29361-29371

7/29/2019 29361-29371

1/61

1

DR.I.SELVARAJ,I.R.M.SB.Sc., M.B.B.S.,(M.D, Community Medicine).,D.P.H.,D.I.H.,PGCH&FW (NIHFW, New Delhi)

By

7/29/2019 29361-29371

2/61

2

Monitoring and evaluation are essential managementtools which help to ensure that health activities areimplemented as planned and to assess whether desiredresults are being achieved.

Monitoring:

1. To provide concurrent feedback on the progress of

activities2.To identify the problems in their implementation

3.To take corrective action

Evaluation:

To assess whether the desired results of a programmehave been achieved if not how it should be redesigned

7/29/2019 29361-29371

3/61

3

MONITORING

A process of measuring, recording,

collecting and analyzing data onactual implementation of the

programme and communicating it tothe programme managers so that anydeviation from the planned operationsare detected, diagnosis for causes of

deviation is carried out and suitablecorrective actions are taken.

7/29/2019 29361-29371

4/61

7/29/2019 29361-29371

5/61

5

Monitoring and Planning

The purpose of monitoring is to ensure thatprogrammes are implemented as planned.

Preparation of action plan

The plan should specify what needs to be done, whois going to do it, and when it is to be done

Inadequacy in planning will result in inadequacy inmonitoring

7/29/2019 29361-29371

6/61

7/29/2019 29361-29371

7/61

7

Different levels of Monitoring Managers at top level

They have to develop health plans based onobjectives, goals, devise strategy and allocatenecessary resources

Managers at the middle level

They are more concerned with whether they aregetting desired output from the inputs that are beingutilized

Managers at the operational level

They have to supervise actual operations and to

ensure that planned activities are being carried out asper schedule

7/29/2019 29361-29371

8/61

8

EVALUATION

It is a systematic way of learning from experience

and using the lessons learnt to improve currentactivities and promote better planning by carefulselection of alternatives for future action

7/29/2019 29361-29371

9/61

9

Reasons for carrying out an Evaluation

To review the implementation of and services providedby health programmes so as to identify problems andrecommend necessary revisions of the programme

To assess progress towards desired health status at

national or state levels and identify reasons for gap, ifany

To contribute towards better health planning

To document results achieved by a project funded bydonor agencies

To know whether desired health outcomes are beingachieved and identify remedial measures

7/29/2019 29361-29371

10/61

7/29/2019 29361-29371

11/61

11

Types of Evaluation

Total Evaluation Partial Evaluation Time related Evaluation Eye wash Evaluation Whitewash Evaluation

Submerged Evaluation Concurrent evaluation Terminal evaluation Pre-evaluation Internal evaluation

External evaluation

7/29/2019 29361-29371

12/61

12

TOOLS OF EVALUATION

Review of Records

Monitoring

Case studies

Qualitative studies

Controlled experiments and intervention studies Sample surveys

7/29/2019 29361-29371

13/61

13

Who is performing Evaluation?

The planner

Adhoc research group

Those responsible for health development

Those responsible for implementation By the Community

7/29/2019 29361-29371

14/61

14

What is to be evaluated?

At what level is the evaluation is to be made?

What is the purpose of evaluation?

What are the constraints that could limit the utility ofevaluation?

Basic steps of Evaluation

Establishing standards and criteria

Planning and methodology

Collecting data

Analyzing the data Taking action

Re-evaluation

7/29/2019 29361-29371

15/61

15

What is to be Evaluated?

Evaluation of structure

Evaluation of Process

Evaluation of Outcome

7/29/2019 29361-29371

16/61

7/29/2019 29361-29371

17/61

7/29/2019 29361-29371

18/61

7/29/2019 29361-29371

19/61

19

The plan should identify key result areas anddefine how they will be measured

The plan should specify prioritize activities,so that they receive adequate emphasisduring monitoring

The plan should cater to local variations

7/29/2019 29361-29371

20/61

7/29/2019 29361-29371

21/61

21

PLANNING CYCLE

Assessment

of health need

Establish

goals

&objectives

Assessment

of resources

Establishment

of prioritiesDesign

alternative

programme

Select the

best

alternative

Action

plan

Time

frame

Implementationof programme

Monitoring

Evaluation GOALS&OBJECTIVES

No

Yes

7/29/2019 29361-29371

22/61

22

EFFICIENCY &EFFECTIVINESS

Monitoring & Evaluation are necessary to ensureefficiency and effective uses of measure

