英文原文

M&E FRAMEWORK

The M&E framework is designed fundamentally as a management tool and as a means to document program success.This system will enable the province and CF to:

1) monitor the progress of the YN-CF program and document its achievements;

2) assist local facilities and sites to enhance their management strategies;

3) improve the quality of care delivered to patients; and

4) address the management concerns of both provincial and national HIV/AIDS offices.

Data and indicators reflecting activities and processes in these local contexts serve to assist local monitoring and decision-making. Similarly, some of these same data, or summaries of, address the interests of provincial and national monitoring and decision-making. Simultaneously, this M&E system will document activities associated with the larger, encompassing YN-CF annual project plan. Several of the outcome indicators found in the annual plan are linked to facility performance.

The YN-CF model of care encompasses the full range of care services contributing to the highest quality of care available to a patient. When this continuum is applied in local contexts, the primary responsibilities fall into discrete facilities and programs already in place in each of the five sites (Figure 1).This framework also has to follow patient movement through the care system. Most activities occur in around the hospital, with referral networks into and out of for additional services.

Indicators used to mark each component and step in this service delivery continuum have to offer utility for monitoring processes and performance.Actual relevance of an indicator needs to be high, and the total number included has to be sensitive to data collection and management burdens.A preliminary listing of these indicators is included here, as well as the relative relevance to local, provincial, and central agencies.These indicators are presented according to association with the YN-CF project (Table 1) and to the performance of actual facilities (Table 2).

SYSTEM DEVELOPMENT

Constructing this M&E framework requires several components to be developed in a stepwise fashion.Elements need to be designated at the local facility level, along with the information channels leading ultimately to the province and national offices (Figure 2).

Identify Indicators

The full inventory of indicators to be included at the local level needs to be finalized. The YN-CF project indicators are defined within the annual plan.In contrast, indicators associated with facility activities require that each facility or component of the continuum of care (i.e., CDC, HA, TB, MMT, DetentionCenter, Satellite, Community/Peer group) determine which indicators are most relevant to monitoring their own programmatic activities and outcomes.Most of the YN-CF effort will target patient care at the hospital and at the CDC, so the majority of this activity will be linked to these two locations.If a patient is enrolled in the Free ARV program at the hospital, data collection will be based on the NCAIDS DataFax forms.

Once these facility indicators are confirmed, those associated with the site project management (e.g., Lincang) will be determined.These data will derive from the facility information, and the total number of indicators will be more limited in number, and possibly include summary data from some of the facilities.Subsequent to the sites, indicators relevant to the provincial project management will be chosen.Again, this number will be lower than that associated with the sites.

Data Collection and Management

This step involves developing data collection and management procedures at each location.These procedures will be based on forms and registers to document activities (based on methods and tools currently in use), and summary documents with which to report monthly (or quarterly) results.

Information Flow Network

The third step is to develop the information flow network to facilitate the movement of data from the facilities, to the site project management office, and ultimately to the provincial management office (Figure 2). Patient data associated with ARV treatment also will be routed to the national NCAIDS office in Beijing. Feedback channels to the sites and facilities also will be defined, to facilitate the utility of management information and enhance the quality of services provided.These channels will promote the rapid response to problems as they emerge, rather than waiting too long as the issues become worse.

Retrospective Data Collection

An important ancillary step is the collection of data for current patients. Due to the incomplete implementation of the DataFax system to record patient health status and changes, this project does not have all of the information necessary to monitor the progress in patient care for the total number currently under treatment.To address this gap, an individual at each site (e.g., project coordinator) will be assigned to review patient charts to collect these data.This information will permit the appropriate longitudinal monitoring of patients to ensure quality care and to support the evaluation of this program. These data also will be submitted through the DataFax system to NCAIDS.

Personnel

Human resource requirements for this M&E system are relatively minimal, in that most of the data collection and management activities are the responsibility of current staff.At the facility level, information already is gathered in most locations and used to track the status of program progress.

Current site project coordinators are responsible for oversight of all activities within each city.The site coordinator also will be responsible for data collection and management auditing at the sites, to ensure the smooth operation of this system at the facility level and the quality of the information collected.

The provincial project managers already participate in the collection and management of information, and this current system will help to complete, formalize, and streamline that process.Two individuals, the BOH representative and the CF representative, will have responsibility for managing and analyzing these data, and for reporting to the BOH directly.These managers also will be responsible for auditing each of the sites, supported by outside expertise on an occasional basis.

IMPLEMENTATION

Implementation of this project will incorporate two primary phases of activity.This M&E system will be introduced at Lincang as a pilot, and subsequently the system will be introduced into the other sites.Preceding these development phases, the DataFax form will be expanded with the addition of one page of questions to respond to the request of the project clinicians.

