Monitoring & Evaluation Framework - UNICEF
Monitoring & EvaluationFrameworkInterpersonal Communication forImmunization Package UNICEF/Vilain
Table of ContentsIntroduction to the Interpersonal Communication for Immunization Package. 2IPC/I Package Objectives . 2IPC/I Package Components . 3Monitoring & Evaluation for the IPC/I Package . 5Recommended Steps towards Developing M&E for the IPC/I Package . 5IPC/I Monitoring & Evaluation Framework . 6Adoption/Adaptation of the IPC/I Package .8Learning Activity .9Value Perception .10Knowledge & Skills .10Workplace Application .12Work Product & Outputs .12System Performance .13Considerations for Adapting IPC/I Package Indicators . 14Other Methods for Monitoring and Evaluation . 14Annex A. Sample Client Exit Interview Questionnaire. 16Annex B. Template for Indicator Matrix . 18Annex C. Interpersonal Communication for Immunization Package Indicators. . 22Annex D. IPC/I Self-Assessment Checklist for FLWs . 25Annex E. Supportive Supervision Self-Assessment Checklist for Supervisors . 34Annex F. Sample IPC/I Supportive Supervision Checklist. 36Annex G. Sample EPI Supportive Supervision Checklist . 41
Introduction to the InterpersonalCommunication for Immunization PackageFrontline health workers (FLWs) are among the most influential sources ofinformation that impact vaccine behavior. Health care providers, communityhealth workers, and community-based volunteers are all part of the frontlineworkforce and serve as a crucial bridge between communities they serve andhealth systems. FLWs can serve as both barriers and facilitators to communitiesadopting desired immunization behaviors. FLWs who routinely engage inpositive and meaningful interpersonal communication (IPC) with their clients areable to build trusted relationships with individuals and families. The 2016Exchange of Best Practices on Reaching Every District (RED)/Reaching EveryChild (REC) Workshop for East and Southern African countries, organized byWHO, UNICEF, USAID and JSI, recommended empowerment of health workers,IPC, and community engagement, as key opportunities to foster collaborationand build local ownership of immunization objectives. This UNICEFInterpersonal Communication for Immunization Package (IPC/I) aims to improveIPC in FLW interactions with families and caregivers so can better engage,mobilize, and empower communities to adopt preventive behaviors such asimmunization.IPC/I Package ObjectivesTo increase routine immunization coverage and support caregiver adherence tothe WHO-recommended immunization schedule, the IPC/I Package seeks toaddress the following knowledge, attitudes, and practices among FLWs:FLW Knowledge: Principles of effective interpersonal communication How to effectively communicate with clients irrespective of FLW workloador the length of the client interaction How to communicate with clients about vaccine safety and how vaccinesprevent diseaseFLW Attitudes: Caregivers and clients are entitled to respect, empathy, and equitableservice regardless of religion, ethnicity, national origin, gender, education,or socio-economic status FLWs are facilitators of community health FLWs feel motivated to ensure every child is vaccinated according to theWHO-recommended schedule Vaccines are safe and prevent diseaseFLW Practices:Monitoring & Evaluation FrameworkInterpersonal Communication for Immunization Package2
Communicate effectively and empathetically with caregivers and clientswith various attitudes towards vaccines or the health system at-large Explain the benefits of various vaccines and possible side effects Encourage caregivers to ask questions and provide clear and appropriateresponses Adherence to and promotion of a rights-based approach to immunization Supervisors: Effectively support and monitor the IPC/I work of FLWs, withemphasis on maintaining or improving staff motivationIPC/I Package ComponentsThe comprehensive IPC/I Package supports IPC aspects of FLWs’ immunizationwork globally. The package contains several core components designedcollectively to address FLW’s IPC/I skills and improve the ability of supervisorsto more effectively support FLWs in providing high quality IPC/I. The table belowdescribes each component of the IPC/I Package.Item/ProductBrief descriptionAudienceAdaptationThis document provides an overview of ProgramGuidance & Needs components of the IPC/I Package as well as six key ManagersAssessmentsteps and three guiding principles to conduct aneeds assessment and adapt the package forindividual needs and priorities.Trainers’ Facilitation This guide is a manual for group training on IPC/I. TrainersGuideIt is organized into seven modules and can beused for preservice, in-service, or on-the-jobtraining.Participants’ Manual This