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
Programme
management of
accountability
discrepancies between
• It alerts the actual and anticipated
management of levels of programme
discrepancy impact
• It identifies strong • It suggests changes in
&weak points of programme procedures,
programme operations operation and objectives
• It identifies the possible
side effects of the
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programme
 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 (B
2007) 2000 (by
y 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. Case detection by active and passive
2. Treatment & Referal services
3. Indoor residual insecticidal spray
operations
4. Anti larval measures
• Logistic flow
1. Timely indenting based on epidemiological data
of previous year
• Financial flow
1. Timely payment of wages for casual laborers
involved in spraying operation
2. Repair of equipment and Local purchases

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 Malariometry
• Annual Blood Examination Rate
• Annual Parasite Incidence
• Annual Falciparum incidence
• Slide Positivity Rate
• Slide falciparum rate
• Parasite rate
• Infant parasite rate
• Spleen rate
• &parasite density index
Vector indices
• Mosquito density
• Sporozoite rate
• Inoculation rate
• Man biting rate
• Human blood index 38
Indicators for spray operation

• % of villages covered

• % of houses sprayed

• % of rooms sprayed

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 Goal & objectives of National
Filaria Control Programme

• To carry out survey in different parts of country to

determine magnitude of problem. Delimitation surveys in
hitherto unsurveyed areas
• Large scale pilot studies to evaluate known method of
filariasis control
• To train professional and personnel required for the
programme
• To control filaria in urban areas by anti-larval measures
• To control filaria in rural areas by case detection and
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 India’s 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

• Programme management
• IEC and social mobilization
• Blood safety
• Condom promotion
• Control of STD
• Clinical management
• Care & Support
• Surveillance

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 Monitoring & Evaluation

• Prevention indicator survey (PI)

• To assess the achievements made
• To assess the achievements made
• 10 indicators

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• Monitoring of family health awareness campaign
• Monitoring of IEC for availability and distribution of
materials for awareness programme
• Ensuring the availability of condoms
• Ensuring availability of drugs for opportunistic infections in
the hospital
• Ensuring the availability of Anti retroviral drugs
• STD/HIV/AIDS surveillance
• Financial control
• Monitoring of Blood banks

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 Goal & objectives of National
Leprosy Eradication Programme

• To arrest the disease activity in all known cases of leprosy

by the year 2000 A.D

• To reduce the prevalence rate to less then 1/10,000

population by the year 2000 A.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
• Primary prevention of cancers by health
education regarding hazards of tobacco
consumption and necessity of genital hygiene for
prevention of cervical cancers
• Secondary prevention( Early detection and
diagnosis of cancer, for example Ca Cervix, Ca
breast, Ca oropharynx, by screening methods
and patient education on self examining methods
• Strengthening of existing cancer treatment
facility
• Palliative care of terminal stage of cancers

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 Goal & objectives of National
Mental Health programme
• To ensure availability and accessibility of
minimum health care for all in foreseeable future,
particularly for most vulnerable/under privilege
section of society
• To encourage application of mental health
knowledge in general health care and in social
development
• To promote community participation in mental
health services and increase efforts towards self
help in the community

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