UGANDA NATIONAL TUBERCULOSIS AND LEPROSY …

1 MINISTRY OF HEALTH UGANDA NATIONAL TUBERCULOSIS AND LEPROSY control PROGRAMME revised Strategic Plan 2015/16 - 2019/20 Monitoring and Evaluation Plan Narrative of the Operational, Budget and Technical Assistance Plan June 2017 UGANDA NTLP Rev. NATIONAL Strategic Plan 2015/16 2019/20 | Monitoring & Evaluation | 2 TABLE OF CONTENTS 1. Introduction 3 Overview of the NTLP M&E System 3 Data Collection Methods 4 2. Monitoring and Evaluation Plan 5 M&E Plan Objectives 5 Indicators by objective and strategic intervention 6 Indicator definitions 27 3. Narrative of the Operational, Budget and Technical Assistance Plan 42 UGANDA NTLP Rev. NATIONAL Strategic Plan 2015/16 2019/20 | Monitoring & Evaluation | 3 1. Introduction TUBERCULOSIS (TB) and LEPROSY continue to threaten public health in UGANDA . The Ugandan Ministry of Health addresses TB and LEPROSY response in its Health Sector Development Plan II 2015/2016 2019/20.

2 TB is the fifth most common cause of death in UGANDA , potentially resulting in adverse socioeconomic impacts as the majority of notified patients/cases are in their years of greatest economic productivity. LEPROSY is still endemic in UGANDA . A total of 1,003 new cases were reported to NTLP during the last 3 years. In 2013, over 60% of new cases were concentrated in 10 of 116 districts. Recent advances in the fight against TB and LEPROSY , findings from the 2014/15 NATIONAL TB Prevalence Survey, and revisions to the UGANDA Xpert MTB/Rif policy and urban DOTS model necessitated revisions to the current NTLP NATIONAL Strategic Plan (NSP) 2015/16 to 2019/20. Accordingly, the NTLP revised the monitoring and evaluation (M&E) plan to reflect changes in the strategic plan 2015/16 2019/20. Overview of the NTLP M&E System The goal of the current M&E plan is to enable evidence-based decision-making to improve performance.

3 Based on this, the M&E plan sets out to: Guide the process of collecting, analysing and presenting specific data, based on pre-defined indicators; Describe and guide the process of measuring progress towards NTLP targets; Ensure the set of indicators, tools and M&E systems are adapted to monitor the quality and coverage of service delivery, both at health facility and community levels; Ensure effective implementation of the M&E plan by regularly monitoring and periodically evaluating the plan itself; and Provide a framework for implementation of NTLP monitoring and evaluation activities. The WHO and MOH joint review of the NTLP conducted in September 2013 revealed that NTLP reports are not channelled through the Electronic Health Information System, UGANDA s District Health Information System 2 (DHIS2). Managed by the MOH Division of Health Information, the DHIS2 has a user-friendly interface and 100% health facility reporting coverage for the public and private non-for-profit sectors.

4 Although health facilities are reporting some TB indicators through DHIS2, these reports are often incomplete and inaccurate hence not analysed or used. More so, the TB indicators have not been completely integrated into the DHIS2. The only indicators in DHIS 2 are; proportion of PLHIV screened for active TB; proportion of PLHIV diagnosed with TB and proportion of PLHIV diagnosed with TB who are started on TB treatment. A disadvantage of the DHIS2 is that it aggregates data, preventing individual data for cohort analysis. The NTLP is still investigating how to integrate TB data collection and management in the DHIS2 while providing for the NTLP s data needs (List of the proposed indicators to be included in DHIS2 is in Table 4). Table 1 provides an overview of the current NTLP reports and data sources. UGANDA NTLP Rev. NATIONAL Strategic Plan 2015/16 2019/20 | Monitoring & Evaluation | 4 Table 1: Description of NTLP reports and data sources.

5 Data Source Relevant Time Period Frequency of Collection Responsibility NATIONAL TB Prevalence Survey 2014-2015 Every 5-10 years NTLP & Partners NTP reports and WHO Global TUBERCULOSIS Report Previous year Annually NTLP, WHO NTP quarterly reports Previous quarter Quarterly NTLP EQA quarterly reports Previous quarter Quarterly NATIONAL TB Reference Laboratory (NTRL) TB services in prisons reports Previous quarter Quarterly Prison Health Service Supervisory visit reports Previous quarter Quarterly for selected districts NTLP, NTRL Data Collection Methods The routine reporting system follows these lines of reporting: Diagnostic and Treatment Units (DTU) report to the district. Districts report to regions. Regions report to the central NTLP office. Currently, the M&E unit at the central NTLP office consists of an M&E specialist, epidemiologist, data manager and data analyst. The M&E specialist and data manager, funded through the Global Fund to Fight AIDS, TB, and Malaria (Global Fund), collate and analyse data from the districts.