manual, a companion to the Facilitator’s FLWs;Guide, provides practical content to help improve Supervisorsdelivery of IPC/I. Each of the seven modules isfilled with activities, reflection questions, and keypoints.SupportiveSupervisionThis manual is designed to help supervisors Supervisorssupport FLWs to improve IPC in immunizationservices. It takes into account commonsupervision practices, obstacles to supervision,and IPC/I-specific needs and information.Animated videosA series of short, animated videos illustrating FLWsinterpersonal communication-based challengesand solutions to improving immunizationcoverage. The videos are intended to be used aMonitoring & Evaluation FrameworkInterpersonal Communication for Immunization Package3
job aids to support FLWs as they address barriersto immunization in their communities.Supportive supervision is also role modeled.Audio Job AidsA series of audio recordings that model effective FLWsIPC practices and serve as another channel forFLWs to access key messages that respond tosome of the common, difficult questions theymay encounter during visits with caregivers. TheAudio Job Aids are a quick refresher that FLWscan listen to while on-the-go.Reference CardsThese cards provide easy access to information FLWs,aboutvaccinesandvaccine-preventable Communitydiseases. These cards can be used as selflearning tools, guides for conversations withcaregivers and community members, andinformation resources for education and training.WebsiteThe entire IPC/I Package will be hosted as a digital Programtoolkit on a dedicated IPC/I website. The website Managers,will also host curated IPC/I resources.FLWsSmartphoneApplicationAndroid application developed on open-source FLWsplatform that hosts abbreviated training content,videos, and audio.MonitoringEvaluationFrameworkand A framework to guide monitoring and evaluation Programto determine the relevance, usage, and Managerseffectiveness of the IPC/I Package.Monitoring & Evaluation FrameworkInterpersonal Communication for Immunization Package4
Monitoring & Evaluation for the IPC/I PackageMonitoring and Evaluation (M&E) are important in assessing theimplementation, use, learning, and impact of the IPC/I Package at various levels(global, regional, national, subnational, district, facility, and community).Appropriate indicators, data collection systems, and reporting mechanismsinform the decision-making to help guide successful implementation of thePackage and structure the learning and opportunities for improvement overvarious stages of the project. The collection and monitoring of key indicators areespecially important in ensuring that data inform decision-making anddemonstrate progress toward the objectives, targets, and goals of the IPC/IPackage. It should be noted that shifts in outcome and impact indicators, suchas vaccination coverage, may not always be directly attributable to the IPC/Iintervention efforts like FLW trainings, as there are many other factors play arole in the shifts in these indicators. Nevertheless, where possible, it can beuseful to collect outcome and impact indicators in order to understand thebroader health context within a region or country around immunization services,and the ways in which the IPC/I Package intervention can lead to impact overtime.Recommended Steps towards Developing M&E for the IPC/I Package11. Organizational structures with M&E functions. Establish and maintain anetwork of organizations responsible for M&E of the IPC/I Package at theregional, national, sub-national, and service delivery levels.2. Existing M&E Systems. Determine what existing M&E structures andsystems might already be in place and how to utilize those existingsystems to build on the M&E plan for the IPC/I Package.3. Human capacity for M&E. Ensure adequate skilled human resources at alllevels of the M&E system to ensure completion of all tasks defined in thecosted M&E workplan. This requires sufficient analytical capacity to usethe data and produce relevant reports.4. Annual costed M&E workplan. Develop an annual costed M&E workplanincluding specific and costed M&E activities of all relevant stakeholdersand identified sources of funding. Use this plan for coordination and forassessing the progress of M&E implementation throughout the year.Monitoring and Evaluation Toolkit – 4th Edition, 2011. The Global Fund to Fight AIDS,Tuberculosis and Malaria.Monitoring & Evaluation FrameworkInterpersonal Communication for Immunization Package15
