2.8 Answers to activities

Activity 2.2: Monitoring specific issues in your practice

1. As a health worker, you have a responsibility to identify risk factors experienced by the children you treat and to take appropriate action as early as possible. Regardless of what action you take in Achen’s best interests, you could also consider an action plan to tackle this issue. This requires that you are aware of risk factors and indicators of all forms of violence and of the local mechanisms of reporting. It is also important to know the extent of sexual abuse and whether children of particular ages, genders or living in particular locations are at risk. Monitoring will help to build up a more detailed picture of sexual abuse.
2. Age, gender and locality are important factors. It will also be helpful to know the relationship with the person who has abused the child, at what age the abuse started, and the impact of the abuse on the child’s health and development. You may have identified other kinds of information that would be useful to collect so you can build up statistical information about child abuse over a period of time.
3. If processes for reporting sexual abuse are in place, then the information collected may already be standard. If detailed reporting processes are not in place, then information about different child abuse cases could be brought together and analysed. As more information is gathered, it may become clearer where sexual abuse is more prevalent and which children are especially at risk.
4. It is unlikely that a single child abuse case will lead to a programme of action to address child abuse in a community. However, analysis of monitoring information can create evidence, revealing the extent of child abuse and which children are especially at risk. Information about a single child may be ignored or explained away. Evidence generated from information about abuse of 50 children is much harder to ignore. It may lead to action that could help to prevent abuse of other children in the future.
5. By planning to gather information, summarise it and produce a report about child abuse in a community, you will be creating an output. Your report is an output. If you know that reporting of child abuse is low in your community, you may want to encourage children and their parents or guardians to tell you. You could establish an indicator to increase the number of reports that are made to you.

Activity 2.3: Knowing who has responsibility for monitoring and evaluation

1. In this example, the health workers had an important monitoring role because they needed to keep records of how many households they visited and how many people they spoke to. The volunteer Community Health Workers had a similar monitoring role in the second stage of the programme.
2. Staff at the EACEWC were responsible for evaluation, collecting data together, summarising it and reporting progress to the Kenyan government.
3. The government had responsibility for making decisions about the future of the programme. By including it in the Community Health Plan, they have indicated that they will support the work in the future, which may affect funding or other resources made available for the project.

It is not obvious from the case study, but in addition to measuring the number of people reached (outputs), information about the outcomes is important, for example whether the programme led to any reduction in health problems, such as food poisoning or malaria infection.

Activity 2.4: Monitoring and evaluating projects

Aim 1 is the primary aim of the project. The project recognises that child abuse cannot be tackled or reduced unless it is reported. If the project is successful, the number of cases reported will increase. This is not an indication that child abuse cases are increasing, but that the reporting of them is increasing. The indicator for this aim, an increase in reporting by 10%, can only be measured if ‘baseline data’ has been established. Baseline data is knowing what the rate is before any action is taken. If there was no baseline data, then the percentage increase could be replaced with the number of cases reported, which can be measured without baseline data. All the community health workers and the paid health worker are involved in recording information and reporting it.

Aim 2 is primarily a measure of output rather than outcome. It is concerned with getting schools involved in the project so that children can be educated about their rights and know how to report abuse. Getting five schools involved in the first year is an indicator of success, but it will also be important to know they are giving children the information the project wants them to receive.

Aim 3 is also a measure of output rather than outcome. It is concerned with educating parents and other adults about children’s rights so they know how to identify signs of child abuse, and can take action to inform children about their rights and protect them from harm. In addition to reaching at least 50 parents through a class, it is important that parents report positive feedback because they are more likely to take the advice seriously if they have felt the experience was worthwhile.

For all of the aims, the senior health worker has a key role in analysing the information received, evaluating the project as a whole, and reporting progress, outputs and outcomes to the NGO funder.