Technical Assistance to the All Ukrainian Network of PLWH. Strengthening of Monitoring and Evaluation Systems

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1 Technical Assistance to the All Ukrainian Network of PLWH Strengthening of Monitoring and Evaluation Systems Final Report November /1 Erskineville Rd, Newtown NSW 2042 Australia Ph: Fax: ABN

2 Table of contents: 1. Background: APMG methodology and team: APMG inputs: APMG deliverables: Progress of development of Network s M&E system: Immediate priorities: Discussion and recommendations:... 9 Appendix 1: Quarterly indicator grid Appendix 2: Data flow diagram Acronyms Acknowledgement: This work was funded by the International HIV/AIDS Alliance and carried out by APMG team members Sam Avrett, Gennady Roshchupkin, Andrey Zheluk, Lou McCallum and Dave Burrows. The work was a collaborative effort with the All-Ukrainian Network team, particularly Natali Salabaj, Olga Sova and Hanna Khodas. Thanks also to the Alliance Ukraine team for their assistance, particularly Olga Varetska, Olga Morozova and Paola Pavlenko. APMG Final report All-Ukrainian Network M&E Assistance Nov

3 1. Background: In mid-2006, the All-Ukrainian Network of PLWH (the Network) was nominated by the Ukraine s National Coordination Council (equivalent of CCM) as one of the two Principal Recipients (PR) of the Ukraine s funding proposal for the 6 th Round of funding from the Global Fund to fight AIDS, TB and Malaria (GFATM). The International HIV/AIDS Alliance in Ukraine (Alliance Ukraine) was nominated as the other co-pr. In the Round 6 funding proposal, submitted to the GFATM in August 2006 and approved by the GFATM Board with a list of conditions in November 2006, the Network is responsible for management, accountability, support, monitoring and evaluation (M&E), and reporting on all but one of the objectives, namely: Objective 2: Access and use of HIV treatment and medical services, Objective 3: Access and use of HIV-related care and support Objective 4: Development of a supportive environment, and Objective 5: M&E (in relation to the service delivery areas allocated to the Network). During February and March 2007, the GFATM Local Fund Administrator (LFA) Price Waterhouse Coopers assessed the Network s capacity as a co-principal Recipient (PR) in accordance with the standard GFATM PR procedures and requirements, and identified a number of areas requiring immediate improvement. This report acknowledged that the Network had strong qualitative data collection systems and processes but that there were weaknesses in its quantitative data collection that would impact on its ability to report on Round 6 activities. The LFA report recommended external technical assistance to assist the Network to strengthen its M&E systems so that it could comply with GFATM reporting requirements for Round 6. In May 2007, APMG began to provide short and intensive technical support to the Network under (a contract with the International AIDS Alliance) to assist them to strengthen their M&E systems to meet these requirements. The activities of APMG have aimed to support the Network to effectively improve and implement a: 1. Network M&E system (aligned with that of the co-pr) to efficiently collect, aggregate, review and record reliable programmatic data with appropriate quality control measures. 2. Network reporting system (aligned with that of the co-pr) to prepare regular, timely and reliable programmatic reports to donors and other relevant stakeholders. 3. Network system to plan and manage regular quality studies and evaluations. 2. APMG methodology and team: In line with APMG s methodology for capacity development, support to the Network has included a series of visits to scope the tasks and work alongside M&E staff in the Network, combined with regular contact between visits to progress the work and provide input into day to day issues that emerge. This was carried out in the main by Andrey Zheluk, drawing on assistance from APMG group members Dave Burrows, Lou McCallum APMG Final report All-Ukrainian Network M&E Assistance Nov

