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HopeLVB Toolkit

Table of Contents

Section 3: Design, Implement, and Evaluate a PHE Program

3.1 Designing a PHE Project

As we plan to implement a PHE project, there are several stages during which specific information needs to be gathered from project areas, such as during proposal and/or workplan development, strategy development, activity design, and M&E design phases. If a PHE project is designed in response to a call for proposals, there would be certain criteria and parameters defined by the funding agency within which information would be collected to inform the proposal writing and partner selection. If the PHE project is to be built onto an existing P, H or E standalone project, information about the possible linkages between ongoing project interventions and the potential new PHE interventions, and interaction between local human behaviors and ecosystem health, would be valuable for analyses. A general pre-project scoping exercise is important to assess whether the project sites are suitable for PHE interventions; whether are interested in owning some parts of the project for sustainability; and whether partners and potential champions exist within government as well as among community groups who are likely to embrace and advocate for a PHE approach.

3.1.1 Assessing Ecological Status

A critical first step to identifying the most salient environmental interventions for a PHE program for a particular area is to conduct an ecological assessment and a threats analysis. It is important to collect accurate information often available from published government agency literature and other available online reports and available research papers and tap into the broader knowledge base of what the current driving forces, pressures, state, impact and responses1 are to the natural environment within the proposed project sites. It is especially also important to understand how the surrounding communities’ management and consumption of natural resources could alter the course of some threats that exist, and what could potentially be done to ensure sustainable use of natural resources.

These analyses will allow the project to define the boundaries of the natural environment/ecosystem and the demarcation of administrative units for the project’s scope. Both the participating communities and the project’s environmental scope may change over time—especially as projects evolve and expand—but clearly defining these two elements up front is important for project design and evaluation purposes.

The HoPE LVB ecological assessment example can help facilitate your organizations to consider the types of information to collect, that would support the design of activities to achieve impact.

1 This framework, known as the DPSIR framework, was adopted by the European Environment Agency and can be found here. Policy Mapping

PHE is often a new concept to a community, and thus a mapping of existing local policies and how to advocate for the embedding of PHE concepts into existing policies and programs becomes a major focus. A key aim of PHE advocacy is to foster establishment of policies enabling integration across sectors to be philosophically accepted and, importantly, operationally implemented. An integrated PHE approach can become sustainable and scalable only if there are strategic and consistent advocacy efforts in place from the start that complement successful PHE field implementation. During the situational analysis phase, it is useful to conduct a desk review of existing sub-national and national government policy documents to see if a PHE approach appears as a recommended strategy in reaching local and national development objectives. Those policy documents (in addition to regional and global ones such as the United Nations’ Sustainable Development Goals), are useful when advocating for the inclusion of PHE initiatives in funding envelopes for local health, conservation, and broader sustainable development-oriented programs. As a best practice for advocacy, it is also important to design advocacy messages after refining the target audiences, namely policymakers and important stakeholders who are likely PHE champions or sympathizers, who hold the power to make policy, budgetary, and programmatic decisions. Community and Stakeholder Involvement

Stakeholder involvement is an important aspect of any project. For HoPE-LVB, it served as a critical entry point allowing the project to assess expectations, perceptions, and attitudes of existing partners and stakeholders. This process was also important in creating constructive and productive relationships throughout the life of the project.

To foster community and stakeholder involvement, PHE programs should identify all relevant stakeholders who may contribute to or affect the project’s success. This assessment should capture a diverse group of stakeholders because the integrated nature of a PHE program calls for inclusion of cross-sectoral partners drawn from each of the three PHE sectors. For the HoPE-LVB project, these stakeholders included: national and sub-national ministries of health, environment, forestry, agriculture and fisheries, government administrators, civil society organizations implementing any or all the PHE facets, and community members. Of relevance to HoPE-LVB, the Lake Victoria Basin Commission, a regional body of the East African Community that represents regional interests and government agencies, is also involved with PHE interventions. The scale of involvement with stakeholders should extend to all levels to ensure future sustainability and scale up of successful interventions.

Once stakeholders are identified, projects should hold consultations with these groups (first through informal dialogues and later through more formalized channels such as project steering committees or advisory groups) to share the project idea, gauge stakeholders’ perception of it, and assess the possibility of buy-in. These for are a valuable source of information for the project, and they can also form the foundation for future collaboration and partnerships.

