Assessment of a programme is the measurement of the extent to which its objectives have been fulfilled. This may be called assessment of efficacy. For this the objectives have to be defined in quantifiable terms i.e., the extent and period of time problem of tuberculosis will be reduced. This is yet to be done for the National Tuberculosis Programme (NTP). Assessment, of efficacy is difficult as the impact of Tuberculosis Programme is felt only after a fairly long period of time during which other socio-economic factors etc., also influence the problem. Any early assessment of problem reduction will only be a very costly attempt at proving the obvious and will possibly lead to frustration. Hence, a different methodology of assessment has to be adopted.

Assessment of Efficiency: Measurement of the extent to which the expectations for various activities under the programme are being fulfilled is referred to as assessment of efficiency. This seems to be a practicable solution to the problem of assessment of NTP. Realistic expectations for output and coverages under different activities can be set up on the basis of potentials on one hand and performance of programmes with reasonable efficiency on the other. Achievements of the programme could then be matched against these expectations. There is a need to define stages of programmes as different districts will have the programmes developed to different levels. Any overall assessment of such a heterogeneous programme situation may give a confusing picture. Advantages of this method are; i) number of districts which qualify to do from one stage to other will itself indicate the progress achieved; ii) after assessment attention can be concentrated on the corrective actions required. A detailed stage by stage assessment could be supplemented by monitoring i.e., a continuous watch on some key indices of the programme calculated from the periodic reports. This requires reasonably efficient reporting machinery. The key indices are: i) achievement of activities: Case-finding, treatment completion and BCG vaccinations against the expectations; ii) contribution from Peripheral Health Institutions; iii) No. of cases diagnosed against the prevalence of cases in the district.

Assessment should be objective enough to inspire confidence and its findings should be accepted or at least appreciated by the persons in-charge of the actual functioning of the programmes. For this, a proper climate for assessment should be created so that assessment is welcomed by programme organisers and corrective actions are taken soon after completion of assessment.