This document discusses the evaluation of national health programmes, specifically focusing on the evaluation of India's Revised National Tuberculosis Control Programme (RNTCP). It begins by defining evaluation and describing its purposes and types. It then provides details about the RNTCP, including its history, structure, processes for monitoring and evaluation at various levels, and external funding sources. Key aspects of evaluating the RNTCP involve assessing performance indicators, conducting internal and external evaluations, and repeating surveys to measure disease prevalence and drug resistance over time.

1. GOOD
AFTERNOON

2. EVALUATION OF A
NATIONAL HEALTH
PROGRAMME
Dr. Rahulputra Gajbhiye
Jr II
Seminar

3.  Introduction
 What is Evaluation? … Definition of evaluation
 Types of evaluation
 Principles of evaluation
 The evaluation process
 National Health programmes
 Evaluation of RNTCP
 References

4. INTRODUCTION

5. Health services have become more complex
There has been a growing concern about their
functioning both in the developed and developing
nations
Questions are raised about the quality of medical care,
utilization and coverage of health services, benefits to
community health and improvement in the health status
of the recipients of care

6. An evaluation study addresses itself to above issues
So, program evaluation is an essential organizational
practice in public health
However, it is not practiced consistently across program
areas, nor is it sufficiently well-integrated into the day-to-
day management of most programs
Thus, a framework for understanding program
evaluation and facilitating integration of evaluation
throughout the public health system is needed

7. The mandate to fulfil society’s interests and
assure healthy conditions and quality services
puts public health in frequent and compelling
contact with the legal system.
Public health system employ law as a tool to
achieve its goal. Thus these laws play a unique
role in ensuring the population’s health.

8. The purposes of this seminar is to:
summarize the essential elements of program
evaluation;
provide a framework for conducting effective program
evaluations;
clarify the steps in program evaluation;
review standards for effective program evaluation; and
address misconceptions regarding the purposes and
methods of program evaluation

9. What is Evaluation ?
And
Definition of evaluation

10. “Research seeks to prove,
evaluation seeks to improve…”
M.Q. Patton

11. • Evaluation has its origin from the Latin word “Valupure”
which means the value of a particular thing, idea or
action
• Evaluation means finding out the value of something.
• Evaluation, thus, helps us to understand the worth,
quality, significance amount, degree or condition of any
intervention desired to tackle a social problem
• Evaluation simply refers to the procedures of fact finding

12. Its began in the field of education
Strengthened during the 1960’s emphasis on social
programs and determining their effect on society
Further strengthened during the 1990’s emphasis on
outcomes measurement and quality improvement

13. “The systematic investigation of the worth, merit, or
significance of an ‘object’ ”
Michael Scriven
Evaluation has been defined as
“ The systematic and scientific process determining the
extent to which an action or set of actions were successful
in the achievement of pre-determined objectives. It involves
measurement of adequacy, effectiveness and efficiency of
health services”
-WHO

14. Evaluation is defined as the collection and analysis of
information to determine program performance
i.e. ‘ finding out value of something”
- J Kishor

15.  To gain insight about a program and its
operations – to see where we are going and where
we are coming from, and to find out what works
and what doesn’t
 To improve practice – to modify or adapt practice
to enhance the success of activities
 To assess effects – to see how well we are
meeting objectives and goals, how the program
benefits the community, and to provide evidence of
effectiveness

16.  To build capacity - increase funding, enhance
skills, strengthen accountability

17. • Direct service
interventions
• Community mobilization
efforts
• Research initiatives
• Surveillance systems
• Policy development
activities
• Outbreak investigations
• Laboratory diagnostics
• Communication
campaigns
• Infrastructure-building
projects
• Training and educational
services
• Advocacy works

18. Planning a
NEW
program
Assessing a
DEVELOPING
program
Assessing a
STABLE,MATURE
program
Assessing a
program after
it has ENDED
Conception Completion

19. Monitoring
• Recording
Analysis
Reporting
Corrective action at the operational
level
Information
Recording
Information from
Monitoring
Information
from other
sources
Analysis
Recommendations
Evaluation
Affirmation or modification in
objectives, resources, and process

21. • Based on purpose, progress and components and
activities, evaluation can divided as
1) Total (overall)
a) plan
b) program,
c) project
2) Partial
a) part of the year
b) part of project
c) part of program
d) some of the activities

