Skip to main content

What is Community-Led Monitoring?

Community-led monitoring (CLM)  is a social accountability mechanism led by communities to identify and articulate the health issues, service issues or inequalities they face. Communities routinely gather data at health services or other sites, analyse it, and use it to inform action.

CLM has existed in many forms for decades. It is used for a range of issues, including quality of HIV, tuberculosis, malaria, and COVID-19 services, abuse of human rights, the state of sexual and reproductive health and rights, threats to the environment, and climate change.

There is strong evidence that CLM can improve the quality, effectiveness and impact of programmes. In CLM, communities engage directly with services and service recipients. They analyse findings and then advocate and engage with stakeholders in government and other sectors to identify and implement solutions based on the findings. Communities with established CLM programmes often pinpoint and address challenges before they become major problems. CLM programmes can strengthen channels of communication between communities, government and policy makers. Often, CLM builds trust and identifies pathways to rapid action.

What kinds of programmes is CLM for?

Community-led monitoring programmes have been an integral part of HIV, TB and malaria health services for more than a decade – and, indeed, have yielded the most robust evidence of CLM impact in the health arena.

CLM was included in the US President’s Emergency Plan for AIDS Relief country planning guidance in 2020 and is a condition for PEPFAR funding of country-based programmes.

CLM is an important part of the objectives of the 2023-28 strategy of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has funded CLM in more than 60 countries to date.

UNAIDS, the global partnership of UN agencies working to end the AIDS pandemic by 2030, has documented the impacts of CLM. These include:

  • Improvements in health systems and improved health outcomes:
  • Drastic reductions in medication stock outs (Democratic Republic of Congo)
  • Increased childhood immunization rates and decreased absenteeism and wait times (Uganda)
  • Increased viral load testing coverage, HIV virologic suppression and understanding of the link between undetectable viral load and “untransmittable” (U=U) status (South Africa, Zambia)
  • Removal of barriers to accessible health services:
  • Abolition of user fees for HIV-related services, a major barrier to uptake of services (several countries)
  • Identification of requirements and/or clinic protocols that deter individuals from seeking care, and successfully implementing changes to ensure access for all (Malawi, South Africa, Uganda and others)
  • Rapid responses to emergent pandemic and outbreak threats:
  • Shifts towards multi-month prescriptions and other interventions that have decongested clinics and ensured continuity of care (India, Togo and others)

More on the global CLM program can be found here.

CLM in Papua New Guinea - the KPAC model

Background to CLM in PNG

The objectives and activities of KPAC’s CLM initiative are to:

The activities of the Community-Led Monitoring are as follows:

KPAC PNG's CLM Framework

The KPAC Community-Led Monitoring (CLM) Framework is a nationwide system that amplifies the voices of key populations and people living with HIV through three interconnected platforms — Virtual Spaces, Communities, and Facilities — delivered via five monitoring modules that capture real-time, routine, and observational feedback. Data is collected and analysed against seven key dimensions of service quality, including accessibility, availability, acceptability, equity, respect, effectiveness, and responsiveness, measured through fourteen community-defined quality indicators. Together, these elements form a robust, evidence-based framework that informs advocacy, drives accountability, and strengthens the overall quality and inclusiveness of the HIV response in Papua New Guinea.

KPAC CLM Platforms

KPAC delivers CLM across three separate platforms:

1. CLM in Virtual Spaces (continuous)

This platform provides ongoing monitoring and feedback through digital and communication channels. It enables key populations and people living with HIV to connect with KPAC through calls, text messages, social media, and email, or to visit the KPAC office when needed. Operated by the KPAC National Response Center team and supported by provincial delegates, this virtual platform captures community experiences in real time, offering a safe and accessible way for individuals across PNG to raise concerns, seek information, and report issues related to service access and quality.

2. CLM in Communities (routine)

Conducted regularly throughout the year, this platform gathers direct feedback from key populations within their own communities. Through structured interviews and community forums, monitors collect insights from those who have accessed health services, as well as from individuals who have not, to understand barriers, service experiences, and unmet needs. This community-level engagement creates space for open dialogue, strengthens local accountability, and helps track progress in improving access and quality of care over time.

