The programme has identified several major areas where evaluation information is needed and this information is being gathered through specific operations research studies for example the studies of treatment seeking delay and the impact of advocacy, communication and social mobilization.
In order to understand the population levels of infection there is a two pronged approach using a) the Tuberculin surveys in schools and b) a national prevalence survey which allow the National Leprosy Tuberculosis Programme to assess at a population level the current “true” prevalence of TB.
The programme is able to use the information gathered through its monitoring of core and comprehensive output indicators from the programme activities and link these to the individual outcomes obtained from the facility level data that are derived from the District TB registers. This forms a key step in building the capacity of the programme to monitor and evaluate itself.
Impact of Advocacy, Communication and Social Mobilisation (ACSM)
The program through KEMRI carries out an operational research to determine the impact of ACSM on the targeted groups. This study establishes the knowledge, attitudes and practices of those who were exposed to this campaign.
Socio-economic Burden of Tuberculosis
The program carries out surveys to establish the socio-economic burden of tuberculosis in the country.
Tuberculosis Knowledge, Attitude and Practice Among Private Health Providers in Kenya
The programme has had the PPM component in the TB control strategy since 1998 but the KAP of the private providers have not so far been evaluated except in the Kibera slum and in the Moi teaching and referral hospital. The program would like to get a better understanding of the KAP among the private providers since they will start to benefit from free TB drugs from the program.
So far only one delay study has been undertaken by the program in Nairobi. The program will to carry out a more representative baseline delay survey with a national outlook and then follow this with other studies to show the impact of the programmes interventions on reducing delay in diagnosis.
Annual risk of TB infection (ARTI) indicates the proportion of the uninfected population who will become primarily infected with tubercle bacilli during the course of a year. This risk of infection depends on the prevalence of the sources of infection, especially the smear-positive pulmonary TB cases. This can be used as a measure of transmission to youngest population and has implications on how this can be curtailed. The risk is based on tuberculin surveys done in the population in question. Serial tuberculin surveys have been conducted in Kenya to establish the annual risk of tuberculosis infection (ARTI) among primary school going children (age 8 to 15 years).
This entails examining representative sample of the population in question and determining the numbers of TB patients that are present in that sample and the durations which they have been sick, in effect resulting in the point prevalence of TB and the average duration of illness for all the patients so identified. This can then be used to calculate the incidence of TB.
Validation and Quality Assurance Support Supervision
Within the NLTP scope of work are scheduled field supervisions that are conducted on a regular basis. At the beginning of each calendar year, all programme staffs prepare work plans which include supervision visits. These include visits by the DTLC to the health facilities, the PTLC to the districts and the Central Level to the provinces and districts. This activity enables data verification at the various levels.
NLTP holds quarterly meetings of the provincial teams which includes all DTLCs and district medical lab technologists (DMLTs) in that province. The data submitted by the DTLCs is reviewed by the team with queries raised where there are discrepancies. Similarly, during similar quarterly meetings of the Provincial TB and Leprosy Coordinators and the NLTP central unit, the PTLCS present their data which is reviewed by all and queries are raised on any discrepancies.
The M&E system contains both detailed monitoring of specific indicators that measure the programme’s specific activities and outcomes, and a systematic method of evaluation which measures whether the programme inputs and outcomes are linked to outcomes and whether these outcomes translate into measurable levels of impact on the disease morbidity and mortality within the populations affected. Evaluation is, however, expensive and traditionally not a major focus of TB programmes. The NLTP is developing its methods of evaluation and has chosen several pathways through which to do this.