Mitigation of HIVAIDS at the District Level: The Case for the Collection of Local Indicators

1
Mitigation of HIV/AIDS at the District Level The
Case for the Collection of Local Indicators the
Development of DEMMIS

• Peter Badcock-Walters
• Mobile Task Team on Impact of HIV/AIDS on
  Education (MTT)
• HEARD, University of KwaZulu Natal
• Centre for AIDS Research Conference
• The Geography of AIDS
• 27 May 2004

2
The Developing Environment

• HIV/AIDS impact is variable across societies,
  sectors and areas and shows evidence of hot
  spots
• Effective response requires a decentralised
  strategy and empowerment of local
  decision-making
• Operational experience suggests that HIV/AIDS
  response and delivery at sub-national levels is
  constrained by lack of data and indicator-based
  decision support systems
• National level MIS can provide the big picture
  but often cannot provide the sub-regional data
  required to guide, support and monitor response

3
(No Transcript)
4
The Developing Environment

• Deepening the critical knowledge base for AIDS
  impact assessment and mitigation will require
  functional sectoral data collection and analysis
• Such systems and capacity function to some degree
  in education but are less evident in health and
  almost non-existent in social welfare
• Development of new indicators, methods and models
  is the critical challenge, at both the national
  and district levels
• Examples of countries where multi-sector
  development activity and HIV/AIDS impact
  mitigation are coordinated are almost unknown at
  this stage.

5
Key Issues

• All social sector ministries should routinely
  generate early warning indicators of system
  malfunction/failure, and HIV/AIDS impact
• Widespread MIS collapse due in part to lack of
  management demand for decision support
• Problem in education may be dwarfed by that in
  health, social welfare and related ministries
• Repeated failure of national MIS affirms need to
  consider district level development to support
  local system management and delivery
• The AIDS era presents a unique opportunity to
  motivate multi-sectoral innovation, particularly
  if centered on OVC and development reporting.
  

6
HIV/AIDS Impact on Education

• The primary impact of HIV/AIDS is to explode the
  scale of existing systemic and management
  problems in education
• It will directly and indirectly affect
• Labour attrition, recruitment training
• Access, enrolment gender equity
• Increase orphaning drop out rates
• Reduce household/school fee income
• Learner transition, graduation rates quality
• Some geographic areas more than others
• Most education systems are somewhat
  dysfunctional, and HIV/AIDS makes these problems
  worse.

7
EMIS System Management

• Conventional EMIS at best capture annual
  snapshots of the system and may take 2 or 3
  years to analyse and disseminate data
• Few EMIS systematically deliver timeous or
  reliable data or provide basic decision support
  information
• This compounds the difficulty of deciding where
  normal dysfunction stops and HIV/AIDS erosion
  starts and masks it
• Result is failure to provide reliable evidence of
  HIV/AIDS impact or even regular system
  performance/crisis (fuelling data scepticism).

8
Education MIS The Need

• There is a clear need to develop new and/or
  supplementary EMIS able to stimulate management
  demand and
• capture/monitor key indicators of system input,
  performance output more regularly and
  efficiently
• Link these indicators to HIV/AIDS impact and
  provide early warning measurement/monitoring
• This implies EMIS reform and/or the development
  of supplementary systems
• Should not duplicate EMIS but be located at the
  point of delivery to empower managers to mitigate
  local HIV/AIDS impact
• A key feature should be the capacity to capture
  monthly (or at least quarterly) time-series data.
  

9
The Response

• A decentralised District Education Management and
  Monitoring Information System (DEMMIS) has been
  developed to test viability of monthly data
  capture
• The pilot system has been designed to capture key
  indicators of HIV/AIDS impact on a monthly basis,
  to guide response at the school, circuit and
  district levels
• Indicators must be simple and easily extracted
  from the routine (?) school reporting system
• The data captured reinforces school, circuit and
  district management systems and supplements
  annual EMIS data with time-series and trends.

10
The System

• The DEMMIS system captures monthly statistics on
  teachers, learners, support staff and school
  governing bodies
• Provides time-series data on enrolment,
  absenteeism, attrition, contact time, drop-out,
  pregnancy, orphaning and fees all by gender and
  grade
• Copy to school, one to the Circuit and District
• Indicators of HIV/AIDS impact can be quickly and
  easily derived from these
• Linked to a District Managers Resource Kit with
  FactSheets and Management Response Checklist

11
(No Transcript)
12
(No Transcript)
13
Annual School Survey (EMIS)(reported 2 to 3
years in arrears)
14
EMIS Data Mortality due to Illness
15
DEMMIS - Change in Enrolment Figures by Month 72
Schools
Decline of 2.3 Annualised -2.8 2001 -2.6 (32
schools)
16
Enrolment Change by Gender72 Schools
Drop in Enrolment Annualised Female learners
-3 Male learners -1.4
17
Pupils leaving the System, all Schools, 2002
18
Pupil Attrition
19
New Orphans
Orphans as a of enrolment 2001 1.5 2002
2.3
20
Sample of 32 schools
21
Teacher loss
Teacher Loss 2001 5 2002 5
22
Reason for Teacher Loss
23
Absenteeism

• Teachers
• Illness 72
• Unknown Reasons 26
• Pupils
• Illness 40
• Unknown Reasons 55
• Compassionate Reasons 2
• Pregnancy 1

24
Rates of Absenteeism
25
Loss of Contact Time
Loss of time 2001 7 2002 7.6
26
Schools with Orphans in Relation to Clinics
Schools, with no orphans
Schools, with orphans
Clinics
27
Incidence of Orphans
As of enrolment Less than 1 Between 1 and
2 2 to 6
28
The Lessons

• The pilot confirmed that a time series of monthly
  returns by age, grade and gender can provide
  unprecedented insights into impact and trends
• Shows trends previously unseen in annual school
  census data and analysis
• Confirms HIV/AIDS is exacerbating existing levels
  of system dysfunction
• Impact appears lower than some projections
  perhaps due to sample but confirms upward
  trends
• Demonstrates that communities are responding to
  OVC impact through fee exemptions

29
The Lessons

• Suggests that if unchecked, trends point to
  large-scale systemic crises over time
• Provides the opportunity to ground assumptions
  and future research in local data
• Confirms that it is possible to identify and
  collect school-level indicators and analyse these
  at the district level
• Proves viability of systematising routine
  data/indicator collection to inform local level
  management response
• Provides basis for regular monitoring and early
  warning of HIV/AIDS impact.

30
Future Development

• Pilot results suggest that DEMMIS provides an
  effective, complementary method of collecting and
  analysing key HIV/AIDS indicators
• It should be seen as an adjunct to EMIS with the
  capacity to link annual data with monthly time
  series and verify the reliability of conventional
  EMIS
• It is likely that DEMMIS will be regulated and
  taken to scale in KwaZulu Natal, and is being
  piloted/developed in Zimbabwe, Zambia, Kenya,
  Ghana, Uganda, Botswana and Namibia.

31
Mitigation of HIV/AIDS at the District Level The
Case for the Collection of Local Indicators the
Development of DEMMIS

• Contact peterbw_at_eastcoast.co.za