5. Annual costed national HIV M&E work plan Although annual work plans have been developed they have never been successfully costed. In addition to costing a plan, the main challenge is to mobilise resources based on that plan and effectively use them for achieving M&E targets. The HIV-STI surveillance plan for was costed and this facilitated resource mobilisation for its implementation. Situation analysis of the monitoring and evaluation and surveillance environment in PNG 4

11 6. Advocacy and communications culture for HIV M&E There is an increasing receptiveness to the incorporation on M&E into HIV programming. The new NHS places a strong emphasis on communication of strategic information as the basis for evidence-informed interventions in its three priority areas. 7. Routine HIV program monitoring The ProMEST coordinating mechanism is only functioning in a small number of provinces. Those provinces that have a well functioning ProMEST are generally better at reporting HIV-related data than provinces where ProMEST is not functioning. One of the overall challenges for routine HIV program monitoring is the existence of parallel reporting mechanisms. In addition to ProMEST and provincial surveillance systems, many implementing partners, particularly non-government organisations (NGOs) and faith based organisations (FBOs), have their own reporting systems and have not been using ProMEST monitoring tools and guidelines to report to provincial and national levels. Instead they report using other formats and frameworks, in line with the conditions set by their parent organisation or donor(s). 8. Surveys and surveillance NDoH is responsible for national coordination of all surveillance activities for STI, HIV and AIDS. Its core mandates include: 1. Routine surveillance of STI, HIV and AIDS through case reporting. 2. Development of estimates and projections for HIV and AIDS, with the assistance of a panel of experts. 3. Conducting annual sentinel surveys of STI clients, antenatal care (ANC) clients and tuberculosis (TB) patients. 4. Conducting behavioural surveillance surveys (BSS). Reports on all of these activities are available. Three rounds of BSS surveys have been conducted between at various sites targeting more-at-risk populations (MARPs) such as youth, sex workers, economic enclave workers and truck drivers. NDoH works in partnership with NRI in designing and conducting behavioural and bio-behavioural surveys. The BSS component of the surveillance system has been sub-contracted to NRI. NDoH intends to initiate similar arrangements with IMR to support BSS as part of implementing comprehensive second generation surveillance. An integrated bio-behavioural survey among the general population is being planned for The Independent Review Group s (IRG) 2010 report noted that the HIV surveillance system in NDoH has been steadily improving. This is a result of the increase in HIV testing sites and the establishment of a sentinel surveillance system. The IRG also found that the quality of HIV surveillance reporting has improved, with a greater number of sites reporting more complete information. 5 Situation analysis of the monitoring and evaluation and surveillance environment in PNG

12 A significant challenge is limited surveillance of MARPs by either NDoH or other institutions which limits comprehensive programming targeting these groups. Other key challenges include the need for surveys to be gender and age sensitive and the importance of disaggregating data to assist with analysis. 9. National and sub-national HIV databases With technical and financial support from development partners, ICME has established the National HIV and AIDS Database using the Country Response Information System (CRIS). Aligning all HIV and AIDS data from all sources is still in train. Data needs to be more widely available to all partners. 10. Supportive supervision and data auditing NACS policy is to decentralise many M&E and surveillance functions to the provinces, including the reallocation of resources, delegation of power, infrastructure support and local capacity building. Implementing this policy faces many challenges. There are ongoing issues related to the quality management of data coming from the provinces. Specific data quality assurance and control mentoring programs for staff are required. The NDoH Surveillance Unit, with the assistance of WHO and the United States Centres for Disease Control s regional program, is currently piloting quality assurance and data quality improvement tools. 11. HIV evaluation and research A prioritised National HIV/AIDS Research Agenda ( ) was launched in In addition, the NACS RCU conducted a thorough and systematic review of 62 studies carried out or published in 2007 and 2008 and synthesised findings in a published report. A national Research Advisory Committee (RAC) has been established and is functioning to ensure ethical design and implementation of HIV and AIDS research and compatibility of research with the HIV and AIDS Management and Prevention Act, 2003 (HAMP). The RAC comprises members from PNG research and academic institutions, NGOs, community based organisations (CBOs), donor organisations and NDoH, as well as representation of people living with HIV and AIDS (PLHIV). The Independent Review Group (IRG) also contributes to ongoing M&E of PNG s national HIV response. This is a group of inter-disciplinary international experts engaged by NACS, with funding support from AusAID and the United Nations (UN). The IRG carries out regular assessments of progress in implementing various aspects of the national response and publishes reports of its findings. The AusAID-funded Strengthening HIV Social Research Capacity in Papua New Guinea Project is a collaboration between IMR and the National Centre in HIV Social Research at the University of New South Wales. The project is contributing to building the capacity for HIV social research in PNG. It is designed to position social research as a central component of the evidence base for effective, sustainable responses to the HIV epidemic through a cadetship program and the dissemination of findings. Situation analysis of the monitoring and evaluation and surveillance environment in PNG 6

