The five elements of DOTS
Monitoring and evaluation system, and impact measurement
Recording and reporting system. Establishing a reliable monitoring and evaluation system with regular communication between the central and peripheral levels of the health system is vital. This requires standardized recording of individual patient data, including information on treatment outcomes, which are then used to compile quarterly treatment outcomes in cohorts of patients. These data, when compiled and analysed, can be used at the facility level to monitor treatment outcomes, at the district level to identify local problems as they arise, at provincial or national level to ensure consistently high-quality TB control across geographical areas, and nationally and internationally to evaluate the performance of each country. Regular programme supervision should be carried out to verify the quality of information and to address performance problems.
Enhanced recording and reporting. Both developed and developing countries now have additional diagnostic information at their disposal, including sputum culture, DST and HIV test results, all of which can be used to guide patient management. TB programme managers also need to monitor records and reports from public and private care providers not directly linked to the NTP. Special attention must be paid to ensuring the confidentiality of patient information. (Advice on what additional data should be routinely collected and how these data should be compiled, collated, analyzed and used to inform TB control can be found here.) Use of electronic recording systems (now available) will be considered where appropriate.
Making the best use of data at all levels will mean many countries having to train staff in the analysis and interpretation of data, as well as in the use of the computer software that can greatly facilitate this work. As electronic recording systems become more widely available, consideration should be given to storing individual patient data, which will make more detailed analyses of aggregated data possible.