TY - JOUR T1 - Systems approach to monitoring and evaluation guides scale up of the Standard Days Method of family planning in Rwanda JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT SP - 234 LP - 244 DO - 10.9745/GHSP-D-13-00165 VL - 2 IS - 2 AU - Susan Igras AU - Irit Sinai AU - Marie Mukabatsinda AU - Fidele Ngabo AU - Victoria Jennings AU - Rebecka Lundgren Y1 - 2014/05/01 UR - http://www.ghspjournal.org/content/2/2/234.abstract N2 - Scaling-up lessons included: (1) simplifying provider training and client materials; (2) ensuring core aspects of the intervention, for example, that the CycleBeads client tool was integrated into the supply chain system; (3) addressing provider-generated medical barriers; and (4) managing threats from changing political and policy environments. A focus on systems, the use of multiple M&E data sources, maintaining fidelity of the innovation, and ongoing environmental scans facilitated scale-up success.There is no guarantee that a successful pilot program introducing a reproductive health innovation can also be expanded successfully to the national or regional level, because the scaling-up process is complex and multilayered. This article describes how a successful pilot program to integrate the Standard Days Method (SDM) of family planning into existing Ministry of Health services was scaled up nationally in Rwanda. Much of the success of the scale-up effort was due to systematic use of monitoring and evaluation (M&E) data from several sources to make midcourse corrections. Four lessons learned illustrate this crucially important approach. First, ongoing M&E data showed that provider training protocols and client materials that worked in the pilot phase did not work at scale; therefore, we simplified these materials to support integration into the national program. Second, triangulation of ongoing monitoring data with national health facility and population-based surveys revealed serious problems in supply chain mechanisms that affected SDM (and the accompanying CycleBeads client tool) availability and use; new procedures for ordering supplies and monitoring stockouts were instituted at the facility level. Third, supervision reports and special studies revealed that providers were imposing unnecessary medical barriers to SDM use; refresher training and revised supervision protocols improved provider practices. Finally, informal environmental scans, stakeholder interviews, and key events timelines identified shifting political and health policy environments that influenced scale-up outcomes; ongoing advocacy efforts are addressing these issues. The SDM scale-up experience in Rwanda confirms the importance of monitoring and evaluating programmatic efforts continuously, using a variety of data sources, to improve program outcomes. ER -