Annex 2 - Approach and
Methodology
A structured process-led approach was designed to execute this
assessment which involved multi-stakeholder consultations and participation. Following
were some core principles put in place while designing the approach:
- Multi-stakeholder engagement and participation
- Open-minded discussion
- Proactive information collection
- Avoiding any conflict of interest
- Validation of information at each stage
- Acquired necessary signoffs and approvals from countries
Following methodology was formulated to confide with the above-mentioned
principals
As you can see above, the methodology was divided into 5 main steps
starting from,
Collection, Curation, Validation, Analysis, Recommendation.
Each step can be further elaborated with sub-processes as given below:
1.1. Collection:
1.1.1. Country engagement process
As an initial introduction to the project and to seek the NTP’s support,
an official letter from Executive Director office of Stop TB Partnership was shared in
the month of July 2021 informing and inviting to participate in this assessment process
to all 20 NTP managers of TB high burden countries namely- Bangladesh, Cambodia,
Cameroon, DR Congo, Ethiopia, Ghana, Myanmar, India, Indonesia, Kenya, Mozambique,
Nigeria, Pakistan, Philippines, South Africa, United Republic of Tanzania, Ukraine,
Uganda, Vietnam, Zambia.
A series of follow-ups were done to seek convenient time to organise the workshop from
the office of Stop TB Partnership. Following were the areas where country’s engagement
and participation was requested:
- As a first step, all the countries were invited for an introductory meeting where
the countries were introduced to the project, objectives and expected outcome.
- Countries were also requested to complete the online questionnaire already shared to
them before hand
- Countries were also requested to appoint a point of contact from the NTP could lead
the coordination on behalf of the NTP.
The list of NTPs who were contacted with dates can be found in Annex 1
1.1.2. Tools for data collection
Various tools and documentation templates were used as part of the data
collection process. Following are some of the examples of tools and templates that were
used:
- Detailed survey questionnaire template: This is a detailed questionnaire
which was administered during the detailed assessment workshop calls with the
national program representatives.
- Online survey: This is an online tool that was created for the participants
to share basic information’s with the objective of optimising time during the
assessment workshop calls.
- Desktop research data collection template: A detailed desktop research was
done before the introduction workshop and detailed assessment with the objective of
optimising time during the calls and also to help with targeted and specific probing
questions.
- Probing questionnaire: Based on the desktop research specific and focused
questions were asked and validated.
- Analytical Framework/Country Assessment Template: This is the most important
and elaborative tool of the entire assessment. The analytical template consists of
the complete country assessment information put into a structured format. The
framework allowed in converting a subjective and unstructured information into a
more structured and analysed insights. This also allowed in capturing
recommendations which is one of the core components of the assessment report.
- Minutes of the meeting (MoM): There were primarily 3-4 calls (Introductory
call, detailed functional assessment, detailed technical and financial assessment
call, follow-up call) happened per country as part of the core assessment processes.
Each of the calls were recorded and detailed minutes were shard and captured with
the country representatives. All video recordings are archived and can be obtained
on request.
- Introduction PPT: This was an anchor presentation which was used for the
first introductory meeting with the NTP highlighting the objective and rational for
this assessment and seeking his/her support for the entire assessment duration.
1.2. Curation:
Once the data collection process was complete, data gathered by the team
from different sources (i.e., desktop research, online survey, introductory meetings,
and detailed workshop) was curated to extract meaningful insights for country-wise
compilation in this report. The exercise was repeated from time to time during the
assessment, and a step-by-step process was followed to conduct the data curation:
- Documenting the data
First step in the process was to make sure that the data is
adequately documented. A designated team worked on compiling all the data in
country-wise folders and doing a proof reading of the first version files to
check for any inconsistencies or errors, which would in turn help in identifying
areas to seek more information and clarification. The primary intent of this
exercise was to assess and improve the intelligibility and ease of use of the
collected information, by putting it in a logical order.
