Transcript By DR.I.SELVARAJ,I.R.M.S B.Sc., M.B.B.S.,(M.D, Community Medicine)., D.P.H.,D.I.H.,PGCH&FW (NIHFW, New Delhi) • Monitoring and evaluation are essential management tools which help to ensure that health activities.

By
DR.I.SELVARAJ,I.R.M.S
B.Sc., M.B.B.S.,(M.D, Community Medicine).,
D.P.H.,D.I.H.,PGCH&FW (NIHFW, New Delhi)
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•
Monitoring and evaluation are essential management
tools which help to ensure that health activities are
implemented as planned and to assess whether desired
results are being achieved.
• Monitoring:
1. To provide concurrent feedback on the progress of
activities
2.To identify the problems in their implementation
3.To take corrective action
Evaluation:
To assess whether the desired results of a programme
have been achieved if not how it should be redesigned
2
MONITORING
A process of measuring, recording,
collecting and analyzing data on
actual
implementation
of
the
programme and communicating it to
the programme managers so that any
deviation from the planned operations
are detected, diagnosis for causes of
deviation is carried out and suitable
corrective actions are taken.
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1.It helps in setting norms of performance
2.It helps in measuring level of performance
3.It helps in comparing performance level with
standards or norms
4.It helps in identifying deviations and explain
the reasons for the deviation for taking
necessary corrective action
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Monitoring and Planning
• The purpose of monitoring is to ensure that
programmes are implemented as planned.
• Preparation of action plan
• The plan should specify what needs to be done, who
is going to do it, and when it is to be done
• Inadequacy in planning will result in inadequacy in
monitoring
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Monitoring process
• Detecting deviations from plans
• Diagnosing causes for deviations
• Taking corrective action
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Different levels of Monitoring
• Managers at top level
• They have to develop health plans based on
objectives, goals, devise strategy and allocate
necessary resources
• Managers at the middle level
• They are more concerned with whether they are
getting desired output from the inputs that are being
utilized
• Managers at the operational level
• They have to supervise actual operations and to
ensure that planned activities are being carried out as
per schedule
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EVALUATION
It is a systematic way of learning from experience
and using the lessons learnt to improve current
activities and promote better planning by careful
selection of alternatives for future action
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Reasons for carrying out an Evaluation
• To review the implementation of and services provided
by health programmes so as to identify problems and
recommend necessary revisions of the programme
• To assess progress towards desired health status at
national or state levels and identify reasons for gap, if
any
• To contribute towards better health planning
• To document results achieved by a project funded by
donor agencies
• To know whether desired health outcomes are being
achieved and identify remedial measures
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• To improve health programmes and the health
infrastructure
• Allocation of resources in current and future
programme
• To render health activities more relevant, more
efficient and more effective
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Types of Evaluation
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Total Evaluation
Partial Evaluation
Time related Evaluation
Eye wash Evaluation
Whitewash Evaluation
Submerged Evaluation
Concurrent evaluation
Terminal evaluation
Pre-evaluation
Internal evaluation
External evaluation
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TOOLS OF EVALUATION
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Review of Records
Monitoring
Case studies
Qualitative studies
Controlled experiments and intervention studies
Sample surveys
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Who is performing Evaluation?
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The planner
Adhoc research group
Those responsible for health development
Those responsible for implementation
By the Community
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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 of
evaluation?
• Basic steps of Evaluation
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Establishing standards and criteria
Planning and methodology
Collecting data
Analyzing the data
Taking action
Re-evaluation
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What is to be Evaluated?
• Evaluation of structure
• Evaluation of Process
• Evaluation of Outcome
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Process of Evaluation
The process of evaluation consists of the
following components:
1.
2.
3.
4.
5.
6.
7.
8.