3. CLM in Facilities (continuous)

This platform focuses on the quality of services delivered within health facilities, using ongoing, client-based observations. Community monitors visit health facilities and assess service delivery from a client’s perspective, including respect, confidentiality, timeliness, and responsiveness of staff. These insights provide evidence for improving service delivery environments and help ensure that facilities are meeting the expectations and rights of key population clients.

KPAC CLM Modules

CLM Module 1 – KPAC National Response Center

Focus: Real-time feedback, support, and issue reporting through direct communication channels.
How it works:
Operated by trained Response Center Operators, the National Response Center is open several days a week and serves as a central point of contact for key populations and people living with HIV. Community members can call the landline or mobile number, send messages through Facebook, Messenger, WhatsApp, or email, or visit the KPAC office in Port Moresby. The Center records and responds to concerns, service access challenges, rights violations, or general inquiries, ensuring quick follow-up and referral to appropriate support or advocacy channels.

CLM Module 2 – Social Media Monitoring

Focus: Tracking community discussions and feedback through social media platforms.
How it works:
KPAC’s provincial delegates in Morobe and Eastern Highlands oversee the organisation’s Facebook page, Messenger, and WhatsApp groups to monitor public posts, private messages, and comments. They identify emerging issues, misinformation, or service complaints raised by community members and document these for inclusion in the broader CLM data system. This module provides a digital pulse on community sentiment and helps KPAC respond promptly to online concerns. It is supported by the Global Fund.

CLM Module 3 – Facility Exit Interviews

Focus: Understanding client experiences immediately after accessing services.
How it works:
Community monitors conduct structured interviews with key population clients and people living with HIV as they leave health facilities. Using a standardised health service quality scorecard, they gather feedback on factors such as confidentiality, respect, waiting times, and service availability. Conducted approximately every four months, these interviews provide quantifiable data on service quality and client satisfaction that inform both community advocacy and health system improvement efforts.

CLM Module 4 – Key Population Community Forums

Focus: Collective dialogue and feedback from community members on access and quality of services.
How it works:
Community monitors convene small forums 1–3 times per year, engaging key population members who have accessed services in the past six months, as well as those who have not. Participants use a scorecard and discussion tools to identify barriers, successes, and priorities for improvement. These sessions promote community voice, accountability, and solutions-oriented discussion, ensuring that recommendations come directly from lived experiences.

CLM Module 5 – Mystery Client Facility Observations

Focus: Assessing service delivery from a client perspective through unannounced visits.
How it works:
Trained community monitors act as “mystery clients,” visiting health facilities to experience and evaluate service delivery firsthand. Using an expanded scorecard, they assess staff attitudes, privacy, confidentiality, responsiveness, and overall service quality. Conducted once every four months, these observations provide candid, independent insights into how services are delivered in practice, complementing feedback from other modules and strengthening accountability between facilities and the communities they serve.

KPAC CLM Key Dimensions

CLM under KPAC PNG uses a standardized, evidence-driven framework to assess the quality of HIV and health services. This framework focuses on seven key dimensions:

KPAC CLM Quality Indicators

To ensure objective measurement, 14 structured quality indicators are applied across these dimensions, feeding into a CLM Scorecard System that ranks and scores service delivery points. This tool enables communities and health providers to identify strong performers and areas needing improvement.

 A1. You had information on the service before going to the facility.

 A2. You were given more information on the service when you were at the facility. 

 B3. You did not wait for more than 1 hour before being served at the facility.

 B4. You did not delay going to this facility the moment you felt that you needed the service (did not hesitate because of inaccessibility like distance).

 C5. You were provided with the service you intended to avail in the facility. 

 C6. You were given information (became aware) on how or where to avail for services that were not available in the facility. 

 D7. You were not asked to pay for the services availed to you. 

 D8. You were not expected to use your personal money (expected service to be free) to spend on items (medicines, etc) related to the service.

 E9. You were provided with at least one service specific to your need as KP. 

 E10. You were provided with at least one service specific to my need as a Young Person (<25yo).

 F11.  You did not feel stigmatized or discriminated at the facility. 

 F12. You did not feel afraid to avail of the service as you did not worry that someone may learn your status (as KP or PLHIV). 

 G13. You were aware of a mechanism or a person to make complaints related to the services at the facility .

 G14. You fully understand the information provided by the service providers at the facility.

