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Monitoring and evaluating the End TB Strategy
Photo: Riccardo Venturi
Haileyesus Getahun, MD, MPH, PhD. Global TB Programme WHO
• CDR • TSR • DOTS coverage
The TOP 10 prirority Indicators • TB treatment coverage • TB treatment success rate • Catastrophic costs due to TB • newly notified patients diagnosed
with rapid tests • LTBI treatment coverage • Contact investigation coverage • DST coverage for TB patients • New TB drug treatment coverage • HIV status among TB patients • Case fatality ratio (CFR)
DOTS EXPANSION • Case detection rate • Treatment success rate new • DOTS coverage DOTS PLUS • MDR-TB patients detected • % MDR-TB cases treated in DOTS-Plus • MDR-TB treatment success rate (%) TB/HIV • TB screening • IPT • TB patients HIV tested • CPT • ART PPM • Notified TB Cases
Operational indicators and associated targets for 10 areas
NTP NTP + NAP + Private + NGOs
MoH+ Other ministries beyond health
Paper based Mix of paper and electronic ? Exclusively electronic/digital
Context and evolution : M&E of TB strategies
Goal 3: Ensure healthy lives and promote well-being for all
Target 3.3- End the epidemics of
AIDS, tuberculosis, malaria & NTD
From stopping TB to ending the TB epidemic
Vision: A world free of TB Zero TB deaths, Zero TB disease, and Zero TB suffering Goal: End the Global TB epidemic
The WHO End TB strategy
PILLAR 1: INTEGRATED, PATIENT-CENTRED CARE AND PREVENTION
Core indicators of PILLAR 1: 9 out of the top 10 priority indicators
• % of new patients diagnosed with rapid tests
• Contact investigation coverage
• DST coverage
• TB treatment coverage
• New TB drug coverage
• TB treatment success rate
• Case fatality ratio
LTBI treatment
coverage in PLHIV and under 5 years old
children
Documented HIV status among TB
patients
PILLAR 2: BOLD POLICIES AND SUPPORTIVE SYSTEMS
Core indicator of PILLAR 2: one out of the top ten priority indicators
Percentage of TB-affected households
that experience catastrophic costs due
to TB
X X
X
Other non-top-10-priority indicators to measure Pillar 2
• % of TB patients with social protection
• % of population adequately nourished (FAO/WFP)
• % of annual budget in NSPs that is funded
• Public health spending per capita
• Coverage of case reporting to NTP(%)
• Total TB notifications from community referrals(%)
• TSR of patients with treatment support (%)
• % of population covered with insurance
• % THE accounted for OOP expenditures
• Case notification mandated by law (Y/N)
Non-top-10-priority process indicators to measure research pillar
* Source: WHO global TB data collection system, 2016
However,
Benin, Swaziland,
South Africa lack
routine system to
track community
contributions.
Measuring community contributions
Measuring private sector contributions
Reporting from the
private sector
increases with the
introduction of case-
based electronic
registers (e.g. India,
China)
Digital health is crucial enabler of M and E
NTP Other programmes
Non-health sector
The future of good TB programming to end to end the TB epidemic is dependent
on massive investment, joint work, openness and desire to change.
The future of good monitoring evaluation of the end TB efforts depend on investment and transition from paper based to digital
health approaches.
The future
Key documents for M and E
1. Share experiences, best practices, bottlenecks and enablers for M and E of the End TB strategy, TB/HIV and latent TB implementation;
2. To provide inputs and get updates on novel methods of data collection to monitor the implementation of the End TB strategy;
3. Identify critical actions and interventions to strengthen the monitoring of the End TB Strategy, TB/HIV and LTBI implementation;
4. Adapt critical actions and interventions to country context (roadmap) for subsequent follow up and investment through the Global Fund.
What do we want to achieve out of this meeting?