Compendium of Indicators for Monitoring and Evaluating

National Tuberculosis Programs

Objectives of Session

• Provide an overview of the development of 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 evaluation of 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

INPUTPolicy environment

Human and Financial Resources

Infrastructure

PROCESSManagement

Training

Drug management

Laboratories

Communication

Advocacy

OUTPUTDiagnostic services

Treatment services

Improved knowledge, attitudes, and practices

Reduced stigma

OUTCOMECase detection

Treatment success

IMPACTPrevalence 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 ProgramsUSAID, MEASURE, CDC, WHO, IUATLD, KNCV, MSH. WHO/HTM/TB/2004.344, August 2004

INPUTPolicy environment

Human and Financial Resources

Infrastructure

PROCESSManagement

Training

Drug management

Laboratories

Communication

Advocacy

OUTPUTDiagnostic services

Treatment services

Improved knowledge, attitudes, and practices

Reduced stigma

OUTCOMECase detection

Treatment success

IMPACTPrevalence 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 ProgramsUSAID, MEASURE, CDC, WHO, IUATLD, KNCV, MSH. WHO/HTM/TB/2004.344, August 2004

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

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 collected at facility level that 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 and expert review

Step 3: Field testing

• Peru, Kazakhstan, Haiti, and Thailand• Revision of indicators based on field-testing

results

Step 4: Building capacity• Egypt (March ‘05), Mexico (April ‘05), Tanzania

(September ‘05), India (this workshop), Eastern Europe (TBD ‘06)

• 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 and 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