Supervision & Monitoring strategy RNTCP-India by d9n1aQO


									Strategy for Supervision and
   Monitoring of RNTCP
       Dr Malik Parmar
      WHO Medical Consultant,
        RNTCP, Gujarat
      Need for a monitoring and
        supervision strategy
• Re-focus from an “expansion / preparatory” to a
  “maintenance / consolidation” mode
• Overall good performance but some districts continue
  to perform poorly
• Good practices need to be established and sustained in
  newly implementing districts
• Over time, people tend to slip into ‘routine’ behaviour
 Objectives of supervision and monitoring
• Ensure activities as planned and data reported is
  accurate and valid
• System for analysis, supervision and review which
  leads to remedial action
• Tool for continuous on the job sensitization
• Involvement and commitment of higher authorities
• Ensure full participation of general health staff and all
• Equitable provision of services to all sections of
    Existing inputs for facilitating
     supervision and monitoring
• Clear technical and operational guidelines in
• Comprehensive modular training to all staff
• Robust recording/reporting system
• Additional full-time sub-district level supervisory
  staff (STS, STLS) with two-wheelers
• Full time district/ state level programme managers
• Adequate funds for mobility/operationalization
• Technical assistance through RNTCP consultants
   Why Regular Supervision ?
•All Health workers need guidance and
feedback on their performance
•Supervision aims to increase efficiency of
Health Workers by
      –   Developing their knowledge
      –   Perfecting their skills
      –   Improve their attitude towards work
      –   Increasing their motivation
• An extension of training

• Carried out in direct contact with the health worker

• Performed at all levels
   – All health workers need help to solve problems and overcome

   – They also need feedback on performance and encouragement
     in work
            Supervisory Protocol
• STO: visit to each district- at least 2/yr
• DTO: visit to all TUs/month, all DMCs/quarter, ensure home
  visits to at least 3 randomly selected NSP patients, reserve
  20 days per month for field visits (between DTO & 2nd MO)
• MO-TC: visit to all DMCs per month, PHIs per quarter,
  reserve at least 7 days per month for field visits
• STS: visit to all DMCs and PHIs every Month, all S+ patients
  within 1 month of start of Rx
• STLS-visit to all DMCs at least once a month
• INSTRUCTIONS: Use check list for supervision, record
  observations in supervisory register, send copy of
  observations to concerned officials, maintain tour diary
               Tools for Supervision
•   Records
•   Reports
•   Check list
•   Supervisory register
•   Using information from supervisory visits to improve
    the programme:
    – Immediate local identification of problem and solutions
    – Information left in the supervisory register and tour reports
      reviewed by others and follow-up action taken
    – Few key information transferred to PMR reports (e.g. patient
    Why Regular Monitoring ?
• Monitoring ensures compliance to planned activities
• Continuous oversight of the implementation of an
  activity to ensure that:
   – input deliveries, work schedules and targeted outputs are
     proceeding according to plan

• Aims to identify evidence of diversions
• Identifies need for formal evaluation
• Allows timely solutions
       Programme indicators
• Input indicators
  – e.g. indicators on human material and financial resources
• Process indicators
  – e.g. indicators on involvement of health facilities, quality
    of microscopy, drug supply
• Outcome indicators
  – e.g. indicators on case detection and treatment success
• Impact indicators
  – E.g. reduction in incidence, prevalence, mortality
      Monitoring indicators (1)
• Levels of monitoring
  –   PHI other than DMC
  –   DMC
  –   TU
  –   District
  –   State
  –   National
          Monitoring indicators (2)
Indicators for different Components of RNTCP
• Political and administrative commitment
• Human resource
• Diagnosis (includes private sector and other sectors)
• Drugs
• DOT and follow-up (includes private sector and other sectors)
• Recording and reporting (includes private sector and other sectors)
• Supervision
• Financial management
          Key monitoring tools
• Reports: Monthly/Quarterly/Annual for all levels of
• Supervisory register at PHIs
• Supervisory check list for programme managers
• Programme review check list- CMO, DM,
• Tour diary/ duty travel report of supervisory staff
• Internal evaluation reports of the districts
• Review meeting minutes district/ state level
• DTCS/STCS meetings minutes
    Special Tools for Monitoring prepared at
                    state level
• Common Minimum Agenda for District Review Meetings
• Pediatric TB Management indicators under “Nirogi Bal Varsh”
• Initial home visit format and Counseling of smear negative cases in
  diagnostic algorithm in Gujarati
• Tracking Honorarium Payment
• Tracking TU wise performance in NSP and RT cases with advance
  follow up reminder line-listing
• Tracking sputum conversion and outcomes of TB HIV cases
• Tracking TU wise repeat sputum examinations done in each quarter
• Situational analysis of diagnostic facilities in all sectors to diagnose
  Smear Negative and EP TB cases.
• Summary report to monitor sputum collection and transport
• DTOs / MOTCs tour dairy report
  (Need to be used regularly in the field in all the districts)
    Data Analysis for Monitoring
• Indicators
   – Inputs
   – Process
   – Output
   – Impact
• Descriptive Analysis - Microanalysis to identify
  underperforming TB Units, DMCs, PHIs, Sub Centres,
  villages and slum pockets
• Trend analysis of various indicators over time
• Correlation analysis of interdependent indicators
How to implement the S&M Strategy
           in your area
• Ensure adequate and skilled human resource
  – Full complement of staff at State TB Cell
  – Full time programme officers at State/District levels
  – Ensure all STS/STLS/MOTC/LT posts are filled at
    all times
  – Ensure training for all staff
• Communicate the strategy and action plan for
  RNTCP S&M to all DMs from Health
  Secretary, and to all CMOs from DHS
How to implement the S&M Strategy
      in your area (contd..2)
• Establish functions of STDC at the State level
  – Intermediate level reference lab for EQA in
    sputum microscopy
  – Programme monitoring team with mobility
  – Training team for ensuring good quality training:
    Initial/induction, retraining/refresher, updates
• Establish State Drug Store to maintain
  uninterrupted supply of drugs
• Follow the S&M strategy
 True Epidemiology and Achievement
      is what’s on the Ground..
• RNTCP objectives are reasonable & achievable
• The standardized recording & reporting system reflects
  the actual ground conditions
• Any attempt made to tamper with the system. and the
  data, will distort the outcomes & programme quality
• There should be no attempt to create or report inflated performance
   – Enough examples where programme have degenerated into simple target
     achievement exercise
• Under achievement should not be merely condemned but lead to an
  analysis & understanding of the difficulties and possible solutions
 Let’s remind ourselves


        …GETS DONE!!

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