The implementation of novel differentiated service delivery models (DSDM) involves fundamental changes to health care delivery systems. This has created challenges for routine monitoring and evaluation (M&E) of DSDM, as key information is not presently captured by traditional M&E approaches. In order to efficiently document the data needed to guide individual patient management and to assess the coverage, quality, and impact of differentiated HIV services, M&E systems will need to evolve and adapt.
CQUIN member countries have identified “Differentiated M&E” as one of their primary cross-cutting challenges. In response, CQUIN has developed a series of resources, and has launched a community of practice to facilitate ongoing experience sharing and resource co-creation.
Information available on this page includes:
- Differentiated M&E: Frameworks and Resources
- The CQUIN Staging Dashboard
- The CQUIN M&E Consultation in Eswatini
- The CQUIN Differentiated M&E Community of Practice
Differentiated M&E: Frameworks and Resources
Implementing Differentiated Services Delivery: Differentiated M&E: A presentation by ICAP Epidemiologist Bill Reidy, PhD from the CQUIN launch meeting in Durban, South Africa.
You can also view Dr. Reidy’s presentation from the 2017 IAS conference in July, at the CQUIN satellite session Differentiated Service Delivery: Innovating for Impact.
The ICAP Approach to Differentiated Service Delivery (DSD)
This ICAP document focuses on DSDM for stable adults and adolescents, and includes a variety of clinical, monitoring, and evaluation resources from ICAP country programs and international organizations. It is divided into five main sections focused on:
- Cinical criteria for classifying patients as stable or unstable, and the package of care and delivery of services
- Service delivery models of differentiated care for stable patients, both in the community and health facility
- Considerations for DSD for adolescents living with HIV and pregnant and breastfeeding women
- Monitoring and evaluation of DSD, including necessary adaptations to existing monitoring systems
- Implementation considerations for scaling up DSDM
The guide is part of a four-part series designed to support countries in the implementation of effective strategies that support reaching the global 90-90-90 targets, including increasing targeted HIV testing, improving ART coverage and retention in care, and maximizing services to ensure viral load suppression.
The CQUIN Staging Dashboard
The CQUIN Dashboard is a structured self-assessment tool that systematically describes the progress of national DSD scale-up initiatives. The tool can be used by policy makers to identify implementation gaps and facilitate decision-making. CQUIN supports semi-annual DSD Dashboard assessments in each of its network countries, to track progress, and to identify areas of common challenges.
CQUIN country teams have systematically described the maturity of their national DSD programs using the Dashboard, and presented their progress each year, mostly recently in country posters at the second annual CQUIN meeting in November 2018. This process has shown that most countries have made substantive progress towards developing supportive DSD policies, scale-up plans, guidelines, and training materials. Many countries have also improved the coordination of DSD services, and have developed standard operating protocols, job aides, and monitoring and evaluation (M&E) tools.Read more key takeaways in the second annual meeting report
The CQUIN M&E Consultation in Eswatini
In 2016, the Kingdom of Swaziland’s National AIDS Program (SNAP) began implementing differentiated ART services under the Community-Centered Models of ART Service Delivery (CommART) initiative. Members of the CQUIN team visited Eswatini in June 2017 to work with SNAP to assist with the development of an updated national M&E approach, tailored to services integrating CommART.
The team collaborated with SNAP and other key stakeholders to adapt core elements of the national M&E system — such as data collection via the national electronic medical record system (the Client Management Information System), as well as registers, routine indicators and reports, and M&E procedures — to better capture patient uptake, services received, and outcomes for individual differentiated ART models. SNAP has since begun the process of finalizing changes and updating elements of the M&E system in part based on the collaboration.
The CQUIN Differentiated M&E Community of Practice
CQUIN fosters joint learning and knowledge exchange between countries as they work toward the scale up of DSD. CQUIN’s communities of practice (CoP) convene groups of experts to focus on topics related to HIV care and treatment that require special consideration when implementing DSD models.
The M&E of DSD CoP is currently made up health systems leaders from five CQUIN network countries: Eswatini, Mozambique, Uganda, Zambia, and Zimbabwe. The participants meet virtually once a month to share experiences, learn how others have approached common challenges, and collaborate on the development of an M&E framework for DSD.
The ICAP M&E Framework for DSD
This framework, conceived and co-created by members of the M&E of DSD CoP, is intended to serve as a guide for countries or program implementers that are leading the scale-up or supervision of differentiated ART services. Details of indicators are intended to be adapted to reflect national priorities, relevant aspects of national guidelines for DSD, and M&E systems.