Evaluation of the Tuberculosis Control Assistance Program (TB CAP)

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The Compendium of Indicators is often recommended for measuring program interventions and impact,but the indicators are not prioritized and there is insufficient guidance on when they are valuable.There are no criteria and methodology for evaluating the quality of a TB control program as a whole.Although WHO and the Union have published methods for organizing program assessments, theassessments rest on individual experience and there are no criteria for which areas are critical and whatlevels of performance are acceptable.RecommendationsThe indicators for NTPs should be targeted to specific interventions and critical processes andobjective (not dependent on estimates).The Compendium of Indicators needs to be updated with priorities and guidance on the pros and consof each indicator, and when to use them.TB CAP should study the feasibility and usefulness of developing standard criteria to evaluate thequality of TB control programs.I. OPERATIONS RESEARCHContrary to impressions held by a number of partners and country programs, USAID does allow TA foroperations research (OR) at the country level through TB CAP. This is a weak area in almost everycountry. Most studies can be done with local resources based on available or easily collected data, butstaff need some training and guidance. In most cases OR to improve service delivery and programeffectiveness is very similar to monitoring, and OR would improve self-evaluation at the peripheral level.However, staff capacity to plan OR and to draw conclusions for action is very limited.TB CAP support should incorporate preparation of simple protocols, recommendation on areas for fieldOR, training of staff in pilot projects, and dissemination of the procedures and results. Examples ofsimple protocols would be the proportion of adult outpatients with persistent cough to compare withroutine detection, patient and provider diagnostic delay, reasons for default, and the proportion of patientsreally taking DOT.USAID support to the TREAT TB project through the Union represents an opportunity to build nationalcapacity, but has some risks. The resources of TREAT TB can support useful studies and also NTPcapacity building for use of the results not only for research but also for analysis of routine data andmonitoring. However, competition between research and program activities for the limited humanresources at the national level is a risk.RecommendationsTB CAP should develop and test simple protocols for operations research at the service level, andtrain staff in using them and analyzing the results for action.Where PHC facilities are not available, develop and test alternative ways to increase access of thepopulation to quality TB diagnosis and treatment.Coordinate with other projects (such as the USAID TREAT TB project) to ensure that in-countryactivities are complementary.30 EVALUATION OF THE TUBERCULOSIS CONTROL ASSISTANCE PROGRAM (TB CAP)
IV.COMPILED RECOMMENDATIONSOVERARCHING RECOMMENDATIONSUSAID should continue its support for TB TA but should take a more long-range and ambitiousapproach to it.If USAID chooses to implement a follow-on project to TB CAP, there should be only a minimal gapbetween the end of the current and the beginning of the new one. In fact, USAID should plan forsome overlap to account for the initial period of planning new project activities that would be anecessary precursor to implementation and thus ensure smooth continuity from one project to thenext.The new project should be launched during the original TB CAP timeframe; the period of timecovered by an extension is an exceptional opportunity to complete unfinished work.In the current project, TB CAP should not expand the number of countries supported beyond thosealready identified in APA5 unless the project period is extended with sufficient additional financialresources. Within resources, the focus should be on qualitatively improving current assistance.The USAID implementing mechanism should have a board that is composed and enabled to activelyfocus on issues of governance, program strategy, and budgeting, and given a mandate from USAID todevelop and implement a strategic agenda for scale-up of support to countries. The PMU should beempowered to make and execute management decisions and to make recommendations for boardleveldecisions.USAID should encourage and provide guidance to its Missions to draft multiyear workplans for TBcontrol, linked to national TB control strategies, and formally support the approval of such workplanswhile providing for annual adjustments of activities and resourcing based on needs, progress, andfunds. Longer-term planning with the anticipation of funds would make country TB control measuresmore sound and help stimulate investment in the technical capacity needed to meet current andprojected country demand.STRATEGY AND GOVERNANCEThe roles and responsibilities of the board, working groups, and the PMU should be clearlycommunicated, and the operational practices of each revisited to ensure they are acting on thesemandates.Working groups should institute regular meetings, electronically or telephonically when possible, sothat they can keep strategies for core and country projects up to date.TB CAP assistance in countries with weak peripheral DOT services should prioritize reinforcingDOT, consistent with the Stop TB Strategy, while also addressing, in a balanced way, the emergingproblems of drug resistance, infection control, and TB/HIV coinfection.Although there are many priority needs, TB CAP should focus on ensuring that the fundamentalbuilding blocks of an effective TB control program are in place, especially drug management systemsand the capacity and coordination of laboratory networks.TB CAP should shift focus from short-term, high-yield projects toward longer-term, country-wideprojects that scale up the experiences it has gained and convert them into national improvements andthus greater global impact.EVALUATION OF THE TUBERCULOSIS CONTROL ASSISTANCE PROGRAM (TB CAP) 31
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TreatmentDrugsM&EMDRNumber of suspe
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Global Health Technical Assistance
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