22. • 3) Time related
a) Longitudnal
b) cross- sectional
c) initial (at the start of program)
d) mid term
4) Relation to planning
a) Baseline or benchmark
b) Baseline for next planning cycle
c) appraisal
d) concurrent evaluation
5) according to agency
a) external
b) Internal

24. Formative evaluation
Evaluation intended to improve performance, most
often conducted during the design and/or
implementation phases of projects or programs
Its intent is to assess ongoing project activities
Formative evaluation has two components:
implementation evaluation and progress evaluation

25. Implementation(Process) evaluation:
The purpose of implementation evaluation is to assess
whether the project is being conducted as per planned
Progress evaluation:
To assess progress in meeting the goals of the program
and the project. It involves collecting information to learn
whether or not the benchmarks of participant progress
were met and to point out unexpected developments

26. Summative(Outcome/Impact) evaluation
 An evaluation conducted at the end of an
intervention to determine the extent to which anticipated
outcomes were produced such as improved survival or
reduced disability
The traditional outcome components are the 5 D’s of ill
health, viz. disease, discomfort, dissatisfaction, disability
and death

27. • A way of living , thinking
• That is adopted volunterily
• Upon the basis of Knowledge attitudes and
• Respossible decisions
• By individuals and couples
• in order to promotes the health and welfair
• Of the family groups and thus
• Contributes effectively to the
• social development of country

28. Participatory evaluation
 Evaluation which provides the active involvement
of those with a stake in the program, (providers,
partners, beneficiaries, and any other interested parties)
in designing, carrying out and interpreting an evaluation
360 degree Evaluation (evaluation by planner &
implementers)
An evaluation by those who are entrusted with the
design and delivery of a project

29. WHO:
UNFP
A,

32. Relevance:
Relates to the appropriateness of the services, whether
it is needed at all
For example, vaccination against small pox is now
irrelevant because the disease no longer exists

33. Adequacy:
Implies that sufficient attention has been paid to
certain previously determined courses of action, such
as the various issues to be considered during broad
programming
For example, the staff allocated to a certain program
may be described as inadequate if sufficient attention
was not paid to the quantum of workload and targets
to be achieved

34. Accessibility:
Proportion of the given population that can be
expected to use a specified facility, service, etc.
The barriers of accessibility may be
physical(distance, travel, time); economic(travel cost,
fee charged); or social and cultural(caste or
language)

35. • Acceptability:
• The services provided may be accessible but not
acceptable
• eg.male sterilisation,
• rectal cancer screening

36. Efficiency:
 Expression of the relationships between the results
obtained from a health program/activity and the efforts
expended in terms of human, financial and other
resources, health processes and technology, and time
(number of immunizations provided in an year as
compared with an accepted norm)
 Cost-benefit analysis will be useful for this purpose
 To find out if optimal utilization of available resources is
being made

37. Effectiveness:
Expression of the desired effect of a program,
service, institution or support activity in reducing a
health problem or improving an unsatisfactory
health situation
Measures the degree of attainment of the
predetermined objectives & targets of the program,
service/institution

38. Impact:
Expression of the overall effect of a program,
service/institution on health and related socio-
economic development
Aimed at identifying any necessary change in the
direction of health programs so as to increase their
contribution to overall health and socioeconomic
development

39. Sustainability:
Meeting needs without compromising the ability of
future generations to meet their needs (project will
continue after donors intervention)

42. To improve health programs and the services for
delivering them
To guide the allocation of resources in current and
future programs
Should be used constructively & not for the
justification of past actions/merely to identify their
inadequacies

43. Decision-oriented tool and to link closely with
decision making, whether at the operational/the
policy level
The very process of carrying out an evaluation often
induces a better understanding of the activities being
evaluated, and a more constructive approach to their
implementation and to any further action required

45. Responsibility for evaluation will lie on individuals
and groups responsibility for development and
application of marginal process at various policy and
operational levels eg. Local, district and central.
 Evaluation can be done by,
1. The planner themselves
2. Ad hoc research group
3. Those responsible for health devlopment

46. 4.Those responsible for implementation
5. Community itself.