13 An important challenge is the translation of research into the day-to-day practice of service providers. Additionally, operations research is not being conducted by either service providers or researchers. 12. Data dissemination and use While relatively good-quality data and information is being produced in PNG it is not consistently or systematically being passed on and promoted to program planners and managers. There is a demonstrated need for an agreed plan on how to regularly update policies and programs based on the regular review of available knowledge of the HIV epidemic and response in PNG. Although there has been a lot of information generated and written about the epidemic in PNG, having program planners and policy makers use this information has been a challenge. 7 Situation analysis of the monitoring and evaluation and surveillance environment in PNG

14 The scope and goals of the National Monitoring and Evaluation Framework This framework has been developed to guide STI, HIV and AIDS monitoring, evaluation and surveillance activities in PNG. The scope of this framework is the national response to STI and HIV epidemics. As such the framework measures the totality of the national response and is not designed to be an M&E framework for any one program. The goals of the National Monitoring and Evaluation Framework The goals of the framework are to: 1. direct the M&E of the NHS 2. guide the development of M&E plans for programs under the NHS 3. harmonise the implementation of strategic objectives and major activity areas of the NHS related to strategic information, surveillance and M&E. Based on the above-mentioned scope and goal, this framework: should not be used as a step-by-step guideline for developing program- and project-level M&E plans will not provide a full list of indicators to be used in monitoring and evaluating different programs and projects, especially at the input and output levels will not replace the National Research Agenda (NRA). The scope and goals of the National Monitoring and Evaluation Framework 8

15 Structures for coordination and management of strategic information One of the strategic priorities of the NHS is to improve strategic information systems, which includes M&E, surveillance, research and utilisation of evidence. This requires an emphasis on ensuring effective management and coordination of strategic information. Responsibility at the national level for data collection, management and analysis is split between NACS and NDoH. NACS is responsible for strategic information for all HIVrelated activities outside the health sector, whilst NDoH has responsibility in relation to strategic information for health-sector activities and surveillance of the HIV epidemic. Within NACS, the ICME is the responsible entity. At NDoH, there are two responsible units. Firstly there is the Surveillance Unit which is responsible for monitoring of HIV testing, care and treatment services and surveillance activities (including HIV case reporting, sentinel surveillance and survey-based surveillance). Secondly, the Monitoring and Evaluation and Research Unit is responsible for the surveillance system for STIs. The NACS RCU is the main coordinating and supervisory body for all HIV-related research in PNG. The NACS RAC oversights ethical aspects of research conduct and application of the HAMP Act s provisions in research practice. The NRI and the PNG IMR are the two main research institutions that design and implement many of the HIV-related surveillance and research studies. The NOC has overarching responsibility for coordination of all activities related to M&E, surveillance and strategic information. The Committee is chaired by the Director of NACS and has representation from NDoH, NRI, IMR, the National Statistical Office, key government departments, the PNG Alliance of Civil Society Organisations, the Business Alliance Against HIV and AIDS, FBOs, international NGOs and the Development Partner s Forum. The NOC reports to NAC and NACS. There are two other national-level, multisectoral technical working groups that provide advice on the development of data collection tools, data collection activities, data management, analysis and reporting. The STWG provides technical advice on strategic information for all health sector and epidemiological surveillance activities. Its secretariat is provided by the NDoH Surveillance Unit. The Monitoring and Evaluation Technical Working Group provides technical advice on strategic information for all HIV-related activities outside the health sector. Its secretariat is provided by the ICME. Both of these technical working groups report to the NOC as well as NAC, NACS and NDoH. NOC s key areas of responsibility are to: 1. Coordinate and provide high-level oversight to ensure that the M&E framework for the NHS is being effectively implemented, consistent with the aim of one national M&E system. 9 Structures for coordination and management of strategic information