For community-level consultations, PHE programs should seek individuals who: are knowledgeable of the local context; put forward new, innovative ideas; hold sway in communities and could champion a particular approach or the PHE perspective. The individuals’ positions, vested interests, and potential bias should be taken into consideration. Diverse stakeholder consultations should continue throughout the project so that champions are supported and implementation is monitored and mirrored back to implementers from different perspectives. Even at an advanced stage of the project, feedback from stakeholders is valuable and can lead to new insights to be integrated into the project approach. In addition, the project should disseminate results to relevant stakeholders at all stages of the projects. (For more on this, see Section 4 on sustainability and scale up).

In the process of conducting a situational analysis in the implementation sites and prior to designing data collection, projects should identify strengths and weaknesses of local partners who could potentially support implementation and assess their ongoing activities. These partners could include community groups such as women’s groups, youth groups, health workers, beach management units, in addition to local NGOs and government agencies that relate to any of the three PHE sectors. For HoPE-LVB, Pathfinder International prioritized working with local environmental NGOs to implement the project’s interventions, rather than rolling out all the components on its own. Hence, it was crucial to assess the potential partners and their capacity through visits and interviews with the leaders of these organizations. Ideally, community members and others will be brought in to cross-check their perceptions of the potential organization or group as a partner. In an ideal scenario where there is more time and freedom in the design, the sites could be selected with some scalability criteria in mind, in discussion with stakeholders who come from places where scale-up would likely eventually take place.

3.1.2  Determine Resource Needs

As activity design starts taking shape, the project team will have to determine what types of resources already exist and what types of resources are needed, in consultation with key local stakeholders. Existing resources should be examined and utilized first. Adjustments can be made to existing resources to the specific context of the activity. An example of resources that could be sourced or created would be a PHE training manual designed for local contexts, specialized data collection tools, where to find resources persons to conduct specialized training (such as for alternative livelihoods), where to source raw materials for project inputs (e.g. locally available materials to construct latrines, to start tree nurseries, etc.), and where to turn to for supplemental supplies if there are chronic shortages at health facilities (e.g. contraceptives, assuming demand is going to be created as access improves.

3.1.3 Gathering Data

The next step is to deepen understanding of the socio-economic (including health) and environmental context in which the PHE efforts will be implemented. PHE programs should determine the most appropriate data sources for each of the sectors involved. Depending on resources, projects could collect primary data, using methods considered valid for that sector, or rely on secondary data. Care should be taken to plan to limit the data that will be collected as to avoid collecting data that will not be utilized. Focusing on the information most needed limits the burden on communities and staff.

The following sections contain guidance and required considerations for data collection in each sector. Family Planning and Related Sexual and Reproductive Health Services

Specifically, for women’s reproductive health in the context of a PHE initiative, minimum standard metrics include: data on provision and use of family planning information, services and methods; current use of a contraceptive methods; quality of services provided. It is important to use existing data as much as possible for any PHE program (service statistics, clinic outreach records, etc.) so that efforts could easily be duplicated in other areas. Also, it should be noted that adding 1-2 questions onto an existing data collection form is much more sustainable than creating an entirely new one in terms of compliance and scalability.

Data collection would involve identifying services provided by and identifying the location of the main health facilities and closest referral facility linked to targeted communities, reviewing clinic logbooks or summary forms such as client records for the previous two years (or at least one full year for reference as a baseline) to extract relevant data. Projects should also interview clinic staff responsible for sexual and reproductive health service provision to assess clinic operations and the quality of service delivery. Baseline results should be documented in a highly standardized way to enable the project to assess change over time. The same standardized questions should be used in follow-up data collection.

In addition to clinic-based quantitative and qualitative data collection, relevant information related to sexual and reproductive health beliefs and norms should be gathered via one-on-one and group interviews with a variety of stakeholders. The latter should include women of reproductive age including adolescents/young adults; community health workers; leaders or active members of community women’s groups; male opinion leaders in the community (e.g. village chief, head of the village planning committee); and program managers and other decision makers at a level(s) higher than the community, such as those responsible for sub-national and national programs.

