Unit 10. Monitoring and evaluation TB Infection Control Training for Managers at the National and Subnational Levels.

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

4

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

6

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