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LearningObjec/ves
• Studentsareabletoexplaintheimportanceofmonitoringandevalua/onaprogrammanagement
• Studentsareabletoapplyconceptsofmonitoringandevalua/oninaprogrammanagement
Dimension Monitoring Evalua2on
Frequency Periodic,occursregularly Episodic
Func2on Tracking/oversight Assessment
Purpose Improveefficiency,provideinforma/onforreprogrammingtoimproveoutcome
Improveeffec/veness,impact,valueformoney,futureprogramming,strategyandpolicymaking
Focus Inputs,outputs,processes,work-plans(opera/onalimplementa/on)
Effec/veness,relevance,impact,cost-effec/veness(popula/oneffect)
Methods Rou/nereviewofreports,registers,administra/vedatabases,fieldobserva/ons
Scien/fic,rigorousresearchdesign,complexandintensive
Informa2onsource
Rou/nesurveillancesystem,fieldobserva/onreports,progressreports,rapidassessment,programreviewmee/ng
SamePopula/onbasedsurveys,vitalregistra/on,specialstudies
Cost Consistent,recurrentcostsspreadacrossimplementa/onperiod
Episodic,oSenatthemidpointandendofimplementa/onperiod
TheGlobalFund.(2011).MonitoringandEvalua/onToolkits.
Monitoringgivesinforma/ononwhereapolicy,program,orprojectisatanygiven/me(andover/me)rela/vetorespec/vetargetsand
outcomes.Itisdescrip/veinintent.Evalua/ongivesevidenceofwhytargetsandoutcomesareorarenotbeingachieved.Itseekstoaddress
issuesofcausality.
Kusek&Rist.(2004).TenStepstoResultsBasedMonitoring&Evalua/onSystem.WorldBank.
M&E
Monitoring• Clarifiesprogramobjec/ves• Linksac/vi/esandtheir
resourcestoobjec/ves• Translatesobjec/vesinto
performanceindicatorsandsetstargets
• Rou/nelycollectsdataontheseindicators,comparesactualresultswithtargets
• Reportsprogresstomanagersandalertsthemtoproblems
Evalua2on• Analyzeswhyintendedresults
wereorwerenotachieved• Assessesspecificcausal
contribu/onsofac/vi/estoresults
• Examinesimplementa/onprocess
• Exploresunintendedresults• Provideslessons,high-lights
significantaccomplishmentorprogrampoten/al,andoffersrecommenda/onsforimprovement
Kusek&Rist.(2004).TenStepstoResultsBasedMonitoring&Evalua/onSystem.WorldBank.
WhyM&Eareneeded?
• Toensurethatresourcesareusedeffec/veandefficient(input)
• Toensurethattheprogramisimplementedasplanned(process)
• Toinformaboutthelevelofachievedoutput,thereforecorrec/onsmaybeconductedifneeded(output/outcome)
• Toassessimpactofprogram(impact)
PlanningofM&ESystems
Indicators,baseline,target
Datasource+Methodsofdata
collec/on
Analysis+Synthesis
Communica/on+Useof
informa/on
ResultsbasedM&E
Goal
Outputs
Outcome
Ac/vi/es
Input
Results
Implem
enta/o
n
Longterm,widespreadimprovementinsociety
Intermediateeffectofoutputsonclients
Productsandservicesproduced
Taskperssonelundertaketotransforminputsintooutputs
Financial,human,andmaterialresources
Kusek&Rist.(2004).TenStepstoResultsBasedMonitoring&Evalua/onSystem.WorldBank.
Example:ResultsbasedM&E
Goal
Outputs
Outcome
Ac/vi/es
Input
Results
Implem
enta/o
n
ToendTBepidemicinIndonesia
Increasethecaseno/fica/onrateannualytoachieveaminimuncasedetec/onrateof70%,by2019,as
comparedto33%in2014
34provincialleveltraining1na/onalworkshopontheguideline
IntensifiedCaseFinding(ICF)isimplementedinall34provinces
Guidelines,training,implementa/onofICF
Trainers,Trainee,DraSofguideline,etc
Indicators,Baseline,Target
Kusek&Rist.(2004).TenStepstoResultsBasedMonitoring&Evalua/onSystem.WorldBank.
IndikatoryangBaik
Clear Relevant Economic
Adequate Monitorable
Kusek&Rist.(2004).TenStepstoResultsBasedMonitoring&Evalua/onSystem.WorldBank.
M&EDataSource
AnnualReport
MonthlyReport
DailyRegister
IndividualMedicalRecords
Agregate
Detail
Kusek&Rist.(2004).TenStepstoResultsBasedMonitoring&Evalua/onSystem.WorldBank.
Designanevalua/onOvretveitJ.2003.Evalua/ngHealthInterven/on.OpenUniversityPress
Purpose
Whentheevalua/onis
undertaken:before/during/aSer?
Focusofevalua/onScope:
limitedorcomprehensive?