For projects/programs with sufficient resources that plan to implement programming over a long time period (5-10  years) and with adequate intervention intensity to achieve measurable change at the population level, a household survey can be a useful way to secure baseline data and follow-up on knowledge of, attitudes towards, and use of family planning services.  The survey must be carefully designed, implemented, and resourced to produce accurate information. Health

Remote rural communities dependent on a dwindling or damaged natural resource base often face numerous health challenges.  The process of identifying which of these health challenges are most important to the community, cross-referenced with threats to environmental degradation, and related in some way to local gender issues, is another critical step in the PHE analysis process.  This choice serves to unify the PHE strategy and inform decisions regarding which health interventions to support.

The particular health challenge(s) selected can be either acute or chronic, but should be of key concern to the beneficiary population. Many location-specific factors affect which health interventions should be focused upon, which in turn, affects what health data are collected. Another key factor relates to donor support and outcome expectations for that support. In addition to family planning, HoPE-LVB focused particularly on maternal health interventions since this was of special interest to one of the donors, as well as water, hygiene and sanitation (WASH) which was identified by communities and policymakers as critical to public health and environmental conservation. See the data collection tools HoPE-LVB utilized during the baseline.

Information about health can and should be collected through reviewing facility logbooks or conducting interviews with staff. Access to health services and the quality of those services are fairly generic questions that apply, regardless of the targeted health condition(s). Change in prevalence of specific health condition(s) is not easily documented over a short period of time, but household surveys may potentially provide a proxy measure, such as respondent perceptions regarding their health and/or use of health services for a specific condition. Change in knowledge, behavior, and practices to prevent certain health conditions can be measured both qualitatively and quantitatively (e.g. through interviews or through data collection on the establishment of latrines and handwashing facilities, sales of mosquito nets or water purification tablets, and production of fuel-efficient cookstoves).

Keith, a young boy from Bussi Island, washes his hands using a tippy-tap. Environment

Environmental conservation projects, which are founded on the principle of community involvement and which target community development in conservation efforts, routinely conduct participatory rural appraisals (PRAs)2,3,4 as an integral component of project design. By definition, PRAs incorporate the knowledge and opinions of targeted community members in the planning and management of their projects.

PRAs can include a number of different data collection methodologies depending on resources and objectives. Group discussions are a common component, and involve a range of community members. These discussions traditionally focus on community development needs, how community members interact with the local natural environment, the extent to which they depend upon local resources, how that resource base may be changing, how the community functions in terms of furthering their own development, and how the community organizes, or wishes to organize, itself and its desires and actions to maintain environmental integrity while simultaneously furthering sustainable development. Interesting findings could include current positive practices that have been or are being adopted by particular individuals or groups (“first adopters”) that may serve as models for learning by others; and sources of knowledge and support that are currently available and accessible to support these positive practices. Gender issues may not always come up during the PRAs, but for PHE-related projects, the way in which all members of the community (women and youth included) affect local conditions, and are affected by them, should be featured.

A group discussion on Bussi Island in Uganda.

In addition to group and one-on-one discussions with village leaders, opinion leaders, and members of livelihood-related community groups (such as fishers and farmers), PRAs may also incorporate a number of other data collection methods including:

  1. transect walks;
  2. resource mapping;
  3. matrix ranking/scoring exercises;
  4. seasonal calendars;
  5. historical event timelines;
  6. review of relevant quantitative data/records.

See the photo below for an example of community scoring used during a PRA.

For HoPE-LVB, these methods were executed in the following ways:

Example of Community Scoring During PRA

Conservation-related frameworks differ in orientation from health-related frameworks; thus, data collection should reflect this difference. Specifically, conservation goals relate to the state of the environment itself as well as the more localized goal of reducing human threats to environmental conservation. At a minimum, PRAs should document key threat-related behaviors and data on how those behaviors affect the community and the environment. Projects should establish expectations about what targets are feasibly achievable given what is already being done (by the project, the government, and others) within a relevant time frame to maximize gains in all three domains and at their intersection.

The state of the local environment may only be measurable at large scale (e.g. local, national, park, or forest level) and/or over a longer time period than what is possible through any one project. For planning purposes, qualitative information from key informant interviews should be collected on the perceived state of the local environment, specifically the ecosystems relevant to PHE. Quantitative data from fishery, wildlife or other environmental management departments may be available as an additional resource to assess environment interventions. See also section 3.1.1 above on Assessing Ecological Status.