4 and Sam Avrett. Assistance with the initial on-site scoping was also provided by Gennady Roshchupkin. As a Ukrainian-Australian, Andrey Zheluk s Russian and Ukrainian language skills and understanding of culture were an essential enabling asset for skills and information exchange. APMG approached the technical support task using a bottom up approach, with an initial focus on strengthening client level data collection. This focus on accurate sub-recipient data collection enables the Network to report more effectively as treatment, care and support interventions are scaled up over the course of the grant 3. APMG inputs: The contract set out the following activities for the work between APMG and the Network: A review of the Network s current M&E system and M&E plan. This will include a thorough evaluation of the data collection and reporting methods of the Network to date and an analysis of the needs A review of the Global Fund s Monitoring and Evaluation Strategy and associated guidelines and the guidelines for performance based funding. A review of national M&E requirements, including those associated with the MoH. An analysis of the data collection and quality assurance needs for the care and support, treatment and procurement programmes to be undertaken. Assist in the development of a framework and action plan for incorporating the Network s monitoring and Evaluation system into Ukraine s national Monitoring and evaluation system. This will take into consideration the programmatic linkages between care and support and prevention activities. Assist in updating and strengthening the Network s M&E plan. The plan will need: to meet the data collection and quality assurance needs of the programme and to include a time bound workplan, milestones and key deliverables which correspond with the Network s overall workplan. Develop processes, tools, and templates for the collection, aggregation, analysis, review of programmatic data. Support the development of a system and functions to ensure reliable and timely programmatic reports. Develop necessary skills of relevant Network staff in M&E systems, data collection and aggregation tools and methods and quality assurance. The consultancy should also take into consideration and advise upon the immediate and longer term resource requirements to enable the Network to implement an effective monitoring and evaluation system. A scoping visit and desk review was conducted in May 2007 resulting in the development of an agreed workplan for the collaboration between APMG and the Network. APMG carried out the following inputs in line with that agreed workplan: Follow-up input into the Network s response to the Global Fund/LFA questions on M&E prior to signing of the grant A review and categorisation of all evaluation and reporting forms conducted in June/July 2007 APMG Final report All-Ukrainian Network M&E Assistance Nov

5 A follow-up visit in July 2007 to work on the further modification and categorisation of forms and data flow processes Technical assistance for the development of indicators for sub-recipients, particularly in relation to measuring changes in the supportive environment for programs Development of a data flow summary and a system for organising data collection forms against the GFATM 6 Objective areas Input into an algorithm for aligning the Network s M&E system with the Alliance Ukraine M&E system for Round 6 A further follow-up visit in August 2007 to assist in the preparation of tools for monitoring of sub-recipients. The most immediate priority at the beginning of the collaboration was to assist the Network to respond to a set of the LFA/GFATM questions about the M&E system, indicators and targets that had to be resolved before the GFATM contract could be signed. The contract period was 9 th April 31 st July 2007, but a no-cost extension was granted until October 31 st 2007 to allow additional time to complete the complex task of data form coding and review. 4. APMG deliverables: During the five months of the collaboration, AMG provided the following deliverables: 1. A detailed workplan following the initial scoping visit May An internal report responding to GF observations and questions on Round 6 funding May An Interim Report on project progress May Technical advice paper on performance indicators for Objectives 2,3 & 4 July Suggestions for indicators for Implementing Partners who will run projects on providing Integrated Care Services (OB2) - July Technical advice paper on indicators for Objective 4 at local level September Technical assistance paper on Data Flows and Quality Assurance, including a coded summary of all data collection forms September Draft Network Monitoring tool for use with implementing partners, including suggestions for ongoing operations research September Interim monitoring tool for immediate use - October 2007 These are not attached as appendices as some of them are large and detailed documents. They have been provided in draft and final forms to the Network, and in electronic form to the International AIDS Alliance, Brighton. Copies of progress reports have also been provided to Alliance Ukraine as the work has progressed. APMG Final report All-Ukrainian Network M&E Assistance Nov

