GAMET HIV Monitoring & Evaluation Resource Library

Using Evidence to Ground the Results Cycle

The national HIV/AIDS response involves four key processes that are described briefly below. These processes make it clear that the results cycle should be grounded in evidence: from the policy development process, to strategic planning, managing for results, and results-based M&E.

The policy development process
Strategic planning
Managing for results
Results-based monitoring and evaluation

The policy development process

Policy formulation is inherently a political process – it reflects the priorities of the government currently in power and focuses on how that government communicates to citizens and other stakeholders its position on various issues. Although political in how it is communicated, policy development in most democracies is typically informed by evidence acquired through a rigorous analytical process to guide and justify government action. For example, prior to setting national HIV/AIDS policy, a government would want to know the key drivers of the epidemic, in addition to the views of its citizens on acceptable measures to contain the epidemic.

Strategic Planning

The formulation of a national HIV/AIDS strategy is a process through which a country defines fundamental principles, priority programs, expected achievements and the institutional framework to guide the national response to the epidemic. What makes an HIV/AIDS strategy “strategic” is that it takes into account the underlying determinants of the epidemic and how they affect different social groups, and then carefully selects approaches and actions that will address each group to achieve specified results. Readers may like to consult UNAIDS, 2000, Guide to the Strategic Planning Process for a National Response to HIV/AIDS: (1) Situation Analysis, (2) Response Analysis, (3) Strategic Plan Formulation, and (4) Resource Mobilization; and also ASAP, 2006 Self-Assessment Tool and Guidelines for National HIV/AIDS Strategies.

The social situation and the HIV epidemic change over time, so a strategy has to be flexible enough to adapt in a significant way to these changes and to new information from monitoring and evaluation. Hence the process is shown as a cycle (figure 1) to reflect an iterative process.

The strategy formulation process contributes to shaping policy outcomes and brings together political and technical elements. Interventions and population groups must be selected to be prioritized to receive services, based on evidence of what works and what does not work, and stakeholder support and resources need to be mobilized to implement the strategy. Therefore, the planning team would include individuals skilled at policy-making and social analysis as well as service delivery and cost estimation (see figure 2).

Figure 2: Skills Mix of a National Strategy Planning Team

Source: R. Rodriguez-García, J. Reno and R. Bonnel, GHAP, World Bank, 2007

Traditional planning approaches focus on tracking inputs (financial and human resources) to provide goods and services and to achieve corporate or program goals. Results-based planning applies a logical approach to the use of inputs for implementing projects and programs in order to achieve longer term results with greater societal benefits. The Results Cycle provides added value to the traditional approach to strategic planning in that it helps decision makers look back – at evidence of past achievements and things that did not achieve results – and forward to select priority interventions that would help reach the strategy’s goals. This process is mindful of the country contextual environment for policy formulation and implementation and the role of stakeholders.

Figure 3: Principles of Strategic Planning

Source: GAMET, GHAP, World Bank, 2007

Strategic planning applies a logical approach to define how:

Underlying determinants and biological/social factors affect HIV outcomes and over time demographic outcomes (i.e. health impacts) = conceptual framework;
Programs should operate (i.e., from inputs to impacts) = logical framework;
Policies, strategies and programs achieve goals = results framework.

Managing for Results

Managing for results refers to a comprehensive and integrated management system that focuses on achieving national objectives for the population while assuring accountability for public funds. Earlier defined as performance management (the basis for these three concepts “results-based management”, “managing for development results” and “managing for results” are the same and have the same aim: to improve performance.), managing for results started in the private sector, where it is embedded in all levels of the management structures of many high performing corporations.

Results management enables managers and staff to value open and honest performance assessment and reporting, which in turn improves productivity, accountability and learning. In the 1990s, many governments and the international development community adopted performance approaches and tools in support of more effective development. As results-based management was gradually introduced in the public sector in the 1990s, a more systematic approach to program planning and management became the basis for numerous public sector reforms (OECD-DAC, 2007).

