17.5 Programme assessment


To be complete, evaluation should look at how well the programme functions, particularly with respect to three aspects: organization of care, established procedures and human resources. A set of quality criteria is evaluated for each of these aspects. The criteria may be either qualitative (description) or quantitative (indicators). The following tables can be used as a rough guide.

17.5.1 Organization

Criteria

Indicators

Goals

Access to care

• Accessibility of treatment facilities, decentralization, etc.
Home-based treatment available when appropriate.

Easy access to care during the intensive/continuation phases

Patient comfort

Patient welcome
Condition of the facility, heating (or cooling), overall organization and cleanliness.
Food during hospitalization and/or for outpatients (supplemental rations, quantities, organization in charge).
Bed occupancy rate of the TB ward.

According to needs
Bed occupancy rate ≤ 100%

Information and therapeutic education

Patient interviews conducted.

Patient understanding of treatment

Hospital hygiene

Equipment (respirators, masks, gloves, gowns, autoclaves, cleaning supplies, etc.)
Waste management (sorting, incinerator, etc.)

All necessary equipment is available and used.

Constant supply of lab materials

Supplied by (government, agency or facility, other)
Buffer stock
Number and duration of shortages

3-month buffer stock
No shortages

Constant supply of quality-assured
anti-TB drugs

Stock card maintenance
Order frequency, delivery time, buffer stock
Shortage(s)
Drug sources
Institution in charge of supply
Use of FDCs first-line drugs
Storage conditions
Organization of supply for peripheral facilities

Stock cards up-to-dated
One person in charge of the pharmacy
All adequate
No shortages
WHO-prequalified sources (or equivalent)
Use of FDCs
Appropriate storage conditions
Regular supply

Case detection

Type of case detection (active or passive)

Contacts screening
Detection rate of new smear-positive cases
Percentage of smear-positive patients out of the total number of patients who had a sputum smear.
Detection rate of MDR-TB

Know the type, in order to interpret the quantitative results of case detection
100%
Depends on the context
< 20%
Depends on the context

Diagnosis of smear-negative PTB and EP forms

Automated molecular test
Culture or molecular techniques
X-rays
Others (e.g. ADA, Pandy, Rivalta, FNAC)
Algorithms used

Yes
Yes
Yes
Yes
Yes

DST

DST possible (methods, quality control)

Detection of DR-TB

Treatment support

Number of patients receiving treatment support/month

100% of those eligible for support

Identification of non-adherent patients

System for identifying and looking for non- adherent patients
Percentage of patients who resumed treatment among those missing for less than 2 months who had to be looked for

Yes
> 90%

Integrated TB/HIV care

Access to voluntary counselling and testing (VCT)
Access to ART
Access to cotrimoxazole prophylaxis
HIV treatment integrated in the TB service (or TB treatment in the HIV service)

Yes
Yes
Yes
Yes

17.5.2 Procedures

Criteria

Indicators

Goals

Registers/records

Description of the documents
Consistency between TB registers and treatment cards
Consistency between TB register and lab registers

Records reliable
• 100%
• 100%

Standard case definitions

Percentage of patients with exact case definition out of a randomized sample of patients

100%

Adequate standard treatment regimens and follow-up

Percentage of new cases correctly treated (combinations, dosage, duration) out of a randomized sample of patients
Percentage of patients who did not have bacteriological follow-up according to schedule out of a randomized sample of patients
Percentage of MDR-TB patients who did not have biochemistry tests according to schedule out of a randomized sample of patients

• > 95%
< 10%
< 10%

HIV testing

Percentage of new cases tested for HIV

100%

ART

Percentage of HIV-positive TB cases started on ART
ART started within:
< 2 weeks; 2 weeks-< 2 months; ≥ 2 months

100%

Criteria for cure

Percentage of confirmed cases declared cured who actually met the definition of cure out of a randomized sample of patients

> 90%

Regular monitoring of drug-susceptible TB and DR-TB

Quarterly report and cohort analysis for drug-susceptible TB
Bi-annual report and cohort analysis for DR-TB

Quantitative data on inclusions and results collected
Rapid detection of potential problems

Adherence monitoring

Percentage of patients coming in for their appointment out of number of patients expected
Percentage of doses given under DOT for DR-TB treatment in a randomized sample of patients

> 90% in both the intensive and continuation phases
100%

Prevention of M. tuberculosis airborne transmission in TB facilities

Isolation

Building ventilation, lights, UV lamps (hospital wards, outpatient clinics, laboratory); respirators for staff and visitors in contact with contagious patients; masks for contagious patients (if they move about)
Written prevention plan?
Person in charge identified?

Isolation of smear positive patients
Isolation of DR smear positive patients
Appropriate use of means
Yes
Yes

Standard precautions Description Standard precautions followed
Laboratory quality control

Regular evaluation of laboratory functioning

Quarterly EQA of smear microscopy
Annual EQA of DST

Ensure the quality of laboratory analyses for bacteriological diagnosis
Results according to standards
Results according to standards

17.5.3 Human resources

Criteria

Indicators

Goals

Staff

Job descriptions (doctors, nurses, lab technicians, cleaning staff, etc.)
Medical staff-to-patient ratio

On average:
One nurse for 10-15 patients
One doctor for 40-50 patients

Training

Refer to training programme evaluation criteria

Competent staff

Other contributors

Description: other NGOs, local associations, etc.


A grid for evaluating TB clinic operations can be found in Appendix 35. Each criterion is rated either “satisfactory” or “unsatisfactory”.