49. 1) Review of records from National Health Information
System
2) Monitoring: Input/ effort analysis, Management by
objectives, Gratt charts, PERT and CPM analysis
3) Case Studies.
4) Quantitative studies.
5) Sample Surveys: cross-sectional studies.
6) Cohart Studies.
7) Panel Studies.
8) Controlled experiment and intervention studies.

50. History timeline
Of
National programmes

51. “An organized response to
eradicate or eliminate or reduce
one or more problems where the
response includes one or more
objectives & the expenditure of
resources” ( Kane et al.)
“Any set of organized activities
supported by a set of resources
to achieve a specific and
intended result.”

52.  Program is formal set of procedures to conduct an activity.
 National planning start in india in 1951.
 GDP expendatures for Health in India is only 4.8%
 various National policies in India
1) National Health Policy 1983
2) National Health Policy 2002
3) National Health Policy 2017

54. 1) National Vector Borne Diseases Control Programme
(NVBDCP)
2) Revised National Tuberculosis Control Programme
3) National Leprosy Eradication Programme
4) National AIDS Control Programme

55. 5. Universal Immunization Programme
7. Integrated Disease Surveillance Programme

56. • National Program for Prevention and control of
cancer, Diabetes, CVD and stroke
• National Iodine Deficiency Disorders Control
Program.
• National Mental Health Programmes
• National Nutritional Anaemia Prophylaxis Programme
• Mid- Day Meal Programme

58. Process & outcome evaluation
Impact evaluation
Evaluation by funding agencies

59. Being done at different levels:
Evaluation at review meetings at district & state levels
a) Internal evaluation
• Those conducted by states
• Those by CTD (central TB division)
b) External evaluation
(Joint Monitoring Mission at a frequency of 3 years)

60. • Performance indicators are monitored & evaluated
at:
The sub-district level through monthly meetings at
district level.
District level through quarterly meetings at state
level with DTOs.
State level by the center every 6 months Quarterly
reports are regularly published on the website
(tbcindia.org)

61.  Each state select 2-districts based on performance (one
good & one bad performing district)
 Evaluation done by another district DTO & RNTCP
consultant (4 days)
 STO is a member of the team
 Report & recommendations sent to central TB division &
STO
 Corrective actions taken checked at next quarterly review

62.  One state each month, standardized forms used for data
collection & reporting
 Purposive sampling of 2-districts
 5 DMCs(designated microscopy centers): one at the DTC,
4 randomly selected, additionally one DMC (medical
college/NGO/Private/tribal/urban slum)
 Visit all the DOT centers in the DMC area & 3 more in the
district with unique characteristics
 Visit 5 NSP(new sputum positive) cases (randomly
selected) in each of the 5 DMCs

63. Visit 2 pts. (not NSP) from the DOT centers at DTC &
TU level
Visit at least 3 pediatric patients
Review state level issues

64. Repeat community based survey in a rural area , by
TRC(training and research center).
Two ARTI ( Acute respiratory tract infection) survey
completed disease prevalence surveys at 5 sentinel
sites
Drug Resistance Surveillance

65. • External funding for the RNTCP
World bank: >60% of RNTCP fund.
USAID:(united states agency for international
development) Haryana
GFATM:(global fund to fight AIDS,TB,malaria)
 AP, Chhattisgarh, Jharkand, Uttarakhand, Orissa &
parts of Bihar and UP
DFID;(Department for international development) For
drugs through GDF/WHO (almost half of the drug
requirement of RNTCP supplied by DFID)

66.  J kishor text book of National health programmes of india ,11 th
edition , century publication, Publication year 2014,page 652-657.
 P.V.Sathe book of epidemiology and management for health care
for all 3rd edn chapter 16 planning ,monitoring and evaluation
 R. Deter, R.Beagelhole “ oxford textbook of Public Health” 5th
edition, oxford university press, Publication year 2011, page no.540-
560.
 K.Park’s text book of preventive and social medicine ,24nd edn,
Bhalani publication, Publication year 2017,page 824-825
 Tb 2017, http://www.tbcindia.nic.in/( assesed on date 21/04/2017)
 Framwork for programme evaluation. https://www.cdc.gov
(accessed on date 21/04/2017)

67.  RNTCP, Communicable National Health programmes in
India http://mohfw.gov.in/ (accessed on date 21/04/2017)