Methods
Evaluatorrole:internal/external
evaluator?HowoSen
Focusofevalua/on
Needs Demands Inputs Processes Outputs Outcome
Feasibility Process/Forma/ve Lookattheeffect
AssessmentofDOTSstrategyimplementa/oninhospitalsinIndonesia:2005-2007
AdiUtarini,AriProbandari,TrisasiLestari,HarySanjoto,KtutAs/,Agus/na,MohammadArifin
32
TheStudy
BurdenofTB TBservicesinhospital
DOTSstrategyimplementa/on
DOTSCentre Lab Districtwasor
Pa/ent Provider
ISTC
Prescrip/on
ThePerspec/ves
Service
Provider
Pa/-ent
Sputumcollec/onandprac/cesintheward
37
“HIVpa/entswereputinthesameroomwithTB,TB-HIVorotherpa/entswithinfec/ousdiseases”(Fieldnotes)
38
UseofsecondlinedrugsinTBtreatment
Common pattern : -HRE-Cipro (Cat 1) -HRZE-Cipro (Cat 1) -Cipro (Cat II)
• CategoryI,IIandExtra-pulmonaryTBCases:
– firstlinegenericdrugs(41-64%)
– FDCprovidedbyNTP(21-40%)
• Children:
– firstlinegeneric(82%)
– first-linebranded(18%)
39
MostCommonSourceofTBdrugsusedbyTBpa/ents
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 2 3 4 5 6 7 8
TypeDosageSecondline drug
DeficienciesinTBdrugsprescrib/onanddosageinTBAdultCases
ISTCStandard Criteria Hosp(%)
ChestClinic(%)
Standard1 Coughfor2-3weeksasTBsuspects 88.9 50.0Standard2 SputummicroscopyforTBdiagnosis:
Sputumtestcarriedout 94.4 100.0Atleast2specimensfordiagnosis 94.4 100.0
Standard3 Microscopyexamina/onforEP-TB 66.7 50.0Standard4 Sputumexamina/onforsugges/veofTB 94.4 100.0Standard5 DiagnosisofSS(-)TB:
Repeatsputumexamina/on 22.2 50.0Repeatsputumexamina/on&XRay 22.2 0.0Clinicaljudgement&XRay 33.3 0.0
Standard6 ScoringsystemforpediatrictTB 11.1 100.041
ISTCStandard Criteria Hosp(%)
C.Clinic(%)
Standard7 Treatmentmonitoring 77.8 100.0Standard8 TBtreatment:
Firstlinedrugs 94.4 100.0Dossageconformtointerna/onalrecommenda/on
94.4 100.0
Standard9 Treatmentadherence:Treatmentsupporter 72.2 50.0Referralforpooradherence 83.3 100.0
Standard10 SStestformonitoringtreatment 88.9 100.0Standard11 Recordingallmedica/ons 88.9 100.0Standard12 TB-HIV:
HIVriskassessed 50.0 50.0ReferraltoVCT 77.8 50.0 42
ISTCStandard Criteria Hosp(%)
C.Clinic(%)
Standard13 ARVtreatmentini/a/on:ARVandTBdrugsgivenconcurrently 55.6 50.0Cotrimoxazoleprofilaxis 50.0 50.0
Standard14 Monitoringofdrugresistance 44.4 50.0Standard15 DrugresistanceTB:
ConsulttoMDRexpert 72.2 100.0Effec/vefourdrugregimen 44.4 50.0
Standard16 Contacttracing 50.0 0.0Standard17 Repor/ngallTBcasestohealth
authori/es94.4 100.0
43
44
ISTCPublicHealthResponsibili/es
ISTCStandard Criteria Hosp(%)
ChestClinic(%)
Standard16 Contacttracing 50.0 0.0Standard17 Repor/ngallTBcasestohealth
authori/es94.4 100.0
45
Findings
STRUCTURE
1. Ownershipofhospitals
2. Qualityassurancesysteminhospital
3. TBcaseload4. Trainedstaffs5. DOTSteam6. DOTSunit7. NTPGuidelines8. Financialincen/ves
fromDHOtohospitals
PROCESS
1. Commitmentfromhospital
2. Adherencetostandardofdiagnosisandtreatment
3. Conversionrate4. Caseholding
process
OUTCOME
1. Treatmentsuccessrate
2. Treatmentcomple/onrate
3. Defaultrate4. CoverageofDOTS
withinahospital
ProbandariA,UtariniA,Hur/gAK.AchievingqualityintheDOTSstrategyimplementa/onprocess:achallengeforhospitalPPMinIndonesia.GlobalHealthAc/on2008.DOI:10.3402/gha.v1i0.1831
Outpa/entUnit
TB suspects
Outpa/entUnit
HospitalLaboratory
DOTSunit
TBsuspectsdonotperformsputumtest
TBsuspectsperformsputumtest
TBcases NotTBcases
TreatedwithinthehospitalnotunderDOTS
unit
Refertootherhealthservicefacili/es
MedicalRecordReportICDXA.15-A.19
DOTSpaBentregister
Labregister
ReferralratefromIrawa/et.al.(2007)20-53%
LossoffollowupamongSS(+)TBcases:8-18%
46
ProbandariA,LindholmL,StenlundH,UtariniA,Hur/gAK.MissedopportunityforstandardizedtreatmentamongadultTBpa/entsinhospitalsinvolvedinPPM-DOTSinIndonesia.BMCHealthServicesResearch2010;10:113
M&EResultU/liza/on
• Mass-Media• Internet• E-government• AnnualReport• PublicHearingwithHouseofRepresenta/ve• PublicDiscussion
Con/nuingM&E
• Demand• Clearrolesandresponsibility• Trustworthyandcredibleinforma/on• Accountability• Capacity• Incen/ves