Training of health care workers on

Visceral Leishmaniasis
Nov. 13-15,2017
Bahir Dar

Leishmaniasis Control
Monitoring, Evaluation and
reporting system

Dagnachew Mulugeta, Data Manager,

NTD, WHO, woldemeskeld@who.int

NTD
 Objectives
Improve understand on:
• Concept of M&E.
• Evaluation parameters in assessing VL/CL
interventions
• Importance of VL/CL control monitoring &
Evaluation systems.
 Cont.-
• Key VL/Cl performance Indicators
• Sources of data and formats used to measure
VL/CL indicators
• Reporting Tools
• Common problems observed while VL/CL
reporting
 Concept of M&E
What is Monitoring ?
A working Definition of monitoring
• ‘The systematic and continuous assessment of the
progress of a piece of work over time….It is a basic
and universal management tool for identifying the
strengths and weaknesses in a programme. Its
purpose is to help all the people involved make
appropriate and timely decisions that will improve
the quality of the work.’

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 Cont.
What is Evaluation ?
• Evaluation is defined as the systematic and
objective assessment of an on-going or
completed intervention, programme or policy, its
design, implementation and results.
• The aim is to determine Relevance and
Fulfilment of objectives, as well as Efficiency,
Effectiveness, Impact and Sustainability.
 Cont. Evaluation
• An evaluation should provide information that is
credible and useful, enabling the incorporation
of lessons learned into the decision-making
process of both recipients and donors.
 Important Evaluation parameters in assessing
VL/CL interventions :
The five basic evaluation parameters that are
important when assessing VL/CL intervention:
• Effectiveness;
• Efficiency;
• Relevance (Appropriateness);
• Impact;
• Coverage.

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 Cont.…

definition of the terms.

• Effectiveness: achieving objectives – doing the right
thing at the right time, includes cost-effectiveness
• Efficiency: doing it right, making maximum use of
resources: effort, time, money, people, material
• Relevance/Appropriateness: doing the right thing in
the right way in relation to local context, needs and
priorities thereby increasing ownership &
accountability
 Cont.…

• Impact: contributing to changing the situation

more profoundly and in the longer-term,
positively or negatively, intended or unintended
• Coverage: who has been reached by the
intervention, where and why or why not? It is
linked to effectiveness
 The Importance of VL/CL Monitoring and
Evaluation
Quality
• To improve programme management and decision-
making, ensuring best use of often scare resources
and minimise negative effects.
• To provide data to plan future resource needs. For
example, monthly monitoring of number of
admissions to VL/CL treatment can help predict
future resource need for possible scale up.
• To provide data useful for policy making and
advocacy.
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 Cont.
Accountability
• To ensure accountability to stakeholders
particularly
- those affected by the disease and
- to whom interventions are targeted, also
- to donors and partners
thereby increasing the transparency of the
response.
• To justify the resources used.
 Cont…
Learning
• To improve opportunities to learn from the experience of the
current Intervention program. For example, monitoring shows
high default rates due to high hospital bed & related medicine
costs on patients may trigger to think action to reduce such
costs.
• To provide evidence about what works /not working to
inform future programmes and scaling up.
• To retain knowledge on best practice plus systematic
dissemination of results to all stakeholders helps to have
documentation to retain knowledge, which may lost due to
staff turnover
 Key VL/Cl performance Indicators
Indicators
A quantitative or qualitative variable that allows the
verification of changes produced by a development
intervention relative to what was planned.
E.g.
# of VL/Cl patient received service (Admission)
# of patient cured, died, defaulted, relapsed
(Outcome)
Prevalence of cure, death (case fatality rate)
(indicators)
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 How M&E System linked to VL/CL
objectives
What are Objectives of VL/CL Control program?
NTD global goal National goal Objectives
Leishmaniasis control Control • Maintain case fatality
Leishmaniasis by rate due to VL to less than
2020 3%;
• Scale up VL treatment
centers from 18 to 30
facilities in endemic
districts
• Scale up CL treatment

