Performance Indicators for Monitoring and Evaluation
Session 4: Performance Indicators for Monitoring and
Evaluation
Total Session Time: 120 minutes + 2 hours Assignment
Prerequisites
Learning Tasks
By the end of this session students are expected to be able to:
situations
pharmaceutical situations
Resources Needed:
SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Tasks
20 minutes Performance Indicators in Monitoring and
Presentation
2 Evaluation of Pharmaceutical Situations
Buzzing
80 minutes Explanation on Performance Indicators in
Presentation Small
3 Monitoring and Evaluation of Pharmaceutical
group discussion
Situations
4 10 minutes Presentation Key Points
5 05 minutes Presentation Evaluation
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SESSION CONTENTS
STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)
READ or ASK students to read the learning tasks and clarify
ASK students if they have any questions before continuing.
STEP 2: Performance Indicators in Monitoring and Evaluation of
PharmaceuticalSituations (20 minutes)
Activity: Buzzing (5 minutes)
ASK students to pair up and buzz on the following question for 2 minutes
situations?
ALLOW few pairs to respond and let other pairs to add on points not mentioned
WRITE their response on the flip chart/board
CLARIFY and SUMMARIZE by using the content below
approach with three groups of indicators: Level I, Level II and Level III. This provides a
standard methodology to follow progress over time and to compare situations in
different facilities, districts and countries
PST 06211 Monitoring and Evaluation of Medicines Use NTA Level 6 Semester 2 Facilitator Guide
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Level II
indicators
(outcome)
Level III
Level I • TRIPS, Drug pricing, Tra
indicators
(structure& process)
infrastructure and key processes of each component of the pharmaceutical sector.
access (affordability and availability of key medicines and geographical accessibility of
dispensing facilities) and rational use of quality medicines, including some indication
of the quality of medicines at health facilities and pharmacies.
components and areas such as those elaborated in several indicator documents in
medicine pricing, medicine supply management, HIV/AIDS, TRIPS, rational drug use
(RDU) and regulatory capacity assessment.
STEP 3: Performance Indicators in Monitoring and Evaluation of
Pharmaceutical Situations (80 minutes)
PST 06211 Monitoring and Evaluation of Medicines Use NTA Level 6 Semester 2 Facilitator Guide
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Activity: Small Group Discussion ( 30 minutes)
DIVIDE students into small manageable groups
ASK students to discuss on the following question
ALLOW students to discuss for 15 minutes
ALLOW few groups to present and the rest to add points not mentioned
CLARIFY and SUMMARIZE by using the contents below
o The Level I core indicators are used to assess existing structures and processes of
national pharmaceutical system. They provide a method to rapidly assess the
implementation of NMPs and their components.
o Indicators, a knowledgeable informant can coordinate the gathering of information.
Most data will be available within the Ministry of Health, although data on intellectual
property rights protection may require consultation with the responsible
ministry. Data collection does not require field surveys and information can easily be
updated periodically, for example every two years.
o The questionnaire on Level I indicators is included as Annex of the WHO operational
package for assessing and monitoring pharmaceutical situations. The indicators in this
questionnaire are summarized below.
o National Medicines Policy (NMP)- An NMP document that covers the public and
private sectors, a written implementation plan and the integration of medicine and
health policies provide a basic framework to organize and improve the pharmaceutical
system.
They also assist in coordinating the functions and strategies of each component as
they are being implemented. Regular monitoring helps to inform the NMP and its
implementation.
o Regulatory system-Regulations on medicine manufacturing, promotion and advertising,
sales, distribution, dispensing and prescribing must be in place. Legislation directed at
generic prescribing, dispensing and substitution can help increase access to essential
medicines in both the private and public sectors
o Medicines supply system- Access and availability of essential medicines, especially at
public sector facilities, are affected by how medicines are purchased and distributed
and how medicines are managed in the health system.
PST 06211 Monitoring and Evaluation of Medicines Use NTA Level 6 Semester 2 Facilitator Guide
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o Medicines financing- Access and availability are also affected by how much money
the government can allocate to medicines, pricing policies, financing schemes (such as
insurance programmes and user fees) and medicine donations.
o Production and trade – Activities ranging from repackaging to formulation of products
to developing new medicines are important in assessing the pharmaceutical sector.