16 2. Promote better collaboration and coordination amongst multi-sectoral agencies in regular data reporting and data use. 3. Ensure the multi-sectoral M&E and surveillance technical working groups have functional secretariats at NACS and NDoH respectively, and report on their progress and obstacles to NOC, NACS and NDoH. 4. Ensure that all stakeholders in the HIV and AIDS response who collect data based on either routine reporting of service delivery activities or other means (including research), comply with reporting deadlines, guidelines, tools and reporting lines and procedures as developed by the two technical working groups. 5. Report to NAC and all stakeholders about the situation of the HIV and AIDS epidemic and the response. 6. Mobilise financial and other resources for the development and operation of the M&E system and monitor the functionality and sustainability of the system. 7. Advocate at all policy-making levels for an evidence-informed approach in decision making and management of the HIV response. 8. Ensure that all stakeholders at national and provincial levels have been informed about reports and analyses relevant to them. Joint ProMESTs have been established at the sub-national level. These teams consist of the Provincial Health Office (PHO), the Provincial AIDS Council Secretariat (PACS) and key program implementers and service providers within the province. Each team is mandated to collect data from all service providers and to ensure quality and completeness of data. Summarised data reports are sent to the NACS ICME each quarter. The NOC, the two national technical working groups and the ProMESTs are the key multi-sectoral committees supporting and oversighting HIV and AIDS M&E activities. The functions of these groups, NACS, NDoH and provincial level bodies in relation to data flow activities are shown in Figure 2. Structures for coordination and management of strategic information 10

17 Flow of data and reports HIV and AIDS data and reports related to M&E and strategic information in PNG originate from a wide range of activities including delivering services, conducting nation-wide studies and compiling secondary information. There is a division of labour between NACS and NDoH in managing data and information related to the HIV response. NDoH is the custodian and manager of epidemiological data and data related to providing services in health care facilities and NACS deals with data from all other sources (that is, data from non-health sector services). Health facility services include HIV counselling and testing (HCT), treatment and care of HIV infection, STI diagnosis, care and treatment, and some prevention activities like prevention of parent-to-child transmission (PPTCT) and post-exposure prophylaxis. On the other hand, non-health sector services include social support and protection for people living with or affected by HIV, prevention interventions through awarenessraising among the general population and key populations at higher risk, and other targeted promotion and education interventions. Some service delivery, like condom provision to the general population and key populations at higher risk, may be provided by both health care facilities and non-health services. Data flow is affected by the presence of multiple funding agencies and the operations of NGOs and FBOs which are conducting projects in multiple provinces. These organisations need to report their M&E data to provincial and in some cases national authorities as well as their funding agencies and governing NGOs or FBOs. The national M&E framework will follow the data flow systems summarised in Figure 2. Data flow for monitoring of services provided by health care facilities In each province, the PHO is the authority receiving data based on national M&E indicators and program specific indicators. Data comes from facilities providing the following services: 1. HCT, including rapid testing, followed by laboratory confirmation or point-ofcare (POC) rapid testing and use of another rapid test for confirmation. HCT is provided through voluntary counselling and testing (VCT) in stand-alone sites or other testing facilities or through provider-initiated testing and counselling in ANC clinics, STI or TB or other clinical facilities, as well as screening of all blood donors. 2. Anti-retroviral therapy (ART), including adult and paediatric regimens as well as providing anti-retroviral (ARV) drugs for prevention of mother-to-child transmission (PMTCT) and post-exposure prophylaxis. 3. Diagnosis (syndromic and aetiological) and treatment of STIs. 11 Flow of data and reports

