Session 9: Tuberculosis and HIV Co-Management
Monitoring and Evaluation
This session will wrap up with a discussion of monitoring and evaluation efforts and how the data collected through these efforts is used locally and nationally.
Learning Objectives
By the end of this session, you will be able to:
- Define the NTPL’s monitoring and evaluation/surveillance systems.
- Describe the End TB Strategy’s indicators and targets.
Learning Activities
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TB Monitoring and Evaluation (5 min)
Tuberculosis surveillance remains a critical element of the national response to the TB epidemic. Similarly, continuous monitoring and evaluation (M&E) of the National TB Programme provides a clear view on the country’s progress towards achieving the goals and objectives of the National TB and Leprosy Control Programme (NTLP) Strategic Plan 2017 – 2020 and the WHO’s End TB Strategy targets.
M&E activities are carried out to continuously and periodically measure and evaluate the programme’s progress in achieving its set objectives and targets which have been developed through the NTLP strategic plan.
The purpose of monitoring and evaluation activities are to:
- Ensure that training, supervision, logistics management, and communication activities are being carried out effectively at each level from the national level to the primary health-care level.
- Ensure that data needed to assess case notification rates and treatment outcomes are collected and enable programme management units at all levels to take the necessary corrective actions.
- Provide evidence that enables staff to improve standards of practice for patient care and support.
- Monitor the progress that has been made towards achieving outcomes at a specific point in time.
- Identify technical and operational problems and determine the reasons for the problems.
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Structure of the NTLP Recording System (10 min)
The data used for monitoring and evaluation of the NTLP comes from the routine recording and reporting of information from all levels of the health services starting with the collection of TB patient related data at the community level.
Once clients are screened and presumed of TB, their data begins to flow as shown below. Tap on each box to learn more.
Presumptive register
All clients screened and presumed to have TB are documented in the presumptive TB register.
Laboratory request form
Presumptive TB clients are asked to submit sputum samples. The samples and completed laboratory request forms are then sent to the laboratory.
Laboratory register
At the laboratory, the samples are documented in the laboratory register.
Health facility TB register
Once diagnosed with TB, a patient is registered in the health facility TB register.
Notification forms forwarded to DTLC
Notification forms are completed and forwarded to the DTLC.
TB treatment card
The client is given the TB treatment card and the DOTS activities are recorded in the health facility TB register.
Quarterly TB report form
At the end of each quarter, facilities complete the quarterly TB report form and it’s forwarded to the DTLC for compilation of the district report.
Information entered into DH1S2
All the information is then entered in the DHIS2 by the district health information officer (DHIO) where it can be accessed by everyone.
The data that is collected is used differently depending on the health service level. Tap on each level to read more.
Health facility
At the health facility level, data is used for evaluating case detection and case management. Data is also used to rapidly assess the facility’s program performance using the quarterly reports compiled from the facility recording tools. Using this data, individual clients who are not doing well, such as those with interrupting treatment, whose sputum is not converted to negative after two months of intensive phase, or who have poor weight gain, are identified and targeted to improve their progress.
District
At the district level, data is used for planning and distributing resources, comparing health facilities, detecting problematic areas early, providing feedback, and remedying problems within the district.
Provincial
At the provincial level, data is used for comparing districts, allocating resources to districts, detecting problem districts early, providing feedback, and improving performance.
National
At the national level, data is used for mobilizing resources and meeting international reporting requirements. It is also used for formulating TB policies and advocating for political commitment to the TB response and the TB prevention and care programme.
TB cohort analysis
A cohort is a group of clients diagnosed and registered for treatment during a specific time period. The cohort analysis system is the key management tool for evaluating NTLP’s performance. Cohort analysis takes place about a year after treatment initiation. A typical cohort consists of all those new clients registered during a quarter (for example from 1 January to 31 March). Treatment outcome assessment is conducted for all clients at the end of TB treatment. This information is then available on the patient treatment card, TB health facility register, and district TB register. Thus, recording accurate and complete information on treatment cards enables the NTLP to monitor clients and the progress of the various health units with regards to achieving local and national targets.
For more information, see the TB Data Use Guide for Health Care Workers included in the resources section of this training.
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End TB Strategy’s Indicators and Targets (5 min)
In the first section of this session we talked about the WHO’s END TB Strategy that sets out to end the tuberculosis epidemic globally. This strategy asks all countries to practice stewardship and accountability through monitoring and evaluating activities. The National TB and Leprosy Control Programme (NTLP) uses indicators to monitor Zimbabwe’s progress in reaching the END TB Strategy targets. Tap on each indicator to learn more.
Case notification rate
The number of TB cases reported to the NTLP per year per 100,000 population. Case notification rates are usually calculated for new bacteriologically confirmed pulmonary TB cases and all forms of TB cases. The END TB Strategy target for this rate is 90%.
Treatment success rate
The percentage of TB cases registered in a specified period who completed treatment regardless of if there is bacteriologic evidence of success (“cured”) or not (“treatment completed”). The END TB Strategy target for this rate is 90%.
Treatment failure rate
The percentage of TB cases registered in a specified period who are smear positive at five months or later after initiating treatment.
Lost to follow-up rate
The percentage of TB cases registered in a specified period who did not start treatment or whose treatment was interrupted for two consecutive months or more.
Not evaluated rate
The percentage of TB cases registered in a specified period who were not evaluated for an outcome.
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Knowledge Check (5 min)
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Key Points (5 min)
- Continuous monitoring and evaluation (M&E) of the National TB Programme provides a clear view on the country’s progress towards achieving its goals and objectives.
- The data used for monitoring and evaluation of the NTLP comes from the routine recording and reporting of information from all levels of the health services. The data that is collected is used differently depending on the health service level.
- The cohort analysis system is the key management tool for evaluating NTLP’s performance.
- It’s important to monitor MDR-TB patients for adverse events and for clinical and bacteriological treatment response.
- The NTLP uses indicators to monitor Zimbabwe’s progress in reaching the END TB Strategy targets.