By

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)

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 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

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 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

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 Monitoring and Planning

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

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 Monitoring process

Detecting deviations from plans

Diagnosing causes for deviations

Taking corrective action

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 Different levels of Monitoring
Managers at top level
They have to develop health plans based on
objectives, goals, devise strategy and allocate
necessary resources
Managers at the middle level
They are more concerned with whether they are
getting desired output from the inputs that are being
utilized
Managers at the operational level
They have to supervise actual operations and to
ensure that planned activities are being carried out as
per schedule

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 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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 Reasons for carrying out an Evaluation

To review the implementation of and services provided

by health programmes so as to identify problems and
recommend necessary revisions of the programme
To assess progress towards desired health status at
national or state levels and identify reasons for gap, if
any
To contribute towards better health planning
To document results achieved by a project funded by
donor agencies
To know whether desired health outcomes are being
achieved and identify remedial measures

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 To improve health programmes and the health
infrastructure

Allocation of resources in current and future

programme

To render health activities more relevant, more

efficient and more effective

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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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 Who is performing Evaluation?

The planner
Adhoc research group
Those responsible for health development
Those responsible for implementation
By the Community

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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?

Basic steps of Evaluation

Establishing standards and criteria

Planning and methodology
Collecting data
Analyzing the data
Taking action
Re-evaluation

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 What is to be Evaluated?

Evaluation of structure
Evaluation of Process
Evaluation of Outcome

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 Process of Evaluation

The process of evaluation consists of the

following components:

1. Specify the particular subjects

2. Information support
3. Verify relevance
4. Assess adequacy
5. Review progress
6. Assess efficiency
7. Assess effectiveness
8. 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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Types of indicators for evaluation

Output indicators
Process indicators
Product indicators

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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 Yes
GOALS&OBJECTIVES

Assessment
No
of health need

Monitoring

Establish
goals
Implementation &objectives
of programme
PLANNING CYCLE
Assessment
of resources
Time
frame

Select the Design Establishment

Action
best alternative of priorities
plan
alternative programme
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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 Evaluation

It determines
It determines
Programme effectiveness
Programme efficiency
It identifies
It establishes standard
inconsistencies between
of performance at the
the programme
activity level
objectives and activities
It forms a basis for
It alerts the management
Programme of discrepancies between
accountability actual and anticipated
It alerts the levels of programme
management of impact
discrepancy It suggests changes in
It identifies strong programme procedures,
&weak points of operation and objectives
programme operations It identifies the possible
side effects of the
programme
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 EXISTING CONTROL PROGRAMMES

National Anti Malaria Programme

National Leprosy Elimination programme
Revised National TB control programme
National AIDS control programme
National programme for control of Blindness
Nutritional Surveillance
National Diabetes control programme
National Surveillance programme for Communicable
Disease
National Polio surveillance programme
Reproductive child health programme

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Monitoring & Evaluation of RCH
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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 National
Millennium
Tenth Plan Population
RCH II Goals Development
Indicator Goals (2002- Policy
(2005-2010) Goals (By
2007) 2000 (by
2015)
2010)
Population 16.2% (2001- 16.2% - -
Growth 2011) (2001-2011)

Infant 45/1000 35/1000 30/1000 -

Mortality Rate
Under 5 - - - Reduce by
Mortality Rate 2/3rds from
1990 levels

Maternal 200/100,000 150/100,000 100/100,0 Reduce by

Mortality Ratio 00 3/4th from
1990 levels

Total Fertility 2.3 2.2 2.1 -

Rate
Couple 65% 65% Meet -
Protection Rate 100%
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THE ACTION PLAN FOR CARRYING OUT R.C.H SERVICES

Goal:Health For All

Objective:Population stabilization by 2045

Target :Total fertility rate to the replacement

level by 2010 and to achieve the other
indicators of health for all

Programme:Comprehensive R.C.H services

Plan :High quality, integrated, decentralized,

needs based and holistic approach

Monitoring &
Evaluation:R.C.H indicators/Feedback data
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 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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 ACTION PLAN FOR R.N.T.C.P

Goal :To extend the RNTCP to cover the entire

population of the country by 2005

Objective:1) To cure 85% of the sputum positive

cases
2) To detect 70% of the estimated
cases of T.B

Target :Three million cases have to be treated

and 1.5 million cases have to be cured.
Program :RNTCP

Strategy:DOTS

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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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 Goal & objectives of National Anti
Malaria Programme (MPO)

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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 Monitoring broadly covers two
components

1.Monitoring of implementation efficiency of various

activities

2.Monitoring/assessment of the impact of control

measures

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Monitoring of implementation efficiency
of various activities
Technical
1.Casedetectionbyactiveandpassive
2.Treatment&Referalservices
3.Indoorresidualinsecticidalspray
operations
4.Antilarvalmeasures
Logistic flow
1. Timelyindentingbasedonepidemiologicaldata
ofpreviousyear
Financial flow
1.Timelypaymentofwagesforcasuallaborers
involvedinsprayingoperation
2.RepairofequipmentandLocalpurchases
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 Malariometry
AnnualBloodExaminationRate
AnnualParasiteIncidence
AnnualFalciparumincidence
SlidePositivityRate
Slidefalciparumrate
Parasiterate
Infantparasiterate
Spleenrate
&parasitedensityindex
Vector indices
Mosquitodensity
Sporozoiterate
Inoculationrate
Manbitingrate
Humanbloodindex 38
Indicators for spray operation

