Compendium of Indicators for Monitoring and Evaluating National Tuberculosis Programs

1. Compendium of Indicators for Monitoring and Evaluating National Tuberculosis Programs

2. 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

3. What is the Compendium? A comprehensive and standardized collection of the most widely used and recommended indicators for monitoring and evaluating National TB Programs.

4. 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.

5. 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

6. 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

7. 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

8. 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

9. M&E Framework for TB 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 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

10. 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

11. 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

12. M&E Framework for TB 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 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. Compendium of Indicators for Monitoring and Evaluating National Tuberculosis Programs Using the Compendium to Plan for Monitoring and Evaluation of NTPs

23. Table of Contents • Introduction • Defining M&E • M&E for National TB Programs • Indicators • Appendices

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

25. Definition • Type of indicator • Numerator and Denominator • Yes/No • Brief review of criteria for assessment

26. 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?

27. 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

28. 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

29. 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

30. 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…