Monitoring success of HIV/AIDS health care delivery : balancing donor requirements with internal management needs

Abstract

Health care delivery organizations bear the burden of meeting monitoring and evaluation requirements set by numerous external organizations often at the cost of implementing internally defined management needs. Monitoring and evaluation in global health delivery has received increasing attention over the last few years. For instance, the World Health Organization and UNAIDS have published guidelines and provided technical assistance for HIV/AIDS monitoring and evaluation programs. In doing so, they establish international standards for performance measures, defining success metrics and related data indicators. Donor organizations, such as the President's Emergency Plan For AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosk and Malaria (GFATM), and the World Bank's Multi-Country AIDS Program (MAP), have also contributed to defining HIV/AIDS success measures and data indicators in the way that they require funding recipients to report on performance. The multitude of players at the global level has made monitoring and evaluation in HIV/AIDS management confusing with regards to coordination, priority-setting, authority, and information clarification. Health care delivery organizations that act as local service providers must balance fulfilling donor requirements with addressing internal management priorities, which considers beneficiary needs, internal strategy, and available resources. This thesis discusses the challenge of obtaining this balance by comparing data indicators set at the global level with data monitoring priorities at the enterprise level. A case study of Kyetume Community Based Health Care Programme, a health care delivery organization in Mukono, Uganda, is presented to illustrate management complexity of data monitoring at the enterprise level. The application of basic data management solutions at a local service provider shows how business management practices can be applied towards improving health care delivery processes. Drawing upon the case study as well as the concepts presented about global and enterprise level contributions to monitoring and evaluation, this paper discusses stakeholder incentives and the implications on monitoring HIV/AIDS care delivery.