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

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 M&E Framework for TB programs p7, Compendium of Indicators for Monitoring and Evaluating National Tuberculosis Programs USAID, MEASURE, CDC, WHO, IUATLD, KNCV, MSH. WHO/HTM/TB/ , August 2004

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 M&E Framework for TB Programs p7, Compendium of Indicators for Monitoring and Evaluating National Tuberculosis Programs USAID, MEASURE, CDC, WHO, IUATLD, KNCV, MSH. WHO/HTM/TB/ , 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