Since 2003, the World Bank has adopted a results agenda to improve Bank operations and achieve stronger results on the ground; i.e., outcomes, defined as specific improvements in the quality of life and economic productivity. A focus on results recognizes that counting inputs, outputs and disbursements is not enough; there needs to be attention to outcomes and impact. A focus on results includes: (i) promoting better financial management, (ii) supporting capacity enhancement and statistical institutions for monitoring and evaluation within countries, (iii) assisting national efforts to disclose and disseminate results information, especially to policy makers, (iv) preparing results-based country assistance strategies, (v) improving monitoring and evaluation components of loans and grants, (vi) promoting pursuit of the MDGs, and (vii) strengthening attention to measuring the success of analytical and advisory work and evaluation efforts (World Bank, 2004b).

A 2006 assessment of the Bank’s results focus approach to development identified several important lessons from country experiences and assistance programs that have delivered the strongest results. Effective programs: (i) emphasize growth and the measures that help the poor share in the growth process, (ii) build on realistic and informed assessments of political commitment, and capacity to deliver results, (iii) combine sustained engagement with clear intermediate outcomes, and (iv) emphasize transparency and local control of public institutions. Effective articulation and utilization of the results-chain is an essential tool for effective aid, together with country capacity to collect and use performance information (World Bank, 2006).

In the international development community, the introduction of management for development results was driven by the recognition that international aid needed to be more effective in improving development outcomes if countries were to achieve the Millennium Development Goals (MDGs). Figure 4 summarizes the evolution of managing for results to increase aid effectiveness.

Figure 4: Evolution of Managing for Results

Source: R. Rodriguez-García, GHAP, World Bank, 2007

Managing for Results uses a variety of tools and processes to generate information that can be used to improve policies, planning, management, monitoring, evaluation and delivery of good and services. The Strategy Results Cycle is such a tool. It responds to a key goal: to provide timely, reliable, and useful feedback about ongoing and completed actions, and to derive relevant strategic implications that are immediately useful in strategy design and program management (Rodriguez-Garcia and White, 2005).

Results-based Monitoring and Evaluation

Increased reliance on information for decision making demands continuous refining of planning and monitoring and evaluation methods. The more so when countries are willing to be held accountable for providing goods and services to their populations through effective use of resources, and for showing partners the outcomes of their investments. It follows that M&E becomes an essential tool for decision makers – a mechanism to collect and provide evidence of outcomes that decision makers need. A results-based monitoring and evaluation system adds the “fourth leg” to the governance chair traditionally built around systems for budgeting, human resources and auditing, providing an essential feed-back mechanism on the outcomes and consequences of government policies and actions (Kusek, Rist and White 2004).

A Results Chain helps identify the logic (cause-and-effect relationships) behind policy and strategy design. It posits that inputs are needed for activities and products and these lead logically to the achievements of outcomes and impacts (see figure 5). It depicts an “if-then” theory of clearly articulated goals coupled with specific expectations of achievement at each stage of the logical results chain (“If-then” refers to the logical progression that if X is done or happens, then Y will follow). So, for example, if pregnant women who are HIV-positive are offered counseling, testing, appropriate treatment and follow-up, then parent-to-child transmission can be reduced.

Monitoring produces the data that managers need to make routine programmatic adjustments towards achieving the desired outputs and outcomes. Evaluation and analytical reviews go a step further to provide the strategic information policymakers need to steer policy formulation and strategy planning towards sustainable outcomes. Together, monitoring and evaluation are critical tools for management, learning and accountability.

Decision-makers manage for results by using information to steer policies and programs to achieve results on the ground, and making decisions that improve learning and knowledge geared towards improving performance and accountability.

Figure 5: The Logical Approach of the Results Chain

Source: Binnendijk, 2000; Kusek and Rist, 2004