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)
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)
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)
DR.I.SELVARAJ,I.R.M.S
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
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
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
Monitoring process
Detecting deviations from plans Diagnosing causes for deviations Taking corrective action
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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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
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TOOLS OF EVALUATION
Review of Records Monitoring Case studies Qualitative studies Controlled experiments and intervention studies Sample surveys
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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?
What is to be Evaluated?
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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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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
Assessment of health need
No
Monitoring
Establish goals &objectives PLANNING CYCLE Time frame Assessment of resources
Implementation of programme
Action plan
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 23 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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Indicator
Population Growth
16.2% (2001-2011)
45/1000
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35/1000
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30/1000
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Reduce by 2/3rds from 1990 levels Reduce by 3/4th from 1990 levels 27
200/100,000
150/100,000
100/100,0 00
2.3 65%
2.2 65%
Goal:
Objective: Target
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Health For All Population stabilization by 2045 Total fertility rate to the replacement level by 2010 and to achieve the other indicators of health for all
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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Target
: Three million cases have to be treated and 1.5 million cases have to be cured. Program : RNTCP DOTS
Strategy:
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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%=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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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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1.Monitoring of implementation efficiency of various activities 2.Monitoring/assessment of the impact of control measures
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Malariometry
Annual Blood Examination Rate Annual Parasite Incidence Annual Falciparum incidence Slide Positivity Rate Slide falciparum rate Parasite rate Infant parasite rate Spleen rate ¶site density index
Vector indices
Mosquito density Sporozoite rate Inoculation rate Man biting rate Human blood index
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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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Clinical indicators
Incidence of acute manifestations Prevalence of chronic manifestations
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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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Programme strategy
Programme management IEC and social mobilization Blood safety Condom promotion Control of STD Clinical management Care & Support Surveillance
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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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Objective: 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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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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