3. Monitoring, Evaluation, Accountability, and Learning

Introduction

This guidance document is for CARE staff, MEAL specialists, and team leads for how to assess Sexual and Reproductive Health needs in Emergencies and how to monitor the activities using the tools templated in the Annex section.

Assessment

Assessment is a critical step in emergency response and several different assessment tools were developed to help data collection, including the Initial Rapid Assessment (IRA) tool developed by the Inter-Agency Standing Committee (IASC). See the “Assessments” section for this tool and more information on assessments.

In SRHRiE, health facility assessments are conducted by the team lead in coordination with the SRH focal point. The following tools are used in SRHRiE:

(a) Acute emergencies

• For a rapid health facility assessment in SRHRiE, use the Initial Rapid Assessment (IRA) Field assessment tool (Annex 26.1) which is a joint needs assessment tool that includes SRH as well as infection disease and child health. For health facility assessment, use part two of the form.
• For a rapid SRH assessment, kindly use the MISP checklist tool. The Minimum Initial Service Package (MISP) is a series of crucial actions required to respond to reproductive health needs at the onset of every humanitarian crisis (Annex 26.2).
• After a rapid assessment, an in-depth assessment is essential to tailor activities and address the unique needs of communities in emergencies. The SRH cluster developed the in-depth SRH assessment tool (Annex 26.3) for general information and for health facilities. (Annex 26.6)

Qualitative:

• • MISP qualitative tools (Annex 26.4): FGD guides to assess immediate SRH needs in line with the MISP have been developed for specific age groups and populations that may be used in the early stages of an emergency.
  • If you are doing a rapid gender analysis, kindly use the Sector Specific Questions that relate to the SRH sector (Annex 26.5).
  • The SRHR Minimum Commitments for Gender and Inclusion self-assessment questionnaire includes 5 minimum commitments to make gender sensitive and inclusive programming tangible, simple and practical (Annex 26.5.23).

These different assessment tools are available in paper forms and can be undertaken using smart phones/tablets and free data collection software such as Kobo Toolbox.

(b) Protracted-settings; CARE’s Nexus Approach to SRHR

• Comprehensive health facility assessment (similar to the in-depth SRH assessment tool) (see Annex 26.6)
• Situation analysis that determines social and gender norms to identify barriers to SRHR to inform community outreach and mobilization strategies (see Annex 26.7)

Find the assessment tools listed here. (Annex 26.1-7)

Monitoring

Monitoring is important during emergencies to allow changes to reach the needs of the affected populations. For additional guidelines, see the monitoring and evaluation page of the CARE Emergency Toolkit. The SRHRiE cluster developed some data collection tools to monitor data:

Acute emergencies (First 3 -6 months)

• Data collection form (Annex 26.8) including instructions on how to use the tool

This form can be utilized at mobile health clinics and/or health facilities at the beginning of an emergency. It is recommended to adapt this form in alignment with requirements of the local government and/or health cluster and/or SRH sub-working group data collection systems.

Daily Activity Report (Annex 26.9)

This word-based form can be utilized to collect SRH awareness and community-based surveillance data during community activities.

Result summary (Annex 26.10) including instructions on how to use the tool

This excel-based document can be utilized to summarize your data on a monthly basis. This document should be used in the first 1-3 months of an emergency after which it is recommended to transition to a DHIS2 based system as noted in the next step.

Monthly Activity Report (Annex 26.11)

This word-based document can be utilized to summarize community activities data on a monthly basis.

As soon as the situation allows, 

• The electronic database Data Information System at CARE (DISC) based on DHIS2. A user ID will be created for each emergency country (https://srhedata.care.org/dhis-web-maintenance/index.html#/list/otherSection/legendSet)
• In line with CARE’s nexus approach to SRHR programming, for more comprehensive monitoring, use these toolkits (Annexes 26.12 and 26.13) which includes MEAL components for competency-based training checklists and follow up, health facility supervision tools, client consultation cards, registers, community engagement tools, and community engagement log frame.

Indicators

The SRHRiE indicators should be based on the context and be linked the project MEAL framework if one exists. The following table provides some examples of SRHRiE indicators. Additional SRH indicators can be found in Sphere.

Core indicators

• Number and percentage of disaster/crisis-affected people supported through/by CARE who accessed at least one SRH service including STI treatment, family planning provision, delivery by skilled birth attendant, clinical management of rape, referral for EmONC, CMR, ANC or PNC.

SRHR indicators

Supplementary sectoral indicators

• Indicators based on Humanitarian – SRHR
• SRHRiE 1: Proportion of health facilities providing at least 3 contraceptive methods (aside from condom) at the time of the visit
• SRHRiE 2: Number and percentage of deliveries attended by skilled personnel in health facilities
• SRHRiE 3: Number of clients that receive STI services
• SRHRiE 4: Number of clients that receive clinical management of rape (including psycho social support)
• SRHRiE 5: Number of clients referred to Emergency Obstetric and Newborn Care services

After Action Review

When there is an SRHR component to an emergency response, it is critical to undertake an After-Action review to identify lessons learned and strengthen future emergency programming (Annex 26.5.29).