Download Introduction to the Compendium of Indicators for Monitoring and

Compendium of Indicators for
Monitoring and Evaluating
National Tuberculosis Programs
Objectives of Session
• Provide an overview of the development of
the Compendium
• Explain the organization of the
Compendium and how indicators are used
• Provide examples of how each subheading
for an indicator guides selection/use of
indicators
What is the Compendium?
A comprehensive and standardized collection
of the most widely used and recommended
indicators for monitoring and evaluating
National TB Programs.
Who is it for?
• NTP managers, data managers, regional and
district officers
• NGO program managers/data managers
involved in TB programming
• Evaluation specialists
• Health system planners (HMIS, etc.)
Anyone with responsibility for collecting,
processing, analyzing, and presenting data
on tuberculosis programs.
Specific Objectives
• Standardize M&E terminology across indicators
and programs
• Encourage consistent use of indicators to monitor
and evaluate programs
• Provide guidance for the development of
comprehensive evaluation plans
• Serve as a resource for the different components
of the monitoring and evaluation process
Current status of TB M&E
• Patient follow up/case management using
WHO-standardized forms
• Small number of indicators focusing on
outcomes of DOTS implementation
• Project-specific monitoring forms
• Periodic assessment visits at facility level
Why a new TB M&E Guide? (1)
• Need for a broader view of M&E
• Inputs-processes-outputs-impact: allows
better understanding of how to achieve
impact
• Standardized guidance for global use
• Program-based to complement casemanagement
• Program-specific indicators for different
settings, types of programs
Why a new TB M&E Guide? (2)
New Global Initiatives
• Global Fund for AIDS, TB & Malaria
• STOP TB Partnership
• Increased USAID involvement
• TB/HIV initiatives
• DOTS Plus
M&E Framework for TB programs
INPUT
PROCESS
OUTPUT
OUTCOME
IMPACT
Policy
environment
Management
Diagnostic
services
Case detection
Prevalence of
TB infection
Human and
Financial
Resources
Infrastructure
Training
Drug
management
Laboratories
Communication
Advocacy
Treatment success
Treatment
services
Prevalence of
TB disease
Improved
knowledge,
attitudes, and
practices
TB morbidity
TB mortality
Reduced
stigma
p7, Compendium of Indicators for Monitoring and Evaluating National Tuberculosis Programs
USAID, MEASURE, CDC, WHO, IUATLD, KNCV, MSH. WHO/HTM/TB/2004.344, August 2004
Expansion of M&E activities
• Framework links inputs, processes to
outputs, outcomes, impact
• Standardized indicators for global use
• Program-based to complement case
management
• Program-specific indicators for different
settings, types of programs
International M&E Guidance
• Provide most useful indicators for monitoring
and evaluating TB control programs
• Encourage use of standardized definitions of
indicators and terminology across programs,
countries and donor agencies
• Provide measures of process and output linked
to program activities
• Promote process and impact evaluation of TB
control programs
M&E Framework for TB Programs
INPUT
PROCESS
OUTPUT
OUTCOME
IMPACT
Policy
environment
Management
Diagnostic
services
Case detection
Prevalence of
TB infection
Human and
Financial
Resources
Infrastructure
Training
Drug
management
Laboratories
Communication
Advocacy
Treatment success
Treatment
services
Prevalence of
TB disease
Improved
knowledge,
attitudes, and
practices
TB morbidity
TB mortality
Reduced
stigma
p7, Compendium of Indicators for Monitoring and Evaluating National Tuberculosis Programs
USAID, MEASURE, CDC, WHO, IUATLD, KNCV, MSH. WHO/HTM/TB/2004.344, August 2004
Compendium Development
• Step 1: Assessment of existing M&E systems
within National TB programs and MOH
• Step 2: Create an international TB M&E Working
group to develop and review indicators
• Step 3: Field test indicators in selected countries
• Step 4: Build capacity in M&E to collect,
disseminate and use information
Step 1: Assessment of current
M&E systems
• Field visits to examine M&E systems: data
collection forms, reporting, supervision,
data use