%ofvillagescovered

%ofhousessprayed

%ofroomssprayed

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 Goal & objectives of National
Filaria Control Programme

Tocarryoutsurveyindifferentpartsofcountryto
determinemagnitudeofproblem.Delimitationsurveysin
hithertounsurveyedareas
Largescalepilotstudiestoevaluateknownmethodof
filariasiscontrol
Totrainprofessionalandpersonnelrequiredforthe
programme
Tocontrolfilariainurbanareasbyanti-larvalmeasures
Tocontrolfilariainruralareasbycasedetectionand
treatment

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 Measurement of filarial problem
Indicators of filarial measurement
Micro filarial rate
Filarial endemicity rate
Micro filarial density
Proportional case rate
Measurement of vector problem
Vector density
Percentage of mosquitoes + ve for infective larvae
Percentage of mosquitoes + ve for all stages of larvae
Clinical indicators
Incidence of acute manifestations
Prevalence of chronic manifestations

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 POLIO ERADICATION PROGRAMME

Conduct pulse polio immunizations for two days every

year for three to four years or until polio is eradicated.
Sustain high level of routine immunizations.
Monitor OPV coverage at district levels and below.
Improve surveillance capable of detecting all cases of
polio.
Ensure rapid case investigation, including the
collection of stool samples.
Arrange follow-up of all cases of paralytic polio at 60
days to check for residual paralysis.
Conduct outbreak control for cases confirmed or
suspected to stop transmission.

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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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 National Immunization Days
9.12.1995 - I st NID
20.01.1996
07.12.1996 2nd NID
18.01.1997
07.12.1997 3rd NID
18.01.1998
06.12.1998 4th NID
17.01.1999
24.10.1999 5th NID
21.11.1999
19.12.1999
23.01.2000
2004 - ( 5- NID, 3SID)
2005 ( 2-NID, 6 SID) 48
 Goal & objectives of National
AIDS Control Programme
Prevention of HIV infection
Decrease the morbidity and mortality
associated with HIV infection
To minimize the socio- economic impacts
resulting from HIV infection
Phase-II
To reduce the spread of HIV infection
To strengthen Indias capacity to respond to
HIV/AIDS on a long term basis

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 Medium term objectives

To establish effective surveillance in all states to

monitor the epidemic
To provide sound technical support
To ensure a high level of awareness of HIV/AIDS and
its application in the population
To promote the use of condoms for safe sex
Target intervention to high risk group
To ensure safety of blood
To develop the services required for providing
support to HIV infected persons, AIDS patients &
their associate

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 Programme strategy

Programmemanagement
IECandsocialmobilization
Bloodsafety
Condompromotion
ControlofSTD
Clinicalmanagement
Care&Support
Surveillance

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 Monitoring & Evaluation

Preventionindicatorsurvey(PI)
Toassesstheachievementsmade
Toassesstheachievementsmade
10indicators

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 Monitoringoffamilyhealthawarenesscampaign
MonitoringofIECforavailabilityanddistributionof
materialsforawarenessprogramme
Ensuringtheavailabilityofcondoms
Ensuringavailabilityofdrugsforopportunisticinfectionsin
thehospital
EnsuringtheavailabilityofAntiretroviraldrugs
STD/HIV/AIDSsurveillance
Financialcontrol
MonitoringofBloodbanks

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 Goal & objectives of National
Leprosy Eradication Programme

Toarrestthediseaseactivityinallknowncasesofleprosy
bytheyear2000A.D

Toreducetheprevalenceratetolessthen1/10,000
populationbytheyear2000A.D

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 GOAL AND OBJECTIVE OF LEPROSY
ERADICATION PROGRAMME

Goal: Elimination of leprosy as a public health

problem i.e.to reduce the prevalence rate to less than
I per 10000 population by the year 2000 AD.
Objective: To arrest disease activity in all the
known cases of leprosy by the year 2000AD
Strategy: The elimination 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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 Goal & objectives of National
Iodine Deficiency Disease Control
Programme

Survey to assess magnitude of problem in

the community
Supply of iodated salt in place of common
salt
Resurvey after 5 years
Lab monitoring of iodated salt
Health education

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 Goal & objectives of National
Programme for control of
Blindness

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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 Goal & objectives of National
Cancer Control Programme
Primarypreventionofcancersbyhealth
educationregardinghazardsoftobacco
consumptionandnecessityofgenitalhygienefor
preventionofcervicalcancers
Secondaryprevention(Earlydetectionand
diagnosisofcancer,forexampleCaCervix,Ca
breast,Caoropharynx,byscreeningmethodsand
patienteducationonselfexaminingmethods
Strengtheningofexistingcancertreatment
facility
Palliativecareofterminalstageofcancers

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 Goal & objectives of National
Mental Health programme
Toensureavailabilityandaccessibilityof
minimumhealthcareforallinforeseeablefuture,
particularlyformostvulnerable/underprivilege
sectionofsociety
Toencourageapplicationofmentalhealth
knowledgeingeneralhealthcareandinsocial
development
Topromotecommunityparticipationinmental
healthservicesandincreaseeffortstowardsself
helpinthecommunity

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