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 What are the strategies to meet the Objectives?
Delivery
Strategies Channels
• Increase access to early diagnosis and treatment; • Primary health
• Improve diagnostic and treatment skills; care unit),
• Conduct operational research on prevention of hospitals
Leshimaniasis
• Academia and
• Strengthen disease surveillance;
• Health education and promotion; research
• Vector Management (indoor residual spraying institutes
and Long Lasting Insecticide Treated Nets);
• Conduct clinical trial on treatment of CL and use
evidence to Increase treatment of severe CL cases
from 8 to 80 health facilities in endemic districts
by 2020.
 What are the sources of data?
Registers, Logbooks & Disease record forms filled at
facilities and timely reported
- help us to measure VL/CL indicators
1. VL Registration book
2. Disease record form
3. Lab-logbook

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 VL Registration Form

Lab Result
A S Patient adderss (DAT/RDT/ Nutritonal
g e Travel Aspirate/Skin Nutritional treatement/m
S.N MRN Patient Full Name e x Zone District Kebele Village history Diagnosis scraping Status anagement

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 VL Registration form

Date of Months sick Complications Date of

HIV Sero- admission before Pregnancy Other OI or drug Side Discharge Treatment Conformation
status (DD/MM/YY) admission (Yes/No/NA) & its RX Effect Treatment (DD/MM/YY) outcome of Cure Remark
 VL Registration Form
Key how to fill the Leishmanises Registration Format
1. Card number : Write the card number of the patient given at the health facility
2. Nutritional Status: Categorize the nutritional status of the KA patient as follows:
A. not malnourished B. Wt/Ht ≤ 70% or MUAC ≤ 11cm for children, C. BMI < 16 or Nutritional edema or MUAC ≤ 18.5cm for adults

3. Diagnosis and Laboratory Result :write the diagnosis and the diagnostic laboratory result as follows:
For the Diagnosis specify as: Primary KA,Relapse KA,PKDL, CL or MCL
For the lab-the diagnostic lab and the result as: DAT: as Pos, Neg, BL (for Positive, negative or borderline respectively)
Aspirte result with the parasitic load (as SA/BMA /LA +1, +2, +3, etc.)
RDT (Rapid Diagnostic Test, RK39): Pos or Neg.
Skin test result: Pos. or Neg.

4. Treatment : Specify drug and the dose in days given to the patient. E.g. SSG 30 - for a patient who has taken 30 days of SSG.

5. Travel history to KA endemic area : Specify it as: yes,no or Un known for travel to known Leishmaniases endemic areas.

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 Cont.…
6. Treatment outcome : Specify the treatment outcome as follows and and then write the date to the specified outcome in Ethiopian calendar as
day/mon/year: Disharged/cured,referral Defaulted,Relapse,Died or Failure and the date.
7. Conformation of Cure: clincal or parasitological

8. Serostatus : specify the HIV status of the patient as: Pos., Neg.or Unknow. If positive, is she/he on ART?

9. Date of admission/Discharge : write the date of admission/discharge of the patient in Ethiopian calendar
Pregnancy: if the patient is female, document her pregnancy status by 'Yes' or 'No' and state the trimester as 1st,2nd or 3rd. 'NA' if not applicable (in case of
male and children).

10. Other OI and its Rx : Specify the OI and write the treatment given for the specified Opportunistic Infection.

11. Complication or drug side effect: write the complication or side effect the patient developed due to Leishmania illness or the anti-Leishmania drug(s).
Reporting tools

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Monthly VL Facility reporting Form

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Cont.…

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Cont.…

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CL- Monthly Facility reporting
form

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Cont.…
Cont.…
 Common problems observed while
VL/CL reporting
Basic Requirements: Main problems:

1. Quality (meet checks e.g. #M + #F = all 1. Technical

cases= ∑Age group) (e.g. skill gap)

2. Accuracy (no under/over reporting)

2. Structural
3. Timeliness (keep reporting period)
(e.g. lack of assigned staff for
4. Completeness (include all reporting )
variables, months/ facilities and
disaggregation of sex and age)
3. Behavioral
(e.g. negligence, give low value for
5. Relevance (include important reporting )
indicators to measure VL Performance)

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Analysis of VL caseload based on
available performance data

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 Group Exercise
• Using 6 fictitious cases participant will practice
recording the patient’s history and treatment
status on the VL register book
• Based on the result of the exercise feedbacks will
be give by team

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