A continual monitoring and evaluation process should be put in place to measure progress of the implementation of the National Cholera Control Plan . Each NCP should include a monitoring and evaluation plan with a detailed set of indicators tailored to the activities included in the operational plans.
This monitoring and evaluation process should include regular updates (at least quarterly), periodic in-depth reviews (annually), as well as other monitoring and evaluation methods (such as simulation exercises and after-action reviews) .The regular updates and periodic reviews should be led by the NCP coordination body.
In addition to the NCP monitoring and evaluation plan that should be put in place, the GTFCC will collect indicators and report on progress toward the Global Roadmap at its annual meeting .The indicators to be reported annually are the following:
A. Coordination
Indicator 1 — Proportion of the NCP which is funded through domestic and external funding
Definition and use: Measures the level of funding of the national cholera plan for elimination or control by the government and/or external partners .
Numerator: Amount of funding received from donors and allocated by the government (respectively) for implementation of the national cholera plan for elimination or control .
Denominator: Total budget of the national cholera plan for elimination or control .
Target: 100%.
Source: Country information on resources allocated to the NCP/budgeted NCPs.
Indicator 2 — Number of multisectoral meetings held annually by the NCP coordination body
Definition and use: Measures the functionality of the coordination mechanism . During these meetings, at least 75% of the NCP Committee members - representing at least 3 pillars - should be present .A meeting agenda and meeting minutes should be readily available.
Numerator: Number of multisectoral meetings related to the monitoring of NCP implementation conducted over the past 12 months .
Denominator: N/A
Target: Quarterly meetings (at minimum).
Source: Country data.
B. Surveillance and reporting
Indicator 3 — Incidence rate of suspected cholera
Definition and use: Incidence rate of suspected cholera in the country (over the preceding 12 months).
Numerator: Number of suspected cases of cholera reported.
Denominator: National population.
Target: As set in the national cholera control programme .
Source: National-level cholera surveillance data.
Indicator 4 — Proportion of cholera signals verified within 48 hours of detection
Definition and use: Measure a country's ability (over the preceding 12 months) to quickly verify signals of suspected cholera. Verification is the proactive cross-checking of the validity (veracity) of the signals collected by EWARS, by contacting the original source, additional sources, or by performing field investigation. Verification requires that hoaxes, false rumours and artifacts are eliminated from further consideration.
Numerator: Number of cholera signals detected (verified) within 48 hours.
Denominator: Number of cholera signals detected.
Target: 90%.
Source: National-level cholera surveillance data.
Indicator 5 — Proportion of peripheral health facilities (PHF) located in cholera hotspots with access to functional laboratory
Definition and use: Measure a country's ability (over the preceding 12 months) to quickly confirm cholera via laboratory methods.
Numerator: Number of PHF in all hotspots with access to functional laboratories for cholera confirmation.
Definitions:
- Access is defined by the capacity for delivery of viable clinical specimens from investigation of a suspected cholera event to a functional laboratory within 48 hours of collection for confirmatory testing.
- Functional laboratories:
- Must have current accreditation according to national regulations .
- Reports no out-of-stocks of reagents and supplies for more than 2 weeks in a one-year period .
- Capable of turnaround time for communicating test results within 2 to 4 days of specimen reception at the laboratory.
Denominator: Total number of PHF in hotspots .
Target: 95% .
Source: Country surveillance data, laboratory data, surveys and assessments conducted during supervisory visits.
C. Health care system strengthening
Indicator 6 — Number of deaths from cholera
Definition and use: Number of deaths attributed to cholera in the country (over the preceding 12 months).
Numerator: Number of cholera deaths in the country reported from both health care facilities and from the community (over the preceding 12 months) .
- At facility level (sub-indicator A).
- At community level (sub-indicator B).
Denominator: N/A
Target: 90% reduction of absolute (or average) annual mortality figures (nationally).
Source: National level cholera surveillance data, breakdown of deaths reported in the community and deaths reported in the facilities at whatever administrative level available and surveys in Cholera Treatment Centres and Oral Rehydration Points .
Indicator 7 — Case fatality ratio in treatment centres
Definition and use: Proportion of suspected cholera patients who die of cholera in a treatment structure (over the preceding 12 months).
Numerator: Number of deaths attributed to cholera in treatment structures (over the preceding 12 months).
Denominator: Number of patients with suspected cholera treated in the same structures (over the preceding 12 months).
