Pursue high-quality DOTS expansion and enhancement
Element 5: Monitoring and evaluation system, and impact measurement
Recording and reporting system
Establishing a reliable monitoring and evaluation system with regular communication between the central and peripheral levels of the health system is vital. This requires standardized recording of individual patient data, including information on treatment outcomes, which are then used to compile quarterly treatment outcomes in cohorts of patients.
These data, when compiled and analysed, can be used at the facility level to monitor treatment outcomes, at the district level to identify local problems as they arise, at provincial or national level to ensure consistently high-quality TB control across geographical areas, and nationally and internationally to evaluate the performance of each country. Regular programme supervision should be carried out to verify the quality of information and to address performance problems.
Enhanced recording and reporting
Both developed and developing countries now have additional diagnostic information at their disposal, including sputum culture, DST and HIV test results, all of which can be used to guide patient management. TB programme managers also need to monitor records and reports from public and private care providers not directly linked to the national TB programme (NTP). Special attention must be paid to ensuring the confidentiality of patient information. Use of electronic recording systems will be considered where appropriate.
Making the best use of data at all levels will mean many countries having to train staff in the analysis and interpretation of data, as well as in the use of the computer software that can greatly facilitate this work. As electronic recording systems become more widely available, consideration should be given to storing individual patient data, which will make more detailed analyses of aggregated data possible.
WHO's report on Global TB Control compiles data from 200 countries each year, monitoring the scale and direction of TB epidemics, implementation and impact of the Stop TB Strategy, and progress towards the Millennium Development Goals.
TB impact measurement
TB impact measurement has two major components. The first is measuring the epidemiological burden of TB, and trends in this burden, in terms of three so-called "impact indicators": incidence (the number of newly-arising cases of TB each year), prevalence (the number of cases of TB in the population at a given point in time) and mortality (the number of deaths from TB in a given year). These are the major indicators being used to measure progress in TB control at global level, for example in the context of targets set within the Millennium Development Goals (MDGs) and by WHO and the Stop TB Partnership. The second major component of TB impact measurement is evaluation of the extent to which interventions to control TB are responsible for changes in incidence, prevalence and mortality (so-called "impact evaluation").
WHO has established the Global Task Force on TB Impact Measurement.