1. MONITORING & EVALUATION OF HEALTH PROGRAMMEBy
DR.I.SELVARAJ,I.R.M.S
B.Sc., M.B.B.S.,(M.D, Community Medicine)., D.P.H.,D.I.H.,PGCH&FW (NIHFW, New Delhi)

2. Monitoring and evaluation are essential management tools which help to ensure that health activities are implemented as planned and to assess whether desired results are being achieved.
Monitoring:
1. To provide concurrent feedback on the progress of
activities
2.To identify the problems in their implementation
3.To take corrective action
Evaluation:
To assess whether the desired results of a programme have been achieved if not how it should be redesigned

3. MONITORING
A process of measuring, recording, collecting and analyzing data on actual implementation of the programme and communicating it to the programme managers so that any deviation from the planned operations are detected, diagnosis for causes of deviation is carried out and suitable corrective actions are taken.

4. 1.It helps in setting norms of performance
2.It helps in measuring level of performance
3.It helps in comparing performance level with standards or norms
4.It helps in identifying deviations and explain the reasons for the deviation for taking necessary corrective action

5. Monitoring and Planning
The purpose of monitoring is to ensure that programmes are implemented as planned.
Preparation of action plan
The plan should specify what needs to be done, who is going to do it, and when it is to be done
Inadequacy in planning will result in inadequacy in monitoring

6. Monitoring process Detecting deviations from plans
Diagnosing causes for deviations
Taking corrective action

7. Different levels of Monitoring
Managers at top level
They have to develop health plans based on objectives, goals, devise strategy and allocate necessary resources
Managers at the middle level
They are more concerned with whether they are getting desired output from the inputs that are being utilized
Managers at the operational level
They have to supervise actual operations and to ensure that planned activities are being carried out as per schedule

8. EVALUATION
It is a systematic way of learning from experience and using the lessons learnt to improve current activities and promote better planning by careful selection of alternatives for future action

9. Reasons for carrying out an Evaluation
To review the implementation of and services provided by health programmes so as to identify problems and recommend necessary revisions of the programme
To assess progress towards desired health status at national or state levels and identify reasons for gap, if any
To contribute towards better health planning
To document results achieved by a project funded by donor agencies
To know whether desired health outcomes are being achieved and identify remedial measures

10. To improve health programmes and the health infrastructure
Allocation of resources in current and future programme
To render health activities more relevant, more efficient and more effective

11. Types of Evaluation Total Evaluation Partial Evaluation
Time related Evaluation
Eye wash Evaluation
Whitewash Evaluation
Submerged Evaluation
Concurrent evaluation
Terminal evaluation
Pre-evaluation
Internal evaluation
External evaluation

12. TOOLS OF EVALUATION Review of Records Monitoring Case studies
Qualitative studies
Controlled experiments and intervention studies
Sample surveys

13. Who is performing Evaluation?
The planner
Adhoc research group
Those responsible for health development
Those responsible for implementation
By the Community

14. Basic steps of Evaluation
What is to be evaluated?
At what level is the evaluation is to be made?
What is the purpose of evaluation?
What are the constraints that could limit the utility of evaluation?
Basic steps of Evaluation
Establishing standards and criteria
Planning and methodology
Collecting data
Analyzing the data
Taking action
Re-evaluation

15. What is to be Evaluated? Evaluation of structure Evaluation of Process
Evaluation of Outcome

16. Process of Evaluation The process of evaluation consists of the
following components:
Specify the particular subjects
Information support
Verify relevance
Assess adequacy
Review progress
Assess efficiency
Assess effectiveness
And assess impact

17. INDICATORS
The indicators based on a valid, reliable, reproducible, repeatable, sensitive, specific and relevant are used to monitor and evaluate the various activities

18. Types of indicators for evaluation
Output indicators
Process indicators
Product indicators

19. The plan should identify key result areas and define how they will be measured
The plan should specify prioritize activities, so that they receive adequate emphasis during monitoring
The plan should cater to local variations