6 5. Progress of development of Network s M&E system: Despite the recommendations in the initial LFA report, there was already significant capacity in the Network s M&E section when APMG began this collaboration and many of the forms and processes necessary for monitoring Round 6 were in place. The experience gained by the Network during Round 1, and technical assistance provided by Alliance Ukraine was much in evidence and placed the M&E team in a strong position to respond to the significant challenge of scaling up to respond to the demands of Round 6. In many areas, the Network already had effective monitoring and evaluation capacity and the tools in place to independently report against Round 6 requirements. What was missing was: a transparent system for organising the flow of data; a coded summary of all data forms, aligned with Round 6 objective areas; a set of processes for M&E transition from Round 1 to Round 6; a mechanism for aligning the Network s M&E system with Alliance Ukraine s M&E system for Round 6; and, sufficient staffing at the Network and human resource capacity at the subrecipient Implementing Partner level to immediately and rapidly respond to these M&E systems design and scale-up needs presented by round 6. Progress has been made in the following areas: The capacity of the M&E Unit: The single-person M&E Unit has now grown in size with the appointment of a Unit Head. Recruitment is underway for two additional team members an IT person and a general M&E officer. There have been some difficulties in finding a suitable IT person and the recruitment of the second M&E officer was briefly delayed due to lack of office space. This has now been resolved and the four-person team should be in place by December Updating the M&E Plan and M&E Capacity Strengthening Action Plan: APMG had input into the M&E Plan and Capacity Strengthening Action Plan during the inception visit and immediately afterwards. It was agreed that the Network would further progress the development of these Plans whilst APMG focussed on assisting with the audit and categorisation of data collection tools and other tasks. A revised M&E Plan and Capacity Strengthening Action Plan have been developed and will be submitted to the LFA/GFATM in mid-november. Modification and codification of data collection forms: The Network s data collection forms have been modified to ensure that they are able to return information that allows the Network to report against the Round 6 objectives. All forms have been assigned a code and organised under their relevant objective area. This has been a significant task, as the Network had a vast collection of forms for use with a wide range of sub-recipients. The modification process is almost complete and should be completed within the Unit by the end of November Systematic map of data flows: The Unit and APMG have worked together to develop a systematic map of data flows, linked to the coded system of data collection areas and APMG Final report All-Ukrainian Network M&E Assistance Nov

7 forms. This makes it clear how data flows between sub-recipients and the Network, between the Network and its stakeholders and the GFATM. A copy of the data flow diagram is attached in Appendix 2. It will be regularly updated to reflect developments in the M&E system. Round 1/Round 6 combined and separate reporting: The Network and Alliance Ukraine have developed an algorithm to assist them in organising the flow of data in the overlap period between Rounds 1 and 6. This contains the four scenarios of interest to the Network: Network only recipients Round 1; Network & Alliance recipients Round 1; Network only recipients round 6; and Network & Alliance recipients Round 6. Finalisation of an interim monitoring tool: The Interim Monitoring tool has been revised and is ready for use in Year 1. APMG has provided additional information for upgrading the Interim Monitoring Tool in Year 2, particularly aimed at strengthening areas of quality assurance. Finalisation of indicators for Year 1 sub-recipients and insertion of M&E requirements into sub-recipient contracts: This is largely completed. The Unit considered the suggestions made by APMG for enhancement of indicators under OB 2, 3 and 4 and used these in the Expressions of Interest (EOI) process. Reporting requirements have been inserted into the call for EOI sent to potential sub-recipients. More work on the indicators for OB 4 (measuring the changes in the supportive environment at local level) will be carried out in Year 2. There are three key areas that require some more work, but that have not been able to be completed as they have been awaiting decisions in other areas. These are: 1. The integration of PSM indicators into the Network s M&E system (the Network is subcontracting PSM activities to the Alliance and will need to insert PSM indicator measurement into the Network s M&E system) 2. The integration of measures for treatment, care and support indicators (awaiting further work on the exact functionning and design of the integrated care services) 3. Detailed information on how data to monitor substitution therapy uptake will flow from government HIV/AIDS treatment and care services to the Network to allow them to report against Objective 2 (depending on further discussion and negotiation with the Ministry of Health, Institute of Public Health Policy and Ministry of Internal Affairs.) The Network is now is a strong position to be able to report against the Round 6 quarterly indicators at the end of Quarter 2 of the grant. Indicators and a summary of the Network s current capacity to report against them are set out in the table in Appendix 1. APMG Final report All-Ukrainian Network M&E Assistance Nov