中文译文

监督与评价框架

此监督评价框架是一个管理工具，同时也是可以用于确保项目的成功实施的一种方法。本系统将适用于该省和CF达到以下目标：

• 监督YN—CF项目的进程并证明其成果；
• 帮助当地机构和项目点加强管理措施；
• 改善针对病人的卫生服务质量；
• 指引出省和国家HIV/AIDS机构应重视管理的问题。

下文所提到的数据和活动及进程相关的指标将利于协助当地的监测和决策。同样，这些数据或摘要将展示出省级和国家的监督及决策应重点关注的问题。同时，监督评价体系将包括更多的活动，包括YN—CF项目年度计划中的活动。几个年度计划中的结果指标被采纳，以方便展示。

YN—CF服务模式围绕卫生服务系统的所有范围开展以使病人得到最高质量的卫生服务。

正如下文对这个系统的展示，主要职责已经落实到这五个环节的每个部门和项目中。（图1）这个框架不得不通过卫生服务系统追踪病人。大多数的活动将会发生在医院，同时转诊网络的转进和转出将提供其它另外的服务；

用于为每个组成单位打分并容许包含进此服务网络的指标必须显示此单位能够有效监督项目进程和项目执行。实际上指标相关性必须要高，总的数字显示必须对数据收集和管理负担敏感。初步的指标列表以及与当地、省级和国家部门的关系如下所列。这些指标是与YN—CF项目合作（表1）以及根据实际部门的表现（表2）列出的。

体系发展

监督评价体系的建设需要几个方面的逐步发展。各要素的制定需要考虑当地实际水平以及省和国家的来自各信息渠道的信息。（图2）

指标确认

当地水平的全部指标目录需要最后定稿。YN—CF项目的指标在年度计划中已经详细说明。不同的是，各部门活动的相关指标需要每个部门或服务系统中的单位（比如，疾病控制中心，卫生局，结核病防治所，美沙酮维持治疗点，拘留所，社区诊所Satellite，社区/同伴组织）决定哪些指标更利于监测他们自己的项目活动和成果。大多数的精力将投入在医院和疾病控制中心的病人服务上，所以多数的活动都应该与此相关。如果有病人是纳入了医院的免费ARV项目，数据将会由国家性病艾滋病防治协会的DataFax系统收集。

一旦这些指标证实，与项目点（比如，临沧）的专案管理将会被确定。这些数据也将由机构的信息部门得到，总的指标数目也会减少，并且尽可能包括一些来自这些机构的摘要数据。与此同时，省级项目管理的相关指标将会选择出来。另外，这些数字将会低于与各个项目点相关的数字。

数据收集与管理

这一步包括在各个部门开发数据收集和管理程序。这些程序将基于记录活动的表格和登记本（基于现在应用的方法和工具），以及每月（或每季度的）的总结报告结果。

信息流程网络

第三步是建立信息流程网络以便利于数据由各部门传递到项目点管理办公室，最终到达省级管理办公室。（图2）接受ARV治疗项目的病人数据也会发送到北京的国家艾滋病协会办公室。对项目点和机构的信息反馈渠道也会建立以方便管理的信息应用和加强服务质量。这些渠道的建立将有利于问题的快速反应，因为这些非常紧急，否则将会等待太长时间以致于问题恶化。

回顾性数据收集

一个重要的辅助步骤是现有病人数据收集。由于DataFax系统尚未完全执行以记录病人的健康状况和变化，这个课题不具备所有的必要的信息监督现在所有正在治疗的病人的服务过程。为了弥补这个空白，每个项目点的一个人（比如项目协调员）将负责回顾这些病人的记录图表收集这些信息。这个信息将会允许给与病人适当的纵向监测以确保服务质量并支持本项目的评价。这些数据也将通过DataFax系统上报给国家爱滋病协会NCAIDS。

人力

本监督评价框架需要的人力资源相对较少，因为大多数的数据收集和管理活动是当事人员的本职工作。在当地，大多数机构的数据已经收集并用于跟进项目过程。

现在每个项目点的协调员将负责监督每个市的各项活动。同时负责项目点的数据收集和管理审核以确保系统的执行顺畅和信息收集的质量。

省级项目管理者已经在参与信息收集整理，现有系统将确保工作的完全、正规和顺畅执行。另外两个人，希望桥梁组织（BOH）代表和CF代表将负责数据管理分析，并直接上报BOH。这些管理者也将在外单位专家的协助下随机的对每个点数据进行审核。

实施

本项目的实施将主要分两个阶段。此管理评价框架将选择临沧作为试点，随后本系统将在其它点引进。在此发展阶段之前，DataFax表格将被扩展，附加一页问题用于回答项目中临床医生的要求。