If resources allow, consider collecting quantitative data using the tools and techniques considered most valid by the respective disciplines to serve as baseline for future impact evaluations (e.g. remote sensing analysis, fish catch surveys, wildlife or bird counts). See the tools HoPE-LVB utilized in Section 6 of this Toolkit.

2 Examples include: http://www.kstoolkit.org/Participatory+Rural+Appraisal+(PRA)
3 Robert Chambers. Whose Reality Counts? Putting the First Last Intermediate Technology Publications, London, 1997, p. 106.
4 Rural Development: Putting the Last First, Robert Chambers, 1983, Longmans Gender

Gathering data on gender norms requires thoughtful questioning that should be included as part of the one-on-one and group interviews, as well as any household survey. Projects should specifically target representatives of women’s groups, female school teachers, and female participants in community governance structures to gain a greater understanding of local gender dynamics and gender-related pathways connecting population, health, and environment in the local context. While gender was not an explicit focus of HoPE-LVB objectives, it was a cross-cutting issue that was valued by both implementing partners as well as funders from the start. However, there was insufficient PHE-relevant gender expertise among the project implementing team, and project funds were stretched and did not allow the project team to design interventions and measures that analyzed and documented the gender-specific impacts of HoPE-LVB more fully. The project did develop some measures of success related to increased gender balance as follows: decrease in women’s chore burdens; increase in women’s participation in resource use and governance; men’s participation in family planning and maternal health care; women as PHE champions; women’s participation in decision-making; men’s participation in savings; and women’s livelihood participation. As the HoPE-LVB project was being implemented, agencies such as IFPRI and USAID continued to develop and test tools to measure women’s empowerment as it relates to agriculture5 as well as other useful manuals6 which are highly relevant to PHE programs and should be referenced for future projects.

Harriet and John Lwegaba in their farm on Bussi Island, Uganda.

5 The Women’s Empowerment in Agriculture Index developed by International Food Policy Research Institute (IFPRI) in 2012, available here.
6 USAID’s Guidelines for Integrating Gender into an M&E Framework and System Assessment published in 2016, available here. Another useful resource, Gender and Indicators Cutting Edge Pack, from the Gender and Sexuality Cluster at the Institute of Development Studies’ BRIDGE resource center, can be found here.

3.1.4 Design

After all the necessary data has been collected and analyzed to inform project decisions, the project team should meet to further refine the design of project activities. The guidance from ExpandNet’s “Beginning with the End in Mind” is helpful in determining what would make the most sense to design a project package that is relevant, affordable and implementable with available resources including staffing and local capacities. To accommodate this step, there should be reasonable flexibility built in for the project team to be able to adjust what was written into the project proposal and budget. Alternatively, a donor agency could choose to provide a planning grant as the first step to feed into the design for a larger award, or data collection and project design refinement could be clearly spelled out as a planning phase of the project. Iterative dialogue with beneficiaries and local policy makers during scoping trips, data collection and sensitization meetings with local leaders, as well as with various community groups through a variety of communication channels, have all been critical to HoPE-LVB project’s wide appeal, broad acceptance, community ownership, and eventual demonstration of institutionalization.  (For further detailed information about how HoPE-LVB went about designing the project with scale up in mind, please refer to this article.7)

7 L Ghiron et al. Beginning with sustainable scale up in mind: initial results from a population, health and environment project in East Africa. Reproductive Health Matters 2014;22(43):84–92.

3.2 Implementation

3.2.1 Staffing Your Project

First, a project should establish the core project team, who will be responsible for preparing plans, overseeing project implementation and interacting with external partners/consultants and donors. Core staff should have technical expertise in the population, health, or environment domains as well, ideally, as cross-sector/domain interest and expertise, management capacity and the ability to work using the lenses of gender equity, community empowerment, advocacy, a youth focus and also some specialized skills in planning for sustainability and some knowledge of the science of scaling up. So many skills may be hard to find in any one individual, but taking a team approach and using specialized global and local consultants where needed, one can ensure that as many as possible are represented.