5. Partnerships to plan, coordinate and manage the M&E system. Establishand maintain partnerships among in-country, local, and internationalstakeholders involved in the planning and managing the M&E system.6. Multisectoral M&E plan. Develop and regularly update the M&E plan,including identified data needs, standardized indicators, data collectionprocedures, and tools as well as roles and responsibilities forimplementation of the IPC/I Package.7. Advocacy, community, and culture for M&E. Ensure knowledge of andcommitment to M&E and the M&E system among policymakers, programmanagers, program staff and other stakeholders.8. Routine program monitoring. Plan for and produce timely and highquality (valid, reliable, and comprehensive) routine program monitoringdata.9. Surveys and surveillance. Produce timely, valid and reliable data fromsurveys and surveillance systems.10. Supportive supervision and data auditing. Monitor data qualityperiodically and address obstacles to producing high-quality data.11. Evaluation and research. Identify evaluation and research questions,coordinate studies to meet identified needs and enhance the use ofevaluation and research findings.12. Data dissemination and use. Disseminate and use data from the M&Esystem to guide the formulation of policy and the planning andimprovement of IPC/I Package programs.13. National and subnational databases. Develop and maintain national andsubnational databases that enable stakeholders to access relevant data forformulating policy and for managing and improving IPC/I Packageprograms.IPC/I Monitoring & Evaluation FrameworkThe M&E framework shown in Figure 1 provides adaptable, actionable guidanceto review, monitor, and measure the implementation, use, learning, and impactof the IPC/I Package and its components. This M&E Framework was presentedat the Dakar meeting in 2018 involving UNICEF colleagues, partnerorganizations, and immunization stakeholders. From right to left, the frameworkhighlights how the training and use of the IPC/I package is expected to translateinto knowledge and skills of FLWs and their supervisors, and how thoseMonitoring & Evaluation FrameworkInterpersonal Communication for Immunization Package6
knowledge and skills will then lead to improvements in IPC around immunizationat the workplace. The application of the knowledge and skills andsystematization at the workplace is expected to improve the quality of workbeing performed by FLWs and their supervisors as well as improve the overallimmunization outcomes such as better quality of service, improved caregiverFLW interaction, and increased caregiver willingness to seek immunizationservices. The M&E systems across the global, regional and country levels areexpected to monitor and report on these elements of the M&E framework rformanceWorkProduct &OutputsWorkplaceApplicationKnowledge& SkillsSystemsValuePerceptionFigure 1: IPC/I Initiative M&E FrameworkThe above M&E framework (Figure 1) shows the conceptual foundation uponwhich the project’s M&E system should be built. The framework informs the keyquestions that will guide the monitoring and evaluation of project processes andimpact at each level: Inputs: How have the resources (materials, financial, and human) beenused to implement activities?Activities: What actions have been undertaken to generate outputstowards delivering project goals?Outputs: What direct tangible products or services has the projectdelivered?Outcomes: What changes have occurred as a result of the outputs and towhat extent are these likely to contribute towards the project objectivesand desired impact?Impact: To what extent has the project contributed towards its long-termgoals?Monitoring & Evaluation FrameworkInterpersonal Communication for Immunization Package7
Key M&E Checklists in the IPC/I PackageThe IPC/I FLW self-assessment checklistSupervisor self-assessment checklistSupportive supervision checklistEPI supportive supervision checklistThese checklists are made available in Annexes D, E, F and G respectively. Theyshould be utilized to assess the extent to which FLWs are using good IPC skills duringimmunization sessions, outreach and education, and supervisors are using supportivesupervision techniques in their interactions with FLWs. The checklists are also helpfulin identifying areas for improvement for both the FLWs and supervisors. Thechecklists provide key language that should be adapted and used to operationalizeindicators within each of the M&E components and to develop relevant datacollection tools, such as surveys or interviews. The checklists provide parameters onhow to measure FLWs and supervisors using IPC/I and supportive supervision. Pleaserefer to the footnotes of particular indicators below for which specific checklistsshould be referenced for indicator operationalization and measurement.Adoption/Adaptation of the IPC/I PackageThe IPC/I Package provides a comprehensive array of resources and materials.However, not all of the content, methodologies or tools