20. Identify all inputs to be provided
Activities to be carried out
Outputs desired for the programme
Select the key inputs, activities, output variables for monitoring
Identify the indicators for measuring the variables
Prepare a plan for collecting and processing the information on the selected indicators
Prepare a format for giving feedback on these indicators to managers responsible for implementation

21. Yes
Evaluation
GOALS&OBJECTIVES
Assessment of health need No
Monitoring
Establish goals &objectives
Implementation of programme
PLANNING CYCLE
Assessment of resources
Time frame
Select the best alternative
Establishment of priorities
Design alternative programme
Action plan

22. EFFICIENCY &EFFECTIVINESS
Monitoring & Evaluation are necessary to ensure efficiency and effective uses of measure
Efficiency is usually measured by the ratio of activity to input
Effectiveness is measured by the ratio of output to activities

23. Evaluation
Monitoring
It determines Programme effectiveness
It identifies inconsistencies between the programme objectives and activities
It alerts the management of discrepancies between actual and anticipated levels of programme impact
It suggests changes in programme procedures, operation and objectives
It identifies the possible side effects of the programme
It determines Programme efficiency
It establishes standard of performance at the activity level
It forms a basis for Programme accountability
It alerts the management of discrepancy
It identifies strong &weak points of programme operations

24. EXISTING CONTROL PROGRAMMES
National Anti Malaria Programme
National Leprosy Elimination programme
Revised National TB control programme
National AIDS control programme
National programme for control of Blindness
Nutritional Surveillance
National Diabetes control programme
National Surveillance programme for Communicable Disease
National Polio surveillance programme
Reproductive child health programme

25. Monitoring & Evaluation of RCH PROGRAMME

26. The 5 year RCH phase II is being launched in TamilNadu on 2005 with a vision to bring about outcomes as envisioned in the Millennium Development Goals, the National Population Policy 2000 (NPP 2000), the Tenth Plan, the National Health Policy 2002 and Vision 2020 India, minimizing the regional variations in the areas of RCH and population stabilization through an integrated, focused, participatory programme meeting the unmet needs of the target population, and provision of assured, equitable, responsive quality services.

27. National Population Policy 2000 (by 2010)
 Indicator
Tenth Plan Goals ( )
RCH II Goals ( )
National Population Policy 2000 (by 2010)
Millennium Development Goals       (By 2015)
Population Growth
16.2% ( ) -
Infant Mortality Rate
45/1000
35/1000
30/1000
Under 5 Mortality Rate
Reduce by 2/3rds from 1990 levels
Maternal Mortality Ratio
200/100,000
150/100,000
100/100,000
Reduce by 3/4th from 1990 levels
Total Fertility Rate
2.3
2.2
2.1
Couple Protection Rate
65%
Meet 100% needs

28. THE ACTION PLAN FOR CARRYING OUT R.C.H SERVICES
Goal: “Health For All”
Objective: Population stabilization by 2045
Target : Total fertility rate to the replacement
level by 2010 and to achieve the other
indicators of health for all
Programme: Comprehensive R.C.H services
Plan : High quality, integrated, decentralized,
needs based and holistic approach
Monitoring &
Evaluation: R.C.H indicators/Feedback data

29. ACCESSIBILITY INDICATOR
No. of eligible couples registered/ANM
No. of Antenatal Care sessions held as planned
% of sub Centers with no ANM
% of sub Centers with working equipment of ANC
% ANM/TBA without requisite skill
% sub centers with DDKs
% of sub centers with infant weighing machine
% sub centers with vaccine supplies
% sub centers with ORS packets
% sub centers with FP supplies

30. QUALITY INDICATOR % Pregnancy Registered before 12 weeks
% ANC with 5 visits
% ANC receiving all RCH services
% High risk cases referred
% High risk cases followed up
% deliveries by ANM/TBA
%PNC with 3 PNC visits
% PNC receiving all counseling
% PNC complications referred
% Eligible couple offered FP choices
% women screened for RTI/STDs
% Eligible couple counseled for prevention of RTI/STDs
% ADD given ORS
% ARI treated
% children fully immunized