18 4. Case reports of new diagnoses of HIV are sent to the PHO on a monthly basis. Unified data collection forms for each centre are provided by NDoH or the PHO to reflect the data collection needs at provincial, program or national level. The PHO compiles provincial summaries from service providers and shares these with all stakeholders at provincial level through ProMEST. Summarised reports, based on national indicators for services 1, 2 and 4 above, are sent to the Surveillance Unit at NDoH. Data on service 3 above are sent to the Monitoring and Evaluation and Research Unit (also known as NHIS). In some circumstances, health services may be required to send a copy of their reports directly to relevant units at NDoH. Where this occurs the Surveillance, M&E and Research Units compile provincial reports and send them to the PHO. In summary, health service providers send data to the PHO as their first-line M&E reporting authority. In addition, some data is sent to NDoH as the second line or national authority, as a backup in situations when the reporting to PHO is not working properly. The PHO reports summarised information to provincial stakeholders through ProMEST and to NDoH. NDoH sends summary provincial and national reports to the PHO and they have to share them with stakeholders through ProMEST. Data flow for monitoring non-health sector services In each province, the PACS is the authority receiving data based on national M&E indicators and other program-specific indicators. These data have to be sent to the PACS on a quarterly basis. Unified data collection forms for each service will be provided by the NACS ICME or the PACS to reflect data collection needs at provincial, program and national levels. The PACS compiles provincial summaries from the service providers and share these with all stakeholders at provincial level through ProMEST. The PACS sends a summarised report, based on national indicators to ICME. ICME sends summary provincial and national reports to the PACS, which share these with stakeholders though ProMEST. Data flow for research and study results All researchers are required to send a copy of their research reports to the RCU. The RCU shares a copy of these findings with the PACS in the province(s) where the study was conducted or requests the principal investigator to share the findings. Management of data and information at provincial and national levels The PACS and PHO in each province receive monitoring data from service providers throughout the province. All data and information are entered into a single database at provincial level and shared with stakeholders through ProMEST or other mechanisms Flow of data and reports 12

19 suitable for that province. This database should be the basis for developing summarised reports which are sent to the national level. To standardise the structure of the database and format of the reports the CRIS should be used to develop all provincial databases. This would enhance consistency with the data held at the national level. At national level, a CRIS database is used for all data coming from the provinces, NDoH and the RCU. This National HIV and AIDS Database is the data centre for all HIV-related reports produced through service provision, surveillance and studies. This data centre is used for all national and international reporting, unless other sources of data are needed. 13 Flow of data and reports

20 Figure 2: HIV and AIDS data flow in PNG National Oversight Committee Surveillance Technical Working Group National HIV and AIDS Database M&E Technical Working Group National Level Surveillance Unit NDoH NHIS Unit M & E Unit NACS Academic, Research & Statistic Institutes (NRI, IMR, NSO) SURV4 SURV1 SURV4 SURV5.1 SURV5.2 NHIS1 NACS2 SURV5.3 ProMEST Provincial Level Provincial Lab PHO PAC Data Sharing / Coordination SURV4.1 SURV4.1 SURV4 SURV2 SURV1 SURV5.1 SURV5.2 SURV5.3 NHIS1 NACS1 Service type Health services data (VCT, ANC, STI, TB clinics, Hospitals, Clinics, Health Centre, sentinel sites, Blood Banks) Non-Health services data (GLA, NGOs, CBOs, FBOs, PS, and D/FAs) DHS, BSS & IBBS other researches Reporting Feedback NACS1: NACS Quarterly Reporting Form for Non-Health Agencies NACS2: NACS Quarterly Reporting Form for Non-Health Agencies NHIS1: National Health Information System Monthly Report SURV1: HIV Monthly Testing Summary Form SURV2: HIV/ART Monthly Data Collection Sheet SURV3: STI Clinic Patient Record Form (this form will be kept at health facilities) SURV4: Notification Form for HIV and AIDS Cases SURV4.1: Laboratory Request Form for HIV Confirmatory Test SURV5.1: HIV Sentinel Surveillance Form for ANC/PPTCT Clinic SURV5.2: HIV Sentinel Surveillance Form for STI Clinic SURV5.3: HIV Sentinel Surveillance Form for TB Clinic Flow of data and reports 14