will be appropriate forevery country, training opportunity, or trainee audience. All materials within thepackage were developed for a global audience and it is recommended that theIPC/I Package be reviewed and adapted to maximize relevance and accessibilityto local contexts, immunization projects, and needs of health workers andcaregivers. Please refer to the Adaptation Guidance & Needs Assessmentcomponent of the IPC/I Package to determine how the global package may betailored to meet your immunization project needs and priorities.The following set of indicators illustrate what could be captured at the global,regional or national levels around the adoption and adaption of the IPC/IPackage:Number of government approvals of the IPC/I Package adoption/adaptationNumber of countries adapting IPC/I resources and package elements to reflectcountry/local needsComponents of the IPC/I Package that were adapted and usedNumber of countries institutionalizing the IPC/I training for all FLWs in the countryNumber of countries/partners reporting allocation of resources devoted to theimplementation of the IPC/I PackageMonitoring & Evaluation FrameworkInterpersonal Communication for Immunization Package8
Number of countries adapting the M&E Framework for reportingNumber of countries conducting program-level needs assessment for IPC/INumber of countries/partners developing IPC/I integration plans with capacitybuilding as a priorityPlease note that this is not necessarily a comprehensive list of indicators; it couldbe expanded based on programmatic needs.Possible data sources for the above adoption/adaption indicators could be: Memorandums of Understanding (MOUs): Implementing partners maydevelop an MOU for IPC/I Package and these could be used to track whereIPC/I Package is being adopted as-is, versus adapted to fit local contextsand needs. MOUs may also capture if the entire IPC/I Package is beingadopted or only certain components of the package are.Workplans and Budgets: Project implementers may develop workplansand budgets around the implementation of the IPC/I Package. These couldbe used to track IPC/I adaptation/adoption as well as the scale in whichprojects are implementing the package.National IPC Action Plans: Countries where the government approvals arerequired or acquired for the implementation of the IPC/I Package, theseapprovals or action plans could be used to track buy-ins andadoption/adaptation of the package.Learning ActivityThis component of the M&E framework aims to capture project activitiesinvolving the trainings of the FLWs and their supervisors and mentors. Theindicators below may be used to capture these activities, as relevant to the IPC/Iimplementation:Number of IPC/I training package/components available to trainersNumber/Percentage of FLWs newly trained in the recommended IPC/I techniquesNumber/Percentage of FLWs receiving routine refreshers for up-to-date IPC/I trainingNumber/Percentage of supervisors and mentors trained for supportive supervision ofFLWs for IPC/IA possible data source for the indicators above could be: Project output data: Examples include number of participatingindividuals, number of resources distributed, number of remindermessages sent, etc., which can be tracked and maintained throughtraining records and certifications. Monitoring of routine project outputscan be made simple by deciding early what information needs to bemonitored and how the data will be collected and maintained.Monitoring & Evaluation FrameworkInterpersonal Communication for Immunization Package9
Value PerceptionThe M&E framework aims to follow the pathway from FLWs and theirsupervisors being trained in IPC/I to improvements in their overall perceivedvalue of a positive caregiver interaction, of their own role and of the importanceof immunization in their communities. The following indicators aim to capturethis aspect of value perception:Number of FLWs reporting finding their IPC/I training and resources usefulNumber of supervisors reporting being motivated to effectively support their FLWstowards IPC/I2Number of FLWs reporting the value of a positive interaction with caregivers aroundimmunization3Number of FLWs reporting being motivated to ensure every child in their communityis vaccinatedPossible data sources for value perception indicators could be: Sample surveys: A survey based on a random sample taken from FLWsand/or their supervisors can be used to reflect on the project outcomesand effects. Surveys can be laborious and costly but provide objectivedata. These could include periodic mini-surveys, baseline and endlinesurveys, exit surveys, phone surveys, SMS-based surveys, pre- and posttests, etc.Self-assessments: FLWs and their supervisors could be surveyed to