Monitoring & Evaluation and Surveillance

In Week 1 we looked at some of the concepts and methods for VL control interventions (Step 1.13). Multiple approaches are needed. A VL programme must be designed to address different areas of intervention by including a range of activities. For example, diagnosis and treatment (covered in week 2), vector control (covered in week 3), outbreak response and management (Steps 4.6, 4.7), health system strengthening (e.g. training health workers, enhancing access to services, enriching services with supplies, streamlining networks) (Steps 4.8, 4.9), community engagement and health education (Step 4.10, 4.11); and sustaining VL control and elimination (Step 4.12, 4.13).

In addition to particular activities in intervention areas, a VL control & elimination programme needs ways to understand the progress and quality of its activities. This is important not only to test whether the activities are implemented and that the programme is delivered as planned, but also to examine what effect they have on the burden and spread of the disease, ie. the impact of the interventions and the outcome. In practice, and depending on the setting, not all control activities will be feasible or cost- effective, some will need to be prioritised over others. All will need to be reviewed and assessed. This process is known as monitoring and evaluation, or M&E.

M&E activities are closely aligned to disease surveillance activities and the two go hand-in-hand within a VL control programme. The main aim of M&E and disease surveillance for VL control is to generate evidence for planning and decision making. Applications include:

• Guide immediate action for cases of public health importance
• To describe and monitor health events and trends through surveillance systems
• Set priorities for the use of resources (time, expertise, technology and money)
• Planning, implementing and evaluating public health interventions and programmes.
• Evaluate public policy

Monitoring “is the routine tracking of a programme or project’s performance” (MSF, 2016). It helps answer some of the most basic and essential questions, such as:

• How long a period between diagnosis and treatment? Does this vary between treatment centres (or town, district, area)?
• How many households eligible for a bed-net have one?
• Is there constancy in stock of medicines and diagnostics?
• How often does a particular village/location receive IRS in a specified period of time and is it in line with the guidelines of the control program?

Evaluation “is the periodic assessment of the change that can be attributed to the programme or project intervention”^[1]. It helps relate control activities to the data gathered and answer questions about how effective these interventions are towards controlling VL. For evaluation it is important to collect baseline data. For example:

• Is the RDT used correctly?
• Does training [n] amount of workers have an impact on the correct choice of treatment?
• Does IRS help reduce the burden of VL in this area?
• Is there greater awareness among the population on when and where to seek treatment after health education?

Surveillance is defined as the “systematic ongoing collection, collation, and analysis of data and the timely dissemination of information to those who need to know so that action can be taken”^{[2, 3]}.

The difference between surveillance and data collection for M&E is that surveillance is a systematic, on-going process, which may operate independently from a particular project or control programme. Disease surveillance is often part of a national health notification system (e.g. VL is a notifiable disease in India). In contrast, M&E activities are tied to a specific project with intended, pre-planned intervention activities. As a result, they may take advantage of existing surveillance systems. M&E can recruit other data acquisition methods too, such as rapid assessments or surveys, that are designed to collect both qualitative and quantitative data at specific points in time. Those points in time would be relative to the timeline of the project/programme, for example a “baseline” survey, at the start of a programme and an “end-line” survey, at the end of a programme.

The path of data of M&E and disease surveillance from data collection to application can be summarised in the figure below.

Figure 1. Overview of M&E data path

In the following steps, we will take a closer look at VL surveillance for case detection, health information systems and reporting tools. We will then also explore the importance of disease surveillance during an outbreak, when it comes to activating response systems and monitoring activities with greater urgency.