HEARTS. Technical package for cardiovascular disease management in primary health care. Systems of Monitoring

Monitoring is a crucial element in any successful programme. It is important to know if health care facilities – and ultimately countries – are meeting the agreed goals and objectives for preventing and managing cardiovascular diseases (CVD). Monitoring is the on-going collection, management and use of information to assess whether an activity or programme is proceeding according to plan and/ or achieving defined targets. Not all outcomes of interest can be monitored. Clear outcomes must be identified that relate to the most important changes expected to result from the project and to what is realistic and measurable within the timescale of the project. Once these outcomes have been articulated, indicators can be chosen that best measure whether the desired outcomes are being met. To allow progress to be monitored, this module provides a set of indicators on CVD management. Agreeing on a set of indicators allows countries to compare progress in CVD management and treatment across different districts or subnational jurisdictions, as well as at a facility level, identify where performance can be improved, and track trends in implementation over time. Monitoring these indicators also helps identify problems that may be encountered so that implementation efforts can be redirected. This module starts from the collection of data at facility level, which is then “transferred up” the system: facility-level data are aggregated at subnational level to produce reports that allow tracking of facility and subnational performance over time and allow for comparison among facilities. National-level data are obtained through population-based surveys. Implementing a monitoring system requires action at many levels. At national and subnational levels, staff can determine how best to integrate data elements into existing data collection systems – such as the routine service-delivery data that are collected through facility-level Health Management Information Systems (HMIS). In the facility setting, personnel must be aware of what data are needed. Sample data-collection tools are included, recognizing that countries use different datamanagement systems for HMIS, so the CVD monitoring tools will be adapted to work with the HMIS system being used by the country, such that the indicators can be collected with minimal disruption/work to existing systems and tools