• South Africa, Russia, Honduras, Philippines
• Met with NTPs, USAID missions, WHO,
CDC, local implementing partners
• Review of literature on TB indicators
Results from assessment visits
• Substantial amount of data is collected at
the facility level but is not reported
• Weakness in reporting mechanisms for
facility-level data
• Few indicators on political commitment,
IEC activities, drug supply and TB/HIV
• Lack of data from private sector
physicians
Step 2: Creation of international
working group
• Similar goals to develop more informative
indicators on program implementation
• Bring expertise from a wide variety of
sources:
Stop TB, WHO, UNION, KNCV, CDC,
USAID, World Bank, MSH,
MEASURE/Evaluation
Results of TB M&E Working Group
• Indicators for DOTS: measure key aspects
of the TB epidemic in a country and the
programmatic response
• Based on WHO recommendations and
collected through existing systems
• External & Expert review
Step 3: Field testing
• Peru, Kazakhstan, Haiti & Thailand
• Revision of indicators based on field-testing
results
Step 4: Building capacity
• Egypt (March), Mexico (April), Tanzania
(this workshop), India (November), Eastern
Europe (TBD)
• Technical assistance
Indicators (1)
• Global indicators (5)
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–
–
–
–
Case detection
Treatment success
DOTS coverage
HIV seroprevalence among TB cases
Surveillance of MDR-TB
• Routinely-reported program outcomes
– Case detection
– Smear conversion
– Treatment outcome
Indicators (2)
• Indicators to measure DOTS
implementation under expanded framework:
– Political commitment (12)
• NTP annual workplan and budget
– Diagnosis (7)
• Existence of comprehensive laboratory network
– Case management, including DOT (2)
• Proportion of patients with correct prescription
– Drug management (8)
• Existence of a quality assurance system for drug
management
Indicators (3)
• Indicators to measure DOTS
implementation under expanded framework:
– Recording & reporting (2)
• Accuracy of reports sent to NTP
– Supervision (2)
• Existence of supervision guidelines
– Human resources development (3)
• Proportion of health centers with at least one
professional trained in the DOTS strategy
– Health systems (1)
• Equitable distribution of DOTS
Compendium of Indicators for
Monitoring and Evaluating
National Tuberculosis Programs
Using the Compendium to Plan for
Monitoring and Evaluation of NTPs
Table of Contents
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•
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Introduction
Defining M&E
M&E for National TB Programs
Indicators
Appendices
Indicator Selection
• Detailed description for each indicator
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Definition
What it measures
How to measure it
Data sources
Frequency and function
Strengths and limitations
Definition
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Type of indicator
Numerator and Denominator
Yes/No
Brief review of criteria for assessment
What it measures
• Relevance to program management
– Identifying problems, solutions
– Making decisions
• Key program operation “captured” by the
indicator
• Possible interpretation of results
– Is the NTP reaching its goals?
– What does a low or high value mean for the NTP?
How to measure it
• Source of numerator and denominator
• Detailed criteria for assessment of
qualitative indicators
– Is it a “Yes” or “No”?
• How to perform the calculation
Data sources
• Census data
• Monthly, quarterly and annual reports from
each level of the NTP
• Registers – cough/TB suspects, TB cases,
laboratory
• Treatment cards
• Program documentation
– Stock cards, distribution records, meeting
reports, annual reports
Frequency and function
• How often indicator should be reported
– Monthly, Quarterly, Annually, 2 to 3 years
• Who should receive reports
– Administrative levels within NTP
– Donor agencies
– Key partners in TB control activities
• Monitoring or evaluation?
– Appropriate use of indicator
Strengths and weaknesses
• How accurately does the indicator measure
achievement or implementation of a key
DOTS component?
• Are the data easy or difficult to locate?
• Proceeding with caution…