8 6. Immediate priorities: APMG sees the immediate priorities for the strengthening of the Network s M&E system as: ITEM TIMING NOTES Training and TA for sub-recipients M&E training and TA for sub-recipients Year 1 Q2 Clear delineation between Round 1 and Round 6 for both old and new sub-recipients M&E technical assistance to Integrated Service Centres (ISC) Year 1 Q3 Negotiations required for development of M&E process when first NGO sub-recipients appointed during Year 1. Monitoring visits - commencing Year 1 Q2 Monitoring visits AIDS Year 1 Q2 Negotiations required with National AIDS Centre centres Monitoring visits State Year 1 Q2 Negotiations required with Ministry Internal Affairs Detention Department (capacity for ARV provision in prisons) Monitoring visits ST Year 1 Q2 Negotiations required with Institute of Public Health Policy Monitoring visits ISC Year 1 Q4 Negotiations required with sub-recipient NGO Databases Network installation of Alliance reporting database (MRS) Year 1 Q3 Followed by training from Alliance Ukraine M&E staff Development of standard client database Year 2 Q4 Modified from existing paper-based system M&E Infrastructure Unique identifier code Year 1 Q2 Examine existing client codes and determine most appropriate identifier system for tracking multi-service use over time Standardised client case notes Year 1 Q4 Review existing case notes and determine most appropriate format focus on case management Client Case management Year 2 Q3 Include strengthening of confidentiality, operational research to determine best models Management of projects Year 2 Q3 Clear links between Specialists and M&E Unit to ensure flow of information Quarterly report standards Year 1 Q2 Standards for Program Specialists to assess quality of quarterly IP reports Data quality enhancement for scale up Year 2 Q4 Develop systems for improving data quality standard definitions of inputs, case note reviews and feedback Service quality enhancement for scale up Year 2 Q4 Development and monitoring of a set of agreed standards APMG Final report All-Ukrainian Network M&E Assistance Nov

9 7. Discussion and recommendations: The selection by the GFATM of the All-Ukrainian Network of People with HIV/AIDS as a co-principal recipient for Round 6 is a very tangible expression of Greater Involvement of PLWH (GIPA) principles and goes well beyond the often tokenistic interpretation of these principles by other donors and governments. Whilst it is of course important to have robust M&E systems for all GFATM projects, it is particularly important in this case, as the outcomes and lessons learned through this project can have a significant impact on the roll-out of PLWH driven work in other countries. This GFATM project seeks to reduce HIV transmission and improve the health and wellbeing of PLWH and people affected by HIV and AIDS. The Network s task as co-pr is an important and complex one. It is to ensure that vulnerable groups injecting drug users, sex workers, men who have sex with men, prisoners and street children with HIV (and at risk) are not disadvantaged under the Universal Access agenda and are able to access the prevention, treatment, care ad support services they need. These sub-populations have a history of poor treatment and rejection by health services, brought about by stigma and discrimination and patterns of poor health-seeking behaviour that result from this rejection. There are several significant tasks here for the Network rapidly expanding the reach of PLWH support groups, advocating on behalf of PLWH with government and non-government service providers and re-orienting health services so that the right mix of high quality prevention, treatment, care and support services is provided. Progress against these goals is not easy to measure in the short-term. This is further complicated by the environment in which the project is operating and by the fact that the data that is required to build up a complete picture of improved HIV prevention and care outcomes needs to come from a wide range of providers. Negotiations are underway to secure quality data from government providers and the results of these negotiations will significantly affect the ability of the Network to report effectively. 7.1 External factors: There are several external factors that complicate the implementation process for this grant. These include: Delays in the national approval of substitution therapy for drug users. Providing access to substitution therapy for drug users is a central plank of the Round 6 grant. At the time of writing, legislation has been passed to enable substitution therapy with methadone, but there have been delays in developing the regulations and procedures to implement this. Substitution therapy is a key component of the GFATM Round 6 grant and there is considerable effort being made by a range of partners at present to establish the mechanisms to allow it to go forward. The current review of the national AIDS M&E framework and national AIDS program in the Ukraine. APMG Final report All-Ukrainian Network M&E Assistance Nov