21 National indicators The list of national indicators (see Table 1) is limited to 39 core indicators that are essential for high-level monitoring of STI, HIV and AIDS epidemiology and PNG s national response. Of the 39 national indicators, most are taken from the United Nations General Assembly Special Session on HIV and AIDS (UNGASS) core indicators. Others are taken from the Universal Access indicators list and the additional recommended UNGASS indicators list (UNGASS+). Detailed information about the definitions of the national indicators is in the next section. It should be noted that in addition to the suggested disaggregation levels for the national indicators, geographical disaggregation is also needed, usually at the level of province whenever possible. Questions that should be included in survey questionnaires for measuring some of these indicators are presented in Appendix I Inventory of questions to be included in surveys measuring national indicators. In addition to the national indicators other indicators have been developed or chosen from indicators already in use at the national and international level for program monitoring purposes. These additional indicators are presented in Appendix II Repository of indicators suggested for monitoring and evaluation of programs. These additional indicators can be used, as appropriate, by projects and programs for their own internal M&E. However, there is no requirement to report to PACS, NACS and/ or NDoH on performance against these additional indicators. 15 National indicators

22 Table 1: The list of national indicators Indicator Disaggregation(s) Indicators for the top 10 interventions 1 Percentage of women and men aged 15 to 59 with more than one ongoing sexual partnership at the point in time during the past three months Sex Age 2 Percentage of women and men aged 15 to 59 with more than one ongoing sexual partnership at the point in time during the past 12 months Sex Age 3 Percentage of women and men aged who have had sexual intercourse with more than one partner in the last 12 months Sex Age 4 Percentage of men and women aged 15 to 59 who had more than one sexual partner in the past 12 months and who report the use of a condom during last intercourse Sex Age 1 NHS Priority area 1 Related strategic objective(s) Indicator linkage PA PA PA UNGASS PA UNGASS Data collection method/source Youth and general population survey Special population behavioural surveillance survey (BSS) Youth and general population survey Special population BSS Youth and general population survey Special population BSS Special population BSS Youth and general population survey Data collection frequency Every three to five years Every three to five years Every three to five years Every three to five years National indicators 16

23 Indicator 5 Percentage of female and male sex workers reporting the use of a condom with their most recent client 6 Percentage of men and women who have participated in transactional sex in the last 12 months and who report condom use at last transactional sex 7 Percentage of men reporting condom use the last time they had anal sex with a male partner 8 Percentage of men and women aged 15 to 59 who report condom use during last time of anal sex 9 Percentage of men and women aged 15 to 59 who report condom use during last time of anal sex 10 Percentage of pregnant women who were tested for HIV and received their results - during pregnancy, during labour and delivery, and during the post-partum period (<72 hours), including those with previously known HIV status 11 Number of operational Family Support Centres 12 Percentage of women and men aged 15 to 59 who received an HIV test in the last 12 months and who know the results 2 NHS Priority area 2 Disaggregation(s) Related strategic objective(s) Indicator linkage Data collection method/source Data collection frequency Sex Age Gender PA UNGASS Special population BSS Every two to three years Sex Age PA Special population BSS Youth and general population survey Every two to three years Age Gender PA UNGASS Special population BSS Every two to three years Sex Age Partner sex PA Youth and general population survey Every three to five years ARV regimen type PA UNGASS Program data Estimation Annual Pregnancy stage PA Universal access (UA) Program data Annual PA PA Program data Annual Sex Age PA PA UNGASS Youth and general population survey Every three to five years 17 National indicators