Efficiency is usually measured by the ratio of activityto input

Effectiveness is measured by the ratio of output toactivities

7/29/2019 29361-29371

23/61

23

It determines

Programme efficiency It establishes standard

of performance at theactivity level

It forms a basis for

Programmeaccountability

It alerts themanagement ofdiscrepancy

It identifies strong&weak points ofprogramme operations

It determinesProgramme effectiveness

It identifiesinconsistencies betweenthe programmeobjectives and activities

It alerts themanagement ofdiscrepancies betweenactual and anticipatedlevels of programmeimpact

It suggests changes inprogramme procedures,operation and objectives

It identifies the possibleside effects of the

programme

Monitoring Evaluation

7/29/2019 29361-29371

24/61

24

EXISTING CONTROL PROGRAMMES

National Anti Malaria Programme National Leprosy Elimination programme Revised National TB control programme National AIDS control programme National programme for control of Blindness Nutritional Surveillance National Diabetes control programme National Surveillance programme for Communicable

Disease

National Polio surveillance programme Reproductive child health programme

7/29/2019 29361-29371

25/61

25

Monitoring & Evaluation of RCH

PROGRAMME

7/29/2019 29361-29371

26/61

26

The 5 year RCH phase II is being launched inTamilNadu on 2005 with a vision to bring aboutoutcomes as envisioned in the MillenniumDevelopment Goals, the National Population Policy2000 (NPP 2000), the Tenth Plan, the National HealthPolicy 2002 and Vision 2020 India, minimizing theregional variations in the areas of RCH and populationstabilization through an integrated, focused,participatory programme meeting the unmet needs ofthe target population, and provision of assured,equitable, responsive quality services.

7/29/2019 29361-29371

27/61

27

IndicatorTenth Plan

Goals (2002-2007)

RCH II Goals(2005-2010)

NationalPopulation

Policy2000 (by

2010)

MillenniumDevelopmentGoals (B

y 2015)

PopulationGrowth

16.2% (2001-2011)

16.2%(2001-2011)

- -

InfantMortality Rate

45/1000 35/1000 30/1000 -

Under 5Mortality Rate

- - - Reduce by2/3rds from1990 levels

MaternalMortality Ratio

200/100,000 150/100,000 100/100,000

Reduce by3/4th from

1990 levels

Total FertilityRate

2.3 2.2 2.1 -

CoupleProtection Rate

65% 65% Meet100%

needs

-

7/29/2019 29361-29371

28/61

28

THE ACTION PLAN FOR CARRYING OUT R.C.H SERVICES

Goal: Health For All

Objective: Population stabilization by 2045

Target : Total fertility rate to the replacementlevel by 2010 and to achieve the other

indicators of health for all

Programme:Comprehensive R.C.H services

Plan : High quality, integrated, decentralized,needs based and holistic approach

Monitoring &Evaluation: R.C.H indicators/Feedback data

7/29/2019 29361-29371

29/61

29

ACCESSIBILITY INDICATORNo. of eligible couples registered/ANM

No. of Antenatal Care sessions held as planned

% of sub Centers with no ANM

% of sub Centers with working equipment of ANC

% ANM/TBA without requisite skill

% sub centers with DDKs% of sub centers with infant weighing machine

% sub centers with vaccine supplies

% sub centers with ORS packets

% sub centers with FP supplies

7/29/2019 29361-29371

30/61

30

QUALITY INDICATOR

% Pregnancy Registered before 12 weeks

% ANC with 5 visits% ANC receiving all RCH services

% High risk cases referred

% High risk cases followed up

% deliveries by ANM/TBA

%PNC with 3 PNC visits% PNC receiving all counseling

% PNC complications referred

% Eligible couple offered FP choices

% women screened for RTI/STDs

% Eligible couple counseled for prevention of RTI/STDs% ADD given ORS

% ARI treated

% children fully immunized

7/29/2019 29361-29371

31/61

31

IMPACT INDICATOR

% DEATHS FROM MATERNAL CAUSES

MATERNAL MORTALITY RATIO

PREVALENCE OF MATERNAL MORBIDITY

% LOW BIRTH WEIGHT

NEO-NATAL MORTALITY RATIO

PREVALENCE OF POST NATAL MATERNAL MORBIDITY

% BABY BREAST FEED WITHIN 6 HRS OF DELIVERYCOUPLE PROTECTION RATE

PREVALENCE OF TERMINAL METHOD OFSTERILIZATION

PREVALENCE OF SPACING METHOD

% ABORTION RELATED MORBIDITYPREVALENCE OF ADD

PREVALENCE OF ARI

PREVALENCE OF RTI/STDs

7/29/2019 29361-29371

32/61

32

ACTION PLAN FOR R.N.T.C.P

Goal :To extend the RNTCP to cover the entirepopulation of the country by 2005

Objective:1) To cure 85% of the sputum positivecases

2) To detect 70% of the estimatedcases of T.B

Target : Three million cases have to be treatedand 1.5 million cases have to be cured.