selfassess their own changes in perceptions and motivations since beingtrained in IPC/I. These could be in the form of quantitative surveys orqualitative interviews. These data would be self-reported by FLWs andtheir supervisors. Self-assessments can be performed pre- and posttrainings and can also be used for gaining insights on FLW and supervisorshifts in values around immunization in their community. The IPC/IPackage package includes self-assessment checklists designed for FLWsand their supervisors that can be adapted for use. Please see Annexes D,E, F and G for the IPC/I FLW self-assessment checklist, supervisor selfassessment checklist, Supportive Supervision Checklist, and the EPIobservation checklist respectively.Knowledge & SkillsOne of the key ways the IPC/I Package seeks to improve the capacity of FLWs isthrough increasing their knowledge and skills around effective interpersonalcommunication around immunization. Below are some of the indicators thatSupportive Supervision Self-Assessment Checklist for Supervisors [Annex E].IPC/I Self-Assessment Checklist for FLWs [Annex D].Monitoring & Evaluation FrameworkInterpersonal Communication for Immunization Package2310
may help capture those improvements in the FLWs’ and their supervisors’knowledge and skills:Number of FLWs with proper knowledge of IPC/I principlesNumber of FLWs who are confident in communicating vaccine safety and diseasepreventionNumber of FLWs and supervisors who think vaccines are safe and prevent diseaseNumber of FLWs and supervisors with respectful and unbiased attitudes towards theirclients2,3,4Number of FLWs with increased capacity to practice IPC/INumber of FLWs who are confident in their ability to answer difficult questionseffectivelyNumber of trainers reporting increased capacity to train FLWs in effective IPC/IPossible data sources for capturing improvements in knowledge and skills couldbe: Sample surveys (see above)Self-assessments (see above)Performance monitoring/evaluations: FLWs and supervisors may bemonitored for their performance and provided with feedback forimprovements. FLWs could provide feedback on their supervisors andsupervisors could monitor their FLWs on their performance. The datafrom these performance assessments could be utilized to makeimprovements to the trainings and resources. The IPC/I Package includeschecklists designed for FLWs and their supervisors that can be adaptedfor use.Mystery client surveys: Trained ‘under cover’ people (usually acommunity member or researcher) posing as clients and visiting healthfacilities for immunization services may be utilized to conduct mysteryclient surveys of FLW performance of IPC/I. The FLW has no knowledge ofthe mystery client so this method providers another way of gaininginsights on the client’s experiences of the FLW-client interaction aroundIPC/I. This method provides a useful means for program staff to get apicture of how FLWs perform when they are not being directly supervisedor knowingly observed.Client exit interviews: After the IPC/I session/visit, caregivers or clients canbe engaged to participate in a short survey or interview to try andunderstand their experience with the IPC/I FLW-caregiver interaction.Other ways of capturing this data can be through key informantinterviews, focus group discussions, mystery clients, and observations ofthe actual interaction when possible. A sample client exit interview isincluded in Annex A.Supportive Supervision Checklist [Annex F], EPI Supportive Supervision Checklist [Annex G].Monitoring & Evaluation FrameworkInterpersonal Communication for Immunization Package411
Workplace ApplicationThe M&E Framework expects the systematization of the IPC/I training activitiesand supportive supervision and aims to capture progress made towards theindicators below:Number of facilities where IPC/I is integrated in pre-services and continuum trainingsof service providersNumber of FLWs reporting effective support and monitoring provided by theirsupervisorsNumber of FLWs who are actively using the IPC/I tools and resources to support theirwork3,4Number of IPC/I supportive supervision visits conducted with FLWs2,4Possible ways to track the above workplace application indicators could be: Sample surveys (see above)Self-assessments (see above)Checklist: A list of items used for validating or inspecting thatprocedures/steps have been followed, or that expected behaviors arepracticed could be utilized to track FLW and supervisor performance.Easily developed and implemented for monitoring, checklists provide asystematic review of specific project components and can be useful insetting benchmark standards and establishing periodic measures ofimprovement. Examples include supervision