Monitoring and Evaluation
Monitoring is routine follow-up of program interventions through collecting, analyzing, and reporting TB and leprosy data. Evaluation, on the other hand, deals with analysis of information related to activities and outcomes to determine the performance of the program over a time. A set of indicators and milestones have been identified to help track changes in TB and leprosy control in Tanzania. Monitoring and evaluation generates information needed for decision-making at different levels of care and management.
Key components of monitoring and evaluation
Recording and reporting
Data collection on TB and leprosy is done by health workers at the health facility level using standardized tools coordinated by TB/HIV Officers, DTLCs, and RTLCs. Reporting is done from the district level to higher levels through standardized forms on a quarterly basis. The national level through the TLCU compiles district data, which are then reported to other partners within and outside the country.
The following are the standardized tools used for data collection and reporting on TB and leprosy control in Tanzania.
Data analysis and presentation
Analysis of TB and leprosy data is done at all levels, from the health facility to the national level. Presentation of TB and leprosy data is done in the form of notes, tables, graphs, maps, and reports depending on the needs to be communicated and the intended audience. This information is used to assess the performance of the different levels in TB and leprosy control. Most of this work is done manually due to lack of tools and skills at the different levels. There is also inadequate capacity and infrastructure to utilize the Internet for recording and reporting.
Currently, reports for TB patients can be generated using the case based Electronic TB & Leprosy Register (ETL) software within a fraction of the time, provided that data are entered and updated. However, data entry to ETL is still done at the district level due to ICT infrastructure challenges at most of the health facilities.
Data are considered to be of high quality when they are accurate, comprehensive, consistent, relevant, and timely. To ensure data quality, the NTLP has developed standardized tools to be used for recording and reporting and standard operating procedures to be used by health care workers and program staff in all data recording and reporting pertaining to TB and leprosy care and control. Data quality assurance (DQA) should be conducted routinely at all levels by using standardized DQA tools developed by the NTLP. During quarterly meetings, data or reports should be reviewed to ensure consistence and completeness by comparing hardcopies registers/cards with electronic database. RTLCs should scrutinize all reports from every district for the same.
Reports are used for monitoring, evaluation, planning, and budgeting purposes. It is imperative that data collected at any level be used locally for planning and monitoring purposes. For example, data generated at the district level should be analyzed and disseminated to relevant stakeholders for making evidence-based decisions in the control and care of TB and leprosy. RTLCs and DTLCs should analyze, interpret, and facilitate utilization of data in their respective regions and districts.
The MOHCDGEC supportive supervision guidelines describe supportive supervision as a “process which promotes quality outcomes by strengthening communication, identifying and solving problems, facilitating teamwork, and providing leadership and support to empower health care workers to monitor and improve their own performance”. The scope of supervision methods is expanded by incorporating self-assessment, peer assessment, and community input.
Mentorship is described as a process conducted by a person or team (mentor[s]) for another person or groups (mentee[s]) in order to help that other person or group do a job more effectively. Mentoring can be done for all professions, but when applied in the clinical setting to improve delivery of health care, it is referred to as “clinical” mentoring.
According to WHO, clinical mentoring is a “[s]ystem of practical training and consultation that fosters ongoing professional development to yield sustainable high-quality clinical care outcomes. Mentors need to be experienced, practicing clinicians in their own right, with strong teaching skills”
Purpose of supervision and mentorship in TB and leprosy care and control
The purpose of supervision at the regional, district, and health facility levels is to:
- Provide leadership and guidance to staff through mentorship
- Monitor implementation of planned activities against defined program goals and targets.
- Monitor that all necessary tasks are properly performed.
- Ensure that resources including training and supplies are properly used and are available to staff to carry out their duties.
- Ensure accountability and responsibility.
- Ensure adherence to the set standards of TB and leprosy care.
- Redistribute resources such as drugs and supplies to districts with shortages.
- Identify/Address barriers to service delivery to improve health services on a daily basis.