3.1.1 CHANGE AREA 1: EQUAL ACCESS TO HEALTH SERVICES
This change area has five indicators whose data needs to be collected from different sources using tally-sheets and other tools. Tally-tally-sheets will be used to collect data only for the following indicators:
INDICATOR 1: Life expectancy at birth by sex.
INDICATOR 2: Ratio of health personnel per 100,000 people.
INDICATOR 3: Distance to nearest government hospital.
Measurements have already been calculated and the data can be collected from the National Statistical Offices/Bureaus (NSO/B) or Ministry of Health (MOH) without need for recalculation.
Indicators four and five are qualitative in nature. They are aimed at measuring the perceptions of groups of knowledgeable people regarding the access issues of cost, distance, quality, and adequacy of the health services. FGDs will be used for the purpose. Attempts must be made to ensure that the groups comprise of a mixture of regular and non-regular health service users.11
It should be noted that distance to the nearest hospital applies to situations where FDGs are conducted around particular hospital facilities to gauge perceptions of distance to the hospital. In this case, actual measurements may not be too important. It is the perception of distance that is important. Actual measurements of distance can be collected from the NSO/B for purposes of verification only.
3.1.2. CHANGE AREA TWO: EQUAL ACCESS TO PRIMARY HEALTH CARE SERVICES This change area has four indicators. Tally-sheets will be used to collect data for only one indicator i.e. INDICATOR 1: Prevalence of communicable and immunisable diseases (by sex, age, marital status, residence).
diseases: TB, Typhoid, Typhus, Relapsing Fever, Cholera, Shegella, Malaria, Measles, Meningitis, Whooping Cough, Tetanus, Diphtheria and STIs;
• Sort all the hospital’s admission cards for the particular year according to the type of disease;
• Select the sample size using systematic random sampling; and
• Extract the information as requested by the tally-sheet for the particular indicator from each of the cards. Extra care should be taken to ensure distinction of the place of residence (rural/urban) of the admitted patient, using their address. The evaluator will have to sort the cards again by rural/urban before proceeding to collect the data.
The following will be done to collect the data for the rest of the indicators:
INDICATOR 2: Percentage population with access to safe, potable water (by sex, age, marital status and by residence).
The evaluator will be required to conduct a fresh national household survey, if the data are not readily available at the NSO/B or MOH and/or Ministry for Water Affairs at the provincial/regional or national headquarters.
QUALITATIVE INDICATOR 1: Perceptions of women and men regarding cost, adequacy and ease of access to primary health care services.
QUALITATIVE INDICATOR 2: Perceptions of women and men regarding prevalence of communicable and immunisable diseases, their causes, and remedies.
Data for the above two qualitative indicators will be collected through the procedure described in Section 2.2.3 above. Each discussion group of men and women in the rural or urban settings should comprise a mixture of parents, community health officials, community leaders, etc. It is imperative that the discussion groups are a mixture of regular beneficiaries of primary health care services as well as non-beneficiaries12.
3.1.3. CHANGE AREA THREE: MATERNAL MORTALITY
INDICATOR 1: Maternal mortality rate.
The evaluator will use reports from MOH or NSO/Bs or form other sources (World Health Organization (WHO), United Nations Development Programme (UNDP), etc.) to obtain the data.
INDICATOR 1: Perceptions of women and men regarding extent, causes and remedies of maternal
The data will be collected using steps elaborated in Section 2.2.3 above. Discussion groups should mix regular and non- beneficiaries of primary health care services.
3.1.4 CHANGE AREA FOUR: ILL-HEALTH AND MATERNAL MORBIDITY
This change area has only two Indicators. Tally-sheets will be used only if NSO/B, UN or WHO, have not published data on the indicator.
INDICATOR 1: Maternal morbidity rate13 (by cause, age, marital status and residence).
If rates are not pre-calculated by any agencies, the evaluator will use the tally sheets provided to collect the data from the main or biggest hospital in the province. This will follow the procedure described for collecting data for communicable and immunisable diseases.
QUALITATIVE INDICATOR 1: Perceptions of women and men regarding prevalence of ill health and maternal morbidity, its causes and remedies.
Data will be collected through the procedure described in Section 2.2.3 above.
3.1.5 CHANGE AREA FIVE: PHYSICAL ABUSE & MENTAL HEALTH
This change area has seven indicators. Four are quantitative and require the use of tally-sheets and three are qualitative and require FGDs.
Tally-sheets will be used for:
INDICATOR 1: Registered cases of domestic violence and abuse14 (by sex of victim, age, marital status, sex of perpetrator and residence).
INDICATOR 2: Diagnosed cases of mental illness15 (by type, sex, age, marital status and residence).
INDICATOR 3: Rehabilitated cases of mental illness (by type, sex, age, marital status and residence).
INDICATOR 4: Number of registered cases of substance abuse (by type of substance, by sex, age, marital status of abuser and residence).
