More than 2 billion people, equal to one-third of the world’s population, are infected with tuberculosis (TB). TB is a disease of poverty; affecting mostly young adults in their most productive years. The vast majority of TB deaths are in the developing world, with more than half of all deaths occurring in Asia. Africa accounts for 85% of estimated global HIV-positive TB cases, the leading killer of people with HIV. MEASURE Evaluation supports USAID’s commitment to the implementation of the STOP TB Strategy to reduce morbidity and mortality associated with tuberculosis and in particular to strengthen TB information systems, one of the key Directly Observed Treatment Short Course (DOTS) components. The increase of HIV/AIDS, the emergence of multi-drug-resistant TB (MDR-TB), the expansion of TB control efforts to less formal clinical settings as well as an increase in funding by donors for these new program areas has created new M&E needs. Traditional information systems are ill equipped to address these needs and must be adapted to successfully monitor and begin to evaluate TB programs. Gender and even significant age-specific analyses are lacking at national levels, despite availability of considerable data at lower levels of the surveillance systems.
MEASURE Evaluation achievements in support of the STOP TB Strategy include supporting global standards for TB monitoring and evaluation; capacity building and technical assistance; development of TB tools and supporting country TB information systems; and evaluation/research.
Global Standards for Tuberculosis M&E
Since 2002, MEASURE Evaluation has collaborated with WHO, the Stop TB Partnership and other key TB organizations to develop standards around M&E in tuberculosis. The Compendium of Indicators for Monitoring and Evaluating National Tuberculosis Programs (2004) was a key product of this collaboration. MEASURE Evaluation again joined in 2008 with global TB partners including the Global Lab Initiative (GLI) to map partner resources for laboratory strengthening in the 22 high-burden countries to plan future laboratory strengthening and support activities under the GLI. In 2009, MEASURE Evaluation collaborated on an M&E Plan for new TB Infection Control Policy with WHO and the Netherland TB Institute (KNCV) titled “Implementing the WHO Policy on TB Infection Control in Health-Care Facilities, Congregate Settings and Households.”
Capacity Building/ Technical Assistance
A key role for MEASURE Evaluation is to build M&E capacity for tuberculosis in countries. From April 2005 to May 2006 MEASURE Evaluation conducted four regional workshops in Latin America, Sub-Saharan Africa, Asia and Eastern Europe reaching over 80 TB professionals in 29 countries. In addition, MEASURE Evaluation provided TA to the national TB programs in Kenya and Vietnam and to USAID/Philippines in the form of support for the development of national TB M&E plans. (2006-2007). As part of MEASURE Evaluation support to training partners in the region, MEASURE Evaluation worked with partners to design and integrate a TB M&E module into their existing M&E courses.
In September 2011, MEASURE Evaluation collaborated with TB CARE to facilitate the “Using TB Information for Decision Making” workshop for TB M&E Officers from 16 countries.
Tools and Information Systems
MEASURE Evaluation M&E tools developed at the global level have been adapted and used at the country level for tuberculosis. In 2008, MEASURE Evaluation facilitated a Monitoring and Evaluation Systems Strengthening Tool (MESST) workshop for the grantees of the Global Fund project, Strengthening Tuberculosis Control and Management of People with TB/HIV co-infection in Liberia, in collaboration with the National Leprosy & TB Control Program. In addition MEASURE Evaluation was a key collaborator on the development of the Three Interlinked Patient Monitoring Systems for HIV care/ART, MCH/PMTCT and TB/HIV (2009, revised 2013) with WHO, the Global Fund and UNICEF.
MEASURE Evaluation also supported the National TB Control Program in Democratic Republic of Congo to improve capacity for data quality assurance for the national program TB control information system. To date, MEASURE Evaluation has conducted training at the national level on tools and methods for routine data quality assurance for priority indicators, such as TB treatment success and TB case detection, and conducted a data quality audit (DQA) of these indicators to measure the accuracy, timeliness, and completeness of reporting and to determine strengths and weaknesses in the reporting system.
As the importance for analyzing and using data spatially increases, the demand for building capacity for geographic information system (GIS) skills within national TB programs is growing. In 2013, MEASURE Evaluation trained the TB focal team within the Federal Ministry of Health and Oromiya Regional Health Bureau in Ethiopia to use GIS and spatially integrated data with routine M&E activities to improve program planning, resource allocation, and monitoring.
In 2008, MEASURE Evaluation supported the evaluation of the Division of Leprosy Tuberculosis and Lung Disease in Kenya to review the M&E and surveillance system and make recommendations for next steps in both TB M&E, MDR-TB, and in TB/HIV reporting and use of data. MEASURE Evaluation is also supporting the USAID country programs to evaluate their strategies for implementing TB services particularly for high-risk populations and integrating TB and HIV services.