Program : RNTCP

Strategy: DOTS

7/29/2019 29361-29371

33/61

33

Performance of RNTCP

Monitoring & Evaluation: Total Population covered

No of states covered

Total cases treated

New sputum + ve cases

Annual case detection rate

Ratio of sputum +ve to Sputum ve

Sputum conversion rate at the end of

intensive phase ( New Sputum + ve cases)=90% & any ratio below 80%=correctiveaction

Cure rate (New sputum + ve cases)=85%

7/29/2019 29361-29371

34/61

34

Expected rate of sputum examination among newadult outpatients (2%)

Expected rate of proportion of patients undergoingsputum examination who are smear +ve (10%)

At least 90% of patients who were smear +ve shouldbe placed on treatment and registered

Determine the ratio of New smear + ve to new smear

ve cases. Expected ratio is 1:1 Completed treatment rate (Not more than 3% smear

+ve patients)

Default rate

Relapse rate

MDR rate

Death rate during treatment among new smear + vepatients ( not more than 4%)

7/29/2019 29361-29371

35/61

35

Goal & objectives of National AntiMalaria Programme (MPO)

Prevention of deaths due to malaria

Reduction of Morbidity due to malaria

Maintenance of industrial and green revolution due tofreedom malaria, as well as retention ofachievements gained so far.

7/29/2019 29361-29371

36/61

7/29/2019 29361-29371

37/61

37

Monitoring of implementation efficiencyof various activities

Technical

1. Case detection by active and passive

2. Treatment & Referal services

3. Indoor residual insecticidal spray

operations4. Anti larval measures

Logistic flow

1.Timely indenting based on epidemiological data

of previous year

Financial flow1. Timely payment of wages for casual laborers

involved in spraying operation

2. Repair of equipment and Local purchases

7/29/2019 29361-29371

38/61

38

Malariometry

Annual Blood Examination Rate

Annual Parasite Incidence

Annual Falciparum incidence

Slide Positivity Rate

Slide falciparum rate

Parasite rate

Infant parasite rate Spleen rate

&parasite density index

Vector indices

Mosquito density Sporozoite rate

Inoculation rate

Man biting rate

Human blood index

7/29/2019 29361-29371

39/61

39

Indicators for spray operation

% of villages covered

% of houses sprayed

% of rooms sprayed

7/29/2019 29361-29371

40/61

40

Goal & objectives of NationalFilaria Control Programme

To carry out survey in different parts of country todetermine magnitude of problem. Delimitation surveys inhitherto unsurveyed areas

Large scale pilot studies to evaluate known method offilariasis control

To train professional and personnel required for theprogramme

To control filaria in urban areas by anti-larval measures

To control filaria in rural areas by case detection andtreatment

7/29/2019 29361-29371

41/61

41

Measurement of filarial problem

Indicators of filarial measurement

Micro filarial rate

Filarial endemicity rate

Micro filarial density

Proportional case rate

Measurement of vector problem Vector density

Percentage of mosquitoes + ve for infective larvae

Percentage of mosquitoes + ve for all stages of larvae

Clinical indicators Incidence of acute manifestations

Prevalence of chronic manifestations

7/29/2019 29361-29371

42/61

42

Conduct pulse polio immunizations for two days everyyear for three to four years or until polio is eradicated.Sustain high level of routine immunizations.Monitor OPV coverage at district levels and below.Improve surveillance capable of detecting all cases of

polio.Ensure rapid case investigation, including thecollection of stool samples.Arrange follow-up of all cases of paralytic polio at 60days to check for residual paralysis.

Conduct outbreak control for cases confirmed orsuspected to stop transmission.

POLIO ERADICATION PROGRAMME

7/29/2019 29361-29371

43/61

43

7/29/2019 29361-29371

44/61

44

GOALTo assist governments in their efforts toimmunize every child against polio until polio

transmission has stopped, so that the worldcan be certified polio-free.

