1. Introduction to Monitoring and Evaluation of National Tuberculosis Programs Lisa V. Adams, MD E&E Regional Workshop Kiev, Ukraine May 23-26, 2006

2. Tuberculosis Technical Focus Area Activties and Update All-Staff Meeting 20062 Overview  What is monitoring and evaluation (M&E)?  How can you use M&E for program management?  Practical applications of monitoring and evaluation

3. Tuberculosis Technical Focus Area Activties and Update All-Staff Meeting 20063 What is M&E?  Data collection?  Reporting?  Analysis?  Supervision?  Policy support  Program design & implementation  Systematic  “Working smarter, not harder”

4. Tuberculosis Technical Focus Area Activties and Update All-Staff Meeting 20064 Definitions Monitoring is the routine reporting of data on program implementation and performance Evaluation is the periodic assessment of program impact at the population level and value

5. Tuberculosis Technical Focus Area Activties and Update All-Staff Meeting 20065 Monitoring  Has the program been implemented according to the plan?  Are there any changes in program resources or service utilization?  Are there any weaknesses in the implementation of the program?  Where are the opportunities to improve program performance?

6. Tuberculosis Technical Focus Area Activties and Update All-Staff Meeting 20066 Evaluation  Are there any changes in behavior or health outcomes in the target population?  To what extent are observed changes in the target population related to program efforts?

7. Tuberculosis Technical Focus Area Activties and Update All-Staff Meeting 20067 “Improve the quality and quantity of staff involved in TB control” Decrease average number of days from identification of TB suspect and initiation of DOT Training of health workers to identify and refer TB suspects for sputum testing in a timely fashion GFATM implements supply chain activity to keep labs stocked and avoid delays in testing sputum ?

8. Tuberculosis Technical Focus Area Activties and Update All-Staff Meeting 20068 Monitoring vs. Evaluation Level of measurement: Monitoring Data come from routinely reported data Example: Monthly service statistics Evaluation Data are measured at the population level Example: Prevalence of MDR-TB in Country X

9. Tuberculosis Technical Focus Area Activties and Update All-Staff Meeting 20069 estimated TB cases all true TB cases cases presenting to health facilities cases presenting to public health facilities cases presenting to DOTS facilities cases correctly diagnosed by DOTS facilities diagnosed cases reported by DOTS facilities Chris Dye, 2002 The “ONION” Chris Dye, WHO, 2002

10. Tuberculosis Technical Focus Area Activties and Update All-Staff Meeting 200610 Why is M&E important for National TB Programs?  To follow epidemiological trends in TB  To identify strengths and weaknesses in program design and/or implementation  To address changing priorities  To convince policy makers of the need for action and financial and human resources

11. Tuberculosis Technical Focus Area Activties and Update All-Staff Meeting 200611 Uses of M&E for program management (1)  Informs decisions about program operations and service delivery  Ensures effective and efficient use of resources  Determine whether or not the program is implemented according to plan

12. Tuberculosis Technical Focus Area Activties and Update All-Staff Meeting 200612 Uses of M&E for program management (2)  Meets reporting requirements by different agencies and sectors of government  Evaluates the extent to which the program/project is having or has had the desired impact

13. Tuberculosis Technical Focus Area Activties and Update All-Staff Meeting 200613 Practical applications (1)

14. Tuberculosis Technical Focus Area Activties and Update All-Staff Meeting 200614 Practical applications (2) Case notification and death rates are falling, but not fast enough Case notification

15. Tuberculosis Technical Focus Area Activties and Update All-Staff Meeting 200615 Practical applications (3)

16. Tuberculosis Technical Focus Area Activties and Update All-Staff Meeting 200616 Comments/questions?