monitoring, self-assessmentchecklists, etc. The IPC/I Package package includes checklists designed forFLWs and their supervisors that can be adapted for use. Please seeAnnexes D, E, F and G for the IPC/I FLW self-assessment checklist,supervisor self-assessment checklist, Supportive Supervision Checklist,and the EPI observation checklist respectively.Work Product & OutputsThe IPC/I trainings, improvements in knowledge, skills and supervision, andworkplace systems supporting IPC/I are expected to improve the quality of workbeing performed by FLWs and their supervisors. These improvements could becaptured by examining the work being performed by the FLWs and in theassessment of the interaction experienced by caregivers and clients. Thefollowing indicators may be used to monitor this component of the M&EFramework:Number of FLWs and supervisors reporting improved adherence to the WHOrecommended immunization schedule3Number of caregivers and clients reporting positive interactions with FLWs aroundIPC/INumber of caregivers and clients reporting trust in FLWs around IPC/IMonitoring & Evaluation FrameworkInterpersonal Communication for Immunization Package12
Number of caregivers and clients reporting having their specific concerns aroundvaccinations addressed by FLWsNumber of caregivers and clients being satisfied with FLWs’ attitudes andperformance during their last interaction around immunization servicesPossible ways to capture how the work products and outputs of FLWs and theirsupervisors have changed: Self-assessments (see above)Checklist (see above)Sample surveys (see above)Client exit interviews (see above)Mystery client surveys (see above)System PerformanceThe M&E Framework follows the pathway of training activities, workplacesystematization, and improved quality of work to lead to overall improvementsand efficiency of the system of immunization services. Such outcomes mayinclude better quality of service and improved caregiver-FLW interaction leadingto increases in caregiver willingness to seek immunization services, improvedvaccination coverage rates and decrease in incidence of vaccine-preventablediseases. These successes of the IPC/I Package implementation may be capturedusing the indicators below:Number of caregivers and clients who recall key messages on immunizationNumber of caregivers and clients reporting acceptance of the recommended vaccinesas a result of FLW’s IPC/I counselingNumber of caregivers and clients reporting increased vaccine uptake as a result ofFLW’s IPC/I counselingVaccination coverage rateVaccination dropout ratePercentage of vaccination refusals post-IPC/I counseling provided by FLWIncidence rate of vaccine-preventable diseasesVaccine-preventable diseases mortality ratePossible data sources for system-level performance indicators could be: Client exit interviews (see above)Mystery client surveys (see above)Sample surveys (see above)Secondary Data from National Surveys, Health Facility & ServiceStatistics: Sources of secondary data may already exist and could includegovernment planning departments, university or research centers,international agencies, other projects/programs working in the area, andfinancial institutions. Examples of these include Demographic and HealthMonitoring & Evaluation FrameworkInterpersonal Communication for Immunization Package13
Surveys, Multiple Indicator Cluster Survey, Health Resources AvailabilityMonitoring System, and Health Facility Surveys.Considerations for Adapting IPC/I Package IndicatorsJust as the IPC/I Package components may be adopted, contextualized orrevised5 to fit specific needs of immunization programs, the M&E plan must betailored to capture what is most relevant based on those adaptions of the IPC/IPackage. Programs may differ in aspects such as which of the core componentsthey may adapt for use, their frequency of trainings and refreshers, and theadoption of certain resources or tools or the scale in which they are madeavailable. Such adaptations must then inform what the M&E plan for thoseregions and countries looks like.Effective indicators are a critical element to a functioning M&E system and it isimportant to review indicators with local staff to ensure that they are realistic,feasible, and meet the informational needs. As part of developing the M&Esystem, an indicator matrix must be created that builds on the project’s M&E
IPC in FLW interactions with families and caregivers so can better engage, mobilize, and empower communities to adopt preventive behaviors such as immunization. IPC/I Package Objectives To increase routine immunization coverage and support caregiver adherence to the WHO-recommended immunization schedule, the IPC/I Package seeks to .
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