Enhancing NCD Programs Through Monitoring and Evaluation
admin
Non-communicable diseases (NCDs) such as cardiovascular diseases, cancers, chronic respiratory conditions, and diabetes are the leading cause of mortality worldwide, accounting for 71% of all deaths globally. These diseases significantly burden health systems, economies, and societies, particularly in low and middle-income countries where healthcare resources are often limited and health systems strained. Countries in response are developing robust NCD strategic plans to combat the epidemic and achieve SDG 3.4 of one-third reduction in premature mortality due to NCD by 2030. The implementation of ActionNCD plans globally has been varied and it underscores the critical need for robust Monitoring and Evaluation (M&E) frameworks.
Monitoring and Evaluation are two interconnected management tools that are crucial for assessing the effectiveness and impact of health programs, particularly those aimed at non-communicable diseases (NCDs).
• Monitoring refers to the regular and systematic collection of data on specific indicators to provide management and key stakeholders with indications of the progress and achievements of ongoing interventions or projects. It is a continuous process that helps ensure that inputs, deliveries, and services lead to the expected outputs and outcomes in accordance with a set schedule and budget.
• Evaluation is a systematic assessment conducted periodically or on an ad hoc basis. Its purpose is to determine the relevance, impact, effectiveness, efficiency, and sustainability of interventions and contributions. Evaluations provide opportunities for learning and judgment, typically documented as part of the accountability process, which helps inform decisions about current and future programming. Different types of evaluations (formative, process, outcome, and impact) provide comprehensive insights into the program. Describing qualitative and quantitative methodologies ensures a balanced approach to evaluation.
Together, M&E provides critical insights that help refine strategies, allocate resources efficiently, and improve outcomes, making them indispensable for managing effective health interventions against NCDs.
Steps for NCD Monitoring and Evaluation Planning and Implementation
A systematic M&E plan begins with a detailed plan outlining the specific activities and indicators to monitor and evaluate. The framework should align with the Action On NCD Plan or program’s overall goals, focusing on the prevention and clinical management of diseases and systems to deliver the program.
1. Theory of Change Development: This involves mapping out the intended processes and outcomes that lead to the ultimate impact—reduction of NCD morbidity and mortality. Incorporating a Theory of Change (ToC) is crucial for conceptualizing how various elements of an NCD prevention and control program lead to desired outcomes and impacts.
Example of a Theory of Change for a National NCD Program
2. Indicator Matrix Development: Once detailed activities and theory of change is established the indicator matrix outlining the indicators to be measured and how frequently by whom needs to be established. Indicators should be SMART (Specific, Measurable, Achievable, Relevant, Time-bound) and should cover all aspects of the program, from resource allocation (inputs) to health outcomes (impacts).
The categories of indicators include the following:
• Input Indicators: Resources allocated, such as budget, human resources, and infrastructure. Existing data sources: financial records, budget reports, and human resource databases.
• Process Indicators: Activities conducted, like training sessions, awareness campaigns, and clinical interventions. Existing data sources: training logs, attendance sheets, campaign reports, and clinical records.
• Output Indicators: Direct products of program activities, such as the number of screenings, vaccinations, and clinical treatments. Existing data sources: health facility records, immunization registries, screening logs, and patient treatment records.
• Outcome Indicators: Short- to medium-term effects, including changes in knowledge, behavior, and clinical outcomes. Existing data sources: community surveys, patient follow-up records, clinical outcome reports, and health behavior studies.
• Impact Indicators: Long-term health outcomes, like reduction in NCD incidence, morbidity, and mortality. Existing data sources: vital statistics, national health surveys, epidemiological studies, and the WHO NCD STEPS Survey.
Example Indicator Matrix
3. Data Collection and Management: Identifying reliable data sources is crucial. These sources can include health facility records, surveys, community assessments, and clinical data. Standardized tools for data collection, like questionnaires, checklists, and electronic health records, ensure consistency.
To maintain data quality, implement rigorous procedures for accuracy, reliability, and timeliness. Regular training for staff on M&E concepts and tools is essential to build and sustain capacity.
• Data Collection: Utilize both existing data sources and primary data collection. Instruments like the WHO NCD STEPS Survey, patient records, and public health records, are integral to monitoring and evaluation
• Responsibilities and Training: Assign clear roles for data collection and analysis, ensuring all involved personnel are trained and equipped to carry out their tasks effectively.
• Data Storage and Access: Implement secure, robust systems for data entry and storage to facilitate easy data retrieval and analysis.
• Quality Checks: Regular audits and data quality checks to ensure the reliability and validity of data.
• Data Analysis: Develop a systematic approach for analyzing data to identify trends, effectiveness, and areas needing improvement. Use statistical software and tools to handle large datasets and perform complex analyses.
4. Reporting and Actions
• Reporting: Translate data findings into actionable insights through clear and comprehensive reports, dashboards, and presentations.
• Adaptive Management: Use findings from M&E activities to inform program adjustments and decision-making.
• Reporting Mechanisms: Develop standardized reporting formats to communicate M&E outcomes to stakeholders and funders.
5. Stakeholder Engagement and Feedback Integration
Involvement of Key Stakeholders: Ensure ongoing engagement of all stakeholders, including government bodies, healthcare providers, and community organizations.
Feedback Mechanisms: Establish systems to integrate stakeholder feedback into program improvements.
Conclusion
M&E is not just a tool but a critical component of any successful NCD prevention and control strategy through Action NCD. By effectively implementing this structured M&E framework, NCD program managers can ensure that their efforts are evidence-based, targeted, and adaptable to changing health landscapes, thus significantly contributing to the global fight against NCDs.
What gets measured Gets Done!
References
1. World Health Organization (WHO) NCD Global Monitoring Framework: This framework provides a comprehensive set of indicators for monitoring NCD prevention and control programs globally. It is a key resource for understanding standard M&E practices in the context of NCDs.
o WHO NCD Global Monitoring Framework
2. Centers for Disease Control and Prevention (CDC) Evaluation Framework: The CDC’s framework for program evaluation offers detailed guidance on conducting evaluations, including setting indicators and using data effectively.
o CDC Framework for Program Evaluation
3. WHO STEPS Survey: The STEPS survey is a standardized tool for collecting data on NCD risk factors, providing crucial data for outcome and impact indicators.
o WHO STEPS Survey
4. Global Health Observatory (GHO) Data Repository: This repository from WHO includes data on health indicators worldwide, including those related to NCDs. It’s an excellent source for baseline and comparative data.
o WHO Global Health Observatory Data
5. Johns Hopkins Bloomberg School of Public Health – Monitoring and Evaluation of Health Programs: This resource offers extensive material on M&E practices, including case studies and practical tools for health programs, with relevance to NCD control.
o Monitoring and Evaluation of Health Programs