CLM 1 and CLM2 Recipes

Ingredients

Directions

Step 1 Prepare the CLM tools/forms, mobile phone and venue for receiving the call/message

Step 2 Receive a Call or Message. The RCOs receive incoming calls or messages from various sources, including the National Response Center phone number (mobile or landline) and social media platforms such as WhatsApp, Facebook Page, and Facebook Messenger.

Step 3 Use the CLM 1 Tool – Response Center Issue Documentation Form. The RCOs utilize the CLM 1 Tool – Response Center Issue Documentation Form (latest is v.1.0 2022.05.19) as a template during the call or message handling process. This form serves as a standardized tool to record essential details of the interactions.

Step 4 Fill out the Form. The RCOs complete the fields in the Response Center Issue Documentation Form based on the information provided by the caller/message sender or available through the conversation. They enter details such as their own name as the operator, the date and time of the call, the duration of the call, and the caller’s information, as relevant.

Step 5 Capture Caller/Message Sender Information. The RCOs record relevant details about the caller/message sender including the caller’s name (if consent is given), sex (male, female, or prefer not to say), age and/or age range (categorized in groups such as less than 12,… over 45), and the location of the caller/message sender.

Step 6 Document Issue Category. The RCOs select the appropriate issue category that best represents the subject matter of the call, such as HIV, STI, TB, GBV, COVID-19, or other relevant categories. This helps in categorizing and organizing the collected data for further analysis.

 Step 7 Record Additional Remarks. The form may include a section for additional remarks, allowing RCOs to provide any pertinent information or details that are not covered by the predefined fields.

Step 8 Document Actions Taken. RCOs note down the actions they took during the call or message handling process, such as providing information, offering support, or referring the caller to relevant resources or services.

 Step 9 Note Follow-up Actions. If there are any follow-up actions required, the RCOs document them in the form. These actions may include scheduling a callback, notifying other departments or organizations, or providing guidance to the caller.

Step 10 Submit to Supervisor. After completing the Response Center Issue Documentation Form, the RCOs submit the filled-out form to their supervisor for quality checking and further processing.

Initial Results

KPAC CLM 1 and 2 Results (2023)

Observed gaps

Tools

The Tools

CLM 3 - Facility Exit Interviews

CLM-3 are ‘Facility Exit Interviews’.

These are conducted among KP (Key Population) and PLHIV (People Living with HIV) using a scorecard, and undertaken routinely – approximately 1-4 times per year. 

CLM 3 ‘Recipe’

Ingredients

Directions

Preparation stage

Step 1

Coordinate with government officials and comply with Protocols.  During the initial coordination meetings, the CLM team introduce the CLM concept and start generating buy-in. Obtain permission to visit the facilities and conduct exit interviews.

Step 2

Organize CLM Teams. KPAC forms three teams, each consisting of three monitors, one of which is designated as team leader, who will be responsible for conducting the interviews and collecting responses from the KP community members who just accessed an HIV or health service in a facility .

Step 3

Prepare the logistics for the facility exit interview.

Step 4

Meeting of the CLM teams to discuss the plan for the exit interview.

Conduct of Facility Exit Interview

Step 1

CLM teams visit designated health facilities according to schedule and pay courtesy call to the facility head and scout interview venues.

Step 2

Conduct exit interviews with the respondents. The respondents are individuals from key populations who have accessed health services. CLM monitors approach a client after receiving services, greet, make introductions and obtain consent to interview; if consent is given, the monitor proceeds in administering the Exit Interview questionnaire (scorecard)

Step 3

Use the CLM 3 Tool-Exit Interview Scorecard. Monitors will use the CLM 3 Tool-Exit Interview Key Populations Scorecard (latest v.8.0 2023.05.25), a template designed to gather information about the respondent’s background, their visit to a health facility, and their perception or experience of the quality of services received.

Continue with Health Services Scorecard: The scorecard section of the template measures the quality of services based on various indicators. Ask the respondents to rate their experience using a scale of 1 to 4 for each indicator, covering the 7 As of quality of services: awareness, accessibility, availability, affordability, appropriateness, acceptability, and accountability. Ask for  Additional Information on specific responses explaining low scores on specific indicators of the 7 As, inquiries about any other services needed, and dates.