3.2.2 Developing a Work Plan

With the team in place, the next step is to develop work plans. These include annual, quarterly, and monthly plans. Anticipated outputs and outcomes should be directly related to the project objectives. These may include: 1) improved sexual and reproductive health outcomes; 2) improved natural resource management practices; 3) increased access to alternative livelihoods; 4) clear documentation and dissemination of the project’s PHE model; 5) adoption and scale-up plans; and 6) plans for institutionalizing the project’s PHE model in existing health and environment systems and structures at community and governmental levels.

Given the expansive nature of PHE work, it is helpful to prioritize and select the technical areas of implementation to ensure all partners are attuned and can build their expertise across the key interventions. As an example, the HoPE-LVB prioritized interventions are:

Activities HoPE-LVB undertook to advance family planning access:

  1. Provide technical updates on family planning for health center staff
  2. Advocate for commodity supplies, fill gaps when necessary
  3. Mobilize PHE champions from model households and community-based groups (such as women’s groups and beach management units, etc) to disseminate family planning messages and information
  4. Support young mothers to use family planning to space subsequent pregnancies
  5. Ensure quality of care for family planning
  6. Advocate with government at all levels to provide support to family planning budgetary allocations, PHE-friendly policies and to elevate the status of family planning services as a need and right
  7. Focus on educating men about contraception and the importance of male involvement

Activities HoPE-LVB undertook to improve maternal and newborn health:

  1. Strengthen labor and delivery, antenatal, and postnatal health services
  2. Encourage institutional deliveries
  3. Strengthen water, sanitation and hygiene in communities and schools
  4. Improve immunization coverage
  5. Strengthen providers on basic and emergency obstetric care as well as care for other emergencies
  6. Facilitate emergency transport to health services at the community level
  7. Partner with NGO We Care Solar to install Solar Suitcases in health facilities

Activities HoPE-LVB worked with communities on to improve natural resource management:

  1. Institute demarcation and protection of fish breeding grounds with Beach Management Units and Fisheries agencies
  2. Establish tree nurseries, tree planting
  3. Expand access to alternative energy options (e.g. energy saving stoves)
  4. Encourage household-level behavior change (e.g. pit latrines, planting woodlots for fuel wood, not openly defecating) through model households
  5. Adopting sustainable agricultural approaches including composting, using organic and animal manure for farming instead of chemicals, zero grazing, agroforestry

A tree nursery at a HoPE-LVB site in Uganda.

3.3 Monitor and Evaluate Your Project

This section describes how a PHE program might approach monitoring and evaluation (M&E), building on a description of the HoPE-LVB project’s M&E plan. Generally, the steps toward developing a robust M&E plan include:

  1. referring to the theory of change and log frame, which helped develop the project design, to guide the measures of success;
  2. selecting the measurable and most meaningful project indicators;
  3. conducting routine monitoring of selected indicators; and
  4. periodic evaluation of progress and implementation processes not otherwise captured through routine monitoring.

Documentation of implementation is a critical component of all M&E work. Please note that this section assumes availability of resources for investing in M&E, which may not be the case for all groups. Monitoring of programs is feasible even without dedicated funding for this and always plays a vital role in PHE implementation but may look different than what is described below. Those wanting to replicate this M&E approach for their PHE programs may need to adjust their plans depending on available resources. There are also excellent manuals available on best practices for PHE M&E (most notably the MEASURE Evaluation/USAID Guide to Monitoring and Evaluating PHE Programs)8. Consequently, this toolkit chapter focuses primarily on the approach taken by and learning from HoPE-LVB given the needs of funders, feasibility, and constraints on the ground.

8 See MEASURE Evaluation website

Access USAID’s Latest PHE Monitoring and Evaluation Guide

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3.3.1 Log Frame Development and Indicator Selection

A project log frame shows project outcomes, intermediate outcomes, and outputs with corresponding indicators at each level. The HoPE-LVB Phase I project objectives were largely sectoral, so we added a ‘value-added/cross-sectoral approach’ section to the log frame to capture the potential benefits and value-added of an integrated PHE approach. Other PHE programs should adapt their log frame to align with project objectives.