Collect the data for indicators 2 & 3 from the main regional/provincial mental hospitals (if there are any) or the national mental hospital.
In both cases, the rules set out in Section 2.2.3 above regarding sampling and sampling procedures will be followed and the tally-sheets for the respective indicators used.
FGDs will be used to collect data for the following three qualitative indicators:
QUALITATIVE INDICATOR 1: Perceptions of women and men regarding level of physical abuse (including gender-based violence), its causes and remedies.
QUALITATIVE INDICATOR 2: Perceptions of women and men regarding prevalence of mental illness among women, in relation to men, its causes and remedies.
QUALITATIVE INDICATOR 3: Perceptions of women and men regarding prevalence of substance abuse, its causes and remedies.
For all three indicators, data will be collected using procedures described in Section 2.2.3 above. Each Discussion Group of men and women in the rural or urban setting should comprise of a mixture of husbands/wives, boyfriends/girlfriends over 18, parents, community health officials, community/
traditional leaders, social services and rescue/half-way house officials, the police, and victims and perpetrators of violence.
3.1.6 CHANGE AREA SIX: NUTRITION16
This change area has five indicators – four are quantitative and one qualitative (requiring FGDs.) INDICATOR 1: Amount of energy food consumption (by sex, age, marital status and residence).
INDICATOR 2: Protein foods consumption (by sex, age, marital status and residence).
INDICATOR 3: Prevalence of malnutrition (by sex, age, marital status and residence).
INDICATOR 4: Rate of stunted growth (by sex, age and residence).
The evaluator should first attempt to collect this data from the NSO/B or MOH at the provincial/
regional or national headquarters as the data is likely to have already been collected, analysed and
QUALITATIVE INDICATOR 1: Perceptions of women and men regarding rate, causes and remedies of stunted growth, malnutrition and adequacy of daily food consumption.
Collect data through the procedures described in Section 2.2.3 above.
3.1.7 CHANGE AREA SEVEN: REPRODUCTIVE HEALTH18
This change area has seven quantitative and two qualitative indicators. In most instances, the data for these should already have been collected, analysed and published by NSO/Bs, MOH or other agencies (UN, WHO, etc.). Evaluators should go to these sources and collect the data:
INDICATOR 1: Total fertility rate (by residence).
INDICATOR 2: Number accessing pre-natal care per year (by age, marital status and residence).
INDICATOR 3: Number of births attended by medical personnel per year (by age, marital status and residence).
INDICATOR 4: Number of births un-attended by trained personnel per year (by age, marital status and residence).
INDICATOR 5: Contraceptive prevalence rate (by age, sex, marital status and residence).
The data for the indicators below can be collected from provincial hospitals using tally sheets:
INDICATOR 6: Number of genital tract infections - other than STIs (by sex, by age, marital status, residence)
INDICATOR 7: Age at birth of first child (by age and residence).
The qualitative indicators that require the use of FGDs are:
QUALITATIVE INDICATOR 1: Perceptions of women and men regarding the prevalence of ill-reproductive health, its causes and remedies.
QUALITATIVE INDICATOR 2: Perceptions of women and men regarding the prevalence of
Each FGD should comprise of men and women in the rural or urban setting; include a mixture of husbands/wives, parents, girl-friends/boy-friends over 18, community health officials, community/
traditional leaders, family health providers and people who have experienced difficulties with issues of reproductive health.
3.1.8 CHANGE AREA 8: HIV/AIDS AND OTHER STIs
This change area has eight indicators – five quantitative and three qualitative ones.
The quantitative indicators are:
INDICATOR 1: Percentage of persons living with HIV/AIDS (by sex, age, marital status and residence).
INDICATOR 2: Number of HIV/AIDS-related deaths (by sex, age, marital status and residence).
INDICATOR 3: Percentage of people with STIs (other than HIV/AIDS) (by sex, age, marital status, residence).
Data for the above should be obtained from MOD and/or National HIV/AIDS commissions. If the data is not available, conduct fresh household surveys. Such surveys will have to be carefully designed to collect data on this very sensitive and personal subject.
INDICATOR 4: Number voluntarily submitting to HIV Test (by sex, age, marital status and residence) Data for this should be collected from voluntary HIV/AIDS counselling and testing centres (VCTs).
If these are present at the provincial or regional level, their databases will be used. Otherwise, sampling will have to be done at the district level.
INDICATOR 4: Number voluntarily disclosing HIV/AIDS Status (by sex, age, marital status and residence).
Associations of people living with HIV/AIDS (PLWHA) or their equivalents at the district levels can assist to collect the data because these associations tend to be closer to the grassroots levels than national levels.
For qualitative indicators listed below, collect data through the procedures described in Section 2.2.3 above.
QUALITATIVE INDICATOR 2: Perceptions of women and men regarding adequacy of measures taken by government to tackle HIV/AIDS prevalence especially among women.
QUALITATIVE INDICATOR 3: Perceptions of women and men regarding STI prevalence, its causes and remedies.