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, two to three 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…

Examples Indicator 4.1 – Surveillance of MDR-TB Indicator 2.2 – Case-notification rate – new smear-positive pulmonary-TB cases

Indicator 1.4 Surveillance of MDR-TB Definition “The national TB-control program assesses the prevalence of MDR-TB at least once within a 5-year period. This is a yes/no indicator.” Qualitative indicator (yes/no) Basic criteria for determining response

What it measures Availability of information on drug susceptibility Program quality –Are treatment regimens effective? –Can the NTP estimate the burden of MDR-TB? –Can the NTP plan for DOTS-Plus program?

Data sources Reports or other documentation of national or sub-national surveys of MDR-TB following protocols/quality assurance recommended by WHO & IUATLD

Data sources NTP data and reports

Frequency and Function If “no,” an indicator should be measured every year until it is a “yes.” If “yes,” an indicator should be periodically assessed (every 2 to 5 years) to ensure the activity continues. This indicator is appropriate for NTP program reviews.

Strengths & Limitations Useful for planning and monitoring Easy to measure BUT… Quality of MDR-TB surveillance? Limited policy/NTP response to finding of MDR-TB

Indicator 2.2 Case notification rate-new smear positive pulmonary TB cases Definition “The number of new smear-positive pulmonary-TB cases reported to the NTP per year per 100,000 population.” Numerator & denominator Calculation

What it measures Information on burden of infectious cases Detection of weaknesses in case detection and registration Useful to describe trends – program coverage, prevalence, impact of HIV co- infection Data for program planning Useful to disaggregate by age group and gender

How to measure it The numerator can be found in national level reports for the previous year The denominator should be available from census data  Definition of “notified” may vary by context

Data sources Quarterly reports on TB case-detection Census statistics

Frequency & Function This indicator should be calculated on an annual basis. This is a routinely reported indicator.  This may vary by context; annual reporting is the minimum.

Strengths & Limitations Directly measures NTP capacity to identify infectious cases Easy to compare trends over time Objective measurement (sputum microscopy) BUT… Represents only a subset of cases

Conclusions Indicators are the “CORE” of the Compendium However, Introduction/overview of M&E is also critical information Appendices include tools to facilitate planning for M&E, data collection