Short Abstract

This abstract highlights the Pause and Reflect approach in OVC-IRA’s monitoring and evaluation, showing how regular reflection and trend analysis informed decisions, supported adaptive management, and improved program delivery throughout implementation.

Description

Context

The Infectious Diseases Institute (IDI) implements the Orphans and Vulnerable Children Inter-Regional Activity (OVC-IRA), a three-year, USG-funded program operating across 13 districts in Uganda. The project aims to improve HIV services and overall well-being for children, adolescents, and their caregivers. It brings together a diverse range of stakeholders, including district leadership, community structures, health facilities, and implementing partners, whose roles are crucial in ensuring the acceptability, local ownership, contextual relevance, and sustainability of interventions.

This abstract presents the Pause and Reflect approach embedded within the monitoring and evaluation design of OVC-IRA, demonstrating how systematic reflection on experiences and observing emerging trends informed decision-making, enabled adaptive management, and strengthened program delivery throughout the implementation cycle.

Methods

The Monitoring, Evaluation, Accountability, and Learning (MEAL) approach for OVC-IRA combined robust data systems with participatory learning to continuously improve the program. A key component of this approach is the Pause and Reflect Sessions (P&RS), which gather all project stakeholders to review implementation progress and adapt activities based on lessons learned and results, to collaboratively address any gaps, limitations, or challenges in implementation. This structured approach fosters continuous learning and adaptive management for participatory analysis with project teams, frontline workers, district health officials, and community representatives.

The P&RS, by design, includes stakeholder joint field visits to beneficiaries, youth workshops, community group discussions, and feedback compilation with resolutions documented and tracked. They are themed to address existing gaps by region, sub-population, and gender as per the program areas. Communication was tailored to specific stakeholder groups through infographics, success stories, visual summaries, and QR codes that provided convenient access to program documents. Participatory work planning integrated insights from performance and reflection activities to refine the Theory of Change, optimize resource allocation, adopt effective strategies, and phase out ineffective ones. Together, these activities formed a continuous MEAL cycle grounded in the Pause and Reflect (P&R) methodology.

Findings

The Pause and Reflect sessions transformed evaluation from a reporting exercise into an ongoing learning process. These sessions led to improvements in expanding viral load monitoring and improving adherence support through community-integrated services. Coordination among clinical partners, districts, and communities improved as a result. Participatory feedback sessions fostered collaboration between healthcare providers, program managers, and communities, addressing challenges such as treatment interruptions and disclosure challenges.

Building on these collaborative efforts, district engagement strengthened across planning, supervision, monitoring, and implementation. Local government officials, including Community Development Officers and Probation Officers, assumed stronger leadership roles, ensuring that activities aligned with district priorities and community needs. The program also facilitated direct engagement between local leaders, youth, and women representatives, establishing inclusive platforms that improved accountability and promoted community-led solutions.

Implications

This experience demonstrates that effective communication of evaluation findings requires clarity, co-creation, contextual relevance, and engagement of all stakeholders. The approach of Pause and Reflect sessions promotes sustained engagement and evidence-informed decision-making in complex health systems, offering valuable lessons for evaluations aiming to drive practical change.