Unit 10. Monitoring and evaluation
TB Infection Control Training for Managers
at the National and Subnational Levels
Objectives
After this unit, the participant will be able to:
• Define monitoring and how it is essential to supervision
• List two indicators to use in monitoring infection control at the national level, and two for use at the facility level
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Outline
• Definitions: monitoring vs. evaluation
• Types of indicators: input, output, outcome and impact
• Choice of indicators
• Examples of indicators at global, national and facility levels
• Setting targets
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Lifecycle of IC plan
Develop the plan (to include goals and objectives)
Implement
Monitor,evaluate
Revise
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Monitoring is….
• The routine tracking and reporting of priority information about a programme or project, its inputs and intended outputs, outcomes, and impact
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Monitoring
• Uses data obtained through record keeping, regular reporting, surveillance systems, observation or surveys
• Helps managers determine which areas require greater effort
• Is essential for supervision
• Is also used to measure trends over time, so methods need to be consistent to ensure appropriate comparison
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Evaluation is…
• The rigorous, scientifically-based collection of information about the program activities, characteristics, and outcomes that determine the merit or worth of the programme
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Evaluation studies
• Provide credible information for use in improving programmes, identifying lessons learned, and information decisions about future resource allocation
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short and medium term effects of the outputs
long term, cumulative effect of the programme over timeImpact
Outcome
Output
M&E framework
products or deliverables of the programme’s interventions
Inputfinancial, human and material resources
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Coughing patients are rapidly identified, separated, and served
Fewer health care workers with TB Impact
Outcome
Output
Example of a results chain
HIV clinics have written triage procedures for coughing patients
InputInfection Control focal point staff identified and trained
Indicators
• Provide useful tools for supervision at all levels– Are we doing the right things?– Are we doing them right?
• Help managers and supervisors determine:– What’s going well and should be reinforced
and replicated elsewhere?– What needs improvement and how can the
gaps be addressed?11
Choose indicators that:
• Are able to measure performance• Provide strategic information needed to
make good decisions for managing and improving programme performance
• Are reliable and measurable on a regular basis
• Are clear, with well defined numerators and denominators using standard definitions
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Standardized IC indicators for collaborative TB/HIV activities
• Proportion of health-care facilities providing services for people living with HIV that have infection control practices that include TB control
• Proportion of health-care workers, employed in facilities providing care for people living with HIV, who developed TB during the reporting period
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Global IC indicators and targets
By 2012, 50% of countries should have• Developed a national TB infection control plan• Set up national surveillance of TB disease
among health workers• Assessed major health-care facilities and
congregate settings for TB IC• Reported on the implementation of TB infection
control
By 2013, all countries
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Examples of national IC indicators
• How many health care workers had TB in the past year?
• Have health care workers been trained in the past year?
• Of the country’s tertiary (referral) hospitals, how many have:– A person in charge of TB infection control?– A TB IC assessment done in the past year?– Training on TB IC conducted in the past year?
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Examples of facility level IC indicators
• Facility level plan in place• Person responsible for TB IC• Health facility assessment done• Training conducted• Triage and separation of TB patients
– # TB cases or suspects missed at intake • Adequate ventilation and/or UVGI• Use of respirators by HCWs in high risk
settings16
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Number of TB cases or suspects missed at intake to the facility
Number of health care workers with TB Impact
Outcome
Output
Facility-level indicators
Facility-specific, written triage procedure exists
InputInfection control focal person is identified and trained
Setting targets
• Gap analysis: baseline compared to need not yet met
• Constraints to meeting the need
• Feasibility for scaling up
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Example of setting a target
By 2015, __ of the country’s HIV clinics will have a written policy for identification and separation of coughing patients
• Gap analysis: baseline is 0, need is 100%• Constraints: no template policy, limited
training capacity, few IC focal persons in the HIV clinics
• Feasibility: resources available to address the constraints and fill the gap
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Summary• Monitoring is the routine tracking and
reporting of priority information about a programme
• Use global indicators to allow measurement of impact across countries
• Chose additional indicators that provide strategic information needed to make good decisions for managing and improving programme performance
• Adapt standardized IC indicators to your country context, and use them for supervision at each level 20