24 Indicator Disaggregation(s) Related strategic objective(s) Indicator linkage Data collection method/source Data collection frequency 13 Percentage of more-at-risk populations that have received an HIV test in the last 12 months and know the results Sex Age Gender PA UNGASS Special population BSS Every two to three years 14 Percentage of TB clients who had an HIV test result recorded in the TB register Sex Age TB diagnosis PA UNGASS+, UA Health management information system Annual 15 Percentage of STI clients who had an HIV test Sex Age STI diagnosis PA health management information system Annual 16 Percentage of adults and children with advanced HIV infection receiving antiretroviral therapy Sex Age PA UNGASS Program data Estimation Annual 17 Percentage of estimated HIV-positive incident TB cases that received treatment for TB and HIV Sex Age PA UNGASS Program data Estimation Annual 18 Percentage of adults and children with HIV known to be on treatment at 12/24/36/48 months after initiation of antiretroviral therapy Sex Age PA UNGASS UA ART reporting Annual 19 Percentage of NGOs, FBOs and CBOs submitting their plans and reports to their PACS or NACS on time Agency type Submission type PA NHS management report Annual 20 Percentage of technical assistance deployed to support the NHS implementation at sub-national level compared to the total TA Duration of TA PA NHS management report Annual 21 Percentage of provincial governments that report to the Provincial and Local Level Service Monitoring Authority (PLSSMA) on their specific HIV responsibilities under the Determination on Service Delivery PA NHS management report Annual 3 NHS Priority area 3 National indicators 18

25 Indicator Disaggregation(s) 22 Percentage of women and men who are HIV infected Age 23 Percentage of more-at-risk populations who are HIV infected Sex Age Indicators for monitoring the response environment and inputs 24 Domestic and international AIDS spending by categories and financing sources 25 National Composite Policy Index (NCPI) (Areas covered: prevention, treatment, care and support, human rights, civil society involvement, gender, workplace programs, stigma and discrimination and M&E) 26 The degree of stigma and discrimination as identified by the People Living with HIV Stigma Index Related strategic objective(s) Impact of the NHS Impact of the NHS Cross-cutting across several strategic objectives, specifically: PA PA Cross-cutting across many strategic objectives, specifically: PA PA PA Cross-cutting across several strategic objectives, specifically: PA PA Indicator linkage UNGASS UNGASS UNGASS UNGASS Data collection method/source Data collection frequency Antenatal care (ANC) services IBBS Annual for ANC data and every three to five year for general population integrated bio-behavioural survey (IBBS) Special population IBBS Every two to three years National AIDS Spending Assessment Every two to three years Desk review NCPI interviews Every two years People Living with HIV Stigma Index interview Every three years 19 National indicators

26 Indicator Disaggregation(s) Related strategic objective(s) Indicator linkage Data collection method/source Data collection frequency Indicators for monitoring the national response outputs 27 Percentage of health facilities with post-exposure prophylaxis (PEP) available Type of health facility PA PA UGASS + UA Health facility review Every two to three years 28 Percentage of donated blood units screened for HIV in a quality assured manner PA UNGASS Blood bank review Annual 29 Percentage of schools that provided life-skills based HIV education within the most recent academic year Level PA PA UNGASS School principals survey Every two years 30 Percentage of more-at-risk populations reached with HIV prevention programs Sex Age Gender PA PA PA PA UNGASS Special population BSS Every two to three years 31 Number of district level ART sites Type of health facility Type of ART service PA Program report Annual 32 Percentage of health facilities that offer paediatric ART (that is, prescribe and/or provide clinical follow-up) Public and private sector sites PA UA Program report Annual 33 Percentage of infants born to HIV infected women who are started on cotrimoxazole prophylaxis within two months of birth Sex PA UNGASS + UA Program report Annual 34 Percentage of health facilities that provide STI screening and syndromic management Public and private sector sites PA National Health Information Survey Annual 35 Percentage of ART services that are linked to HBC and other family and community support services Public Private FBOs PA Global Fund to Fight AIDS Tuberculosis and Malaria grant proposal Survey among ART sites Annual 36 Percentage of HIV counselling and testing (HCT) services using the 2009 national point-of-care algorithm Public Private FBOs PA Program report Annual National indicators 20

