Evaluation Framework

I have been struggling to develop an idea of how to approach the conduct of this evaluation and it is has been difficult without having more specific details to work with at this time.

I recently received some good advice about trying to think of a general framework for how to conduct this evaluation of the programs that have been implemented at St. Francis Health Services before I travel to Uganda.  So based on what I know so far, this is how I have put together a rough framework for this evaluation:

Mission Statement: To conduct a complete evaluation of all programs that have been implemented from 2005-2010 at St. Francis.

General top-level list of programs at St. Francis (as I understand them today):
– Treat HIV-infected patients and any secondary infections – such as T.B, etc.
– Provide counseling and medical services to infected and affected people.
– Promote HIV/AIDS prevention and awareness.
– Other support services – such as income generating activities, address orphans and vulnerable children support, support for grandmothers (or “grannies”).

Suggested Breakdown for Evaluation: Three major categories to examine – 1) Treatment activities; 2) Prevention activities; 3) Outreach activities.  A possible fourth category could be to look at the internal organization itself (i.e. fundraising activities, personnel management, record keeping, etc).

Basic Assumptions:
– That adequate records have been kept for at least the past five years.
– That I will have access to the appropriate staff, volunteers, and treatment/service recipients that I will need to talk to.
– That I will have adequate resources to conduct the evaluation and to write the report.
– That my five months or so at St. Francis will be adequate time to conduct the evaluation. – That my initial approach of examining one program at a time will be appropriate.                                                                                                                                                                          Key References: St. Francis Health Care Services Five Year Strategic Plan, 2007/8-2011/12; Uganda AIDS Commission National HIV & AIDS Strategic Plan, 2007/8-2011/12; Uganda AIDS Commission National Performance Measurement and Management Plan; Uganda AIDS Commission National HIV/AIDS Performance Measurement and Management System: Operational Handbook.

A concern I have is how I will be able to “measure” the effectiveness of a program.  For instance, the program for providing HIV/AIDS awareness relies on how people would react to a campaign to educate people on how to deal with the impacts of the epidemic.  A story I read in one of the initial reports from St. Francis spoke about a boy (Joshua) who was laughed at and ridiculed by classmates at his school whenever he pulled out his tin of anti-retroviral treatment (ART) medication.  He was so humiliated by the experience that he would skip medication.  The result was that he got sicker and almost died apparently.

The question I ask myself is how do you measure a program that tries to address situations like this?

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