10 There are processes underway to review the national AIDS indicator set for the Ukraine. Once this is in place it will be a relatively simple task to demonstrate how the Network s indicators can contribute. The Network and Alliance Ukraine have worked together to ensure that they are in a good position to contribute effectively to a national M&E system. The GFATM M&E Self Assessment Tool, required to be completed by the PR on the signing of the grant, focuses in part on the fit between the PR s indicators and the national M&E system. Given the ambitious programme of work for the Network s M&E Unit over the next few months, APMG recommends that the completion of this assessment tool be delayed until the national M&E set has been developed in early Achieving the Network s goals under Round 6 will rely on a close collaboration with government-run health services, prisons and other public institutions. A national AIDS strategy would assist in providing the policy, resource and service environment that would support this work. There is a process underway, funded by DfID and coordinated by UNAIDS, to review the National AIDS program and this should assist to place the work of the Network within a broader strategic environment. 7.2 Deciding what is to be measured and how it is to be measured: The central focus of this project is to put a package of services around an individual or family affected by HIV/AIDS that supports their decisions to reduce HIV transmission, reduce injecting drug use and access HIV treatment, care and support. This is to be achieved by a mix of services at the local level, some provided by PLWH groups, some by other NGOs and some by government services. PLWH groups and NGOs will provide the advocacy and liaison to keep the package of services around the individual or family intact and functioning effectively. Coverage of services will be key to their success. Scaling up coverage of effective HIV programs is regarded as having three key dimensions: 1. increasing reach and frequency of reach (how many are in contact with which services and how often); 2. ensuring the scope of programs is broad enough to initiate and retain contact with target populations and deliver the services needed; and 3. improving quality of services (meeting client needs, friendliness, convenience, abiding by objective standards). APMG has been working with WHO and UNODC on possible indicators which will measure these aspects of coverage, together with national targets for high coverage of programs for drug users. A Technical Guide based on this work will be published by WHO prior to the end of Similar work will soon be undertaken on measurement and targetsetting for work with other populations at risk, including prisoners, sex workers and men who have sex with men. It will be important for the Network to stay up-to-date with these processes as one of the recommendations from the WHO/UNODC work is that all major global organisations (including particularly the Global fund) adopt the indicators and target-setting processes that are being developed. In addition to the Network and Alliance Ukraine, other groups are supporting work in this area, including the Clinton Foundation. There are several models being discussed and APMG Final report All-Ukrainian Network M&E Assistance Nov

11 implemented, including the Integrated Service Centres model referred to in the Round 6 contract. It would be useful at this early stage in the development of these programmes, for the Network and Alliance Ukraine to lead a process of clarification of the essential (or realistic) elements of the package of prevention and care services to be implemented in the Ukraine. The WHO/ UNODC work described above is also facing this issue: indicators required by WHO are not required by UNODC, for example. Consistency in this area will not only assist the groups that are implementing these models, but will make the measurement of outcomes and comparison across programmes much easier. Naturally the way that the package appears at local level will vary from place to place. In some instances, the services will be delivered in one-stop integrated care centres, in other places a wider range of partners will contribute to making up the package. Recommendation: That the Network and Alliance Ukraine lead a process of clarification of the essential (realistic) elements of the package of prevention and care services that will be placed around PLWH and people affected by HIV and AIDS in the Ukraine. Once the package of services is in place, and barriers to access are minimised, it is up to the individual to decide what mix of services he or she needs at any particular time. Individuals require a different mix of services at different times, according to their level of illness, their need for support and so on. Supporting effective HIV prevention and care is a long-term endeavour. Success is defined by the long-term match between the individual s needs and availability of the services they need. This makes it more important to examine the individual s pattern of service use over time than to measure occasions of use of a single service. The Alliance IPs use a use a standard approach to defining minimum package of prevention services. This needs to be broadened to include treatment, care and support services (and possibly other prevention services that are not within the minimum package), in order to provide for an integrated approach. To do this effectively means a move from simple counting of the number of times a service is provided, to a system that is able to track the use of a mix of services by an individual over time usually achieved by clients having a confidential service use code that they use in a range of services (a unique identifier code - UIC). APMG has found in its work with RHRN and other funders of HIV programs that this unique code is also vital to the measurement not only of the reach of specific services and the mix of services, but measuring regularity of reach. The Spectrum of Services and Ring of Services developed for work in Central Asia can be used to measure breadth of services and to audit services provided by a range of agencies. Recommendation: That the Network begins a process of operational research to improve case management and put in place systems to support sub-recipients tracking and reporting on patterns of service use over time. This also requires some rethinking on the part of the GFATM and a process of negotiation over time between the Network and the GFATM over targets. The current Round 6 numerical targets were reasonable at the time they were developed but they may not be the most effective measures to indicate long-term prevention and care outcomes for individuals. Defining what mix and frequency of service availability effectively supports prevention and care, particularly for current and recovering drug users, is a live debate APMG Final report All-Ukrainian Network M&E Assistance Nov

