Global Blindness: Principles of monitoring
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This presentation introduces the principles of monitoring in the programme planning cycle, explains the different kinds of indicator planners use to check how a plan is progressing and explores the role of the manager in monitoring. As you view it, think about monitoring in your own setting. What is being monitored currently? Would you change anything? If so, which indicators would you start to collect? Or stop collecting? © 2016 International Centre for Eye Health, London School of Hygiene & Tropical Medicine. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license. Taken from the free online course: Global Blindness: Planning and Managing Eye Care Services. We encourage the use and adaptation of this resource for teaching and learning. Find more Open Educational Resources for eye care on our website at http://iceh.lshtm.ac.uk/oer
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Global Blindness: Principles of monitoring
- 1. Global Blindness: Planning and managing eye care services Principles of monitoring
- 2. Learning outcomes Define monitoring Explain process, outcome and impact indicators Explore the role of managers in monitoring
- 5. Planning a journey 12 HOURS A Z 60 LITRES
- 6. Planning a journey 09 HOURS A Z 50 LITRESDISTANCE =150KM ?
- 7. Planning a journey 09 HOURS A Z 50 LITRESDISTANCE =150KM ?
- 8. Indicators tell you how the journey is going 09 HOURS A Z 50 LITRESDISTANCE =150KM ?
- 9. Monitoring is the continuous surveillance of implementation NOW FUTURE
- 10. NOW FUTURE Are you doing what you said you will do?
- 11. What gets monitored is more likely to get done
- 12. Monitoring helps to tell success from failure Reward successCorrect failure
- 13. Monitoring helps to tell success from failure Results sustain support for actions
- 14. Achievement is aligned with completion of objectives Tasks Inputs Objective Activity Process
- 15. Achievement is aligned with completion of objectives Impact Outcome Objective Activity
- 16. Indicators what or how much has been done Process indicators Provide information on tasks and inputs
- 17. Indicators what or how much has been done Process indicators Outcome indicators Assess the path taken
- 18. Indicators what or how much has been done Process indicators Outcome indicators Impact indicators Indication of change resulting from a plan
- 19. What information should be collected? And when?
- 20. What COULD be monitored? What SHOULD be monitored? What MUST be monitored?
- 21. Plan: Aim is to reduce cataract blindness Objective: Increase CSR by 50% each year
- 22. Activities Objective: Increase CSR by 50% each year Regular outreach Improve surgical efficiency
- 23. Activities Objective: Increase CSR by 50% each year Regular outreach Improve surgical efficiency Process indicators No. outreach operations each month No. hospital surgeries each month
- 24. Activities Objective: Increase CSR by 50% each year Regular outreach Improve surgical efficiency Process indicators No. outreach operations each month No. hospital surgeries each month Outcome indicator
- 25. Impact indicators may require a new population- based survey at the end of the project
- 26. Examples of process indicators Number of cataract operations per month
- 27. Examples of process indicators Visual outcome of every 100 operations
- 28. Examples of process indicators Number of patients diagnosed with refractive errors per month
- 29. Examples of process indicators Expenditure on staff salaries per month Items NO Amount per item Total cost SALARIES (monthly) Ophthalmologist 2 2000 4000 Refractionist 1 1200 1200 Nurse 4 1000 4000 Driver 2 800 1600 TRANSPORT Fuel 600 5/litre 3000 CONSUMABLES Per cataract surgery 300 50/ 15000
- 30. Examples of process indicators Income from user fees per month
- 31. Examples of process indicators Number of outreach activities per month
- 32. Examples of outcome indicators Cataract surgical rate: the number of surgeries per million each year
- 33. Examples of outcome indicators Percentage of schools where vision testing has been completed in a year
- 34. Examples of outcome indicators Number of community health workers trained in eye care in a year
- 35. Examples of outcome indicators Percentage of poor outcome following cataract surgery (less than 6/60) in a year
- 36. Examples of impact indicators Prevalence of cataract blindness at the end of a 5 year period
- 37. Examples of impact indicators Percentage of self- sustaining school vision testing programmes in the district after 3 years
- 38. Golden rules for monitoring Do not collect too many indicators Use all the indicators collected Use indicators at same level collected at Educate staff about need for indicators Don’t make things worse! 2 3 4 5 1
- 39. Managing monitoring Who collects the indicators at each level?
- 40. Managing monitoring Where are the reports sent and who will review them?
- 42. Plan: Aim is to reduce cataract blindness Objective: Increase CSR by 50% each year
- 43. To monitor activities for objective to increase CSR by 50% each year
- 44. Reports are collected and reflected on by the manager
- 45. The district manager reports to the national coordinator
- 46. Collecting the right data is important to guide programme success Put rubbish IN Get rubbish OUT
- 47. In conclusion Monitoring is important because it: Improves accountability Improves performance Provides a system to record lessons learnt
- 48. Written by Dr Daksha Patel © 2016 International Centre for Eye Health, London School of Hygiene & Tropical Medicine. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license. Taken from the free online course: Global Blindness: Planning and Managing Eye Care Services. We encourage the use and adaptation of this resource for teaching and learning. Find more Open Educational Resources for eye care on our website at http://iceh.lshtm.ac.uk/oer
Editor's Notes
- Welcome. By the end of this presentation you will be able to: Define monitoring Explain process, outcome and impact indicators and relate them to level they are collected Explore the role of managers in monitoring
- In this stage of the planning cycle, planners consider the implementation of the project.