Specify the particular subjects
Information support
Verify relevance
Assess adequacy
Review progress
Assess efficiency
Assess effectiveness
And assess impact
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INDICATORS
The indicators based on a valid, reliable, reproducible,
repeatable, sensitive, specific and relevant are used to
monitor and evaluate the various activities
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Types of indicators for evaluation
• Output indicators
• Process indicators
• Product indicators
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• The plan should identify key result areas and
define how they will be measured
• The plan should specify prioritize activities,
so that they receive adequate emphasis
during monitoring
• The plan should cater to local variations
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Identify all inputs to be provided
Activities to be carried out
Outputs desired for the programme
Select the key inputs, activities, output variables for
monitoring
• Identify the indicators for measuring the variables
• Prepare a plan for collecting and processing the
information on the selected indicators
• Prepare a format for giving feedback on these
indicators to managers responsible for
implementation
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Evaluation
GOALS&OBJECTIVES
Yes
No
Assessment
of health need
Monitoring
Establish
goals
&objectives
Implementation
of programme
PLANNING CYCLE
Assessment
of resources
Time
frame
Action
plan
Select the
best
alternative
Design
alternative
programme
Establishment
of priorities
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EFFICIENCY &EFFECTIVINESS
• Monitoring & Evaluation are necessary to ensure
efficiency and effective uses of measure
• Efficiency is usually measured by the ratio of activity
to input
• Effectiveness is measured by the ratio of output to
activities
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Monitoring
• It determines
Programme efficiency
• It establishes standard
of performance at the
activity level
• It forms a basis for
Programme
accountability
• It alerts the
management of
discrepancy
• It identifies strong
&weak points of
programme operations
Evaluation
• It determines
Programme effectiveness
• It identifies
inconsistencies between
the programme
objectives and activities
• It alerts the
management of
discrepancies between
actual and anticipated
levels of programme
impact
• It suggests changes in
programme procedures,
operation and objectives
• It identifies the possible
side effects of the
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programme
EXISTING CONTROL PROGRAMMES
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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
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Monitoring & Evaluation of RCH
PROGRAMME
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The 5 year RCH phase II is being launched in
TamilNadu on 2005 with a vision to bring about
outcomes
as
envisioned
in
the
Millennium
Development Goals, the National Population Policy
2000 (NPP 2000), the Tenth Plan, the National Health
Policy 2002 and Vision 2020 India, minimizing the
regional variations in the areas of RCH and population
stabilization
through
an
integrated,
focused,
participatory programme meeting the unmet needs of
the target population, and provision of assured,
equitable, responsive quality services.
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National
Population
Policy
2000 (by
2010)
Millennium
Development
Goals
(B
y 2015)
Tenth Plan
Goals (20022007)
RCH II Goals
(2005-2010)
Population
Growth
16.2% (20012011)
16.2%
(2001-2011)
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Infant
Mortality Rate
45/1000
35/1000
30/1000
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Under 5
Mortality Rate
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-
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Reduce by
2/3rds from
1990 levels
Maternal
Mortality Ratio
200/100,000
150/100,000
100/100,0
00
Reduce by
3/4th from
1990 levels
Total Fertility
Rate
2.3
2.2
2.1
-
Couple
Protection Rate
65%
65%
Meet
100%
needs
-
Indicator
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THE ACTION PLAN FOR CARRYING OUT R.C.H SERVICES
Goal:
“Health For All”
Objective:
Target
:
Population stabilization by 2045
Total fertility rate to the replacement
level 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
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ACCESSIBILITY INDICATOR
•No. 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
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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
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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 DELIVERY
•COUPLE PROTECTION RATE
•PREVALENCE OF TERMINAL METHOD OF
STERILIZATION
•PREVALENCE OF SPACING METHOD
•% ABORTION RELATED MORBIDITY
•PREVALENCE OF ADD
•PREVALENCE OF ARI
•PREVALENCE OF RTI/STDs
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ACTION PLAN FOR R.N.T.C.P
Goal
: To extend the RNTCP to cover the entire
population of the country by 2005
Objective:1) To cure 85% of the sputum positive
cases
2) To detect 70% of the estimated
cases of T.B
Target
: Three million cases have to be treated
and 1.5 million cases have to be cured.
Program : RNTCP
Strategy:
DOTS
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Performance of RNTCP
Monitoring & Evaluation:
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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%=corrective
action
• Cure rate (New sputum + ve cases)=85%
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• Expected rate of sputum examination among new
adult outpatients (2%)
• Expected rate of proportion of patients undergoing
sputum examination who are smear +ve (10%)
• At least 90% of patients who were smear +ve should
be 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 + ve
patients ( not more than 4%)
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Goal & objectives of National Anti
Malaria Programme (MPO)
• Prevention of deaths due to malaria
• Reduction of Morbidity due to malaria
• Maintenance of industrial and green revolution due to
freedom malaria, as well as retention of
achievements gained so far.
