Monitoring and evaluation are the backbone of communication programs. The author discusses such monitoring and evaluation by first defining the terms, then considering monitoring and evaluation, indicators and objectives, types of indicators, information, education and communication indicators for monitoring and evaluating AIDS programs, and establishing objectives with regard to indicators. Each project needs its own unique evaluation plan based upon project priority questions regarding the particular implementation strategies. It is important to focus upon the specific aspects which are amenable to change within the institutional framework. Furthermore, one should pay adequate attention to the issues and problems which impede the measurement of results. Given a clear goal and specific objectives, it is possible to develop indicators capable of yielding the information required to measure the progress made in project implementation.
The Zambian government has shifted its emphasis from a hospital-oriented approach to healthcare to a primary health care, community approach. This new approach demands that health education be promoted through mass media and/or interpersonally. The Health Education Unit in Zambia has used television and radio to sensitize individuals and communities to health and health-related problems, as well as to motivate them to initiate activities to solve those problems. 57% of the target population, however, lives in rural areas where they do not have access to television and only poor radio reception, if that. An improved state of television and radio reception in remote areas will go far in disseminating health education to these people in need. For now, the Ministry of Health, together with UNICEF, is undertaking a pilot project on group radio listenership in rural areas to determine the feasibility of small communities coming together and listening to health programs for the purpose of initiating health action in the community. Reception could be improved be either improving transmission facilities at the center or by establishing booster services at each of the six rural provincial headquarters. The latter approach seems the most likely of the two options to provide the desired results.
Evaluation is defined as a process by which comparisons are made and progress is assessed towards accomplishment of stated goals, objectives, and targets since the baseline period or since the last evaluation. The purpose of evaluation is to find out about the project's impact on the community as well as to determine whether or not the project achieved its objectives. Planning and evaluation are intertwined. For the achievement of an accurate evaluation there is need for 1) adequate indicators and 2) regular collection of data. Among different types and models of evaluation, preliminary evaluation or needs assessment is essential before deciding on the viability of the project. This could be a survey of the community, a so-called feasibility study or formative evaluation. At this stage it is also important to collect baseline data. Monitoring and periodic evaluations mean collecting data while the project progresses by means of keeping accurate daily records and holding weekly or monthly meetings. Period evaluations are carried out every 6-12 months to assess problems and achievements. Monitoring requires the reporting of service statistics weekly or monthly (e.g., the numbers of new acceptors and of trainees, contraceptive distribution, and materials purchased). Final evaluation is done right after the project has concluded. It involves the comparison of final data results with the baseline data. It can identify the factors which have led to shortcomings and suggest ways to redress them. Internal evaluations are performed in-house, while external evaluations are carried out by an independent outside evaluator. Measurement tools are used for the measurement of performance at regular intervals, employing indicators (health policy indicators, social and economic indicators, indicators of provision of health, and health status indicators).
Hypothetical cases of interactions between clinic personnel and lactating mothers are provided. The cases teach clinic personnel how they can provide assistance and support for women who are breast feeding their infants. The cases illustrated how clinic personnel can 1) discourage the use of water feeds; 2) promote frequent milk feeds; 3) use a checklist to identify why an infant is not receiving an adequate supply of breast milk; 4) identify why an infant is refusing the breast; 5) help a mother increase her milk supply; 6) provide for the contraceptive needs of lactating women; 7) encourage women to continue breast feeding even if they return to work; and 8) teach mothers to treat and prevent diarrhea in their infants. Women should be encouraged to continue breast feeding for a least 1 1/2-2 years. Supplementary foods should be provided when the infant is 4-6 months old. Clinic personnel should encourage mothers to provide nutrionally adequate weaning foods.