Implementing TRIPS flexibilities in public health can increase access to medicines.
o Rational use of medicines – Medicines policies can often have greater impact with
effective use of strategies to improve the prescribing and dispensing practices of health
workers. Key strategies include standard treatment guidelines, curricula and
continuing education programmes on essential medicines concepts, medicines
information centres and public education campaigns.
o The Level II facility core outcome indicators support the Level I structure and process
indicators by providing specific data about important pharmaceutical outcomes.
o This set of indicators requires field surveys
o These indicators measure the degree of attainment of strategic pharmaceutical
objectives: improved access, quality and rational use.
o Access is measured in terms of the availability and affordability of essential medicines,
especially to the poor and in the public sector.
o Measuring the actual quality of medicines by testing samples can be expensive.
o Instead, the presence of expired medicines on pharmacy shelves and the adequacy of
handling and conservation conditions of medicines are used as indicators of quality.
o Finally, rational use is measured by examining prescribing and dispensing habits and the
implementation of key strategies such as standard treatment guidelines (STGs) and
essential medicines lists (EMLs).
o Level II indicators are measured in public health facilities, private drug outlets, and in
warehouses supplying the public sector.
components and areas such as those elaborated in several indicator documents in
o Medicine pricing,
Medicine supply management
o TRIPS- Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement).
o Rational drug use (RDU)
o Regulatory capacity assessment.
o Countries can use any of these set of indicators as baseline assessment and follow-up
studies depending on needs and capabilities.
Refer students to Handout4.1: Summary list of performance indicators
STEP 4: Key Points (10 minutes)
PST 06211 Monitoring and Evaluation of Medicines Use NTA Level 6 Semester 2 Facilitator Guide
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WHO level I, level II and level III indicators.
components and areas such as those elaborated in several indicator documents in
followings;National medicines policy,Access,Legislation and Regulation, ,Medicines supply
system and Rational use of drugs
STEP 5: Evaluation (5 minutes)
References
PST 06211 Monitoring and Evaluation of Medicines Use NTA Level 6 Semester 2 Facilitator Guide
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Quick, J. D. (1997). Managing drug supply the selection, procurement, distribution and use of
pharmaceuticals. West Hartford, CT: KumarianPress.Bartsch, S. (2007).
The Global Fund to Fight AIDS, Tuberculosis and Malaria. Global Health Governance and the
Fight Against HIV/AIDS,146-171. doi:10.1057/9780230591349
WHO Operational package for assessing, monitoring and evaluating country pharmaceutical
situations. (2015, November 20). Retrieved from
https://www.who.int/medicines/publications/WHO_TCM_2007.2/en/
PST 06211 Monitoring and Evaluation of Medicines Use NTA Level 6 Semester 2 Facilitator Guide
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Handout 4.1: Summary list of performance indicators
Survey Forms 1—17 have been developed to obtain data from survey sites.
The table belowsummarizes the Level II indicators and lists the corresponding survey forms.
Information on data collection and calculation can also be found on the respective survey forms.
Will be given later
Summary list of indicators and corresponding survey form used to collect the data
Indicator Survey
Form
Access
Availability of key medicines in public health facility dispensaries, 1, 10, 15
private drug
1 outlets and warehouses supplying the public sector
% of prescribed medicines dispensed or administered to patients at 6
public health
2 facility dispensaries
Average stock out duration in public health facility dispensaries 4, 16
and warehouses
3 supplying the public sector
Adequate record keeping in public health facility dispensaries and 4, 16
warehouses
4 supplying the public sector
Affordability of treatment for adults and children under 5 years of 3, 12
age at public
5 health facility dispensaries and private drug outlets
Price of key medicines in public health facility dispensaries and 2, 11
6 private drug outlets
Price of paediatrics medicines in public health facility dispensaries 2, 11
and private drug
7 outlets
Average cost of medicines at public health facilities and private 6, 14
8 drug outlets
Geographical accessibility of public health facility dispensaries 6, 14
and private drug
9 outlets
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Quality
% medicines expired in public health facility dispensaries, private 1, 10, 15
drug outlets and
1 warehouses supplying the public sector
Adequacy of conservation conditions and handling of medicines in 5, 13, 17
public health
2 facility dispensaries and warehouses supplying the public sector
Rational use of medicines
% medicines adequately labelled at public health facility 6, 14
dispensaries and privatedrug outlets
1
% patients knowing how to take medicines at public health facility 6, 14
dispensaries and
2 private drug outlets
Average number of medicines per prescription at public health 6, 7
facility dispensaries
3 and public health facilities
% patients prescribed antibiotics in public health facilities 7
4
5 % patients prescribed injections in public health facilities 7
% prescribed medicines on the essential medicines list at public 7
6 health facilities
% medicines prescribed by generic name (INN) at public health 7
7 facilities
Availability of standard treatment guidelines at public health 8
8 facilities
9 Availability of essential medicines list at public health facilities 8
% tracer cases treated according to recommended treatment 9
protocol/guide at public
10 health facilities
11 % prescription medicines bought with no prescription 14
Other information
1 % of facilities that comply with the law (presence of a pharmacist) Sections
A,C
% facilities with pharmacist, nurse, pharmacy aide/health assistant Sections
or untrained staff A,C
2 dispensing
% facilities with doctor, nurse, trained health worker/health aide Section B
3 prescribing
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4 % facilities with prescriber trained in RDU Section B
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