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Monitoring broadly covers two
components
1.Monitoring of implementation efficiency of various
activities
2.Monitoring/assessment of the impact of control
measures
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Monitoring of implementation efficiency
of various activities
• Technical
1. Case detection by active and passive
2. Treatment & Referal services
3. Indoor residual insecticidal spray
operations
4. Anti larval measures
• Logistic flow
1. Timely indenting based on epidemiological data
of previous year
• Financial flow
1. Timely payment of wages for casual laborers
involved in spraying operation
2. Repair of equipment and Local purchases
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Malariometry
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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
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Mosquito density
Sporozoite rate
Inoculation rate
Man biting rate
Human blood index
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Indicators for spray operation
• % of villages covered
• % of houses sprayed
• % of rooms sprayed
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Goal & objectives of National
Filaria Control Programme
• To carry out survey in different parts of country to
determine magnitude of problem. Delimitation surveys in
hitherto unsurveyed areas
• Large scale pilot studies to evaluate known method of
filariasis control
• To train professional and personnel required for the
programme
• To control filaria in urban areas by anti-larval measures
• To control filaria in rural areas by case detection and
treatment
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Measurement of filarial problem
Indicators of filarial measurement
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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
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POLIO ERADICATION PROGRAMME
•Conduct pulse polio immunizations for two days every
year 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 the
collection of stool samples.
•Arrange follow-up of all cases of paralytic polio at 60
days to check for residual paralysis.
•Conduct outbreak control for cases confirmed or
suspected to stop transmission.
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GOAL
To assist governments in their efforts to
immunize every child against polio until polio
transmission has stopped, so that the world
can be certified polio-free.
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National Immunization Days
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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)
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Goal & objectives of National
AIDS Control Programme
• Prevention of HIV infection
• Decrease the morbidity and mortality
associated with HIV infection
• To minimize the socio- economic impacts
resulting from HIV infection
Phase-II
• To reduce the spread of HIV infection
• To strengthen India’s capacity to respond to
HIV/AIDS on a long term basis
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Medium term objectives
• To establish effective surveillance in all states to
monitor the epidemic
• To provide sound technical support
• To ensure a high level of awareness of HIV/AIDS and
its 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 providing
support to HIV infected persons, AIDS patients &
their associate
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Programme strategy
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Programme management
IEC and social mobilization
Blood safety
Condom promotion
Control of STD
Clinical management
Care & Support
Surveillance
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Monitoring & Evaluation
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Prevention indicator survey (PI)
To assess the achievements made
To assess the achievements made
10 indicators
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• Monitoring of family health awareness campaign
• Monitoring of IEC for availability and distribution of
materials for awareness programme
• Ensuring the availability of condoms
• Ensuring availability of drugs for opportunistic infections in
the hospital
• Ensuring the availability of Anti retroviral drugs
• STD/HIV/AIDS surveillance
• Financial control
• Monitoring of Blood banks
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Goal & objectives of National
Leprosy Eradication Programme
• To arrest the disease activity in all known cases of leprosy
by the year 2000 A.D
• To reduce the prevalence rate to less then 1/10,000
population by the year 2000 A.D
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GOAL AND OBJECTIVE OF LEPROSY
ERADICATION PROGRAMME
• Goal:
Elimination of leprosy as a public health
problem i.e.to reduce the prevalence rate to less than
I 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
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MONITORING INDICATORS
• Point Prevalence Rate – Indicator of magnitude of the
problem
• Monthly&Annual New Case detection rate –Indicator of
impact 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
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Goal & objectives of National
Iodine 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
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Goal & objectives of National
Programme 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
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Goal & objectives of National
Cancer Control Programme
• Primary prevention of cancers by health
education regarding hazards of tobacco
consumption and necessity of genital hygiene for
prevention of cervical cancers
• Secondary prevention( Early detection and
diagnosis of cancer, for example Ca Cervix, Ca
breast, Ca oropharynx, by screening methods
and patient education on self examining methods
• Strengthening of existing cancer treatment
facility
• Palliative care of terminal stage of cancers
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Goal & objectives of National
Mental Health programme
• To ensure availability and accessibility of
minimum health care for all in foreseeable future,
particularly for most vulnerable/under privilege
section of society
• To encourage application of mental health
knowledge in general health care and in social
development
• To promote community participation in mental
health services and increase efforts towards self
help in the community
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