Monitoring, Supervision, Evaluation and Reporting

1. Monitoring, Supervision, Evaluation and Reporting CAPACITY BUILDING FOR TUBERCULOSIS CONTROL WITH FOCUS ON TB/HIV.

2. Sustaining services • Initial success complacency resurgence of cases emergence and spread of MDR. • Preserving achievements requires sustained effective implementation of the NTBP - ongoing analysis of data, evaluation of care provided and patient response  continuous improvement of quality of services social dynamics and changing scenario in public health.

3. Cont… • Supervise: Skills, technical accuracy • Monitor: Process/progress quality, efficiency, efficacy, effectiveness adjust programme accordingly. • Evaluate Impact  Result. • TB-HIV/AIDS Monitor treatment outcome, supervise activities. • Monitor target objectives achievement i.e.: 85% cure rate of all cases diagnosed. • Collect and analyze data PERIODICALLY. i.e.: case detection rate, treatment outcomes, programme management indicators, others.

4. Cont… • Supervise compliance with policies identify training needs, motivate and support staff. • Review registers. • Follow up on results. • Report on progress. • Evaluate results  for programmatic decisions and to inform policy i.e.: extend coverage, initiate vaccination, implement DOTS.

5. Proper M&E v.s Program design and implementation • Assess realistically what and how much you can accomplish, set realistic expectations /objectives: • What are the areas of need? • Which activities will help to answer to the needs? • What resources are available? Time, staff, budget, information, time, tools (guidelines, manuals), surveillance system. • What to monitor and /or evaluate indicators (Q-Q-T), independent, specific, measures what is important.

6. Cont… • What community activities, organizations and other contributing factors exist? • What barriers are there? • Which activities would best utilize the resources identified and can fit within constraints identified  PRIORITIES • What are the alternatives to cope with limited resources • Is the M&E system based on a standardized process?

7. Focus for M&E skills enhancement • Establish M&E system: instruments, periodicity, define objectives, assess needs. • Designing training programmes for health personnel M&E competency development. • Increase capacity for data collection/analysis/interpretation and cohort analysis • Conduct exercises leading to monitoring and evaluation based on epidemiological analysis and programme evaluation. • Utilize output of monitoring and evaluation exercises to further develop skills and improve quality of care provided

8. GATHERIGN NEW DATA: PRIMARY REGISTRY-- RESEARCH • Recognition: response capacity is proportional to information available on the problem. • What information? On the problem, on services available, on the target population • Data-- Information: Timeliness, consistency, reliability, representative, quality: Auditing data registry and information systems.

9. Cont… • Cost effective: Surveys versus structured information system. • Use of information: inform policy, trigger action, monitor advances, make adjustment, demonstrate results, evaluate impact.

10. Quantitative and Qualitative Analysis • Quantitative information is usually summarized as percentages, numbers, and averages (% of defaulters from TB programme) • Qualitative information allows you to look for similarities across several different observations, interviews or documents, and can be analyzed using various techniques. (Why did they default?) • Both can be analyzed manually and/or with the help of a computer.

11. Cont… • Quantitative research: a survey sampling a segment of the group to that will allow to assess patterns for the whole target group. • Qualitative research: fewer respondents such that represent the group; less rigorous, open methodology, faster and cost effective: focus group, key informers, others… • Combination of both: focus groups small-scale survey

12. Quantitative Research Large statistical representative sample with: • Structured questions • Face to face interview • Collecting vital statistics Baseline Track changes Set priorities Inform participants but do not provide qualitative data from them Will not indicate unexpected factors or influences

13. Qualitative Research • Explores the why • Provide information on perceptions • Identify target audience issues perceive as related and important • Facilitate in depth discussions • But cannot be considered a representative sample or be projected to a population

14. Interpreting the information • Interpretation involves attaching meaning or significance to the analysis, that is, explaining what the patterns or categories mean or tell you about the experience. • Interpret the results taking into account: purpose and objectives of the initiative and of M&E. • Consider the limitations of the M&E process. • Explore whether there are alternative explanations for the results. • Examine if all data collection methods used to look at a particular outcome or activity show similar results. • Determine what factors influenced the results and through what mechanisms.

15. Reflecting on the results FUNDAMENTAL to the participatory evaluation process in order to: • Allow for an in-depth comprehension of your initiative and the response obtained. • Encourage a continuous, evolving process. • Support those involved in being alert, and open to recognize and explore the questions that arise. • Create a holistic image of the initiative and of the process conducted so far.

16. These are different processes! • ANALYSIS refers to organizing the information collected into patterns, categories and basic descriptions. • INTERPRETATION involves attaching meaning or significance to the analysis, that is, explaining what the patterns or categories mean or tell you about the experience. • REFLECTION implies thinking about the results and achieving consensus about its meaning to the initiative.

17. Purpose of M&E : Institutional strengthening • Requires developing staff skills that will facilitate important elements for programme management such as : • Capacity to plan strategically (National and Local) • Communicate, advocate, educate (Health promotion) • Execute (Provide services) • Monitor and evaluate (Surveillance and health/programme information system)

18. Caribbean TB-HIV Control Thank you.