31. IMPACT INDICATOR % DEATHS FROM MATERNAL CAUSES
MATERNAL MORTALITY RATIO
PREVALENCE OF MATERNAL MORBIDITY
% LOW BIRTH WEIGHT
NEO-NATAL MORTALITY RATIO
PREVALENCE OF POST NATAL MATERNAL MORBIDITY
% BABY BREAST FEED WITHIN 6 HRS OF DELIVERY
COUPLE PROTECTION RATE
PREVALENCE OF TERMINAL METHOD OF STERILIZATION
PREVALENCE OF SPACING METHOD
% ABORTION RELATED MORBIDITY
PREVALENCE OF ADD
PREVALENCE OF ARI
PREVALENCE OF RTI/STDs

32. ACTION PLAN FOR R.N.T.C.P
Goal : To extend the RNTCP to cover the entire
population of the country by 2005
Objective:1) To cure 85% of the sputum positive
cases
2) To detect 70% of the estimated
cases of T.B
Target : Three million cases have to be treated
and 1.5 million cases have to be cured.
Program : RNTCP
Strategy: DOTS

33. Monitoring & Evaluation:
Performance of RNTCP
Monitoring & Evaluation:
Total Population covered
No of states covered
Total cases treated
New sputum + ve cases
Annual case detection rate
Ratio of sputum +ve to Sputum –ve
Sputum conversion rate at the end of intensive phase ( New Sputum + ve cases)= 90% & any ratio below 80%=corrective action
Cure rate (New sputum + ve cases)=85%

34. Expected rate of sputum examination among new adult outpatients (2%)
Expected rate of proportion of patients undergoing sputum examination who are smear +ve (10%)
At least 90% of patients who were smear +ve should be placed on treatment and registered
Determine the ratio of New smear + ve to new smear – ve cases. Expected ratio is 1:1
Completed treatment rate (Not more than 3% smear +ve patients)
Default rate
Relapse rate
MDR rate
Death rate during treatment among new smear + ve patients ( not more than 4%)

35. Goal & objectives of National Anti Malaria Programme (MPO)
Prevention of deaths due to malaria
Reduction of Morbidity due to malaria
Maintenance of industrial and green revolution due to freedom malaria, as well as retention of achievements gained so far.

36. Monitoring broadly covers two components
1.Monitoring of implementation efficiency of various activities
2.Monitoring/assessment of the impact of control measures

37. Monitoring of implementation efficiency of various activities
Technical
1. Case detection by active and passive
2. Treatment & Referal services
3. Indoor residual insecticidal spray
operations
4. Anti larval measures
Logistic flow
1. Timely indenting based on epidemiological data
of previous year
Financial flow
1. Timely payment of wages for casual laborers
involved in spraying operation
2. Repair of equipment and Local purchases

38. Malariometry Annual Blood Examination Rate Annual Parasite Incidence
Annual Falciparum incidence
Slide Positivity Rate
Slide falciparum rate
Parasite rate
Infant parasite rate
Spleen rate
&parasite density index
Vector indices
Mosquito density
Sporozoite rate
Inoculation rate
Man biting rate
Human blood index

39. Indicators for spray operation
% of villages covered
% of houses sprayed
% of rooms sprayed

40. Goal & objectives of National Filaria Control Programme
To carry out survey in different parts of country to determine magnitude of problem. Delimitation surveys in hitherto unsurveyed areas
Large scale pilot studies to evaluate known method of filariasis control
To train professional and personnel required for the programme
To control filaria in urban areas by anti-larval measures
To control filaria in rural areas by case detection and treatment

41. Measurement of filarial problem
Indicators of filarial measurement
Micro filarial rate
Filarial endemicity rate
Micro filarial density
Proportional case rate
Measurement of vector problem
Vector density
Percentage of mosquitoes + ve for infective larvae
Percentage of mosquitoes + ve for all stages of larvae
Clinical indicators
Incidence of acute manifestations
Prevalence of chronic manifestations

42. POLIO ERADICATION PROGRAMME
Conduct pulse polio immunizations for two days every year for three to four years or until polio is eradicated.
Sustain high level of routine immunizations.
Monitor OPV coverage at district levels and below.
Improve surveillance capable of detecting all cases of polio.
Ensure rapid case investigation, including the collection of stool samples.
Arrange follow-up of all cases of paralytic polio at 60 days to check for residual paralysis.
Conduct outbreak control for cases confirmed or suspected to stop transmission.