6 Partners provide additional staff to support the NTLP s efforts to improve recording, reporting and use of TB data at all levels of the health system. As recommended in the Program Review Report (September 2013), the NTLP is developing standard operating procedures (SOPs) to guide health facilities as well as district, regional and NATIONAL level officers to improve data completeness, quality and use for performance improvement at different levels. In addition, quarterly review meetings help to improve the accuracy of data and timeliness of reporting. During regional quarterly review meetings, district supervisors (District TB and LEPROSY Supervisors (DTLS), District laboratory Focal Persons (DLFP) verify outcomes of TB patients transferred from one district to another within the region and Regional TB and LEPROSY Focal Persons (RTLPs) validate the reports before submission to the NATIONAL level.)

7 The district local governments have recruited biostatisticians to improve collection, analysis and use of health information at the district level. The biostatisticians will support the district TB supervisors to improve timely reporting through the DHIS2 and analysis of TB data for performance improvement. UGANDA NTLP Rev. NATIONAL Strategic Plan 2015/16 2019/20 | Monitoring & Evaluation | 5 2. Monitoring and Evaluation Plan This M&E plan aims to monitor the TB and LEPROSY control , implementation of the NSP 2015/16 2019/20, and investments to improve M&E for TB and LEPROSY in UGANDA . M&E Plan Objectives Objectives of the M&E component of the NSP The NTLP NATIONAL Strategic Plan prioritizes M&E in its fourth objective to establish and strengthen systems for effective management of TUBERCULOSIS & LEPROSY services to meet the NSP targets. Broad Objective To establish and strengthen M&E systems for tracking performance and measuring outcomes and impacts to guide decision-making Specific Objectives 1.

8 Improve recording and reporting, data management and analytical capacity at NATIONAL and sub- NATIONAL levels 2. Develop an electronic TB monitoring and evaluation system (eTB) 3. Strengthen TB supervision at all levels Under the same objective, the NATIONAL Strategic Plan calls for implementation of a research agenda through collaboration of NTLP and the UGANDA TB research community. This intervention includes a drug resistant survey and inventory studies to assess under-reporting, to be conducted in the 2015/16 2019/20 period. The NSP M&E intervention aims to strengthen data management and quality through by regularly assessing data quality and developing guidelines and standard operating procedures. To improve timely availability of data, NTLP plans to develop an electronic system that will capture more data as well, for example of key populations, by of this NSP. To support these developments, NTLP will strengthen supervision to all levels.

9 Table 2: Main activities under the M&E strategic intervention Start date M/Year End date M/Year Indicator Target by 2019/20 Total investment Objective 4: To strengthen systems for effective management of TUBERCULOSIS & LEPROSY services to meet the NSP targets Strategic Intervention To strengthen M&E systems for tracking performance and measuring outcomes and impacts to guide decision-making UGANDA NTLP Rev. NATIONAL Strategic Plan 2015/16 2019/20 | Monitoring & Evaluation | 6 Improve recording and reporting, data management and analytical capacity at NATIONAL and sub- NATIONAL levels. Apr-16 Jun-20 Percentage of districts submitting timely complete reports according to NATIONAL guidelines (factor = timeliness x completeness) >90% $5,280,167 Develop electronic TB monitoring and evaluation system (eTB). Oct-15 Jun-20 $649,060 Strengthen TB supervision at all levels. Jul-15 Jun-20 $1,089,382 Total Investment M & E $7,018,608 Indicators by objective and strategic intervention Figure 1 illustrates the monitoring framework to track progress of TB control and NSP implementation in UGANDA .

10 Figure 1. TB monitoring framework Through a consultative process, stakeholders set initial targets in June - July 2014. The NTLP modified these targets during revisions to the NATIONAL Strategic Plan, according to 2014/15 NATIONAL TB Prevalence Survey results and revisions to the UGANDA Xpert MTB/Rif policy and urban DOTS model and recommendations from local, international and global technical partners. UGANDA NTLP Rev. NATIONAL Strategic Plan 2015/16 2019/20 | Monitoring & Evaluation | 7 Goal: To reduce TB incidence by 5%, from 234 cases of TB (all forms) per 100,000 population in 2015 to 222/100,000 by 2020 Indicator Type Baseline Targets Data source Frequency Year Value 2015/16 2016/17 2017/18 2018/19 2019/20 Incidence rate Impact 2015 234 234 234 230 227 222 UGANDA NATIONAL TB survey Annual Objective 1: To increase case notification rate of incident TB from 119/100,000 in 2015/16 to 156/100,000 in 2019/20 and to increase treatment success rate among notified incident cases from 74% in 2015/16 to 85% in 2019/20 Indicator Type Baseline Targets Data source Frequency Year Value 2015/16 2016/17 2017/18 2018/19 2019/20 Notification rate of incident TB cases per 100,000 population Outcome 2015 119 (42,320) 119 (42,320) 115 (42,320) 128 (48,245) 141 (54,999) 156 (62,699) TB annual & quarterly reports Annual Treatment success rate for incident TB cases (Denominator) Outcome 2015 cohort 74% (42,320) 74% (42,320) 78% (42,320) 82% (42,320) 85% (48,245) 85% (54,699)