Monitoring diabetic retinopathy programmes

Monitoring & evaluation are terminologies that are often spoken about together but they are not the same process or done at the same time.

Monitoring is concerned with the ongoing oversight of a programme as it is implemented. It helps you to verify whether the programme is running as planned and reaching the people it is meant for. Monitoring is used to guide implementation and must allow for revisions and changes to a programme as required.

Evaluation is an objective assessment of an ongoing or, more commonly, a completed programme. It can be done at the mid-point (mid-term evaluation) or at the end (terminal evaluation) of the programme. An evaluation looks at a whole programme and establishes if it has delivered its objectives and outcomes in the planned time frame. It also examines whether a programme is sustainable, or can be scaled up, in the future.

The key to an effective monitoring system is to collect and use the ESSENTIAL and MINIMAL core data needed to chart overall progress and NOT to simply re-use the same data as collected for day-to-day project management.

Data can be collected manually or digitally and from many different sources for monitoring purposes. The source will be dependent on the specific objectives of the programme.

A health information management system (HMIS) is used in many places. An HMIS enables the collection, storage, reporting, processing, analysis and dissemination of health-related data, based on a programme’s monitoring needs. Programmes may need to design their own data formats to collect specialised information, for example to assess:

• Which geographical areas are using services better than others
• Patient satisfaction with services
• The overall quality of life of individuals receiving a service.

All data formats should be pre-tested before being finalised for use in an HMIS.

Monitoring indicators are categorised based on the component of the programme they are being used to assess and are measured at different times. Generally, four types of indicators are used:

• Input indicators assess whether the required inputs (e.g human resources, equipment, finances) are in place to achieve the programme’s objective and targets
• Process indicators are directly linked to activities that are expected to have been completed in a given time. For example, number of patients screened per month
• Outcome indicators measure how closely what is happening in the programme compares to what was originally planned (the set targets). Data from process indicators is collated together to track and draw a conclusion on the outcome. For example, the total number of people with diabetes who have been screened at the end of the first year
• Impact indicators measure how successful the programme has been or the percentage change that it has brought about. For example, the prevalence of blindness from DR at the end of 5 years.

As you watch the video, consider why it’s not possible to have a universal monitoring protocol that can be applied across all DR screening programmes?