7/29/2019 29361-29371

45/61

45

7/29/2019 29361-29371

46/61

46

7/29/2019 29361-29371

47/61

47

7/29/2019 29361-29371

48/61

48

National Immunization Days

9.12.1995 - I st NID

20.01.1996

07.12.1996 2nd NID

18.01.1997

07.12.1997 3rd NID

18.01.1998

06.12.1998 4th NID

17.01.1999

24.10.1999 5th NID

21.11.1999

19.12.1999

23.01.2000

2004 - ( 5- NID, 3SID)

2005

( 2-NID, 6 SID)

7/29/2019 29361-29371

49/61

49

Goal & objectives of NationalAIDS Control Programme

Prevention of HIV infection

Decrease the morbidity and mortalityassociated with HIV infection

To minimize the socio- economic impactsresulting from HIV infection

Phase-II

To reduce the spread of HIV infection

To strengthen Indias capacity to respond toHIV/AIDS on a long term basis

7/29/2019 29361-29371

50/61

50

Medium term objectives

To establish effective surveillance in all states tomonitor the epidemic

To provide sound technical support

To ensure a high level of awareness of HIV/AIDS andits application in the population

To promote the use of condoms for safe sex Target intervention to high risk group

To ensure safety of blood

To develop the services required for providingsupport to HIV infected persons, AIDS patients &

their associate

7/29/2019 29361-29371

51/61

51

Programme strategy

Programme management

IEC and social mobilization

Blood safety

Condom promotion

Control of STD Clinical management

Care & Support

Surveillance

7/29/2019 29361-29371

52/61

52

Monitoring & Evaluation

Prevention indicator survey (PI)

To assess the achievements made

To assess the achievements made 10 indicators

7/29/2019 29361-29371

53/61

53

Monitoring of family health awareness campaign

Monitoring of IEC for availability and distribution ofmaterials for awareness programme

Ensuring the availability of condoms

Ensuring availability of drugs for opportunistic infections inthe hospital

Ensuring the availability of Anti retroviral drugs STD/HIV/AIDS surveillance

Financial control

Monitoring of Blood banks

7/29/2019 29361-29371

54/61

54

Goal & objectives of NationalLeprosy Eradication Programme

To arrest the disease activity in all known cases of leprosyby the year 2000 A.D

To reduce the prevalence rate to less then 1/10,000population by the year 2000 A.D

7/29/2019 29361-29371

55/61

55

GOAL AND OBJECTIVE OF LEPROSY

ERADICATION PROGRAMME

Goal:Elimination of leprosy as a public healthproblem i.e.to reduce the prevalence rate to less thanI per 10000 population by the year 2000 AD.

Objective:To arrest disease activity in all the

known cases of leprosy by the year 2000AD

Strategy: The elimination strategy

MONITORING INDICATORS

7/29/2019 29361-29371

56/61

56

MONITORING INDICATORS

Point Prevalence Rate Indicator of magnitude of theproblem

Monthly&Annual New Case detection rate Indicator ofimpact of the programme Timely detection of new cases Proportion of children among new cases Indicator of

early detection Proportion of new cases with deformity Indicator of

effectiveness of programme implementation Proportion of MB among new cases Indicator of late

detection Proportion of female patients among new cases Prevalence discharge ratio Indicator of progress of the

programme related to cure Clinic attendance Indicator of regularity of treatment

Proportion of new cases verified as correctly diagnosed Proportion of treatment defaulters Number of relapses Proportion of patients who develop new/additional

disability during multi drug therapy

7/29/2019 29361-29371

57/61

57

Goal & objectives of NationalIodine Deficiency Disease Control

Programme

Survey to assess magnitude of problem in

the community Supply of iodated salt in place of common

salt

Resurvey after 5 years

Lab monitoring of iodated salt Health education

7/29/2019 29361-29371

58/61

58

Goal & objectives of NationalProgramme for control of

Blindness

To reduce blindness in India from 1.4% to 0.3% To provide comprehensive eye care through primary

health care system

G l & bj ti f N ti l

7/29/2019 29361-29371

59/61

59

Goal & objectives of NationalCancer Control Programme

Primary prevention of cancers by healtheducation regarding hazards of tobaccoconsumption and necessity of genital hygiene forprevention of cervical cancers

Secondary prevention( Early detection anddiagnosis of cancer, for example Ca Cervix, Cabreast, Ca oropharynx, by screening methodsand patient education on self examining methods

Strengthening of existing cancer treatmentfacility

Palliative care of terminal stage of cancers

G l & bj ti f N ti l

7/29/2019 29361-29371

60/61

60

Goal & objectives of NationalMental Health programme

To ensure availability and accessibility ofminimum health care for all in foreseeable future,particularly for most vulnerable/under privilegesection of society

To encourage application of mental healthknowledge in general health care and in socialdevelopment

To promote community participation in mental

health services and increase efforts towards selfhelp in the community

7/29/2019 29361-29371

61/61