27 Indicator Disaggregation(s) Indicators for monitoring knowledge and behaviours 37 Percentage of women and men who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission Sex Age 38 Percentage of more-at-risk populations who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission Sex Age Gender 39 Percentage of young women and men who have had sexual intercourse before the age of 15 Sex Age Related strategic objective(s) Indicator linkage Data collection method/source PA PA UNGASS Youth and general population survey Demographic and health survey PA PA UNGASS Special population BSS PA UNGASS Youth survey Demographic and health survey Other related surveys Data collection frequency Every three to five years Every two to three years Every three to five years 21 National indicators

28 Definitions for national indicators Indicator 1: Percentage of women and men aged with more than one ongoing sexual partnership at the point in time during the past three months Concurrent sexual partnerships potentially increase the spread of HIV by creating more connected sexual networks, reducing the time until onward HIV transmission after acquisition, and eliminating the protective sequencing provided by serial monogamy. Concurrent sexual partnerships are defined as: Overlapping sexual partnerships where sexual intercourse with one partner occurs between two acts of intercourse with another partner. Considering the importance of concurrent, multiple, sexual partnership in HIV epidemics of a more generalised pattern, this issue has attracted a special focus in the NHS and addressing it is one of the Top 10 interventions. PURPOSE DATA COLLECTION FREQUENCY TOOL METHOD OF Numerator Denominator Disaggregation To assess progress in reducing the percentage of people who have concurrent sexual partnerships. Every three to five years. Youth and general population surveys, Demographic and Health Survey or other household surveys among the general population. Special population surveys among MARPs. Respondents are asked whether or not they have ever had sexual intercourse. If yes, they are asked how long ago they last had sexual intercourse, and how long ago they first had sexual intercourse with that person. If the last intercourse occurred in the past three months, they are asked if they have had intercourse with any other person in the past three months, and if so, they are asked to give the time of last and first sex with that second partner. This question is repeated for a third partner if one exists. The proportion of individuals who had more than one ongoing partnership at the exact point in time three months before the interview is calculated based on the dates of first and last intercourse with up to the last three partners in the past three months. See Appendix 1 Inventory of standardised questions to be included in surveys measuring national indicators. Number of respondents aged with more than one ongoing partnership three months before the interview. In the case that one partnership ends and another begins in the third month before the interview, this individual will not be included in the numerator as it cannot be determined whether this is actual concurrency or serial monogamy. Number of respondents aged Sex (male, female). Age (15 19, 20 24, 25 29, 30 34, 35 39, 40 44, 45 49, 50 54, 55 59). Definitions for national indicators 22

29 Indicator 2: Percentage of women and men aged with more than one ongoing sexual partnership at the point in time during the past 12 months Concurrent sexual partnerships potentially increase the spread of HIV by creating more connected sexual networks, reducing the time until onward HIV transmission after acquisition, and eliminating the protective sequencing provided by serial monogamy. Concurrent sexual partnerships are defined as: Overlapping sexual partnerships where sexual intercourse with one partner occurs between two acts of intercourse with another partner. Considering the importance of concurrent, multiple, sexual partnership in HIV epidemics of a more generalised pattern, this issue has attracted a special focus in the NHS and addressing it is one of the Top 10 interventions. PURPOSE DATA COLLECTION FREQUENCY TOOL METHOD OF To assess progress in reducing the percentage of people who have concurrent sexual partnerships. Every three to five years. Youth and general population surveys, Demographic and Health Survey or other household surveys among the general population. Special population survey among MARPs. Respondents are asked whether or not they have ever had sexual intercourse. If yes, they are asked how long ago they last had sexual intercourse, and how long ago they first had sexual intercourse with that person. If the last intercourse occurred in the past year, they are asked if they have had intercourse with any other person in the past 12 months, and if so, they are asked to give the time of last and first sex with that second partner. This question is repeated for a third partner if one exists. The proportion of individuals who had more than one ongoing partnership at the exact point in time three months before the interview is calculated based on the dates of first and last intercourse with up to the last three partners in the past year. See Appendix 1 Inventory of standardised questions to be included in surveys measuring national indicators. Numerator Denominator Disaggregation Number of respondents aged with more than one ongoing partnership 12 months before the interview. In the case that one partnership ends and another begins in the 12th month before the interview, this individual will not be included in the numerator as it cannot be determined whether this is actual concurrency or serial monogamy. Number of respondents aged Sex (male, female). Age (15 19, 20 24, 25 29, 30 34, 35 39, 40 44, 45 49, 50 54, 55 59). 23 Definitions for national indicators