It is best to use an iterative process to select project indicators for the log frame, attempting to balance the needs/desires of many different stakeholders while keeping the indicator list manageable. For HoPE-LVB, the end goal was to develop a streamlined list of essential indicators that were feasible to measure and could reasonably be expected to show change over the project time frame. Keep in mind that all stakeholders will have their own perspective on what is important to measure; thus, the process of reaching consensus can be challenging. The project team may need to make hard choices about what is truly essential to measure, is objectively verifiable, and feasible to collect from the community, rather than what is ‘nice to know.’ Another challenge is including indicators that measure gender mainstreaming and youth empowerment, which are essentials to the HoPE model but are easily missed since they do not easily map onto the P, H, or E sectors. For example, the HoPE-LVB team listed project interventions under each objective and identified a set of corresponding indicators. Then, worked with the project team to obtain consensus on a streamlined list that included sectoral indicators for the PHE sectors as well as value-added and integration indicators. A full Performance Monitoring Plan (PMP) table with corresponding indicators, definitions, data sources, and frequency of reporting was set up. The PMP included: output and effect indicators to be tracked routinely (quarterly); outcome indicators to be tracked annually or at baseline/endline; and impact indicators to which the project would ultimately contribute to but not measure directly. In detail, the HoPE-LVB team used the following approach to develop the log frame and select indicators:

Indicators, by definition, “indicate” or represent a more complex picture. HoPE-LVB aimed to select a subset of indicators that helped paint that picture and that also met these four criteria. To this end, HoPE-LVB went through a systematic process to obtain consensus from all project partners on which indicators met these criteria. The resulting list was included in the log frame. For every indicator suggested, we documented the rationale for selecting or not selecting, per these criteria. Most partners strongly advocated for additional indicators that were ultimately not included in the log frame. The final list was thus already substantially pared-down as a compromise among all partners. To address project partner and donor concerns that not all the indicators they wanted appeared in the final log frame, we agreed that the project could separately track other indicators considered critical for monitoring and evaluating project progress. In the interest of keeping the indicator list short, we purposely chose indicators that addressed a variety of workplan activities (versus just one activity). For example, we chose the indicator ‘% of households engaging in sustainable agricultural practices’ with the understanding that this would cover a variety of agricultural practices being addressed by the project (we asked for specific information pertaining to which of these practices were implemented separately in the baseline/end line studies, but we reported on these practices as one “integrated” indicator).

9 See ExpandNet “Beginning With The End In Mind.”
10 Access USAID’s Latest PHE Monitoring and Evaluation Guide Baseline Data Analysis

A baseline study measures the outcome indicators that are specified in the log frame, and collects baseline information deemed critical by the project team to inform future project design (including validating project assumptions in the log frame and theory of change). The depth of your baseline survey will depend on resources, but it is a good idea to conduct one in any case, as it will inform project design. For HoPE’s baseline study, the team aimed to measure outcome indicators at the population (community) level via a household survey. As described in previous sections, the HoPE-LVB project also conducted a participatory rural appraisal and transect walk with community members to assess ecological threats. This combination of quantitative and qualitative approaches allowed us to obtain information on household practices in agriculture, fishing, etc. as well as to obtain more in-depth information on the reasons behind people’s practices (whether positive or negative). Some of the baseline information contributed to specific project indicators; other information complemented these metrics and was summarized in the form of narrative reports. The baseline also yielded information on other indicators we wanted to track, including in the area of natural resource management11.

One lesson we learned from HoPE-LVB regarding the household survey is that if resources allow, it is best to use a probability-based (e.g., simple random or cluster) household and respondent sampling methodology or post-selection data weighting approach to increase scientific rigor, allow for statistical analyses, and produce generalizable findings.  If resources are insufficient for such a survey, projects might conduct a purposive survey or use another non-probability based sampling technique to gather information from the community to inform project design.  In either scenario, projects should ideally collect data from both male and female participants representing a wide range of ages and if this is going to be undertaken, do so with guidance and support from experts.

After the baseline study, you may want to conduct additional analyses of baseline data. The HoPELVB project team, for example, used this data to calculate key survey variables such as unmet need for family planning, and developed a synthesis report of the baseline study to summarize key findings from the various methodologies applied.

