Monitoring Primary Eye Care

Dr. Sandeep Buttan

MS (Ophth), MSc CEH (LSHTM, UK) Dr Shroffs Charity Eye Hospital New Delhi
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A program is a specific set of activities that are directed towards one or more defined objectives to achieve a goal
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Monitoring
A continuous and systematic process Carried out at regular intervals during the duration of an intervention, Generates quantitative or qualitative data on the implementation of the intervention against defined milestones.
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Monitoring

Continuous surveillance of implementation of the program to ensure that it is proceeding according to plan
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 The intention is to correct any deviation from the operational objectives, and thus improve the performance of the project as well as facilitate subsequent evaluation.

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Objectives of Monitoring
Are we efficient? Are we productive? Are we doing a good job? What is the outcome? Is it what we wanted to be?

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Benefits of Monitoring
It helps in setting norms of performance It helps in measuring level of performance It helps in comparing performance level with standards or norms It helps in identifying deviations and explain the reasons for the deviation for taking necessary corrective action

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Levels of Monitoring
Monitoring Interval: monthly, quarterly, yearly, every 5 years Levels of data collection: local, district, provincial, national, regional, global. Project plan level: Process, Outcome, Impact

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Levels of Monitoring
Process
Activity 1

Outcome

Impact

OBJECTIVE1
Activity 2 Activity 3
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GOAL OBJECTIVE2
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Monitoring tools: Indicators

Indicators can be: numbers, proportion, ratio Indicators measure the extent to which:
program activities are taking place program objectives are being met program goals are achieved

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Monitoring tools: Indicators

Indicators should be SMART
Specific Measurable Attainable Relevant Time bound

DO NOT MEASURE TOO MUCH USE ALL THAT YOU MEASURE

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MONITORING IN EYE CARE

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What to Monitor

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Monitoring : Cataract program

Process
Raise Awareness

Outcome

Impact

Demand for Cataract

Screening Improve QOL by providing GOOD Visual outcome Provide Cataract services

Develop surgical units

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Monitoring: Vision Centers

Outpatients services New OP Review OP Total OP New OP per day 40 + in Total OP Annual growth in New OP Cataract services Cataract surgery CSR as an option Refraction services Eye glasses prescription Acceptance rate Specialty services New Glaucoma Diabetic (Known & diagnosed) Diab. Retinopathy Total speciality diag. Referral to Hospital Acceptance rate
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Monitoring: Visual Outcomes

Loss to Follow Up 58 5 25 28 UCVA (>6/18) 380 Total ECCE SICS Phaco 530 31 162 337 80.51% 11 42.31% 93 68% 276 89.32% BCVA (>6/18) 438 92.80% 18 69.23% 121 88.32% 299 96.76% BCVA Corrected for Co morbidity 452 95.76% 22 84.62% 127 92.70% 303 98.06%

Nov-11 Total Cases

Poor 20 4.24% 4 15.38% 10 7.30% 6 1.94%

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Key Indicators to measure Organizations performance Paying : Subsidy : Free surgery Ratio Sustainability? Cataract Surgery Rate Coverage? Surgery per Ophthalmologist Efficiency? Outreach Productivity Cost Effective?

What is required for a monitoring system?

A good network of motivated people
SMART indicators

Efficient data collection system

Performing basic analysis of all levels of health

service
Provision of feedback
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Planning & Monitoring

If you cant plan it, You cant do it If you cant measure it, you cant manage it

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