- Step 5 is the monitoring phase. This is planned in detail at the beginning of the project and then managed throughout the project lifespan.
- Imagine that you have planned a journey from point A to Z. In the plan you know what car you will use, the route you will travel, how many people will be travelling and the amount of fuel needed for the journey. You also have an estimate of the time for travelling.
- Once the journey starts (the implementation of the plan), every few hours you look at the fuel gauge, check the distance travelled and, perhaps, ask how the passengers are doing. This is monitoring.
- You may even have planned to assess this information at several points along the way where you will decide if the car needs to be refuelled or if a break is necessary to rest the passengers.
- Information on fuel, distance and how the passengers are doing are referred to as indicators. Indicators tell you how the journey is going.
- Monitoring is the continuous surveillance of the implementation of a programme or project. Monitoring activities check if a project is proceeding according to the plan.
- Are you doing what you said you will do?
- Monitoring is important because: What gets monitored is more likely to get done.
- If you don’t monitor performance, you can’t tell success from failure. If you can’t see success, you can’t reward it. If you can’t recognise failure, you can’t correct it.
- If you can’t demonstrate results, you can’t sustain support for your actions.
- In any plan, or programme, achievement is aligned with completion of objectives. There are usually several activities that need to be carried out for an objective to be achieved. Each activity requires inputs (financial, resources, etc.) and for specific tasks to be completed. This is known as the process.
- As a result of process, activities and objectives are completed. This in turn leads to an outcome and an impact.
- Indicators measure what, or how much, has been done. Process indicators provide information on the tasks done, and inputs consumed, as part of activities to achieve objectives. Process indicators are collected regularly, on a weekly, monthly or quarterly basis
- Outcome indicators are used during a project to assess if the path taken is working well and if changes need to be made to the plan’s objectives. They are collected over longer intervals – once or twice a year.
- An impact indicator is an indication of change that has resulted from a plan. Impact indicators are collected and reported on at the end of the project, after objectives have been completed.
- In a programme it is important to decide what information should be collected and when.
- Planners must decide on What could be monitored? What should be monitored? What must be monitored?
- For example, the Zrenya district eye unit develops a plan which aims to reduce cataract blindness in the district. One of the plan’s objectives is to increase cataract surgical rate by 50% each year.
- The unit decides to carry out several activities to achieve this objective – two of the main activities are: to establish regular outreach and improve surgical efficiency at the hospital.
- To check that these two activities actually happen and manage their progress, managers can regularly collect data on several process indicators, such as number of outreach operations and hospital surgeries carried out each month.
- To see if activities make a difference, Managers review the data and calculate an outcome indicator. In our example, cataract surgical rate at the end of each year to see if it has increased by the required 50%.
- Impact indicators are more complex and may require a new population based survey to be carried out at the end of the implementation phase of the project. Image: Clare Gilbert/LSHTM CC BY-NC 2.0 flic.kr/p/dQhSNZ
- Examples of process indicators The number of cataract operations per month
- The visual outcome of every 100 operations
- The number of patients diagnosed with refractive errors per month
- Expenditure on staff salaries per month
- Income from user fees per month
- Number of outreach activities per month
- Examples of outcome indicators The cataract surgical rate (the number of surgeries per million each year)
- The percentage of schools where vision testing has been completed in a year
- The number of community health workers trained in eye care in a year
- The percentage of poor outcome following cataract surgery (less than 6/60) in a year
- Examples of impact indicators Prevalence of cataract blindness at the end of a 5 year period
- Percentage of self-sustaining school vision testing programmes in the district after 3 years
- Golden rules for monitoring Do not collect too many monitoring indicators or collect indicators too often Use all monitoring indicators collected and discard indicators that are not used Use the monitoring indicators at the level that they are collected - as process, outcome or impact Educate staff about the need to collect monitoring indicators Don’t make things worse! Don’t destroy a monitoring system that works.
- Managing monitoring: planners need to decide Who collects the indicators at each level?
- Once the data has been collected where are the reports sent and who will review them? And how will the programme act on the feedback from the review? These are key details that must be managed by the programme, or project, manager.
- Appropriate selection and training of key people to carry out monitoring is essential. Image: Elmien Wolvaardt Ellison CC BY-NC 2.0 flic.kr/p/9d77vE
- As an example, let’s return to the Zrenya eye unit’s plan to reduce cataract blindness in the district.
- In order to monitor activities towards the objective of increasing cataract surgical rate by 50% each year, the outreach clinical officer must send back a report on the number of outreach surgeries done each month. The theatre nurse must also report monthly on the number of surgeries done with the hospital.
- These reports are collected and reflected on by the manager on a regular basis. It is important that the district manager gives feedback to staff about how the programme is doing.
- The district manager reports to the national coordinator. At the end of the programme period it is the final responsibility of the national coordinator to identify resources and address the impact of the programme.
- Collecting the right data is important to guide the programme and its success. There is a saying that if you “Put rubbish in and you get rubbish out” – so planners must remember to select indicators properly.
- In summary, monitoring is important because it: Improves accountability for use of funds and resources Improves performance to achieve outcomes Provides a system to record lessons learnt. These can be shared to improve strategies in the future