In early June, UNAIDS convened the first meeting of the Measurement and Evaluation Reference Group’s (MERG) Indicator Working Group. The purpose of the MERG is, as its name indicates, to measure and evaluate the performance of the UNAIDS Programme around the globe. The MERG currently tracks some 150 indicators of countries’ efforts to address the AIDS pandemic. (More on that in a future blog.) These indicators, as well as others used by the World Health Organization, the Global Fund to Fight Tuberculosis, Malaria and AIDS, and PEPFAR, represent a hodge-podge of outcome measures developed over the last twenty years to monitor performance with little coherence or coordination.
The Indicator Working Group was first established to develop indicators in response to the resolutions of the last UN General Assembly Special Session on AIDS. Once those indicators were established, the Work Group lapsed. The new Indicator Work Group has been given a broader mandate. It is intended to provide two important functions. The first is to harmonize indicators being used globally, whether by the UNAIDS Programme, its co-sponsors, or independent funding entities such as the Global Fund and PEPFAR. The second is to standardize the process for reviewing and evaluating proposed indicators before they are rolled out to meet the technical standards for quality indicators.
With regard to its first task, the Indicator Working Group has no power to compel international programs to use standardized or uniform indicators. However, all of the key bodies have a seat at the table, and most seem to recognize the burden placed on countries that are expected to respond to multiple bodies that use different measures of effectiveness. At the first meeting, the various bodies indicated their willingness to collaborate even while some continued to assert their autonomy. In addition, the Indicator Working Group grappled with the issues of better data collection on HIV in children and youth under the age of 15 and of the age of 50 or over. In both, there is recognition that the data collected is insufficient to support the development of effective responses. What remains to be seen is whether this will lead to an accord with regard to the expanded use of the Demographic and Health Survey or the development of other instruments to collect the information pertinent to these populations.
With regard to its second task, the Indicator Working Group has more clout. In 2010, the MERG adopted a set of Indicator Standards and established the process of independent review by Indicator Review Panels comprised largely of technical experts to vet proposed indicators against these standards. The Indicator Work Group is intended to provide a body of experts from which review panels can be organized. Indicators that successfully pass this review will go into the UNAIDS database of indicators. Other indicators will not be included in this central repository.
The challenge will be whether the Indicator Review Panel can create an efficient and widely accepted review system. To that end, the Work Group established its first review panel for the purpose of reviewing eight newly proposed indicators that look at HIV stigma both in the general population and in healthcare settings. This panel is scheduled to conclude its review by November. If these indicators are approved, they will not only provide a successful test of this new review system, but they will provide the first widely accepted indicators that can be used to measure stigma, a key factor in an effective AIDS response.
The NGO delegation to the PCB has a seat on the Indicator Working Group and is participating in its first review panel. We will keep you abreast of the work of this technical but potentially very important group.