30 Indicator 3: Percentage of women and men aged who have had sexual intercourse with more than one partner in the last 12 months The spread of HIV largely depends upon unprotected sex among people with a high number of partners. Individuals who have multiple partners (concurrently or sequentially) have a higher risk of HIV transmission than individuals who do not link into a wider sexual network. Considering the importance of concurrent, multiple, sexual partnership in HIV epidemics of a more generalised pattern, this issue has attracted a special focus in the NHS and addressing it is one of the Top 10 interventions. While this indicator cannot discriminate between concurrent and serial multiple sexual partnerships, it can measure the overall prevalence of multiple sexual partnerships. PURPOSE DATA COLLECTION FREQUENCY TOOL METHOD OF To assess progress in reducing the percentage of people who have multiple sexual partners. Every three to five years. Youth and general population surveys, Demographic and Health Survey or other household surveys among the general population. Special population survey among MARPs. Respondents are asked whether or not they have ever had sexual intercourse and, if yes, they are asked: In the last 12 months, how many people have you had sexual intercourse with? See Appendix 1 Inventory of standardised questions to be included in surveys measuring national indicators. Numerator Number of respondents aged who have had sexual intercourse with more than one partner in the last 12 months. Denominator Disaggregation Number of respondents aged Sex (male, female). Age (15 19, 20 24, 25 29, 30 34, 35 39, 40 44, 45 49, 50 54, 55 59). Definitions for national indicators 24

31 Indicator 4: Percentage of men and women aged who had more than one sexual partner in the past 12 months who report the use of a condom during last intercourse The spread of HIV largely depends upon unprotected sex among people with a high number of partners. Individuals who have multiple partners (concurrently or sequentially) have a higher risk of HIV transmission than individuals who do not link into a wider sexual network. Considering the importance of concurrent, multiple, sexual partnership in HIV epidemics of a more generalised pattern, this issue has attracted a special focus in the NHS and is one of the Top 10 interventions. Condom use is an important measure of protection against HIV, especially among people with multiple sexual partners. PURPOSE DATA COLLECTION FREQUENCY TOOL To assess progress towards increasing the percentage of people with multiple sexual partners who used a condom during last intercourse. Every three to five years. Youth and general population surveys, Demographic and Health Survey or other household surveys among the general population. Special population survey among MARPs. Respondents are asked whether or not they have ever had sexual intercourse and, if yes, they are asked: 1. In the last 12 months, how many different people have you had sexual intercourse with? METHOD OF If more than one, the respondent is asked: 2. Did you or your partner use a condom the last time you had sexual intercourse? See Appendix 1 Inventory of standardised questions to be included in surveys measuring national indicators. Numerator Number of respondents (aged 15 59) who reported having had more than one sexual partner in the last 12 months who also reported that a condom was used the last time they had sex. Denominator Disaggregation Number of respondents (15 59) who reported having had more than one sexual partner in the last 12 months. Sex (male, female). Age (15 19, 20 24, 25 29, 30 34, 35 39, 40 44, 45 49, 50 54, 55 59). 25 Definitions for national indicators