Step 4

Record Data on Hard Copy Forms (scorecard): Monitors record the responses obtained during the exit interviews on hard copy forms. The data collected includes information such as the date of last access, province, district, name of the facility, main service availed, additional services availed, sex, gender identity, gender expression, gender preference, key population group, age, birth month, and birth year.

Step 5

Conclude the interview and thank the respondent.

Step 6

First-Level Quality Assurance Check. After completing all the forms, the monitors submit the filled-out forms to the team leader for a first-level quality assurance check. The team leader reviews the forms to ensure they are properly-filled and the data is accurate.

Step 7

Second-Level Checking and Coding. The team leader then submits all the quality-checked forms to the supervisor for second-level checking and coding. The supervisor further examines the forms for quality assurance and assigns appropriate codes to the collected data.

Step 8

Signatures and Submission. The monitors, team leader, and supervisor sign the completed forms to confirm their involvement and validate the data collected. Once all the necessary forms are completed, they are submitted to the appropriate officer for further analysis and decision-making.

 The above description outlines the general steps involved in the data collection process based on the information provided and observed during the consultants’ visits and observation of Round 3 exit interviews in 2 clinics.

CLM 4 - Community Forums

Ingredients

Directions

Preparation Stage

Step 1

Train the Community Champions (KP Consortium Monitors) how to assist key population members in filling out the forms A & B completely and accurately. They should be briefed on their roles and responsibilities, including understanding CLM 4 purpose and methodology.

Actual data collection

Step 1

KPAC officers requests forum participants to indicate whether they have accessed any health services in the past 6 months of not.

 KPAC monitors then distribute appropriate forms to community forum attendees. Key population members who have accessed services receive Form CLM 4 Tool A – Community Forum Key Populations Scorecard (latest v.5.0 2023.04.27), while those who have never accessed services receive Form CLM 4 Tool B – Community Forum Key Populations Baseline Info in Non-Access of Services (latest v.5.0 2023.04.27).

Step 2

KPAC Monitors and Community Champions assist KP members in in completing the forms. They guide them through the questions and ensure the accurate collection of all necessary information. The respondents’ responses are recorded accurately by the KPAC monitors or community champions.

Step 3

Data Management. Once the forms are filled out, the KPAC Monitors and Community Champions collect all the completed forms. They hand over the forms to the supervisor for safekeeping and endorsement. This step ensures the data’s security and reliability throughout the process.

Step 4

Encoding and Data Processing. The supervisor forwards the collected forms to the KPAC analyst responsible for encoding and processing the data. The analyst carefully enters the collected information into a data processing system or software for further analysis.

Step 5

Quality Assurance. After the data encoding is complete, a quality assurance check is conducted to ensure accuracy and consistency. The supervisor or another designated officer reviews the encoded data and cross-checks it against the original forms to identify and correct any errors or discrepancies.

Initial Results

Tools

Facility Observations through mystery clients

Ingredients

Directions

Preparation stage

Step 1

Selection of Mystery Clients. Representatives from key populations, known as mystery clients, are chosen to conduct assessments of facility services. These mystery clients act as anonymous evaluators and provide valuable insights based on their firsthand experiences.

 Step 3

Prepare the tools and brief/train the Mystery clients on how to use the tools.

Step 3

Facility Visit Scheduling. Mystery client visits are scheduled to occur every four months. This regularity allows for consistent monitoring and evaluation of the facility’s performance over time and allows for the identification of trends, gaps, and improvements in the quality of services provided.

Actual data collection

Step 1

Mystery clients go to the assigned facilities and utilize various tools to collect data, including the Facility Observation Tool (Version 3.0), CLM Monitors Daily Log, Data Dictionary, and Profiling tool. During their facility visits, mystery clients interact with staff, observe services, and ask specific questions related to the assessment indicators.

Mystery Clients carefully document their observations, interactions, and experiences using these tools. The scorecard provided in the Facility Observation Tool is completed based on their interactions and observations, capturing different aspects of the facility’s performance. Additionally, mystery clients maintain a daily log to provide further context and support for their assessments. This documentation serves as valuable data for analysis and evaluation.

Step 2

Submission and Analysis. After completing the assessment, the mystery clients submit their scorecards and documentation to the KPAC CLM supervisor. The supervisor analyzes the data, validates the findings, and identifies areas for improvement.