Target: <1%.
Source: National-level cholera surveillance, databases or reports from health care facilities, including specific cholera treatment structures.
Indicator 8 — Proportion of the population living in hotspots who have access to ORS within a 30-minute walk from their home
Definition and use: Proportion of the population with rapid access to ORS for cholera suspected cases in health care facilities or via community members/volunteers and community health workers.
Numerator: Number of people living in hotspots with access to ORS within a 30-minute walk from their home.
Denominator: Total population in cholera hotspots.
Target: 100%.
Source: Surveys in hotspots (in conjunction with other pillars), national data on health care access and health workforce.
D. Use of Oral Cholera Vaccine
Indicator 9 — OCV administrative coverage in hotspot areas vaccinated (over the preceding 12 months)
Definition and use: OCV administration coverage implemented (over the preceding 12 months).
Numerator: Total number of doses administered for round 1 and 2 in the reporting year.
Denominator: Total number of persons targeted by the OCV campaigns (round 1 and 2).
Target: 95%.
Source: OCV post-campaigns reporting.
Indicator 10 — Proportion of hotspots targeted by the vaccination plan (in the reporting year) that have been vaccinated
Definition and use: Measure the reach of OCV in the country.
Numerator: Number of hotspots administrative units that have been vaccinated during the reporting year.
Denominator: Number of hotspots administrative units targeted by the vaccination plan during the reporting year.
Target: 100% .
Source: Reports of vaccination campaigns .
Indicator 11 — Proportion of emergency versus total OCV doses administered (over the preceding 12 months)
Definition and use: Measure the proportion of doses used in campaigns to respond to an outbreak compared to doses administered during preventive campaigns .
Numerator: Number of doses administered in the context of an outbreak.
Denominator: Total number of OCV doses administered (over the preceding 12 months).
Target: N/A
Source: Campaign reports, OCV requests.
E. Water, Sanitation and Hygiene
Indicator 12 — Proportion of people with access to safe water in hotspots
Definition and use: Measures the proportion of people with access to basic plus water in cholera hotspots. Access to basic plus water is defined as an improved facility⁷ - within 30-minutes round trip from a person's home - including collection time and low-cost water treatment to ensure safety.
Numerator: Number of people living in hotspots with access to basic water.
Denominator: Total number of people living in hotspots .
Target: At least 80% access to water in hotspots.
Source: National cholera programme, surveys in hotspots, OCV coverage surveys .
Indicator 13 — Proportion of people with access to sanitation in hotspots
Definition and use: Measures the proportion of people with access to basic sanitation in hotspots. Access to basic sanitation is defined as the use of an improved facility that is not shared with other households.
Numerator: Number of people living in hotspots with access to basic sanitation.
Denominator: Total number of people living in hotspots.
Target: At least 80% access to basic sanitation in hotspots.
Source: National cholera programme, surveys in hotspots, OCV coverage surveys.
Indicator 14 — Proportion of people with access to hygiene in hotspots
Definition and use: Measures the proportion of people with access to basic hygiene in hotspots. Access to basic hygiene is defined as the availability of a handwashing facility on premises with soap and water.
Numerator: Number of people living in hotspots with access to basic hygiene.
Denominator: Number of people living in hotspots.
Target: At least 80% access to basic hygiene in hotspots.
Source: National cholera programme, surveys in hotspots, OCV coverage surveys.
F. Community engagement
Indicator 15 — Proportion of trained focal points to support community engagement and cholera prevention and treatment per inhabitants in hotspots
Definition and use: Measures the availability of trained focal points in hotspots that can promote relevant behaviours for cholera prevention and control . Focal points can be a volunteer, a community health worker, a community leader or any other community member.
Numerator: Number of trained focal points to support community engagement and cholera prevention and treatment in hotspots.
Denominator: Total population in hotspot.
Target: TBD.
Source: Training lists, surveys.
Indicator 16 — Proportion of the population in hotspots who have correct knowledge on cholera prevention in communities
Definition and use: Proportion of the population living in hotspots who know how to prevent the transmission of cholera and actively implement these practices.
Numerator: Population in hotspots who have correct knowledge regarding cholera prevention.
Denominator: Total population of hotspots.
Target: 100%.
Source: KAP surveys, OCV coverage surveys, observational studies.
⁷ Improved sanitation facilities are those designed to hygienically separate excreta from human contact.
