EpiToolkit Monitoring and Evaluation Plan Template

Program information
Program name: ______________________________________________
Program goal: _______________________________________________
Geographic area: ____________________________________________
Target population: __________________________________________
Implementation period: ______________________________________

Theory of change
If we provide __________________ to __________________, then __________________ will improve, contributing to __________________.

Objectives
1. __________________________________________________________
2. __________________________________________________________
3. __________________________________________________________

Indicator reference sheet
Indicator name: _____________________________________________
Indicator type: Input / Process / Output / Outcome / Impact
Definition: __________________________________________________
Numerator: ___________________________________________________
Denominator: _________________________________________________
Data source: __________________________________________________
Reporting frequency: __________________________________________
Disaggregation: _______________________________________________
Baseline: __________________ Target: ___________________________
Responsible team: _____________________________________________
Data quality issues: __________________________________________
Interpretation notes: _________________________________________

Data quality plan
Completeness checks: __________________________________________
Accuracy checks: ______________________________________________
Timeliness checks: ____________________________________________
Consistency checks: ___________________________________________

Data review and use
Review meeting frequency: _____________________________________
Decisions supported by the data: _______________________________
Reporting audience: ___________________________________________