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 case- management 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

INPUT Policy environment Human and Financial Resources Infrastructure PROCESS Management Training Drug management Laboratories Communication Advocacy OUTPUT Diagnostic services Treatment services Improved knowledge, attitudes, and practices Reduced stigma OUTCOME Case detection Treatment success IMPACT Prevalence of TB infection Prevalence of TB disease TB morbidity TB mortality M&E Framework for TB programs p7, Compendium of Indicators for Monitoring and Evaluating National Tuberculosis Programs USAID, MEASURE, CDC, WHO, IUATLD, KNCV, MSH. WHO/HTM/TB/ , 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

INPUT Policy environment Human and Financial Resources Infrastructure PROCESS Management Training Drug management Laboratories Communication Advocacy OUTPUT Diagnostic services Treatment services Improved knowledge, attitudes, and practices Reduced stigma OUTCOME Case detection Treatment success IMPACT Prevalence of TB infection Prevalence of TB disease TB morbidity TB mortality M&E Framework for TB Programs p7, Compendium of Indicators for Monitoring and Evaluating National Tuberculosis Programs USAID, MEASURE, CDC, WHO, IUATLD, KNCV, MSH. WHO/HTM/TB/ , 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) –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 Introduction Defining M&E M&E for National TB Programs Indicators Appendices

Indicator Selection Detailed description for each indicator –Definition –What it measures –How to measure it –Data sources –Frequency and function –Strengths and limitations

Definition 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…