Measuring results and impact of TB REACH is of utmost importance, both globally and locally. At the global level – measuring results and impact is mainly guided by TB REACH’s Performance Measurement Framework and some of its key indicators have also been adopted as Key Performance Indicators of the Stop TB Partnership.
At the individual project level, assessing the effectiveness of TB REACH funded interventions is monitored and evaluated via a pragmatic framework, which was developed over the first four TB REACH funding waves by two external M&E agencies (Mott MacDonald and the Royal Tropical Institute (KIT). Data is collected from different sources by the TB REACH team, its independent M&E reviewers and its partner institutions.
Each project must define an evaluation area, where strategies will be implemented, and a control area, which should represent routine services, and must collect historical and intervention period TB case notification data for all the health facilities in these areas. The data is then analyzed on a quarterly basis to identify additional notifications, or patients whose treatment would not have happened in the absence of the TB REACH project, and a percent departure from historical notifications during the intervention period. These analyses are conducted using official National TB Program notification data, and are compared to project data submitted via pre-agreed process indicators.
Unlike other initiatives, TB REACH process indicators are always aligned to the patient care pathway. Indicators usually start with the number of people screened for TB and end with number of people successfully treated. Each step in between (suspected, providing sputum, tested, tested positive, linked to treatment, etc.) is captured and quantified. Often people with TB are lost to follow up between the steps in this cascade and by monitoring yield in this fashion, projects can make data-driven decisions to drive greater impact. For example, if you realize that a low percentage of your referrals are arriving at a health facility for testing, you can implement a sample transport mechanism or transport enabler to reduce this loss. Process indicators are often disaggregated by strategy (for example, screening in the community vs screening in a health facility) and by gender.
As of Wave 5, TB REACH’s has revised its M&E framework which now also requires the grantees to collect and report on data that is more expansive in scope (e.g. to capture treatment outcomes) and disaggregated in selected indicators (i.e. to rep report on TB case notifications by age and sex). As more information will be rigorously and systematically collected, there will be increased potential for the TB REACH initiative and grantees to analyze and disseminate more results or to synthesize a greater diversity of cross-cutting aspects.