12 at present. Emerging developments in this area will need to be incorporated. There are mechanisms in place for negotiation between GFATM and PRs for modification of targets and indicators. A program of operational research conducted by the Network as service models are developed will put it in the best possible position to embark on these negotiations with the GFATM and this will ensure that securing the best possible outcomes for people affected by HIV remains the highest priority of the work. Recommendation: That the Network develops and implements an operational research plan aimed at providing it with the information it needs to revise the Round 6 targets and indicators as the service models develop. APMG has provided advice and options for strengthening the indicators for OB3 (Care and support services) and OB4 (Supportive environment: Coordination and partnership development - national, community, public/private). These are often difficult areas in which to measure change, but the APMG advice begins the process of determining some meaningful ways to measure changes in people s cognitive and social environments due to improved access to care and support, and in the policy and service delivery environments due to structural interventions. Further operational research will be required to determine the particular elements that contribute to social changes and a supportive environment in the settings of the Network s work. Operational research that needs to be considered by the Network includes studies to independently assess the comparative demographics, socioeconomic status, and health risks of the individuals reached by Round 6 services; the ways that clients are encountering, navigating and negotiating prevention, treatment, and other health services; and potential new measures of patient skills, efficacy, and other social and health-related outcomes and impacts that could be incorporated into Round 6 indicators. Recommendation: Include in the Network s operational research agenda an investigation of improved methods for measuring change in the supportive environment. The immediate priorities set out in Section 6 of this report provide a summary of the main areas of M&E systems strengthening that require development by the Network over the next eighteen months. The immediate task for internal systems strengthening is to finalise the review and distribution of the paper-based data collection forms and complete sub-recipient training so that the right data is being collected from the start of project work. This is well underway. Once the paper-based system is in place, the next step should be to move to an electronic reporting system as soon as practicable. This will be the core work of the IT specialist, who should be in place by the end of Recommendation: That a plan for development of a standardised electronic data reporting system be in place by end January Consistent monitoring and mentoring of sub-recipients will be essential to the success of this work. APMG has worked with the Network to update the Interim Monitoring Tool for APMG Final report All-Ukrainian Network M&E Assistance Nov

13 use with sub-recipients and has made recommendations about strengthening this further, particular in the areas of data quality and service quality assurance. Strong links between the M&E Unit and the Network s Program Specialists who will be responsible for monitoring groups of sub-recipients will provide feedback loops that will assist the Network to resolve data and service quality issues as they emerge. The Network is building from a strong base of staff, partners and providers who have experience with the target populations and interventions described in Round 6. However, the implementation of an M&E system to capture long-term biomedical and social impacts will depend on these partners having a nationally consistent understanding of the M&E goals, conceptual basis, and methodologies. The Network can be supported to build and harness this human resource potential through an M&E management system that orients, trains, supervises, and supports staff, volunteers, and clients at each partner organization. Recommendation: That the Interim Monitoring Tool be further modified in Year 2 to strengthen data quality and service quality monitoring and that systems for ensuring effective communication between Program Specialists and the M&E Unit be developed. APMG Final report All-Ukrainian Network M&E Assistance Nov