11 The baseline study synthesis report for HoPE-LVB can be found here. Implementing Routine Monitoring

Routine monitoring is important for PHE programs to understand the ongoing effects of the project. Projects might consider following the HoPE-LVB approach of involving stakeholders at multiple levels (project partners, community group members including beach management unit members, village health teams/community health workers, model households, women’s/farmer/youth, and young mother’s groups) for ongoing monitoring. With this approach, data collection and reporting are not left to M&E officers alone, but instead become the collective responsibility of all M&E and program staff. The M&E team still retains overall responsibility of project monitoring (including oversight and management of data collection, quality checks, analysis and reporting); however, program staff and implementing partners are responsible for data collection and monitoring of indicators relevant to their own activities. To this end, the project might want to:

PHE programs might also consider using a mixed-methods approach for measuring project outputs and outcomes. Quantitative methods provide a standard means for comparing indicator values over time, whereas the qualitative methods provide important insights into project dynamics, which are less easily measured but intrinsic to how integrated PHE efforts “add value.”

PHE program monitoring can quickly become confusing and excessive, given the range of stakeholders and community groups involved. To avoid confusion, projects might consider developing a detailed M&E plan explaining team roles and responsibilities, and standard operating procedures for M&E including data collection and flow (see figure below as an example from HoPE-LVB), processing, quality assurance, reporting, feedback, and utilization. PHE programs should also remain open to revising indicators during implementation when needed (if they prove to be infeasible to measure), while recognizing that some continuity of indicators is important to measure trends. The HoPE-LVB team aimed to strike a balance between revising indicators when necessary versus ensuring indicators remained consistent enough to establish trend data over time.

Looking for More Resources?

To see all HoPE-LVB tools, visit Section 6 of our Toolkit. Midterm Review

When implementing PHE programs, it is useful to conduct a midterm review to obtain in-depth information on progress towards project outcomes and the effectiveness of project interventions—depending on the time frame and resources of the program. It may be possible that strong monitoring information which can be used for learning is sufficient. Following two years of implementing the HoPE-LVB project, Pathfinder conducted a midterm review. We used qualitative methodologies including key informant interviews with policy makers, policy implementers, and funders, and focus group discussions with community resource groups participating in the project in order to capture the richness of how and why the project was bringing about change. We also synthesized quantitative  monitoring data to show trends over time for key indicators like use of family planning services, facility based deliveries, and referrals for services made by community group members.

Hearing from Model Household heads about progress

A midterm review should assess:

  1. the effectiveness of project activities and processes in meeting project objectives and beneficiaries’ expectations;
  2. stakeholder’s perceptions about and preparedness to scale up or replicate project interventions; and
  3. lessons learned in integrating population, health, and environment interventions. Sustainability planning should be considered across all assessment areas.

If possible, projects should consider conducting additional analyses as part of the midterm review. The HoPE-LVB project, for example, also conducted an ecological assessment of local ecological measures that are affected by human behaviors/practices12 (both conservation threats and sustainable practices) during its midterm review. The purpose of the ecological assessment was to obtain quality baseline data on a select set of ecological state indicators relevant to the project that could be used to assess the effectiveness of various HoPE-LVB interventions in maintaining biodiversity and ecosystem health. We collected data in sentinel sites (one per country) where integrated project activities had particularly taken root. We chose indicators that were likely to measurably change as a result of integrated project interventions within 6-10 years but for which some change (based on the project’s theory of change) could also be measured within the next 2-3 years.

12 Read the full ecological assessment report here. Rapid Assessments

If the PHE program is divided into two phases and the second phase includes new project sites where scaling up is taking place, it is important to conduct a rapid assessment at the start of Phase II. The HoPE-LVB project, for example, conducted a rapid assessment to inform the second phase of program activities and to provide baseline data for evaluating program implementation in the new and continuing sites. The rapid assessment examined: the needs, perceptions, and interests of project beneficiaries and community groups; the health, livelihood, ecological situation, opportunities, and threats to resources in the target communities; reproductive, maternal, and child health services; population, health and environmental resources in the target communities; and challenges and gaps in the integration of PHE initiatives.

The rapid assessment methodologies included key informant interviews with key stakeholders, focus group discussions with community groups, transect walks, resource mapping, health facility assessments, and an ecological assessment.