44. GOAL
To assist governments in their efforts to immunize every child against polio until polio transmission has stopped, so that the world can be certified polio-free.

48. National Immunization Days
I st NID
– 2nd NID
– 3rd NID
– 4th NID
– 5th NID
( 5- NID, 3SID)
2005 – ( 2-NID, 6 SID)

49. Goal & objectives of National AIDS Control Programme
Prevention of HIV infection
Decrease the morbidity and mortality associated with HIV infection
To minimize the socio- economic impacts resulting from HIV infection
Phase-II
To reduce the spread of HIV infection
To strengthen India’s capacity to respond to HIV/AIDS on a long term basis

50. Medium term objectives
To establish effective surveillance in all states to monitor the epidemic
To provide sound technical support
To ensure a high level of awareness of HIV/AIDS and its application in the population
To promote the use of condoms for safe sex
Target intervention to high risk group
To ensure safety of blood
To develop the services required for providing support to HIV infected persons, AIDS patients & their associate

51. Programme strategy Programme management IEC and social mobilization
Blood safety
Condom promotion
Control of STD
Clinical management
Care & Support
Surveillance

52. Monitoring & Evaluation
Prevention indicator survey (PI)
To assess the achievements made
10 indicators

53. Monitoring of family health awareness campaign
Monitoring of IEC for availability and distribution of materials for awareness programme
Ensuring the availability of condoms
Ensuring availability of drugs for opportunistic infections in the hospital
Ensuring the availability of Anti retroviral drugs
STD/HIV/AIDS surveillance
Financial control
Monitoring of Blood banks

54. Goal & objectives of National Leprosy Eradication Programme
To arrest the disease activity in all known cases of leprosy by the year 2000 A.D
To reduce the prevalence rate to less then 1/10,000 population by the year 2000 A.D

55. GOAL AND OBJECTIVE OF LEPROSY ERADICATION PROGRAMME
Goal: Elimination of leprosy as a public health problem i.e.to reduce the prevalence rate to less than I per population by the year 2000 AD.
Objective: To arrest disease activity in all the known cases of leprosy by the year 2000AD
Strategy: The elimination strategy

56. MONITORING INDICATORS
Point Prevalence Rate – Indicator of magnitude of the problem
Monthly&Annual New Case detection rate –Indicator of impact of the programme
Timely detection of new cases
Proportion of children among new cases – Indicator of early detection
Proportion of new cases with deformity – Indicator of effectiveness of programme implementation
Proportion of MB among new cases – Indicator of late detection
Proportion of female patients among new cases
Prevalence discharge ratio – Indicator of progress of the programme related to cure
Clinic attendance –Indicator of regularity of treatment
Proportion of new cases verified as correctly diagnosed
Proportion of treatment defaulters
Number of relapses
Proportion of patients who develop new/additional disability during multi drug therapy

57. Goal & objectives of National Iodine Deficiency Disease Control Programme
Survey to assess magnitude of problem in
the community
Supply of iodated salt in place of common salt
Resurvey after 5 years
Lab monitoring of iodated salt
Health education

58. Goal & objectives of National Programme for control of Blindness
To reduce blindness in India from 1.4% to 0.3%
To provide comprehensive eye care through primary health care system

59. Goal & objectives of National Cancer Control Programme
Primary prevention of cancers by health education regarding hazards of tobacco consumption and necessity of genital hygiene for prevention of cervical cancers
Secondary prevention( Early detection and diagnosis of cancer, for example Ca Cervix, Ca breast, Ca oropharynx, by screening methods and patient education on self examining methods
Strengthening of existing cancer treatment facility
Palliative care of terminal stage of cancers

60. Goal & objectives of National Mental Health programme
To ensure availability and accessibility of minimum health care for all in foreseeable future, particularly for most vulnerable/under privilege section of society
To encourage application of mental health knowledge in general health care and in social development
To promote community participation in mental health services and increase efforts towards self help in the community

61. THANK YOU