- Asking questions
Based on the indications from the last step, the curator
gathered more clarity around the identified inconsistencies or gaps in
documents. This was first done internally, by either taking a further dive into
desktop research or a review of the meeting notes from other team members, or by
asking questions to the documenter. In instances, where the collected
information was still insufficient to fill the gaps, questions were shared with
the country point of contacts and follow up meeting were convened, if
required.
- Translating into standard formats
With all the information in place, the data was translated
and put together in standard formats, mostly by standardizing a minutes of the
meeting (MoM) document and further detailing of the detailed assessment template
with the additional data, which would now be in a better usable form and be
logical for the country NTP teams and the report documenters in the next
steps.
1.3. Validation:
A crucial step after each round of country engagement was to validate
the findings internally as well as with the country teams. The validation process for
each country can be broken into three steps:
- After the initial introductory meetings, the Minutes of the Meeting (MoM) document
(in a standardized format) was shared with the country NTP team, and their comments
were sought to ensure that the understandings gathered from discussions were correct
and their feedback was incorporated in the final versions of country documentation.
- The detailed assessment template for each country was pre-populated with some basic
findings from desktop research and introductory meetings and were further filled
during the detailed functional and technical workshop in a screen sharing mode. The
country NTP teams were encouraged to validate the data presented, provide more
inputs to refine the recorded data and suggest corrections wherever required.
The compiled analytical frameworks (templates for country factsheets)
were:
- First shared internally with the assessment team - Dure Technologies and Stop TB
partnership - for the first round of validation. The received feedback was
incorporated.
- The improvised versions were further sent to the country NTPs for their validation
on the processes, challenges, vision and other components of the template, and the
final version of the country factsheets were thus compiled by incorporating the
country feedbacks that were received.
1.4. Analysis:
The collected data for each country was analysed using a standard
template that was designed specifically for this assessment project. The ‘Analytical
Framework’ template was designed right at the onset of the assessment and was mapped to
various data points in the other tools (like the detailed assessment tool), that were
used for engaging with the country teams. Data analysis process focused on the following
areas broadly:
- Situation analysis: TB disease burden in the country.
- Time series analysis: Trend of Disease incidence, treatment coverage and
success rate in the last 6 years; and the development of TB surveillance technology
over the last decade.
- Policy analysis: Commitment of the country to the Global strategies (like End
TB), the strategies/priorities/vision laid out in the national strategic plans
(NSPs), and the immediate plans of the national TB program for execution in 2022-23.
- Information system architecture analysis: The technology mix being used to
support the TB surveillance in the country, data flow and data use arrangements,
system ownership, resources, and the stage of development/implementation of
information systems.
- Technology ecosystem analysis: Status of enabling aspects of the technology
environment, in terms of penetration and use of gadgets and access to internet
services.
- Resource analysis: Mapping of the supporting partners, the challenges being
faced and the resources available to address the gaps in infrastructure,
accessibility and use of technologies.
1.5. Recommendation:
In line with the assessment objectives, the ultimate outcome of these
country engagements and data analysis was to formulate specific recommendations to
strengthen current systems and fast track the plans envisioned by the national TB
programs. This final step of the broader exercise started with preparation of a detailed
master recommendation directory with inputs from internal and external stakeholders.
These recommendations were defined to match the country requirements identified from the
desktop research, online survey responses, introductory meetings, and the detailed
workshops. These recommendations were classified in multiple groups and mapped against
the general level of maturity of the national level TB information systems and the
country plans; and ultimately, were customized for each country based on their specific
needs. All country recommendations were drafted to address these fundamental questions:
- What can be done? The recommendations include steps that are needed to
implement specific policies or actions that are suitable for the country’s
interests, and the resources that would be required in the process to take forward
these initiatives.
- What benefits? Recommendations would also comment on the feasibility of
implementing the solutions and the adaptability induced with these actions. It would
further talk about the future of these enhancements and the related upgradations for
bringing the tools closer to the benchmarked standards for TB surveillance.
- What additional changes? Apart from the technical enhancements, the
recommendations would also bring out the policy level interventions and strategic
initiatives that should be practiced by countries to create a conducive ecosystem
and sustaining the solutions over time.