14 Appendix 1: Quarterly indicator grid Progress of capacity of Network to be in a position to report against Global Fund indicators at the end of Quarter 2: QUARTERLY INDICATORS FOR GFATM Description Indicator Source Treatment: Antiretroviral 2 1 treatment (ARV) and monitoring 2 2 Treatment: Antiretroviral treatment (ARV) and monitoring Treatment: Antiretroviral treatment (ARV) and monitoring Adults with advanced HIV infection receiving antiretroviral combination therapy (number and percentage) (UNGASS) Number of IDUs with advanced HIV infection receiving both antiretroviral combination therapy and substitution opioid therapy Same as AU indicator #3 and #8 I Attachment 5 Prisoners with advanced HIV infection receiving antiretroviral combination therapy (number and percentage) (UNGASS) Health statistics Health statistics Health statistics Can Network report on this indicator in Q2? Additional actions and timelines Current forms used by Alliance will continue until end of Year 1. Mechanism of reporting to Network established and described in APMG recommendations. Additional negotiation with Institute of Public Health Policy required to ensure documentation of data quality and service quality with substitution therapy sub-recipient organisations Current forms used by Alliance will continue until end of Year 1. Mechanism of reporting to Network established and described in APMG recommendations. Additional negotiation with Ministry of Internal Affairs required to ensure documentation of data quality and service quality 2 Treatment: Drug Substitution Therapy 4 IDUs on substitution therapy (opioid maintenance) treatment (number and percentage) Coincides with AU indicator #8 Health statistics Mechanism of reporting to Network established and described in APMG recommendations. Additional negotiation with Dvoriak Institute required to ensure documentation of data quality and service quality with substitution therapy sub-recipient organisations Current forms used by Alliance will continue until end of Year Treatment: Drug Substitution Therapy 2 Treatment: 6 TB/HIV collaborative activities: Intensified case-finding among PLWH Number of integrated service centres (ISCs) established to provide ART, TB services, and ST. Number of occasions of OI treatment provided to PLWH Number of PLWH adult (on ART and without ART) diagnosed for active TB and referred for treatment Number of adult PLWH participating in community-based care and support services Programmatic reports Health statistics Health statistics Programmatic reports Delayed pending resolution of ST, PSM issues Not required in Q2 At least 3 ISCs are required to be established by the end of Year 1. The Network will develop a model in Q2. Reporting is not required until the end of Year 1. Mechanism established and described in APMG recommendations Mechanism established and described in APMG recommendations Mechanism established and described in APMG recommendations 3 Care and support: Care and support for the chronically ill 9 Number of HIV positive MSM reached with care and support programs Programmatic reports Mechanism established and described in APMG recommendations 3 Care and support: Support for orphans and vulnerable children Number of HIV positive prisoners reached with care and support programs Number of HIV-affected children reached with community based care and support programs Programmatic reports Programmatic reports Mechanism established and described in APMG recommendations Mechanism established and described in APMG recommendations 4 Supportive environment: Coordination and partnership development (national, community, public-private) 12 Number of service deliverers (members of trade unions of medical staff, state labour inspectors) trained Programmatic reports Incorporate APMG suggestions for strengthening the indicators in this area inn Year 2. APMG Final report All-Ukrainian Network M&E Assistance Nov

15 Appendix 2: Data flow diagram OB 2 Client E. ART provision OB 3, 4 J. ISC A. Client level data flow mandatory forms B. Client level data flow supplementary forms F. ST G. PSM C. IP Quarterly reporting data flow D. Data aggregation (Based on Network/Alliance algorithm Internal Network processes H. Regular project M&E feedback Monitoring visits GFATM National Stakeholders APMG Final report All-Ukrainian Network M&E Assistance Nov

16 Acronyms AIDS APMG ART AU DfID GFATM GIPA HIV IDU IP ISC LFA M&E MoH MSM NGO OB PLWH PMTCT PR PSM RHRN ST TB UIC UNAIDS UNGASS UNODC WHO Acquired Immunodeficiency Syndrome AIDS Projects Management Group Antiretroviral Therapy Alliance Ukraine Department for International Development (UK) Global Fund to Fight AIDS, Tuberculosis & Malaria Greater Involvement of PLWH Human Immunodeficiency Virus Injecting Drug User Implementing Partner Integrated Service Centres Local Fund Agent (for GFATM) Monitoring & Evaluation Ministry of Health Men who have Sex with Men Non-government Organisation Objective Person Living with HIV Prevention of Mother to Child Transmission of HIV Principal Recipient (of GFATM funds) Procurement & Supply Management Russian Harm Reduction Network Substitution Therapy Tuberculosis Unique Identifier Code United Nations Joint Program on AIDS United Nations General Assembly Special Session on AIDS United National Office on Drug Control World Health Organization APMG Final report All-Ukrainian Network M&E Assistance Nov