Step 3

Facility Validation and Improvement. The assessments conducted by mystery clients, along with facility exit interviews, contribute to the validation of facility performance. The findings help identify areas that require attention or improvement, enabling targeted interventions to enhance service quality.

Initial Results

Enhanced Service Understanding

Data-Driven Improvements

Observed gaps

Data Quality and Documentation: 

Training and Capacity Building:

Tools

Tools List (as of June 2023)

Data collected from KPAC's CLM in Papua New Guinea (2022 - 2025)

Findings from the Data

Click here to visit the CLM Results Dashboards for the 2023 – 2025 period.

Below, you can also read a summary of the findings from this period, under each of the 7 key standards.

Awareness of the Services

Indicator

  • Information about the facility services are disseminated outside the facility (catchment area). 
  • Providers are providing additional information about the service and the facility.

Findings
There were clients who did not know about the services of the facility before going to avail of the service despite living with the community around the facility.

Recommended Actions to Improve Awareness

In the facilities

In the surrounding communities

  • In partnership with KPAC and other organizations in the province (HWW, APNG, WVI, etc)

Accessibility of Services

Indicator

  • Clients did not wait for more than one hour before the service was provided. 
  • Clients did not hesitate to go to the facility (because of accessibility issues).

Findings

There were clients who waited for more than 1 hour or up to 4 hours before the service were provided. 

Recommended Actions to Improve Accessibility

In the facilities

In the surrounding communities

In partnership with KPAC and other organizations in the province (HWW, APNG, WVI, etc)

Availability of Services

Indicator

  • The intended service was available and provided. 
  • For services that were not available, clients were provided information where to avail it (or referred).

Findings

  • Some staff of the facility were unaware of the services available in the facility. For example, the HIV team were not aware if there are Xray services for TB diagnosis.
  • The printed profile of the facilities are outdated. Some services listed are no longer available.

Recommended Actions to Improve Availability

In the facilities

In the surrounding communities

In partnership with KPAC and other organizations in the province (HWW, APNG, WVI, etc)

Affordability of Services

Indicator

  • Client did not pay for or did not use its own money for the services provided (on services that are free).

Findings

  • Some clients were required to pay for the service, despite of the expectation (general knowledge) that HIV tests, STI consultations, diagnosis, treatment and other services are supposed to be free.

Recommended Actions to Improve Affordability

In the facilities

In the surrounding communities

In partnership with KPAC and other organizations in the province (HWW, APNG, WVI, etc)

Appropriateness of Services

Indicator

  • Services specific to KP were provided. 
  • Services specific to young person (24 and younger) were provided.

Findings

  • There were no services specific to KP and Young People. 
  • HIV, STI, TB services were provided to all who go to the facilities.
  • As an example, there are no KP youth peer counsellors,  no transgender-specific information or counselling services (to discuss TG-specific issues).

Recommended Actions to Improve Appropriateness

In the facilities

In the surrounding communities

In partnership with KPAC and other organizations in the province (HWW, APNG, WVI, etc)

Acceptability of Services

Indicator

  • Client did not feel stigmatized or discriminated when the service was provided.
  • Client did not feel afraid to access the service (did not worry about other clients knowing its KP or HIV status).

Findings

  • There were clients who reported some experience of stigma or discrimination while receiving the services. They were:

Recommended Actions to Improve Acceptability

In the facilities

In the surrounding communities

In partnership with KPAC and other organizations in the province (HWW, APNG, WVI, etc)

Accountability of Service Providers

Indicator

  • Client is aware of mechanisms to report complaints about the service.
  • Client feels confident that the provider made him/her fully aware of the service provided.

Findings

  • Multiple clients were not aware where to raise issues or report complaints about the service or the providers.
  • There were very limited client feedback mechanism as this is not part of the PHA and facility policy.

Recommended Actions to Improve Accountability

In the facilities

In the surrounding communities

In partnership with KPAC and other organizations in the province (HWW, APNG, WVI, etc)

Close Menu

HEAD OFFICE

KPAC Sunset Community Hub
Michelle Building, Lot 20, Section 53 (Cnr Ago/Ume Streets) Gordons
National Capital District
Papua New Guinea

T: +675 325 5007
E: executive.director@kpacpng.org